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Mr. John Greenway (Ryedale): It is both a pleasure and a relief to speak to the Adjournment at such an early hour. Whenever I am lucky in the ballot for the 30-minute Adjournment debate, the House either sits throughout the night or the main business collapses. Until the moment arrives no one is ever sure which alternative will prevail.
The first Adjournment debate that I initiated in this Chamber was on the Nestle takeover of the Rowntree factory. Everyone expected that the main business would end at midnight but, as you may recall, Mr. Deputy Speakerlike me, you were a Back Bencher at the timethere were 43 Divisions on the Firearms (Amendment) Bill and the Adjournment began at 5.30 in the morning.
I rather feared that I would have to keep the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), up all nightor rather that some of her colleagues would have been here all night and she would have had to wait around for a long time. I was going to suggest that the wait for my Adjournment debate was not dissimilar to the wait that some patients experience for their operation. However, in the event, I feel as though I have been given my operation ahead of my appointment with the consultant.
The issue that I want to raise is important none the less. I am sure that the Minister will have been briefed and will understand why it is so important. Our community hospitals are held in great affection by our constituents; Malton hospital is no exception.
Two or three years ago, I visited our former colleague, Sir Giles Shaw, at the hospital. Sadly, he died about 18 months ago after a stroke. I shall never forget my visit to Sir Giles; it was a happy occasion. He said, "John, this is a great place. You are lucky to have it and I know that you will do everything you can to fight for it while you are the Member of Parliament". I did not think that circumstances would require us to have a debate of this nature at that time, but I am galvanised by the words of Sir Giles.
Malton is one of three community hospitals within the Scarborough and North East Yorkshire Health Care NHS trust. That creates a difficulty. Scarborough is a small district hospital. Although the population of the area that it covers is not high, the geographical area that it covers is huge and it has to look after three community hospitals. Malton hospital is effectively run by the general practitioners at the Derwent practice in Malton, who work as clinical assistants. I have formed a good relationship with them over many years, especially as various developments have taken place at the hospital.
One recent development prompted me to request the debate, although as I have more time than expected I will take the opportunity to raise one or two other issues as well. Trust managers decided in mid March to cease all general anaesthetic operations at Malton with effect from 1 April. That caused shock and alarm in the local community. The letter sent by the trust to the senior partner at the Derwent practice said that a shortage of consultant anaesthetists meant that it could no longer provide back-up cover for GA operations at Malton hospital.
On 22 February, however, the trust sent out a staff bulletin in which it suggested that the difficulty with continuing GA operations at Malton and the two other community hospitals at Whitby and Bridlington was based on concern about clinical governance. So the issue at that time was whether it was safe to continue GA operations at community hospitals. That caused confusion and we remain confused about what lies behind the decision.
I have made it clear to the trust that we are prepared to accept that the reason for the decision is the shortage of consultant anaesthetists, and I want the Minister to use all her good offices to ensure that the vacancies are filled as quickly as possible. In a written answer from one of her colleagues last week, I was told that more than 1,000 extra anaesthetic specialistsI am not sure that they will all be consultantsare being trained and made available to the NHS. However, it seems that they do not want to live in Scarborough or the Malton area, which is a pity given the quality of life there. Although I accept that their long-term clinical career might be more challenging at another hospital, our area would be a good place for those at the lower end of the learning curve. The shortage needs to be addressed. The local community will test the Government's commitment to the health service and their argument that things are improving by how quickly those posts are filled.
The serious question in the minds of patients and medical staff is that although GA operations are suspended at Malton, they continue at Whitby and Bridlington community hospitals. That is partly because patients have nowhere else to goScarborough does not have the capacity to provide the theatre time required. Given that there is a lingering suspicion that it might not be safe to perform GA operations at community hospitalsthe clinical governance issueI suspect that some patients will wonder why they are being sent from Malton to Whitby or Bridlington where the same circumstances apply.
Will the Minister confirm that the withdrawal of GA operations is only a suspension of the facility at Malton? That is important. I am sure from your long experience as a Member of Parliament, Mr. Deputy Speaker, that you appreciate that if the services provided at a local hospital are changed there should at least be a public consultation involving discussions with GPs, patients and the community health council locally. There has been none of that.
In my early days as a Member of Parliament, the accident and emergency centre at Malton was downgraded to a minor injuries unitagain, largely for reasons of clinical governance and staffing. There was such alarm and concern that some of my political opponents even suggested that the hospital was about to close, although nothing was further from the truth. I must stress that people are not worried that Malton will close; their concern relates to the services that it will provide. When the accident and emergency centre was downgraded, a public meeting at the local hall in Malton was attended by about 1,000 people. I am sure that there will be a similar interest if and when we consult on this latest development.
