REPORT OF THE PARLIAMENTARY ADJOURNMENT
DEBATE
ON 14th FEB 2000
JULIAN BRAZIER'S QUESTIONS
Acute Health Services (East Kent)
HANSARD Motion made, and Question proposed,
That this House do now adjourn.--[Mr. Dowd.] 12.52 am
Mr. Julian Brazier (Canterbury): I am grateful for the opportunity to
hold this debate. I am grateful to my right hon. and learned Friend the
Member for Folkestone and Hythe (Mr. Howard), to the hon. Member for Sittingbourne
and Sheppey (Mr. Wyatt) and to the Minister for being here to debate this
matter well into the witching hour. It is difficult to exaggerate the
scale of concern about the future of acute health services in East Kent,
and particularly Kent and Canterbury hospital. I have received more than
3,000 individually written letters on the subject. It would be out of
order for me to refer to the Gallery, but considerable interest is being
shown--
Mr. Deputy Speaker (Mr. Michael Lord): Order. The hon. Gentleman is quite
correct. It is out of order, and I would be grateful if he did not do
it again, on this or any future occasion.
Mr. Brazier: Indeed, Mr. Deputy Speaker. Since this was last debated,
the situation has worsened. The hospital is the most heavily used and
cost-efficient of all the hospitals in Kent, and the only one in East
Kent with a mixture of regional specialist services. I believe that the
plans in the 'Moving Forward' document will put at risk health care in
the whole of East Kent.
In December 1998, the then Secretary of State for Health concluded his
considerations of East Kent health authority's so-called "better balance"
proposals and sent a letter to Members of Parliament on 22 December, with
a further letter following at the end of March to the chairmen of the
trusts. The first letter said: "my decision is to endorse the Health Authority's
proposals, subject to a number of conditions." By any standard, the conditions
were major. The letter went on to say that "the proposals to the Kent
and Canterbury A&E . . . are not satisfactory and must be improved." The
letter said that EKHA must "guarantee that onsite consultant and anaesthetic
surgical and medical cover will be provided at the Kent and Canterbury
during the day and on-call cover in these specialities . . . out of hours."
That was even reinforced by the condition that "there will be a designated
consultant to develop and lead the Canterbury emergency centre . . . to
ensure that a substantial proportion of consultant time is spent at Canterbury",
including "consultant medical cover for the coronary care unit at the
hospital" and "and a physician with an interest in coronary care." He
also demanded a full review of the provisions for renal medicine. In his
second letter, the Secretary of State gave a further critical guarantee.
He said: In his second letter, the Secretary of State gave a further critical
guarantee. He said: "it is clear that many of the respondents to consultation
were under the misapprehension that the proposal was to move specialist
cancer services, rather than simply the management of those services He
continued:: "The retention of specialist cancer services at Kent & Canterbury
Hospitals was part of that decision. Specialist cancer services at Canterbury,
therefore, have a firm future." He also made a firm commitment to at least
232 beds in Canterbury, as against around 390 at the Kent and Canterbury
and the Nunnery Fields hospitals together.
Mr. Michael Howard (Folkestone and Hythe): Has my hon. Friend seen the
recent letter written to the chief executive of the East Kent hospitals
NHS trust by Mr. Paul Watkins, chairman of the South East Kent community
health council, in which Mr. Watkins asks that the implementation of the
proposals in "Tomorrow's Health Care" be deferred until the Secretary
of State has devised the national strategy that he has promised on the
number of beds to be provided in the NHS? Does my hon. Friend think that
that suggestion by Mr. Watkins has some merit?
Mr. Brazier: I do indeed. Both my right hon. and learned Friend and Mr.
Watkins are right on that point. Last year, in reply to a question that
I asked in the House, the previous Secretary of State said in relation
to the Kent and Canterbury hospital: "If it looks as though things are
going wrong, I am prepared to step in and ensure that the bed reduction
does not proceed as quickly, or as far, as presently agreed".--[Official
Report, 11 January 1999; Vol. 323, c. 45-6.] Even with the commitments
that he made, the Secretary of State's decision caused dismay. It will
mean the rundown of the full A and E department, which has been in the
top third of the major trauma outcome survey for every year since the
survey was launched in 1988, and transferring those services to distant
units that are still to meet the full standard.
