Monday, July 30, 2007

“What do you think of NHS dental services?”

Cumbria's Patient and Public Involvement Forums are, sadly, soon to be abolished due to one of the government's worst recent pieces of legislation.

However, while they are still with us they have launched a new Dentistry Watch campaign to ask for public views on dental services in Cumbria.

They aim to assess a range of issues including public access to NHS dental services, patients’ experiences of treatment and the views of dentists themselves.

Dentistry Watch has been prompted by a large number of forums which have identified issues surrounding NHS dental care.

The chairman of Cumbria Primary Care Trust PPI Forum, Kevin Morrall explained that

“In 2006 new measures came in to improve the provision of NHS dental care throughout England. These gave each PCT a duty to provide reasonable dental care services in their area to meet local patient demand.

“However, evidence suggests that numerous people are either unable to register with an NHS dentist close to their home, or do not know how to find one.

“Many PCTs are also struggling to find the budget to encourage private dental practices back into the NHS system due to lack of funding.

“We hope by questioning patients, the general public and dentists, we will be able to provide an accurate picture of NHS dental provision, whether it matches current government figures and the overall quality of care.”

Patients will be questioned throughout August and up until the beginning of September. The Dentistry Watch campaign comes on the back of the highly successful Care Watch and Food Watch campaigns, which highlighted patients’ views on whether they had been treated with dignity while in hospital, and concerns over the quality of hospital food.

For details contact Jane Macfarlane from the Inhouse Forum Support Team in Cumbria on 01768 899608 or email ForumSupport.

Some of the information in this post came from the News and Star.

Sunday, July 29, 2007

Latest Commons debate on hospitals in West Cumbria

Last Tuesday there was an "adjournment debate" about local hospitals in West Cumbria in the House of Commons.

I welcome the fact that this debate took place and that concerns about the future of our local hospitals were raised. The issue is important enough to be worth quoting in full, which I shall do below, but I should just first point out that the "adjournment debate" format does not always provide an opportunity for a right of reply. Sadly Jamie Reed MP chose to include in his remarks, which otherwise included many good points, the untrue statement that the Conservatives want to cut NHS spending as part of a £21 billion package of cuts.

This was not true even at the time of the last election - the £21 billion of cuts in public spending proposed by the Conservatives in 2005 included the £15 Billion of Gershon savings which the Labour party was also proposing to implement. Where there were additional cuts in NHS administration, as for example by abolishing the Strategic Health Authorities, the money saved would have been put straight back into front-line services for patients.

Since then the government has implemented many of the Gershon savings. Everyone knows perfectly well that you can't save the same money twice, so the Conservatives are not claiming to be able to make savings by repeating cuts which Labour has already made. Hence it is misleading and dishonest to imply that it is Conservative policy to cut £21 billion from current, post-Gershon spending levels.

Having got that point out of the way, here is the text of the Adjournment debate on West Cumbria Hospitals.

Health Services (West Cumbria)

Motion made, and Question proposed, That this House do now adjourn. —[Mr. Khan.]
10:35 pm

Jamie Reed (PPS to Mr Tony McNulty, Minister of State), Copeland, Labour)

This is the second time that I have raised in the House the issue of the future of health services in west Cumbria, the first time being in December 2005. Almost two years later, there has been some meaningful progress in the provision of health services in the area and the Government continue to provide record levels of investment, but much more still needs to be done.

The reason for applying for this debate tonight is because in September, when Parliament will not be sitting, a consultation on the reconfiguration of health services in west Cumbria and Cumbria generally will begin. That consultation has been dubbed the grand plan. With that in mind, it is essential that, on behalf of my constituents and those of my hon. Friend the Member for Workington (Tony Cunningham), health service users and health care professionals alike, certain expectations are now set out, listened to and fully understood.

Those expectations relate to health services across west Cumbria, the services provided by the West Cumberland hospital, the scope and timescale of the consultation, the need for all sections of west Cumbrian society to be able to take part in that consultation and for the opinion of local medical professionals to be listened to in the process of service design. In December 2005, I told the House that anxiety about health services in west Cumbria was seemingly endemic, that the people of west Cumbria had harboured deep anxieties concerning the local health services for well over 20 years and that their fears—my fears—are long held and not simply in response to any given public debate about the NHS at any given time. That is still the case.

