Hospital provision in West Sussex
Nick Herbert (Arundel and South Downs) (Con): May I welcome you to the Chair this afternoon, Mr. Conway? I also welcome the Minister to her new position.
I am grateful to have secured this debate on an issue that is probably arousing more passion and concern in my constituency and throughout West Sussex than anything else. There are hon. Members here from East Sussex and West Sussex who are all affected by the proposed reconfiguration of hospitals. We are grateful for this opportunity to make the case on behalf of our constituents and for the fact that this debate has brought the Minister here to listen to those concerns, which I am sure she will do. I should like to focus on West Sussex, in which my constituency lies, but my hon. Friends and other hon. Members might refer to the situation in East Sussex. I shall also keep my remarks as brief as possible, to allow everyone here the opportunity to take part in this short debate.
The situation in West Sussex is that the newly created primary care trust proposes to downgrade our three acute hospitals to one, so that there will be only one major general hospital for the whole county. That affects every hon. Member in West Sussex and some in East Sussex, and it affects me particularly, because my constituents use all three hospitals. I am therefore in a position to see how the proposals would affect the whole county.
The first thing that I should like to say about our objections to how the primary care trust has handled the process is that the justification for the proposals has fundamentally changed. More than a year ago, we were eventually told-when the strategic health authority and then the primary care trust admitted it-that the overriding reason for downgrading our local hospitals was a financial deficit in the health care sector in West Sussex and that it would get worse. The principal justification for the measures that the PCT said were needed was that it would no longer be sustainable to retain three acute hospitals for a population the size of West Sussex.
It is true that some clinical justifications for the change were set out at the time, but the overriding justification was clearly financial. Indeed, as a former chief executive of the primary care trust, Steve Phoenix, wrote to the West Sussex Gazette on 30 August 2006:
"The financial issues for West Sussex are very serious. Although the NHS will get more money, we are already in debt and there are major challenges in the way we receive funding."
"if we do nothing, we will have a shortfall of £94 million by 2008/09. This an impossible scenario. Our plans will involve significant changes to major hospital services. We must invest our funding in direct patient care rather than expensive hospital buildings."
He could not have been more plain that the principal driver of the changes was the lack of funding available to the primary care trust that he perceived. That position was reinforced by the strategic health authority. As the chief executive of the strategic health authority wrote to me and other hon. Members on 31 July 2006 on the issue of finance:
"It is much better, and more responsible, to plan for a clinically and financially sustainable healthcare system, as we are doing."
The new Secretary of State, whom I welcome to his position, too, said in the debate on access to NHS services yesterday:
"These reconfigurations are being driven by local decisions in local NHS trusts, and they are driven by clinical need, not by any financial constraints."-[Official Report, 3 July 2007; Vol. 462, c. 853.]
However, he cannot have been aware of the primary care trust's original justification for the changes that are taking place.
Nevertheless, it now seems that the financial arguments for downgrading our local hospitals have simply evaporated. The latest case scenarios that the primary care trust has published, along with the plan for reconfiguration of our hospitals, actually show that in five years' time, in 2012-13, the local health care economy-that is, the West Sussex and Brighton PCTs and the three acute trusts-will end up with an annual surplus of £52 million. Let us deal with the argument once and for all: there is no financial case for downgrading our hospitals in West Sussex. The Secretary of State has now also said that there is no financial case for doing so. That crucial part of the argument for change and how the PCT has approached it for the past year has gone, yet the trust persists in the changes that it wants to make.
Now the argument turns on whether there is a clinical case for downgrading our hospitals, but those arguments are strongly disputed. Locally, they are disputed by consultants, who disagree about whether there should be only one major general hospital in West Sussex-an issue to which I am sure my hon. Friends will turn their attention. Nationally, we are relying on the evidence of some of the royal colleges, on which the whole future of two major hospitals could turn, simply because it is argued that the most serious A and E cases ought to be treated in major centres. Given that there is no financial imperative for reorganising those major hospitals, it does not seem to make sense to put at risk major and much-prized local facilities simply to address that concern.
The concern of my constituents and of the whole population of West Sussex is about accessibility. In my area of West Sussex, the question is not about the size of the population served by the three acute hospitals or about the catchment areas, in the narrow sense; it is about whether those hospitals are accessible to a community, many of whose members live in remote areas. From one village-it happens to be called Washington-right in the middle of my constituency, at the foot of the downs, the distance to Worthing general hospital, one of the three hospitals affected, is a very reasonable eight miles, with a travel time of 13 minutes. If Worthing general hospital is downgraded, which is one of the options that the primary care trust has set out, the travel time could increase by two and half or even up to five times if patients have to travel to Portsmouth, which is one of the potential effects of the changes.
