House of Commons debates
Thursday, 16 January 2003
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Pilgrim Hospital
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Motion made, and Question proposed, That this House do now adjourn.—[Keith Hill.]
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6:19 pm
Mark
Simmonds (Boston & Skegness, Conservative) Link to
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sourceI would first like to thank Mr. Speaker for allowing me to initiate this Adjournment debate, which is of fundamental importance to me, as the democratically elected representative of the people of Boston and Skegness, to my constituents, and to all those other individuals who use Pilgrim hospital in Boston. I also thank the Minister for being here to respond to my comments this evening.
Pilgrim hospital is the major provider of secondary health care in my constituency and the immediate surrounding area. As such, it plays a vital role in the community and serves a very large rural catchment population. Indeed, some calculations show that its catchment is greater than that of Lincoln and Peterborough—both of them cities that currently have larger hospitals. The catchment population of the Lincoln hospital is estimated to be 335,000, and that of Peterborough is estimated to be between 280,000 and 300,000. The catchment population of Boston and south Lincolnshire is approximately 400,000.
Before I proceed further with the specifics, I would like to place on record my thanks and admiration for all the hard work that is done, day in and day out, by all those at Pilgrim hospital. I am aware that staff at all levels work as tirelessly and effectively as they can to provide a first-class service. That is in the context of a work force who are increasingly disheartened and a public who are increasingly disappointed as a result of the unattainable level of expectation to which the Government's announcements have given rise, and owing to a recent merger with Lincoln, which in many people's opinion is having a detrimental impact and effect on service provision.
Pilgrim hospital first opened in 1972 and has 670 beds and a small, private wing called the Bostonian. The hospital and associated hospitals provide for approximately 35,000 in-patients, 12,000 day cases, and, depending on how the figures are analysed, up to 120,000 out-patients per annum. Pilgrim is by far the greatest contributor to those figures. It has a 24-hour accident and emergency department, and, currently, all the main speciality departments. As the Minister will be aware, a strategic service review is currently under way, which will assess the provision of services across the whole Trent region. Clearly, I recognise that every hospital in the region cannot provide every service. For example, the small hospital in my constituency at Skegness obviously cannot provide cardiovascular surgery.
There are dangers in relation to encouraging and facilitating centres of specialism, however, particularly in large rural areas such as Lincolnshire. Some low-volume work may have high costs, both in financial terms and in terms of expertise. Some specialist centres will be needed, but it is essential that the specialist centres that are required are provided in Lincolnshire, not outside the county in Leicester or Nottingham. There is pressure from both Government and the royal colleges on consultants to deal with a certain number of cases per year, and that each consultant must deal with a sufficient number of cases to be safe and professional and to maintain a degree of expertise.
That maintenance of professionalism and expertise, however, must be offset against considerations of travel and convenience. A balance must be struck. It is not compassionate or practicable to ask people to travel miles for basic medical care. Many of my constituents are not particularly affluent, and would find it impossible to get to Lincoln or Peterborough, never mind Nottingham or Leicester. The current state of rural transport in Lincolnshire is not conducive to ease of travel.
The current situation in which Government targets are only being met by reprehensible list manipulation is unacceptable to me and to my constituents. Let me give the Minister a specific example. I understand that, if a Boston resident approaches a 12-month wait for an ear, nose and throat appointment, he or she is offered an appointment elsewhere—for example, in Lincoln—with no consideration of his or her ability to get to Lincoln. If that person refuses or is unable to make the appointment, he or she is struck off the list, thereby receiving no treatment but enabling the hospital and the trust to deal with the 12-month waiting list. I am not blaming the Minister personally for that, as I am certain that the practice takes place elsewhere. However, the Government must take some responsibility for applying such draconian pressure on hospitals and trusts to meet waiting list targets that they feel obliged to distort clinical priorities.
It is no exaggeration to say that clinical directions have very little to do with clinical priorities. I would welcome the Minister's confirmation of his disapproval of, and distaste for, this practice. I hope that he will pledge to look into the matter, so that my constituents receive the health care that they need in the hospital that they deserve.
Pilgrim hospital has a 98 per cent. bed-occupancy rate. Indeed, on my frequent visits to the hospital, including having participated on a night shift, I have been amazed by the constant crisis management that exists, shuffling patients around in an attempt to find beds. There are patients who are in accident and emergency who should be in medical wards; patients who should be in medical wards who are in surgical wards; and patients who should be at home who are in surgical wards. Some people should be in care homes, but several care homes have closed, primarily as a direct result of some of the policies that the Government have pursued.
Those problems are coupled with the fact that Pilgrim hospital has only a day contract with the ambulance service—that is, between 9 am and 5 pm—and that means that the hospital staff can only arrange for patients to travel by day. On the surface, that may appear to be fine and acceptable, but the implication is that patients admitted at night cannot be sent elsewhere or even to their home. In some cases, they are treated because there is no ambulance. They have to stay in the ward overnight because they cannot get home. The nursing and other staff arrange for an ambulance to take them home, but there is a 24-hour booking time so they have to stay another night. That means two potentially unnecessary night stays in Pilgrim hospital, and that blocks beds for others. That is madness. The transport bill to transfer some people home by taxi must be horrendous, and an already horrendous bed-blocking problem is exacerbated. The implication is that significant numbers of operations are cancelled. Many are cancelled the day before and some on the day of the operation. That is not acceptable, and the position must be improved.