Ever since I can remember, the people of west Cumbria have had to fend off one threat or another to the services provided by their hospital. For more than 20 years now, The Whitehaven News has reported on what has appeared to be a perpetual threat to our hospital services—most recently through the excellent save our services campaign, which has provided so many local people with an opportunity to have their voices heard. Like my constituents, I want an end to the threats. I want us to be free of the threats and free of fear, and that is what I expect the forthcoming consultation to provide.

The Minister will no doubt be aware of the background to tonight's debate and the imminent consultation. West Cumbria is a unique area which provides unique health policy challenges. With approximately 160,000 people, west Cumbria is both urban and rural: the majority of people live in urban areas, but in small urban areas separated from other urban areas by vast tracts of rural expanse that themselves contain numerous small rural villages. Population centres are widely dispersed, the communications infrastructure is poor, public transport is poorer still and car ownership is low.

In addition, west Cumbria is host to perhaps the most strategically sensitive industrial installation in this or any other country—Sellafield. Put simply, there is no off the shelf solution for the health policy issues facing west Cumbria. Our unique situation requires unique policy solutions and there are no people better placed than the service users and service providers of health care in west Cumbria to produce and implement the solutions. Inevitably, that will require change of some kind, but it must be change for the better.

It is clear that change in the NHS is incredibly hard to achieve for a number of reasons. The size of the organisation means that change is complex, difficult and expensive. The nature of health care means that expert bodies will often violently disagree about the best way forward. The new Secretary of State has recognised all of that, identifying where the Government have got their approach wrong in the past, where they failed to listen to professionals and where they pursued change too quickly. The Secretary of State has called for a period of calm and stability in the NHS and the Prime Minister—the man responsible as Chancellor of the Exchequer for trebling the budget of the NHS—has said that the NHS is his immediate priority. Both approaches are exactly right for the health service in west Cumbria at this moment in time, but I would go further still.

For almost four years now, the health economy of Cumbria has endured a series of consultations, reviews, reorganisations and reconfigurations. The pace of that process has been painful and the objectives very often unclear. The grand plan consultation must avoid the mistakes of the past and bring an end to the uncertainty and confusion.

I mentioned at the outset of this debate that there had been some meaningful progress in the west Cumbrian health economy. I shall give details of some of that progress. The West Cumberland hospital opened in 1964 and it was the first new hospital to be built in Britain after Labour's creation of the NHS. I am proud of this fact. I am proud too of the staff who work there, their care and commitment, their devotion and their absolute professionalism.

I am pleased that the West Cumberland hospital is among the best in the country at preventing MRSA infections. I am pleased that our hospital trust has achieved two-star status. I am pleased that the independent Healthcare Commission reports that standards of care at our hospital are rated as good, and improving all the time. I am pleased that staff in the NHS are being paid better than ever before; they waited a long time for that and they deserve every penny.

In west Cumbria, we have been promised a new acute district general hospital. Our community hospitals in places such as Millom, Keswick, Cockermouth, Maryport and Workington have been saved thanks to the efforts of my hon. Friend the Member for Workington and me, facilitated by an additional £18.5 million cash injection from the Nuclear Decommissioning Authority, over and above the record investment made by the Government. I record my thanks to my hon. Friend, who continues to stand shoulder to shoulder with me as we work to improve the health services of west Cumbria. By convention he is not allowed to speak in this place but he makes up for that outside.

Cynics decry the record investment that Labour has put into the NHS. By cynics, I mean those who want to destabilise the NHS by claiming that increasing investment serves no purpose and worse, in the case of the Conservatives, those who want to cut NHS spending as part of their £21 billion-worth of public spending cuts. However, I am delighted that the Government are investing unprecedented amounts in health services in west Cumbria and in Cumbria as a whole. When I last debated these issues, local NHS spending had risen by 97 per cent. since Labour came to power.