Indeed, in the document that the primary care trust published when the proposals were launched, it conceded that
"a minority of people may have to travel further"
for what it called "improved services." However, we are talking about a population that is relatively elderly. According to the 2001 census, just over one fifth of West Sussex's population were aged 65 years or over, which compares with an average of 16 per cent. in England and Wales. It is extremely difficult for elderly people to make regular visits to health care facilities that are further away. We are not just talking about travel times and safety for A and E services; we are talking about people who have to travel further for visits to facilities that are currently much closer.
The other day I met an elderly constituent of mine who lives in Storrington, in the middle of constituency, who has to travel a number of times of week to Brighton for radiotherapy, making a round trip of 41 miles on each occasion, with a travel time of 76 minutes. There is a huge amount of fear locally that, far from there being a greater provision of local services, which we were promised as part of the reconfiguration, services will be taken further away from the local community.
We have not seen the redeveloped local services that were promised as part of the reconfiguration, or any proposals for them. No assurance have been given in relation to one community hospital in Arundel, in my constituency. It simply does not make sense to say that acute hospitals might be downgraded and simultaneously to be unable to give assurances about the provision of community hospitals, on which people will presumably rely for more local services.
The absence from the primary care trusts' proposals of an option for at least two major hospitals, which is what many clinicians and the public have asked for, is a significant omission. It makes the consultation paper a flawed one, and we asked the PCT board, unsuccessfully, to withdraw the paper until it could present an option that we felt should be considered.
I should like to convey to the Minister the strength of feeling in support of the three hospitals in West Sussex-the Princess Royal hospital in Haywards Heath, Worthing and Southlands hospitals and St. Richard's hospital in Chichester. Some 300,000 people in West Sussex have signed petitions against the closure of those hospitals, and 25,000 people have marched. The Prime Minister may stand on the steps of Downing street, as he did last week, and say that he will listen to people and make the NHS a priority, and the Government may espouse the notion of patient choice, but what can any of that mean if the Government and the PCTs are unwilling to listen to the almost unanimous view of local people?
There can be no better way to demonstrate how people feel about the potential downgrading of their hospitals than to consider the Princess Royal hospital in Haywards Heath, in the constituency of my hon. Friend the Member for Mid-Sussex (Mr. Soames), who has fought tirelessly to retain those facilities. The Princess Royal will be the hospital most affected by the proposals. Under any of the scenarios proposed by the PCT, it will be downgraded. Yet a consultation document published only in 2004 promised that, in reshaping A and E services and moving trauma cases to Brighton,
"It is important to emphasise that the vast majority of local people will continue to receive A&E services from their local hospital. So there is no threat to A&E at the Princess Royal."
That promise was made not only in the consultation document, but to my hon. Friend on the Floor of the House by one of the Minister's predecessors, the right hon. Member for Barrow and Furness (Mr. Hutton), now a Cabinet Minister. He told my hon. Friend on 16 March 2005:
"There is no question of A and E services being downgraded or becoming a minor injuries unit. That is not going to happen."-[Official Report, 16 March 2005; Vol. 432, c. 383.]
When the Prime Minister speaks, as he did yesterday, about rebuilding trust in politics and reconnecting people with the political process, what can those words mean if Ministers feel able to come to this place, give assurances to hon. Members about the future of A and E facilities-an issue that could hardly be of more concern to local people-and renege on those promises within two years? That produces a sense of anger in my constituency and throughout West Sussex about how local people are being treated. They have no voice and they are not being listened to, yet they are being told by the Government that they will be listened to and that the NHS is now the new concern. How can the Minister square that circle? I urge her to recognise local people's concerns about the issue and how the justification for the downgrading of our local hospitals has shifted and been undermined.
I am grateful to the Minister for listening to my case. I hope that she will appreciate the strength of local feeling and that she or one of her colleagues will take the opportunity to come visit the hospitals. The previous Secretary of State visited the hospital at Brighton, but did not visit St. Richard's, Worthing and Southlands or the Princess Royal. If Ministers were to visit one of them, they would understand not only that clinical opinion is certainly divided about the merits of moving to one hospital in a county of that size but also that local feeling is strong. People have paid their taxes, and they feel that they are entitled to high-quality, local and accessible services. I think that they deserve no less.