Furthermore, our area is suffering a winter that has seen the most severe
pressure on East Kent hospitals. In recent weeks, two out of three acute
hospitals in the area have, on several different occasions, been simultaneously
closed to all but blue-light work, with bed use running at well over 100
per cent. of nominal capacity, including trolleys pushed into offices
and corridors. Flu has been part of the cause, but East Kent has some
of the largest and busiest road arteries in Europe. Because the mild winter
has brought relatively little ice and snow, the road accident work load
has been well below average, but still the hospital system has been stretched
to near breaking point. A Government with a large majority can do as they
wish. Despite all those considerations, when the Secretary of State made
his decision, I decided that the best way that I could defend the services
was to engage, rather than simply oppose. He did at least leave us with
a single trust responsible for health care, and I have welcomed the meetings
with Mr. Conrad Blakey and Mr. David Astley, the new chairman and chief
executive.
It was, therefore, with incredulity that I read the "Moving Forward"
document, the opening sentence of which reads: "On 22 December 1998 the
Secretary of State endorsed the Health Authority's proposal". That statement
was repeated five times in the text without any mention of his lengthy
conditions. On those conditions, I shall leave description of the fiasco
over renal services to the hon. Member for Sittingbourne and Sheppey.
As for the rest of the items that I have already listed, the Secretary
of State's findings on coronary care merit a brief mention on one page,
but appear to play no part in the actual plan. Every other pledge has disappeared.
The commitment to retain a full cancer centre has been ignored. The commitment
to 232 beds has been ignored and no specific bed numbers are mentioned
for that site. Consultant cover for emergency work at the Kent and Canterbury
hospital has been ignored again. This imaginative document, "Moving Forward",
involves a degree of creative accounting that I can only describe as remarkable.
East Kent health authority has carefully kept the capital investment figure
just inside the £50 million mark, so that it does not go back to Ministers.
Is the Minister content that a health authority can brush aside pledges
by the Secretary of State? Is she content to see £50 million of taxpayers'
money, along with substantial further sums hidden in revenue flows, go
forward without referring the matter back to the Secretary of State to
see that the pledges have been maintained?
It is very sad to see EKHA restating the same half truths from the old
debate. For example, the document states: "an economic and social impact
study confirmed that the greatest concentration of both the elderly and
the socio-economically deprived in East Kent are located in Thanet". As
independent studies show, there are far more elderly people and a slightly
greater number of deprived people in the catchment area for the Kent and
Canterbury hospital. I raised that point with Mr. Mark Outhwaite, the
chief executive, at a public meeting. He pointed out that the people in
Thanet live closer together. He is quite right--technically, the largest
concentration of elderly and deprived people is in Thanet. Do the people
in rural areas, and in small towns such as Whitstable and Faversham, matter
less because they live further apart, even though there are more of them?
The population figures are flawed throughout the document.
Where EKHA got the fatuous growth figure that was fed into the York study
team, I cannot imagine. Has it never heard of Serplan, with its projections
for huge population growth? Page 11 of the document says that an implementation
plan has been agreed. Yet on page 22, in excusing itself for giving no
detail on plans for the Canterbury site, the same document says: "the
detailed site plan will be drafted when a robust medical services model
has been developed." What sort of medical organisation embarks on £50
million worth of capital spending without a robust medical plan? EKHA's
overstretched financial plans--and they are overstretched, because of
the sheer scale of the capital spending, which is disguised in revenue--include
£600,000 for investment in transport services. There is no mention of
continuing spending.
Most of East Kent's scattered rural communities, and some small towns,
have no public transport access to the other two hospitals. Even if that
allocation survives, does anyone really believe that an all-embracing
taxi service can be delivered by East Kent's undermanned and overstretched
ambulance service? One sinister sentence explains how the financial circle
is to be squared. It says: "the largest single savings will come from
bed reductions and improved efficiency"." Presumably, no one from EKHA
saw the trolleys in the corridors and the offices this winter. Yet the
whole document is swung on 15 per cent. fewer beds. Vast capital expenditure
and a shift from Kent's lowest cost hospital to less efficient sites is
to be financed by removing beds. Is that what the Government want for
the future of health care in East Kent? Will the Secretary of State require
EKHA to resubmit its plans to see that at least those minimum pledges
are met, and to take account of the new national findings on bed numbers?