In addition, in April, the North West strategic health authority, which covers Cumbria, saw its budget rise by 9.3 per cent.—an increase of £878.2 million. At the same time, the Cumbria primary care trust received a 9 per cent. increase in revenue funding—an increase of £56.6 million—taking the revenue budget for the PCT from £632.5 million in 2006-07 to £689.2 million for this financial year, which is the 29th largest increase of the 152 PCTs in England.
The increase comes at a particularly appropriate time, as it means that more money is available to the PCT with which to commission services in west Cumbria, in particular at the West Cumberland hospital, than ever before. That increase in funding must be reflected in the PCT's grand plan and in the design of services provided at either the West Cumberland hospital or a new acute hospital for west Cumbria. The sum of £56.6 million should go a long way in west Cumbria and having been given that additional money, the PCT must act equitably and responsibly to ensure that the grand plan delivers for west Cumbria and west Cumbrians. But that is not enough.

Despite those real improvements and unquestionable investments, I want our services to improve further still—they have to—and it is through the grand plan that I expect the improvements to be realised. When the new Cumbria PCT was brought into being, it promised, through its grand plan, to bring to an end the corrosive doubts about services. The plan is designed to be a final examination of all health services provided across the whole county of Cumbria, with a view to improving services and accessibility to services, driving up clinical standards and achieving clinical and financial sustainability.

I welcome the motives underpinning the plan. However, a great deal of work needs to be done with regard to the plan in terms of its time scale, scope, process and the involvement of medical professionals and the public. I hope the Minister will outline for the benefit of my constituents exactly how she now expects the Cumbria PCT to facilitate that.

It is appropriate at this stage to welcome, in principle, the recently announced NHS next stage review to be undertaken by Professor Darzi. The terms of reference for the review state that it will be clinically driven, patient centred and responsive to local communities. The review seeks to deliver NHS services centred around clinical decision making, improved joined-up patient care, more accessible integrated care and a
"health service based less on central direction and more on patient control, choice and local accountability and which ensures services are responsive to patients and local communities".

Professor Darzi will publish an interim report in October and a full report next year, but I want the west Cumbria grand plan to incorporate those objectives now. I will not countenance another review of services in west Cumbria inadvertently caused by the Darzi review, so can the Minister assure me that she will ensure that the grand plan for health services in west Cumbria will now take account of the Darzi review terms of reference?

I can think of no better précis of how the people of west Cumbria would like their health services to be configured than that outlined in Professor Darzi's terms of reference. When I speak to clinicians and medical professionals they tell me that they want to ensure that their abilities and skills are channelled into meeting local needs. Service users, young and old, on urban estates and in rural villages, tell me that they want a health service that is responsive to the needs of their local community. Expectant mothers tell me increasingly of their desire for choice and everyone—particularly those in the throes of a public consultation—is energised by the need for local accountability in their local health service. Decision making in the NHS cannot always be described as transparent, but transparent, honest and open the grand plan consultation must be.

I could talk at length about a number of key health services in west Cumbria which in themselves would easily fill the time allocated for this debate. I could talk about the need for drastic improvements in dentistry provision, or the real need to address the implementation of local mental health services, or the importance of accident and emergency services at West Cumberland hospital. I expect the grand plan to address all of those, but I wish to talk tonight about consultant-led maternity services at the West Cumberland hospital—not because my wife is seven months pregnant and due to give birth there in September, but because as a service, it underpins so much of what other acute service provision must encompass in a general district hospital like West Cumberland hospital.

Perhaps more importantly, this is about social justice. Centralisation of maternity services in my constituency does not mean the same as it might for other colleagues in all parts of the House. We are not talking about moving services six, seven or eight miles away in this instance, but 42 miles—42 miles of road between Whitehaven and Carlisle, characterised by steep undulations, blind corners, slow-moving heavy freight and agricultural traffic.

I believe that the case for maintaining those services at the West Cumberland hospital is irrefutable. A convincing case has never been made for the centralisation of obstetric services in Carlisle; on the contrary, there is a clear and irresistible case against centralisation. This case is now supported by national experts, national guidelines and clinical practitioners. I have spoken with service users, special interest groups, national experts and clinicians since centralisation was suggested, and have found, with very few exceptions, widespread opposition to the suggestion.

The case for retaining a consultant-led maternity unit at West Cumberland hospital and its potential replacement is based on a number of factors. West Cumbria's birth rate is rising. It continues to rise and is on an upward trend. Last year the hospital delivered 1,330 babies—an increase of 3.7 per cent. on the previous year. The national increase is currently 1 per cent. In 2002, the hospital delivered 1,163 babies. The number of deliveries has risen by 167 over a four-year period—an increase of almost 13 per cent.

