Nick Herbert responds to the 'Fit for the Future' consultation

I have seen the formal responses from the Support PRH and KWASH campaigns, and from Andrew Tyrie MP in support of St Richard's Hospital, and I fully endorse them. There is no need for me to repeat the detailed arguments in these submissions, and I have made my points clear at successive public and private meetings with the PCT. However, as the only MP whose constituents use all three of the hospitals affected by the proposals, I wish to emphasise some general points.

1. Over the course of more than two years the justification for the hospital reconfigurations has shifted markedly.  It was originally and unambiguously driven by financial considerations: the need to save money to correct what was described as an underlying deficit of £100 million.  Since the publication of the formal proposals, with associated figures showing the local health economy in surplus in five years' time on the existing configuration, the financial case has evaporated.  It has been further compromised by the absence of figures for the additional investment in the ambulance service which the PCT has conceded will be necessary to deal with increased travel times.  It seems that the proposed reconfiguration developed a momentum of its own even when the original driver for change disappeared.

2. The clinical case for change has at the very least not been proven.  The evidence base for it is partial and arguable.  Local hospital clinicians are divided and GPs have generally been opposed to the plans.  The proposed model of hospital configuration is essentially an urban one.  There are real doubts as to whether it can sensibly be imported to a rural area where the catchment population is disparate and travel distances are longer.  The PCT has failed to explain why its proposed model is right when it has conspicuously not been followed in East Sussex, a smaller county in area and population, and has been abandoned in Surrey.

3. The failure to include access in the PCT's hurdle criteria is a fundamental flaw in the proposals, sufficient on its own to render them unviable.  No-one is opposed to the idea of more NHS services being available locally, in the home and in GP's surgeries, or of major trauma cases being treated in specialist units.  But the fact remains that under the PCT's proposals two out of the three hospitals affected would lose their ability to deal with a significant proportion - around a fifth - of A&E cases.  The PCT has conceded that treatment for the most serious A&E cases would be moved further away for 59 per cent of the population, while average journey times for the over 65s to receive treatment for major A&E cases would, under all of the PCT's options, increase by 50 per cent.  The inaccessibility of the Royal Sussex County Hospital and regular severe congestion on roads such as the A27 are factors outside the PCT's control, yet insufficient account has been taken of them.  Setting aside the issue of convenience for patients, unless and until key transport infrastructure is upgraded, the PCT's proposals are unrealistic and unsafe.

4. The proposals also fail to take into account the expected growth in the West Sussex population.  With at least 58,000 new homes proposed over the next two decades, the NHS should be planning for expansion of facilities and greater localisation, not the centralisation and withdrawal of key services.  All three options proposed by the PCT would see the downgrading of the PRH, denuding the north of the county entirely of major A&E provision, yet this is the area where most of the development will be cited and in closest proximity to Gatwick Airport.

5. The PCT has wholly failed to win public support for its proposals.  It would be a grave mistake to dismiss this as a failure of public relations.  The PCT has unwisely taken an offensive stance in response to public opinion, dismissing key concerns as "unfounded myths", even declaring that it would "wage a war" against them.  In fact the public has correctly identified the major flaws in the options offered.  I have received thousands of e-mails, letters and messages from constituents expressing opposition to the proposals.  Literally not one constituent has set out their support for the plans.  There is no other issue on which I have received such a quantity of correspondence from constituents and where views have been unanimous.  The level and strength of opposition expressed at public meetings and through extraordinary marches and petitions should speak for itself.  I do not see how the PCT can credibly ignore such opposition.  It must ask itself to whom it is accountable.

6.  From the beginning, this consultation has been poorly conducted.  Original proposals were considered for months in secret by the SHA which failed to reveal them to stakeholders, even for instance when meeting MPs in Westminster to brief them about the issues.  The original pre-consultation document published by the SHA was deliberately vague and failed to spell out what it really meant in relation to West Sussex's acute hospitals.  Public feedback on these proposals was simply ignored.  The timetable for consultation continually slipped.  When the formal consultation document was finally published, the status quo was absent from one of the options because the PCT's had constructed hurdle criteria which rejected it.  The consultation document was not properly distributed to households, and only one formal PCT meeting was organised in my constituency.  The consultation period had to be extended.  The document itself proposes loaded questions.  Late in the day, a new model emerged, with mixed and confusing signals coming from the PCT about its status, and no possibility for the public to support it as part of the formal consultation. 

7.  I welcome the belated consideration by the PCT of a new option which would see the retention of A&E services at St Richard's and WASH, provided that this means consultant led services and intensive therapy units, able to deal with the full range of cases as now.  It would be bitterly disappointing for the public if this new option founders or proves to be less than it has been suggested.  I urge the PCT to clarify as soon as possible what level of A&E services will be retained.  I also urge them to reconsider their determination to see maternity services centralised.

8.  For two years a shadow has been cast over the three hospitals, with adverse consequences for staff morale and recruitment.  With the emergence of the new option, and the stated aim of the Brighton & Sussex University Hospitals Trust to reprieve the PRH's A&E and planned surgery services, there is no need for this to continue, and it should not do so.  The PCT has comprehensively lost the argument.  All three of its original options are flawed.  They must now be formally abandoned without further delay.

Alexander Black