I should like to end by asking the Minister a few specific questions.
Will Canterbury retain the full range of services of a joint cancer centre,
as defined under the Calman-Hine guidelines? Will a new linear accelerator
be purchased, as promised, or just a second-hand one, which can be readily
abandoned?
Do the pledges on emergency cover and coronary care at Canterbury stand?
Does the pledge of at least 232 beds stand, and does the hon. Lady think
that that is adequate for our burgeoning population? People all over east
Kent, relying on our overstretched service, are waiting for answers--the
old, the vulnerable, children, accident victims, doctors, nurses and health
care workers.
top
I urge the Secretary of State to call in the plans to see whether the
earlier pledges are being maintained and whether they go far enough for
the future of acute health care in East Kent. The letter from the former
Secretary of State said that EKHA must guarantee that onsite consultant
and anaesthetic surgical and medical cover will be provided at the Kent
and Canterbury during the day and on-call cover in these specialities
. . . out of hours." That was even reinforced by the condition that there
will be a designated consultant to develop and lead the Canterbury emergency
centre . . . to ensure that a substantial proportion of consultant time
is spent at Canterbury", including consultant medical cover for the coronary
care unit at the hospital and a physician with an interest in coronary
care." He also demanded a full review of the provisions for renal medicine.
In his second letter, the Secretary of State gave a further critical guarantee.
He said: "it is clear that many of the respondents to consultation were
under the misapprehension that the proposal was to move specialist cancer
services, rather than simply the management of those services". He
continued,
"The retention of specialist cancer services at Kent & Canterbury Hospitals
was part of that decision. Specialist cancer services at Canterbury, therefore,
have a firm future." He also made a firm commitment to at least 232
beds in Canterbury, as against around 390 at the Kent and Canterbury and
the Nunnery Fields hospitals together.
Mr. Michael Howard (Folkestone and Hythe): Has my hon. Friend seen the
recent letter written to the chief executive of the East Kent hospitals
NHS trust by Mr. Paul Watkins, chairman of the South East Kent community
health council, in which Mr. Watkins asks that the implementation of the
proposals in "Tomorrow's Health Care" be deferred until the Secretary
of State has devised the national strategy that he has promised on the
number of beds to be provided in the NHS? Does my hon. Friend think that
that suggestion by Mr. Watkins has some merit? Mr. Brazier: I do indeed.
Both my right hon. and learned Friend and Mr. Watkins are right on that
point. Last year, in reply to a question that I asked in the House, the
previous Secretary of State said in relation to the Kent and Canterbury
hospital: "If it looks as though things are going wrong, I am prepared
to step in and ensure that the bed reduction does not proceed as quickly,
or as far, as presently agreed".--[Official Report, 11 January 1999; Vol.
323, c. 45-6.] Even with the commitments that he made, the Secretary of
State's decision caused dismay. It will mean the rundown of the full A
and E department, which has been in the top third of the major trauma
outcome survey for every year since the survey was launched in 1988, and
transferring those services to distant units that still need to meet the
full standard.
Furthermore, our area is suffering a winter that has seen the most severe
pressure on East Kent hospitals. In recent weeks, two out of three acute
hospitals in the area have, on several different occasions, been simultaneously
closed to all but blue-light work, with bed use running at well over 100
per cent. of nominal capacity, including trolleys pushed into offices
and corridors. Flu has been part of the cause, but East Kent has some
of the largest and busiest road arteries in Europe. Because the mild winter
has brought relatively little ice and snow, the road accident work load
has been well below average, but still the hospital system has been stretched
to near breaking point. A Government with a large majority can do as they
wish. Despite all those considerations, when the Secretary of State made
his decision, I decided that the best way that I could defend the services
was to engage, rather than simply oppose. He did at least leave us with
a single trust responsible for health care, and I have welcomed the meetings
with Mr. Conrad Blakey and Mr. David Astley, the new chairman and chief
executive. It was, therefore, with incredulity that I read the "Moving
Forward" document, the opening sentence of which reads: "On 22 December
1998 the Secretary of State endorsed the Health Authority's proposal".