The performance of the consultant-led maternity unit at West Cumberland hospital is impressive. The perinatal mortality rate at the hospital is steadily declining. In fact, the latest figures show that the figures for the hospital are significantly better than the national average. The latest available UK figures, for 2003-04, show an average perinatal mortality rate of 8.2 births per thousand births. In 2006, the perinatal mortality rate for West Cumbria was 4.5 per thousand births.

Consultant-led maternity units are safer and more cost-effective than midwifery-led units. In June 2006 the National Institute for Health and Clinical Excellence published draft guidelines on intrapartum care. NICE found that although midwifery-led units were cheaper to operate, consultant-led units were more cost-effective. NICE also identified a higher perinatal mortality ratio of 7.2 to 7.8 per thousand deliveries in MLUs, as opposed to a rate of 5.1 per thousand deliveries in consultant-led units.

Centralisation would lead to inequalities of access to care and remove the choice of West Cumbrian women. The national service framework for children, young people and maternity services published in October 2004 states that
"care should be provided within a framework that enables easy and early transfer of women and babies who unexpectedly require specialist care."

The emergency ambulance "blue light" transfer time between West Cumberland hospital and the Cumberland infirmary in Carlisle is now one hour 42 minutes. Currently, most women giving birth in north Cumbria are within 35 minutes of obstetric care; meaning that centralisation would increase this time by almost 200 per cent.

Centralisation would also mean that west Cumbrian women were necessarily either classified as high or low risk, with all high-risk patients being immediately transferred to a centralised obstetric unit. That removes choice, in direct contradiction of Government policy.

In addition, the vast majority of west Cumbrian women require obstetric intervention in labour. Obstetric risk prediction is exceptionally difficult. This risk is mitigated by births taking place in an obstetric unit, where most eventualities can be catered for. Of the 1,330 births at West Cumberland hospital last year, the vast majority required obstetric intervention. Given the imprecise nature of obstetric risk prediction, the World Health Organisation has recommended:
"In order to significantly reduce maternal mortality, all pregnant, labouring and recently delivered women must have access to essential obstetric care should complications arise."
Centralisation would mean approximately 1,000 west Cumbrian women per year being transferred to Carlisle to give birth.

Distance matters: women more than 15 miles from an obstetric unit face hugely increased risks. The British journal of gynaecology published studies in 2002 which identified that living more than 15 miles from a maternity hospital was one of the most important variables in cases of maternal mortality.

Perhaps more importantly, the Cumbrian health infrastructure cannot accommodate obstetric centralisation. The centralisation of obstetric services at Carlisle would distort the finances and resources of the local NHS. Significant new investment in human resources and the physical infrastructure would have to be made to the Cumberland infirmary to accommodate approximately 1,000 new cases every year, and the most likely effect is that the necessary financial and human resources would be diverted from the West Cumberland hospital or its replacement.

In addition, national experts refuse to recommend centralisation. Dr. Maggie Blott, author of the North Cumbria Acute Hospitals NHS Trust's obstetric and midwifery service review report wrote that "There is no obvious solution" with regard to reconfiguring services and was unable to recommend centralising services in Carlisle. Local lay members of the steering group also refused to recommend centralisation. They wrote that centralisation would do little to address the needs of disadvantaged groups in west Cumbria and that west Cumbrian women would not regard centralisation as either safe or equitable.

The national maternity tsar has also acknowledged the unique needs of west Cumbria. In "Making it Better: For Mother and Baby", published in February 2007, Dr. Sheila Shribman wrote: "what will be right for Whitechapel will not necessarily work in Whitehaven. There is no optimum number of births to make a unit sustainable."

This is a very brief synopsis of the weight of evidence against centralisation. These decisions will be made locally. I have put this argument to Cumbria PCT, and I will pursue the issue relentlessly. Given the weight of the argument and the strength of public opinion, I expect that the grand plan for health service reconfiguration throughout Cumbria will incorporate those views and recognise the unique nature of west Cumbria's health care needs.

One of the three separate petitions, totalling more than 30,000 signatures, that I have presented in recent months to the House relating to health services in west Cumbria related specifically to consultant-led maternity services.