I want to concentrate on the future. Not only were GA operations unexpectedly withdrawn on 1 April, but the hospital became part of the Scarborough, Ryedale and Whitby primary care trust. A number of community hospitals in other parts of the country experienced a similar change. That development is working well in general. It enables the community hospital to concentrate on diagnostic issues and makes the best use of the facility, so freeing up time that can be spent on more serious matters at district hospitals.
The Minister must expect the chief executive of the PCT, the trust members and doctors to have their own agenda for the future. It was certainly not in their plans that GA operations would be withdrawn on the very day that they took over responsibility for the hospital. Even given the background of the clinical governance issue, they must have expected three to five years in which to plan a withdrawal or contraction of GA operations at Malton.
The PCT, the doctors and patients are worried that no alternative was agreed in advance. Some 640 patients were treated under general anaesthetic at Malton hospital in the past year. In my 15 years in the House I have worked well with the managers at the Scarborough hospital trust and have a great deal of time for them. Although they will do their best, a strain will nevertheless be placed on alternative facilities. People will have to travel long distances for relatively minor operations that cannot be performed under local anaesthetic, which is the case with many procedures.
Some of the operations are not urgent; they concern what the medical profession calls "lumps and bumps", such as minor problems with varicose veins. However, many gynaecological operations are carried out and, on a more difficult point, a number of women have terminations under general anaesthetic at Malton hospital. Clearly, they cannot wait for treatment but have to be seen and dealt with promptly, whatever the rights and wrongs of the situation.
There is, therefore, concern that Scarborough hospital and the trust can cope with the situation. It is accepted that there is a lack of anaesthetist cover, but up to now the telephone back-up cover has worked extremely well. I am told that it is unlikely to continue because of the shortage of consultant anaesthetists, but I stress to the Minister that while the back-up cover clearly is important, it is the GPs, as clinical assistants, who are doing the work. I understand that it is proposed that one of the doctors who provides the anaesthetic service should also do sessions at Scarborough to ensure that he is thoroughly up to date with all the clinical procedures and can work well with the consultant anaesthetists based there.
I seek clarification on another issue. Although consultant anaesthetists do not come to Malton for GA-based operations that are done routinely in the mid-week, half-day sessions, they have been coming to Malton on Sundays for the waiting list initiative. It will stick in people's throats if they discover that routine operations have been withdrawn, but consultants are coming to the hospital for GA sessions on a Sunday and opening theatres that are normally closed simply to do operations under the waiting list initiative. I am sure that the Minister will understand my concern about that.
I mentioned that the primary care trust has its own plans. It is important that we have public consultation about a strategic plan for Malton hospital for the next five years. If there is to be a controlled withdrawal of some of the services at peripheral sites that we have been used to, in tandem with the restructuring of service provision, the public must go along with the plans. For example, as I said, there may be more diagnostic services at Malton, and some surgery may be restricted as the day surgery unit at Scarborough hospital is built up. The public must be reassured that they will receive treatment in a timely fashion and that all the changes are intended to improve not only financial efficiency but the quality and standard of treatment. People understand what is happening, but they must be taken along with the process.
As I have indicated, people will find it difficult to understand why it is not good enough to do GA-based operations at one peripheral unit at Malton, but those operations may continue at Whitby and Bridlington. I find it deeply unsatisfactory that individual clinicians are making what are effectively strategic decisions that have profound and wide-ranging implications for patient care.
So far as the PCT is concerned, I would like to think that as the health service develops, we could have more flexibility within service provision and about who is responsible for employing whom. Someone stopped me in the street at the weekend, knowing that I had secured this debate, and said, "I gather that the primary care trust now runs the hospital. Why can't it employ its own anaesthetists?" That is a very good question. It highlights the fact that NHS structures are too rigid, and we need to bring down some of the barriers. I sincerely believe that community hospitals have an exciting future, but flexible thinking and attitudes are necessary if they are to realise their full potential.
I draw the Minister's attention to another aspect of Malton hospital's future. The two main wards are what are known, in the medical world, as Nightingale wards. I understand that when the Nightingale ward modernisation programme, if that is the correct title, was first mooted, the impression was givenalthough I cannot say whether this is accuratethat the wards would be modernised. Sadly, however, that has not yet occurred. I believe that the first application was not successful, but the Scarborough trust is trying again. The sum involved is £1.3 million. It would significantly reassure the people of the Malton area if the Minister announced today when she thinks that money will be provided.
From the title of the debate as on the Order Paper, "The Future of Malton Hospital", someone who did not understand the issues might have thought that the hospital was to close, but that is not on the agenda. We have been over that matter in the past few years, and we persuaded Ministers in the previous Conservative Government, in particular my right hon. and noble Friend Lord Freeman, that community hospitals had a vibrant future. However, it is harder to convince the public of that when decisions are made out of expediency because of shortages of clinical staff. I believe that Malton hospital can have a great future, but that can be achieved only if managers and clinicians in the Scarborough trust and the primary care trust work together.