That statement was repeated five times in the text without any mention
of his lengthy conditions. On those conditions, I shall leave description
of the fiasco over renal services to the hon. Member for Sittingbourne
and Sheppey. As for the rest of the items that I have already listed,
the Secretary of State's findings on coronary care merit a brief mention
on one page, but appear to play no part in the actual plan. Every other
pledge has disappeared. The commitment to retain a full cancer centre
has been ignored.
The commitment to 232 beds has been ignored and no specific bed numbers
are mentioned for that site. Consultant cover for emergency work at the
Kent and Canterbury hospital has been ignored again. This imaginative
document, "Moving Forward", involves a degree of creative accounting that
I can only describe as remarkable. East Kent health authority has carefully
kept the capital investment figure just inside the £50 million mark, so
that it does not go back to Ministers. Is the Minister content that a
health authority can brush aside pledges by the Secretary of State? Is
she content to see £50 million of taxpayers' money, along with substantial
further sums hidden in revenue flows, go forward without referring the
matter back to the Secretary of State to see that the pledges have been
maintained? It is very sad to see EKHA restating the same half truths
from the old debate. For example, the document states: "an economic and
social impact study confirmed that the greatest concentration of both
the elderly and the socio-economically deprived in East Kent are located
in Thanet". As independent studies show, there are far more elderly people
and a slightly greater number of deprived people in the catchment area
for the Kent and Canterbury hospital. I raised that point with Mr. Mark
Outhwaite, the chief executive, at a public meeting. He pointed out that
the people in Thanet live closer together. He is quite right--technically,
the largest concentration of elderly and deprived people is in Thanet.
Do the people in rural areas, and in small towns such as Whitstable and
Faversham, matter less because they live further apart, even though there
are more of them? The population figures are flawed throughout the document.
Where EKHA got the fatuous growth figure that was fed into the York study
team, I cannot imagine. Has it never heard of Serplan, with its projections
for huge population growth? Page 11 of the document says that an implementation
plan has been agreed. Yet on page 22, in excusing itself for giving no
detail on plans for the Canterbury site, the same document says: "the
detailed site plan will be drafted when a robust medical services model
has been developed." What sort of medical organisation embarks on £50
million worth of capital spending without a robust medical plan? EKHA's
overstretched financial plans--and they are overstretched, because of
the sheer scale of the capital spending, which is disguised in revenue--include
£600,000 for investment in transport services. There is no mention of
continuing spending. Most of East Kent's scattered rural communities,
and some small towns, have no public transport access to the other two
hospitals. Even if that allocation survives, does anyone really believe
that an all-embracing taxi service can be delivered by East Kent's undermanned
and overstretched ambulance service? One sinister sentence explains how
the financial circle is to be squared. It says: "the largest single savings
will come from bed reductions" and from "improved efficiency". Presumably,
no one from EKHA saw the trolleys in the corridors and the offices this
winter. Yet the whole document is swung on 15 per cent. fewer beds. Vast
capital expenditure and a shift from Kent's lowest cost hospital to less
efficient sites is to be financed by removing beds. Is that what the Government
want for the future of health care in East Kent? Will the Secretary of
State require EKHA to resubmit its plans to see that at least those minimum
pledges are met, and to take account of the new national findings on bed
numbers? I should like to end by asking the Minister a few specific questions.
A] Will Canterbury retain the full range of services of a joint cancer
centre, as defined under the Calman-Hine guidelines? B] Will a new linear
accelerator be purchased, as promised, or just a second-hand one, which
can be readily abandoned? C] Do the pledges on emergency cover and
coronary care at Canterbury stand? D ] Does the pledge of at least
332 beds stand? E] Does the hon. Lady think that that is adequate for
our burgeoning population? People all over east Kent, relying on our overstretched
service, are waiting for answers--the old, the vulnerable, children, accident
victims, doctors, nurses and health care workers. I urge the Secretary
of State to call in the plans to see whether the earlier pledges are being
maintained and whether they go far enough for the future of acute health
care in East Kent.
top
Mr. Derek Wyatt (Sittingbourne and Sheppey): I congratulate the hon.