It is my view that the Lincolnshire East Coast primary care trust is keen, like me, to retain local services for local people. I hope that the pressure will convince the trust to keep Pilgrim offering a full range of services. Any diminution of service would not be acceptable. Any removal of a specialism would be seen as a downgrading of the hospital. For example, I understand that conversations are going on about gastro-intestinal specialisms.
I am also intrigued as to who will make the final decision after the strategic review reports. Will it be the regional health authority? Will it be the hospital trust? Will it be the public, whom I understand will be consulted? After all, what is the point of public consultation if the consultative process is ignored? If, as I understand it, the decision will be made at the last port of call—the regional health authority—will it not stand in complete contrast to the Government's supposed devolved decision-making policy and agenda for the health service?
How does that decision-making process fit comfortably with the Government's plans for foundation hospitals? I very much hope that Pilgrim hospital will ultimately become a foundation hospital, with local decision-making and local accountability. It is ironic that, just as the Government, at least, superficially jump on the devolved power bandwagon, the reverse seems to be happening in Lincolnshire.
I am ambitious for, and committed to, Pilgrim hospital. I want it to be empowered and enabled to have greater autonomy and decision-making authority. However, my constituents—both patients and those who work in the hospital—have expressed many concerns about the merger with Lincoln. They are worried not just about the immediate impact, but about the medium and longer-term relocation of specialist services. I understand that the merger has not only led to a large overspend but has been an expensive option, eating into resources that could and should have been used to improve front-line health care provision in Pilgrim hospital on behalf of my constituents.
The merger with Lincoln has brought not just financial problems but actual service provision deterioration on the ground. For example, because of the assistance that was required in the form of staffing resources, waiting times for hearing aids in the audiology department in Boston prior to the merger were four to six weeks. They are now four to six months. A neonatal screening programme to test all children in Lincolnshire was due to begin in Pilgrim in early 2000, but because of the merger it was put on hold and may begin in 2004.
The possible threat in reduction of service provision is causing anxiety among my constituents. Indeed, only last year there was a risk to the ear, nose and throat department when a distinguished and highly regarded consultant, Dr. Graham Westmore, retired. Many patients were unnerved and deeply concerned and there is still concern at the current provision that a seven-day service may be reduced to five. However, I am delighted that tomorrow I will be opening the new ENT department at Pilgrim hospital. I am delighted that this service provision has been cemented in Boston for many years to come.
I am deeply concerned about security at Pilgrim hospital. To be blunt, I have been horrified by the anecdotal evidence from nursing staff in particular about the behaviour of some of the patients towards the hard-working and excellent staff. That applies particularly, although not uniquely, to those who work in the accident and emergency department. There is a particular problem with patients who have a drug or alcohol problem; they tend to be the most aggressive. The local police force have been extremely helpful and now have a presence in the hospital at particular times of the week. Will the Minister talk to his officials and colleagues in the Department of Health and the Home Office to find out whether any new source of funding could provide additional security—not only in Pilgrim hospital, as I am aware that this is a problem across the country? That could link in with the Government's new drugs policy which was debated in the House earlier this week.
I am also perturbed and uneasy at the revelation that the West Lincolnshire primary care trust appears to have run out of money. I understand that there has been a significant overspend in primary care surgery and all future surgical operations such as hernias, eyelid cysts and vasectomies have been cancelled for this financial year. The scheme is to provide patients with more convenient and local treatment in a primary care setting, with the expectation of reducing travel and thereby patient transport costs and avoiding hospital visits. The cancellations are opposed by general practitioners who wish to continue with the scheme and also put pressure on an already overstretched Pilgrim hospital staff.
I have with me an internal NHS document that lists the options regarding the overspend. The only item in the XAdvantages" column is that cancelling the operations
XAvoids any overspend on this budget."
The disadvantages are numerous. The document says that this will cause problems with the providers and patients at a time when Lincolnshire is promoting the development of primary care specialists. It says that some of the providers may withdraw. The third item in the XDisadvantages" column is fundamental and quite unbelievable. It says that there is no scope for undertaking the operations at the acute hospitals as they are unable to deliver their existing activity, let alone any extras. Another disadvantage, according to the document, is that the cessation of this activity could mean that some providers may become deskilled.
That says to me that the myth being perpetrated that everything is fine in the national health service, that there is no shortage of money and that everyone is being treated where and when they want is clearly untrue. I do not expect an answer from the Minister this evening, but I would like him to talk to his officials and come up with an answer on how we can improve that aspect of health care, take the pressure off Pilgrim hospital and make sure that the operations that were being done under the remit of the primary care trust continue.
In conclusion, I want my constituents to be provided with the best possible health care. I also want to continue to facilitate a motivated and enthusiastic work force at Pilgrim. I will not accede to proposals to remove or downgrade services under the auspices of specialisation or any other excuse. I trust that the Minister will assure me that that will not happen.