In conclusion, I want Ministers to scrutinise the grand plan consultation for Cumbria and ensure that it is transparent, open, honest and accessible. I want Ministers to ensure that, as well as the views of the public, those of the medical professionals will be incorporated in the consultation. In addition, I want Ministers to ensure that socio-economic and national strategic considerations are addressed in the consultation. The consultation must recognise the unique qualities of west Cumbria: pockets of isolated social deprivation, peripherality and the considerable challenges and national obligations provided in the shape of the nuclear industry. West Cumbria provides unique health policy challenges, and that must be recognised. On top of that, I want the consultation to take account of the Darzi review, so that the consultation in west Cumbria is final and not subject to further delay.

Finally, I should like Ministers to visit the West Cumberland hospital to meet staff and patient representatives to hear their views and to ensure that the PCT takes account of them. The Minister is a former nurse and understands the issues, and I look forward to her response.

10:52 pm

Ann Keen (Parliamentary Under-Secretary (Health Services), Department of Health)

I congratulate my hon. Friend the Member for Copeland (Mr. Reed) on securing this debate. The future of health services in west Cumbria is of great concern to him, as he has demonstrated on many occasions, particularly in his contribution tonight, and I appreciate the comments that he has made in the House today. I also thank my hon. Friend the Member for Workington (Tony Cunningham) for all the work that he has done for the health service in the areas that they serve.

I acknowledge the important role that my hon. Friend the Member for Copeland has played in raising the profile of this issue and in keeping Ministers regularly up to date with progress, with consultations and public meetings. He is a real unsung hero of his area, and his constituents should be very proud of him. I also to pay tribute to the 1.3 million staff who work in the national health service, particularly the staff in west Cumbria who have made an enormous contribution to improving the local NHS and to whom my hon. Friend referred in his speech. Those achievements have been made following the record investment by the Government, from £33 billion in 1997, rising to over £92 billion by 2008.

My hon. Friend made great reference to the review of services and how we deliver health care. That is absolutely paramount for the future. Of course, he also referred to my noble Friend Professor Ara Darzi and the way that he will conduct the review of our health services. I understand that my hon. Friend has been in great conversation recently with the chief executive of NHS North West to discuss this issue and particularly funding. I ask my hon. Friend to keep me updated on all the consultations, because they are paramount to the future of health services in the area.

The newly formed Cumbria primary care trust had an out-turn deficit of £36 million at the end of 2006-07 and it is intended to look at a whole new system of undertaking in relation to financial viability, so that the health service in the area is fit for purpose but also effective and affordable.

My hon. Friend mentioned the anxiety and fear that surround any change to health services. I relate to that, because sometimes not everybody in the area plays fair on a consultation. Fear and anxiety for patients, potential patients and staff who work in the NHS must be brought to a conclusion soon.

The review is looking at acute hospital services, and mental health and community care services. The aim is to achieve a better use of clinical resources while keeping services close to people. The Department's gateway review team gave its initial assessment of the process and Cumbria primary care trust is working to address the points highlighted by the review team. The public consultation on proposals emerging from the review is now planned for September of this year.

The proposals for the future shape of health services across Cumbria will be shaped by the findings of the feasibility work done following the previous Morecambe bay consultation, and by the commitment given by Cumbria primary care trust to North Cumbria Acute Hospitals NHS Trust to provide a new hospital in west Cumbria.

I note the concerns that my hon. Friend raised and I can assure him that the consultation will be open, honest and transparent, with decisions taken locally which reflect local needs and are based on appropriate clinical evidence. There is no other way for us to go forward with the health service. We should involve everybody.

My hon. Friend made an important point about the provision of maternity services. He is an expectant parent and I am sure that the whole House understands the sentiment with which he spoke tonight. He makes a valid point about the distance between the two hospitals and the road conditions. I also appreciate the relevance of the national service framework for children, young people and maternity services, which my Department published in 2004.

It is with regret—especially as my hon. Friend mentioned my former profession—that I have to say that I cannot give him a commitment about what services will be located where. However, it is vital that the issues are debated as part of the consultation exercise and it is appropriate for local people to voice their opinions on matters such as these, which are important to them. I stress the safety element that he raised. I am sure that all Members appreciate the importance that he attached to that.