Member for Canterbury (Mr. Brazier) on securing the debate. My constituency
lies to the east of the West Kent health authority area and to the west
of the East Kent health authority area. If there were a north Kent authority,
we should lie to the north of that, too. In short, we sit right in the
middle on this matter. If one lives in Warden Bay or Leysdown, it takes
at least an hour and a half to get to the hospitals at Medway or Canterbury.
It also requires the use of three or four public transport services--up
to two buses and two trains. It simply is not possible to get to hospital
at some times. In addition, the Isle of Sheppey is not always connected
to the mainland. We have specific problems, including having more socially
excluded people than anywhere in the south-east of England outside Folkestone.
The issues raised by the hon. Gentleman represent serious problems for
my constituents, who prefer Canterbury because they do not yet trust the
new arrangements at Medway Maritime hospital. I wish specifically to address
problems with renal services in East Kent. There has been a serious change.
Margate hospital has been designated for services from spring 2003, but
it is unacceptable to my constituents. It is on the far eastern side of
Kent, which will cause access difficulties for all patients from my constituency
and for staff, particularly those from west Kent. As my hon. Friend the
Minister knows, renal care requires lifelong associations between patients
and doctors and nurses, who provide great care that involves frequent
visits to clinics. On average, a patient may have to be admitted for in-patient
treatment once or twice a year, and there is an average stay of nine days.
It would not be possible for relatives to visit patients in Margate. They
could not afford it. It is essential in a modern health care service to
consider not only patients but their families, whose love and care contribute
physically to the well-being of patients. It is a serious matter if families
cannot get to hospital to see their loved ones. The proposed relocation
would increase travel times and travel costs beyond the reach of most
of the people on the Isle of Sheppey. Does my hon. Friend really believe
that the nursing staff will transfer to Margate? If not, where will nursing
staff come from? We all know that there is a shortage of trained nurses
for this specialty. The relocation of the unit to Margate is opposed
by patients, by the head of the renal medicine department at the Kent
and Canterbury hospital and by the community health councils for Medway
and Swale and for Canterbury and Thanet. Those are reasonable people who
have thought the matter through. I ask the Minister to think again about
the renal unit and to keep it in Canterbury.
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart):
I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing
a debate on a matter of great concern to his constituents. He has keenly
supported his local hospitals for many years, particularly Kent and Canterbury
and Nunnery Fields. His interest bears testament to his commitment to
the needs of local people, who are keen to see a high-quality health service
for themselves and their families. I assure the hon. Gentleman that we
share their vision. The debate on hospital services in the East Kent health
authority area has gone on for some time. I should like to spend a few
moments outlining the reasons for the change in acute services, but I
will address the hon. Gentleman's specific points later. First, however,
I convey my thanks and those of the House to all the people in the national
health service who worked over winter to cope with extraordinary pressures
arising from the combination of an extended Christmas holiday, the millennium
and the flu. 1]I shall outline the context of the changes to acute services
in East Kent. They are not primarily driven by money, as has been suggested.
I should record the fact that the health authority is receiving an additional
cash increase of more than £23 million, which represents real growth of
3.7 per cent. No matter what the funding stream, changes would still be
necessary to services in Kent. 2]In East Kent, the major issues are not
only money, but the supply and training of doctors and the changes in
medical technology. NHS services cannot stand still--locally or nationally.
Changes in the NHS are complex and, as we all know, contentious. People
want to fight for their local services. That is only right. However, in
East Kent, the process of modernisation has been a long one. As the hon.
Gentleman pointed out, it started back in 1997, after detailed examination
and the most exhaustive local consultation ever carried out for the NHS.
As he said, the matter was referred to Ministers. The then Secretary of
State for Health, my right hon. Friend the Member for Holborn and St.
