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The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): Like the hon. Member for Ryedale (Mr. Greenway), I have the unexpected pleasure of speaking in this debate early in the evening. Hon. Members on both sides of the House talk more sense at a reasonable time of day.
I congratulate the hon. Gentleman on securing this important debate. He is, rightly, eager to ensure that the highest possible standards of health care services are available to his constituents. I know that he has taken a keen interest in the services that Malton hospital provides. He has tabled parliamentary questions about it and written to my ministerial colleagues, and he has been assiduous in following up these issues. I reassure him that the Government are committed to providing high quality services for everybody, no matter where they live.
We want to provide services that are as close to people's homes as possible but that are also safe and viable. Striking the right balance between local access and high quality has always created tension in the NHS; it is a problem that we continue to wrestle with, and its impact on local services is the subject of many Adjournment debates. Getting that balance right is not without its difficulties. It is fair to say that, if possible, most of us want services almost on our doorsteps, yet we also want them to be safe and of the highest possible standard. Trying to explain to the public and patients the difficulty of striking that balance is one of the challenges that faces us all. The hon. Gentleman clearly set out the background. He raised a number of specific queries and I shall certainly try to respond to them during my speech.
The NHS plan, which was published in July 2000, set out an ambitious vision of a service designed around the needs of patients. That new approach is aimed at trying to ensure that we achieve high quality national standards, that the services are fast and convenient, and that we use modern methods to provide care where and when it is needed. To deliver that, I genuinely believe that we needed a fundamental shift in power and resources to the front line. That is why we have, in just the past couple of weeks, established 302 primary care trusts which cover all parts of England and are in the driving seat in the provision of health services locally.
From 1 April, ownership of Malton hospital transferred to the newly established Scarborough, Whitby and Ryedale primary care trust. That locally based organisation will be able to ensure that Malton hospital continues to have a strong future, serving the needs of its rural population. I am delighted that the hon. Gentleman has emphasised the fact that we see a strong and vibrant future for Malton hospital. We are certainly not in the business of seeing services reduced or the hospital being in any danger. I have no doubt that things at the hospital will change, but it certainly has a very useful future in providing health services to local people.
The provision of comprehensive and accessible services is right at the heart of the NHS. We want to try to apply those principles to local services, and to try to strike a balance between convenience and the requirement to ensure safety and quality. Achieving that balance in the case of Malton hospital has led to the need to change the provision of anaesthetic services there.
The Scarborough and North East Yorkshire Health Care NHS trust's department of anaesthesia provides a full range of anaesthetic services at Scarborough hospital, which is the main district general hospital in the area. For many years, it has provided anaesthesia for day-case and overnight-stay patients in community hospitals in Bridlington, Whitby and Maltonall of which are approximately 20 miles from the main hospital.
Much of the anaesthetic service at the community hospitals has been provided by GPs, who work alone as clinical assistants under distant consultant provision from Scarborough. The consultant anaesthetists at Scarborough hospital have become increasingly worried that, owing to the shortage of staff, they are unable even to provide that remote supervision of all the peripheral sites. The trust is trying to provide the highest quality services possible across the whole area for which it is responsible. The decision to withdraw general anaesthetic surgery at Malton was taken because Malton has the lowest level of such activity of all three sites. So the decision is very practical and designed to affect the least number of patients.
The problem in question is really the lack of qualified staff, which is endemic in the health service. The main problem now facing the health service is not necessarily the provision of extra money. People throughout the country will say that they see the resources coming through. The NHS is growing faster than any other health service in Europe, and has undergone the longest sustained period of growth that we have ever known. However, one constraint is the capacity for trained and qualified staff across a range of specialties. Increasing the work force is thus a top priority for us.
We have said that, by 2004, there will be 7,500 more consultants, 2,000 more GPs, 20,000 extra nurses, 6,500 extra therapists and 1,000 more medical school places on top of the extra 1,100 already announced. That is a huge programme of growth. In 1996, there were 2,629 consultant anaesthetists. Five years later, there were 3,549an extra 900but that is simply not enough. We estimate that, over the next nine or 10 years, we will need another 2,540 consultant anaesthetists, but as we expect 1,850 extra, it is looking as if there will be a shortfall. We therefore need a massive recruitment campaign.
The trust currently has an establishment for 10 consultant anaesthetists. One post has been vacant for just over a year, another became vacant on 1 April, a third will become vacant in June, and a retirement is anticipated in late summer. Against an establishment of seven middle-grade doctors, the trust currently has only three substantive appointments and four fairly long-standing vacancies. So the situation is very serious, as the hon. Member for Ryedale has said. The shortage of anaesthetists means that even remote supervision from the Scarborough site, with occasional visits to the community hospitals, is currently unachievable.