My hon. Friend will appreciate that I cannot speculate at this stage on the details of the consultation or indeed its outcome. It is relevant to local people, clinically-led and will be transparent. The debate needs to happen locally and if, in the end, there are concerns about whatever option is preferred, the overview and scrutiny committee can of course refer the matter to the Secretary of State for Health for a final decision. As my hon. Friend may be aware, the Secretary of Sate has already indicated his willingness to refer all reconfiguration proposals that are referred to him to an independent reconfiguration panel. In that way, we can be sure that such decisions, which are of great importance to my hon. Friend and his constituents, properly reflect local clinical considerations.

The issue of the new hospital is a major concern to my hon. Friend. I am aware that he has had several meetings with officials and Ministers and I commend his commitment to his constituents in pursuing the matter with such vigour. I had a similar experience in my constituency and found that determination wins through in the end. The North Cumbria Acute Hospitals NHS Trust's strategic outline business case to build a new hospital for west Cumbria was approved by the former Cumbria and Lancashire strategic health authority in January 2006. Cumbria primary care trust and North Cumbria Acute Hospitals NHS Trust have given assurances that there will be a new hospital for west Cumbria. However, it is not possible at this stage to give details of location and size, or the services that will be offered, because these will be developed in the context of the whole systems review.

As noted earlier, the health service review is very important, and Members of Parliament should encourage their constituents to express their views in the consultation process. That process will shape the future of the NHS, which enters its 60th year next year. I understand the concerns outlined by my hon. Friend and I urge him to continue his dialogue with the local NHS in what is still a pre-consultation discussion.

I have noted the observations made by my hon. Friend and I am sure that he will understand why I cannot comment further, given the proposed consultation process. However, I can assure him that the process will be an open one—and that I would very much like to visit his part of the world, which is noted for its beauty, complexity and uniqueness. It is better see that combination with one's own eyes, as that is the way to greater knowledge.

Eric Martlew (Carlisle, Labour) Hansard source
I hope that the Minister will also visit the Cumberland infirmary, which is in my constituency.

Ann Keen (Parliamentary Under-Secretary (Health Services), Department of Health)

I have been overwhelmed by invitations in the past couple of weeks, and feel confident that I will be able to visit my hon. Friend.

I am sure that my hon. Friend the Member for Copeland will continue to engage with the local NHS and encourage his constituents to take the opportunity to make their views known through the consultation process. I will also ensure that his views are conveyed to the strategic health authority in the area.

Question put and agreed to.
Adjourned accordingly at one minute past Eleven o'clock.

Friday, July 13, 2007

NHS Morale

One of the biggest factor both nationally and here in Cumbria in keeping NHS services open is morale. If morale is low, recruitment and retention of key personnel is harder, and that can be critical to providing safe services.

This week's Times had an interesting section on what doctors and nurses think of the health services. It made worrying reading.

One of the most important task for anyone serving as Health Secretary over the next few years will be to prove to doctors and nurses that they are listened to and valued.

Monday, July 02, 2007

Brown's latest £2 billion cut in hospital funding

It has emerged that one of Gordon Brown's last acts as Chancellor was to cut £2 billion from the NHS capital expenditure budget in England. He reduced the funds available for hospital building and equipment from £6.2 billion to £4.2 billion.

A few days later he became Prime Minister and announced that the health service was his "immediate priority." Cutting the capital available to the NHS by nearly a third is not what most of us would expect the words "immediate priority" to mean. Certainly if this decision were to stand, it would not help the prospects for the West Cumberland Hospital, Millom Community Hospital, or Mary Hewetson Cottage hospital getting the investment and support that our communities in Cumbria desperately want them to receive.

I gather from Rod Liddle in the Sunday Times that the Treasury has admitted that the £2 billion cut will probably be restored in the spending plans for the three years from 2008-9.

In other words Gordon has very quietly cut a large sum of money from the N.H.S. but is likely to put it back just before the next election. Anyone care to bet whether when he does, there will be a huge song and dance about how the prime minister has found more money for the health service?

Some people are naive enough to suggest that because the chancellor has finally become Prime Minister, the era of spin is over. As the saying goes, Yeah, right!