Pancras (Mr. Dobson), gave careful consideration to the issues that had
been raised and to the representations that had been received. He made
his decision at the end of 1998. I fully accept that his decision was
not universally popular, especially in the constituency of the hon. Member
for Canterbury. However, I assure the hon. Gentleman that such decisions
are never taken lightly. Ministers need to combine the needs of the local
population for access to local services with the requirement to provide
top-quality treatment in a safe environment, in facilities that are fit
for the 21st century. The decision taken will ensure that high-quality
care will be provided on three sites--the Kent and Canterbury, the William
Harvey and the Queen Elizabeth the Queen Mother hospitals. It will provide
the opportunity to develop the scope and capacity of local primary care
services. We must not forget what happens in primary care. The decision
lays the foundation for acute and specialist care that will be of long-term
and sustainable benefit to local people. I make it clear again--although
it has been made clear on previous occasions--that the decision announced
by my right hon. Friend is not negotiable. I reiterate that: we shall
not revisit the overall decision. However, it is important to point out
that we shall ensure that the framework for that decision is properly
implemented on the ground; that the plans are robust; and that the needs
of the local population are met. I have, therefore, asked officials from
the south-east regional office of the NHS Executive to monitor the progress
of implementation to ensure that it takes place in a proper, sensitive
and well managed way.
The three trusts are merging to become the East Kent Hospitals NHS trust.
That is right, because the new trust structure supports the implementation
of the changes to hospital services. A single trust is much better placed
to achieve that goal. The new trust combines the benefits of strategic
oversight of hospital services in East Kent with a commitment to be responsive
to local communities and their primary care groups.
The new trust has moved swiftly with its NHS partners to draw up an
implementation plan for the service changes. The hon. Member for Canterbury
referred to the document "Moving Forward". That document sets out the
strategic development plan for acute services in the area. It builds on
the work of clinical specialty groups. It sets out proposals to build
new services and estates configurations. However, it is important to be
clear as to the purpose of the document. Although it addresses a variety
of audiences, it has a specific purpose. It is not a consultation document,
nor, as the hon. Gentleman implied, is it intended to set out in detail
the clinical models for each specialty. Its key purpose is to obtain approval
to move through the private finance initiative process to the outline
business case stage. It has been referred to the regional office of the
NHS Executive--not for the executive to provide the funding, but to ensure
that due process is followed. The implementation plan has been agreed
locally between the trust, health authority, community health council,
primary care groups and the regional office The hon. Gentleman referred
to capital spending of £50 million of taxpayers' money. That is not what
the plan is about. It is intended that the sources of capital will come
from the private sector. If the PFI developments are approved, the plan
will be developed over five years. Only when the future models of care
have been agreed will there be any redevelopment of the Kent and Canterbury
site.
Even when the changes are fully implemented, about 85 per cent. of patients
who would currently expect to attend the Kent and Canterbury hospital
will continue to be treated there. Mr. Howard: Will the Minister deal
with the issue of bed numbers and the specific suggestion that has been
made by the chairman of the community health council? Does she see some
merit in that suggestion? Ms Stuart: I shall come to the issue of bed
numbers in about a paragraph from now. The health authority has stated
that, in accordance with the then Secretary of State's decision, it is
committed to ensuring that robust services at alternative sites are in
place before any service is transferred from its current location.
To assist it in this process--because, as the change occurs, there will
be some duplication of services--the authority has applied for special
assistance funding to help it during this period. A decision on that is
expected shortly. I now turn to the specific issues raised by the hon.
Member for Canterbury and the right hon. and learned Member for Folkestone
and Hythe (Mr. Howard). First, I shall discuss bed numbers. The number
of acute beds will increase from the 1,395 that were originally proposed
to 1,417. We do of course recognise the public concern about the eventual
number of beds in the area and the pressure that they have been under
this winter, and we expect the health authority to continue to monitor
and review bed numbers closely. The right hon. and learned Member for
Folkestone and Hythe made reference to the national bed survey, which
I assume is what was covered in that letter. Some of those findings will
be incorporated, but the overall decision by the Secretary of State stands.
Mr. Brazier: How does the Minister reconcile what she has just said--about
nothing happening immediately and about working in line with that detailed
programme--with EKHA's announcement, out of the blue, that Nunnery Fields
hospital, with almost a quarter of Canterbury's beds, is to close this
summer? Ms Stuart: I was going to discuss the Nunnery Fields hospital
situation, especially in relation to the care of the elderly. The hospital
provides a rehabilitation service for the elderly. It is an old workhouse.
It is no longer suitable for the type of care and rehabilitation that
we expect to give to elderly people and which they deserve. We expect
that, once the reconfiguration has taken place, the hospital care will
take place within the Kent and Canterbury.