The hon. Gentleman specifically asked me whether, if we are successful in recruiting the extra anaesthetists, it would be possible for general anaesthetic surgery to recommence at Malton hospital. Discussions have been taking place with the GP anaesthetists who currently carry out the service, and two issues have arisen. The trust is very keen that GP anaesthetists should retain their skills, so that it will not be impossible to resume the service simply because of the passage of time. It is therefore making arrangements for GPs to go to Scarborough to keep their clinical practice up to date, which is important.
The trust is also mindful of the guidance of the royal colleges. The move is to provide GA services in an environment which includes on-site intensive care and back-up services. I would not at this point rule out the resumption of GA services at Malton, but the trust must be mindful of royal college guidance as well as the need for accessibility and for local convenience for the hon. Gentleman's constituents. I have no doubt that discussions will continue, but I want to ensure that they are not pre-empted by the loss of skills among clinicians who are currently carrying out the work. It is therefore important that we keep their skills up to date.
The PCT, like the hospital trust, is disappointed that staff shortages have precipitated the withdrawal of general anaesthetic surgery at Malton hospital, but supports the operational decision in the interests of patient safety. No long-term plan has been agreed between the PCT and the acute trust. Short-term difficulties have precipitated the change in service provision.
Any strategic decision and associated significant service changes would be subject to public consultation andif the legislation before the House has been enactedlocal authority scrutiny too. I give the hon. Gentleman that undertaking because, like him, I feel that local people must have trust and confidence in their local services. Involving them in full discussion of the available options is the right way to proceed. Local accountability is key in such circumstances, and it is all too easy for local communities to lose confidence in local services if they are not involved in discussions.
Where significant change is proposed and a consultation process takes place, that process will in future be led either by the local PCT, or by a group of PCTs if the issue crosses several boundaries. At the end of the consultation process, the PCT must take into account all the comments it has received. If, as we hope there will be, there is local agreement, the change can go ahead, but if local agreement is not achieved, the matter can be referred to Ministers either by the community health council, if that is still the proper body, or by the local authority overview and scrutiny committee, after implementation of the provisions of the NHS Reform and Health Care Professions Bill.
If the matter is referred to Ministers, we will take account of all the available evidence. We hope to have the independent reconfiguration panel up and running soon. The panel will be able to provide independent advice to Ministers, and help us to create a more coherent framework for future service changes. In that way, local people will be able to feel that the process is fair, transparent and based on established criteria.
The introduction of the new PCTs will enable local communities to commission appropriate services for local people. The hon. Member for Ryedale is right to mention flexibility and new ways of working. The decision to devolve resources and power to front-line local organisations will result in greater diversity in the ways in which services are delivered to local people. Local communities are often innovative and imaginative because they are aware of local needs, so giving them freedom to establish a wider range of ways in which to deliver care is a good step forward.
I assure the hon. Gentleman that the new PCT is committed to ensuring that Malton hospital has a vibrant future in which it continues to serve local people, and that the development of appropriate services continues. The PCT has advised me that there are no plans to withdraw further services from Malton hospital.
The hon. Gentleman is aware of the current work, initiated by the PCT, on the longer-term future of Malton and Whitby hospitals. As he said, that work includes a bid to modernise the Nightingale wards at Malton hospital. The proposal is to extend the existing Fitzwilliam ward, provide the correct match of single bedrooms and two and four-bedded bays, together with the appropriate support facilities, and ensure segregation of the sexes, thus enhancing dignity and proper patient care. The bid is being assessed against the national criteria, and I promise the hon. Gentleman that the results of the bidding process will be announced very soon; but I must ask him to be patient a little longer. I am informed that the announcement is imminent.
It is important that hon. Members have the opportunity to debate important proposals that affect local people. Representing local communities' interests and concerns is one of the most important jobs that we as Members of Parliament do, so the hon. Gentleman was right to secure this Adjournment debate.
I understand that all the patients who will be affected by the decision to suspend general anaesthetics have been contacted by the trust and supported by representatives in ensuring that their future needs are met. It is important that that be done while recruitment activities for anaesthetic services in the trust continue apace. I hope that those efforts are successful.
I assure the hon. Gentleman that general anaesthetic procedures that continue at the other hospitals do so safely. Local people may feel that procedures at Bridlington and Whitby are no longer safe, but I am told that there is a consultant anaesthetist on site at Bridlington for approximately 75 per cent. of the general anaesthetic lists, and that at Whitby the trust's medical director has agreed to take responsibility for the continuation of GP anaesthetists' lists there for a further 12 months, while certain measures are taken. There is adequate consultant cover for the other two hospitals; unfortunately, it has not been possible to retain that at Malton.
I am delighted that the hon. Member for Ryedale has been able to raise such important issues. I hope that he will receive a response to the Nightingale wards bid very soon. In the meantime, I hope that he will feel able to assure his constituents that they will continue to have access to safe, high quality services at the local acute trust.