As I have said, we should focus not only on hospitals but on what is
happening in primary care and the support services that allow people--especially
elderly people--who do not need to stay in hospital to receive care and
support at home or at primary care level. We have spent some £2.5 million
to develop primary care and community-based services for the elderly,
and there will be an additional £5 million further investment in acute
services. More than £500,000 will be directed into the development of
transport facilities. I know that the hon. Member for Canterbury feels
that that may be insufficient, but I think that we should not sneer at
what is a significant amount of money. I shall now address the issue of
the care of the elderly in East Kent, because allegations have often been
made that they have been neglected or even marginalised. Nothing could
be further from the truth. The health authority is looking after the elderly
in East Kent in a very responsive way. For example, community assessment
and rehabilitation teams--a joint initiative, which is so far being implemented
in only one part of the area, although the plan is that there will be
four such units--are helping to develop models of care to ensure that
elderly patients avoid hospital admissions wherever appropriate, and that
patients can be discharged much sooner than they are now. Modernisation
does not only
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|
|
The following is a letter
to the Under Secretary of State for Health that she should have answered
during the adjournment debate conducted by Julian Brazier the Canterbury
MP
16th Feb 2000
Ms Gisela Stuart MP
Under-Secretary of State for Health
House of Commons
Westminster
LONDON SW1A 0AA
Dear Ms Stuart,
As one of the night owls who listened intently to your reply to Julian
Brazier's adjournment debate on Monday 14th Feb, I have to take issue
with various points that you made. The principal reason for Julian requesting
a debate at this time is because we are beginning to see the 'first fruits'
of EKHA's implementation of "Tomorrow's Healthcare" (THC) and there are
several very major causes for concern. You made it very clear (as Frank
Dobson did on many occasions) that the decision is "non-negotiable". One
has to assume that this means non-negotiable downwards as well as upwards.
But this is precisely what is happening.
A. Beds numbers. You stated that there will be 1417 acute beds (the
figure is actually 1414). This is not the case. The published figures
are actually 1218 acute/96 day/100 non-acute = 1414. This figure is actually
total bed numbers across QEQMH, KCH, WHH and BHD. This represents a reduction
of almost 10% in bed numbers against THC (1562). EKHA and EKNHSAT make
no acknowledgement of the fact that all three East Kent Hospitals have
been running at 90-95% bed occupancy for many months; all three A&E departments
are stretched to breaking point (in the national "casualty watch" conducted
two weeks ago, the waiting time at WHH was 12 hours); In patient waiting
lists in all three hospitals are ±20% over target. Although SERPLAN is
not approved it is inevitable that the population of East Kent (and particularly
Ashford which is estimated to triple in size within 15 years) is going
to rise by massively more than the 1% per year predicted by EKHA and by
the York Report. Thus all estimates of demand on the Health Service are
grossly underestimated.
B. Buckland Hospital, Dover. The first element of the implementation
plan related to BHD.' Tomorrow's Healthcare' simply referred to the transfer
of Obstetrics and Gynaecology and a reduction of 25 beds, but the cuts
have been far deeper. The closure of the Dunkirk Ward, a reduction in
Midwives by 11%, the non-replacement of two doctors. EKHA have invested
£30k in a new birthing centre, but only "low risk births" (just 1 in 3)
can take place there. The business plan makes clear that there is to be
no expansion of facilities at WHH (already over capacity) and relies on
the implementation of targets to discharge 60% of women who had given
birth in 6 hours and 80% in 24 hrs - current average is 2.3 days.
C. Nunnery Fields Hospital Even though planned for quarters 2, 3 and
4 of 2001, EKHA told senior staff on 7th Feb that NFH was to close "in
the summer". The NFH patients were intended to fill space vacated by the
departure of acute services from KCH - but this not even due to start
happening (except for Obstetrics and Gynaecology) until Qtr 2 2001. This
would either necessitate temporary accommodation (far from ideal for geriatric
stroke patients) or the premature closure of up to 5 wards in KCH.
D Renal. In THC [TOMORROW'S HEALTH CARE] , EKHA stated that there were
only two possible choices for the siting of the main Renal centre or 'hub'
(which is shared with West Kent) - Ashford or Maidstone. However, they
have now decided, against evidence and recommendations from the committee
set up to examine it, to site the centre at QEQMH. The QEQMH Renal 'hub'
would require 40% of its patients to come from West Kent to remain viable.
There is now a very real possibility that West Kent patients will go to
London, and that Renal Services may disappear in Kent altogether. (How
would Paul Wyatt MP feel about that?) There are to be 4 'satellites' at
KCH, WHH, Maidstone and Medway. However EKHA will not commit to whether
they are simple units (administering only the most basic services) or
intermediate units (able to handle more complex problems). This of course
influences the number of journeys to and from the main 'hub'. Professionals
are very concerned that decision on Renal has been made before the inter-relationship
of Renal, Vascular and Haematology has been established. (Mr Dobson asked
for report on Haematology which hasn't appeared yet). We also understand
that the KCH Vascular Unit has categorically refused (for logistical not
emotional reasons) to move into temporary accommodation at QEQMH as planned
in Moving Forward.
E. Cancer. Frank Dobson insisted that the Cancer Centre remain at KCH,
and even approved funding for a new Linear Accelerator. However, a Cancer
Centre can not function without an adjacent ICU, acute medical and surgical
beds and renal services. It is thus inevitable that without these services
on hand, the Centre would be down-graded to a Unit and be unable to administer
complex chemotherapy, high grade radiotherapy or nuclear medicine. Staff
have been told privately that even though the bunker has been built (cost
£1.4m) the LinAc will now go to Maidstone and KCH will get their 2nd hand
one which is much lower grade. Dept calculates this switch will cost around
£4m. KCH has the reputation of being one of the best Centres in the country
and is the only one in the south of England which can do reconstructive
breast surgery at the same time as invasive surgery. A&E. Although EKHA
have not been specific about their plans for the minor injuries unit,
it is clear from discussions which have already taken place, that they
will fall short of what Mr Dobson asked for. Dr Sue Brooks (one of the
most respected A & E consultants in the country) has resigned in protest
at the plans.
F HImP. [HEALTH IMPROVEMENT PLAN] By the end of March, EKHA, the Trust,
CHC's, PCG's and City Council will have to sign up to Government's Health
Improvement Programme - the main target of which is to "reduce premature
deaths by 20%". With the removal of A&E, ITU, down-grading of Coronary,
Cancer and acute maternity, it is the most serious cases with the most
life threatening of conditions who will have to travel furthest and wait
longest for Hospital treatment. It is inevitable that there will be more
premature deaths not less. THC is 100% incompatible with HImP.
G . Care. At last EKHA board meeting a majority of the board (inc Mark
Outhwaite) admitted in response to CHEK's question that in East Kent the
word "care" had gone out of "healthcare".
H. Finance. "Moving Forward" shows that estimated costs have risen
from £52.5m (THC) to £69.3m (+32%). This does not take account of the
fact that the HA is £5m in deficit for 1999 (M Outhwaite at CHC meeting
on 10 Feb) Considering they had a £2.244m surplus in 1998, this means
THC has cost £7.25m already! There is no apparent comment about estimated
savings (originally £5.4m pa) - it's highly questionable whether there
will be any! For a HA which has run at break even for the last three
years to spend c£80m and cause massive disruption to make negligible savings
makes no financial sense at all.
It is sad irony that having fought so strenuously against any downgrading
of KCH, we are now having to watch EKHA and EKNHSAT take a dangerously
cavalier attitude to the implementation of Frank Dobson's decision, and
to fight to retain even that. All the points outlined above are happening
and we have evidence for them. We suspect that it is at last dawning on
EKHA that the plans which they drew up are not capable of implementation
as they or Mr Dobson envisaged.
I beg you to call a moratorium on THC now to re-assess the plan in light
of what has happened in the year since the decision. I must stress that
we are not against modernisation and fully acknowledge the problems facing
the NHS in the future, but feel, as does virtually every professional
in the area that some relatively minor changes would have made huge differences
and that there is no way that this full 'root and branch' re-configuration
can or could ever provide a service to the people of East Kent which is
better or even comparable to what we have now.
Yours Sincerely
David Shortt (Chairman of CHEK)
cc. Julian
Brazier MP
Michael
Howard MP
Derek
Wyatt MP
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