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Nick
Herbert MP's response to the consultation
FORMAL RESPONSE TO 'FIT FOR THE FUTURE' CONSULTATION
I have seen
the formal responses from the Support PRH and KWASH campaigns, and from
Andrew Tyrie MP in support of St Richard's Hospital, and I fully endorse
them. There is no need for me to repeat the detailed arguments in these
submissions, and I have made my points clear at successive public and
private meetings with the PCT. However, as the only MP whose constituents
use all three of the hospitals affected by the proposals, I wish to
emphasise some general points.
1. Over the
course of more than two years the justification for the hospital
reconfigurations has shifted markedly. It was originally and
unambiguously driven by financial considerations: the need to save money
to correct what was described as an underlying deficit of £100 million.
Since the publication of the formal proposals, with associated figures
showing the local health economy in surplus in five years' time on the
existing configuration, the financial case has evaporated. It has
been further compromised by the absence of figures for the additional
investment in the ambulance service which the PCT has conceded will be
necessary to deal with increased travel times. It seems that the proposed
reconfiguration developed a momentum of its own even when the original
driver for change disappeared.
2. The
clinical case for change has at the very least not been proven. The
evidence base for it is partial and arguable. Local hospital clinicians
are divided and GPs have generally been opposed to the plans.
The proposed model of hospital configuration is essentially an urban one.
There are real doubts as to whether it can sensibly be imported to a rural
area where the catchment population is disparate and travel distances are
longer. The PCT has failed to explain why its proposed model is right
when it has conspicuously not been followed in East Sussex, a smaller
county in area and population, and has been abandoned in Surrey.
3. The
failure to include access in the PCT's hurdle criteria is a fundamental
flaw in the proposals, sufficient on its own to render them unviable.
No-one is opposed to the idea of more NHS services being
available locally, in the home and in GP's surgeries, or of major trauma
cases being treated in specialist units. But the fact remains that under
the PCT's proposals two out of the three hospitals affected would lose
their ability to deal with a significant proportion - around a fifth - of
A&E cases. The PCT has conceded that treatment for the most serious A&E
cases would be moved further away for 59 per cent of the population, while
average journey times for the over 65s to
receive treatment for major A&E cases would, under all of the PCT's
options, increase by 50 per cent. The inaccessibility of the Royal Sussex
County Hospital and regular severe congestion on roads such as the A27
are factors outside the PCT's control, yet insufficient account has been
taken of them. Setting aside the issue of convenience for patients,
unless and until key transport infrastructure is upgraded, the PCT's
proposals are unrealistic and unsafe.
4. The
proposals also fail to take into account the expected growth in the West
Sussex population. With at least 58,000 new homes proposed over the next
two decades, the NHS should be planning for expansion of facilities and
greater localisation, not the centralisation and withdrawal of key
services. All three options proposed by the PCT would see the downgrading
of the PRH, denuding the north of the county entirely of major A&E
provision, yet this is the area where most of the development will be
cited and in closest proximity to Gatwick Airport.
5. The PCT
has wholly failed to win public support for its proposals. It would be a
grave mistake to dismiss this as a failure of public relations. The PCT
has unwisely taken an offensive stance in response to public opinion,
dismissing key concerns as "unfounded myths", even declaring that it would
"wage a war" against them. In fact the public has correctly identified
the major flaws in the options offered. I have received thousands of
e-mails, letters and messages from constituents expressing opposition to
the proposals. Literally not one constituent has set out their support
for the plans. There is no other issue on which I have received such a
quantity of correspondence from constituents and where views have been
unanimous. The level and strength of opposition expressed at public
meetings and through extraordinary marches and petitions should speak for
itself. I do not see how the PCT can credibly ignore such opposition. It
must ask itself to whom it is accountable.
6. From the
beginning, this consultation has been poorly conducted. Original
proposals were considered for months in secret by the SHA which failed to
reveal them to stakeholders, even for instance when meeting MPs in
Westminster to brief them about the issues. The original pre-consultation
document published by the SHA was deliberately vague and failed to spell
out what it really meant in relation to West Sussex' acute
hospitals. Public feedback on these proposals was simply ignored. The
timetable for consultation continually slipped. When the formal
consultation document was finally published, the status quo was absent
from one of the options because the PCT's had constructed hurdle
criteria which rejected it. The consultation document was not properly
distributed to households, and only one formal PCT meeting was organised
in my constituency. The consultation period had to be extended. The
document itself proposes loaded questions. Late in the day, a new model
emerged, with mixed and confusing signals coming from the PCT about its
status, and no possibility for the public to support it as part of the
formal consultation.
7. I welcome
the belated consideration by the PCT of a new option which would see the
retention of A&E services at St Richard's and WASH, provided that this
means consultant led services and intensive therapy units, able to deal
with the full range of cases as now. It would be bitterly disappointing
for the public if this new option founders or proves to be less than it
has been suggested. I urge the PCT to clarify as soon as possible what
level of A&E services will be retained. I also urge them to reconsider
their determination to see maternity services centralised.
8. For two
years a shadow has been cast over the three hospitals, with adverse
consequences for staff morale and recruitment. With the emergence of the
new option, and the stated aim of the Brighton & Sussex University
Hospitals Trust to reprieve the PRH's A&E and planned surgery services,
there is no need for this to continue, and it should not do so. The
PCT has comprehensively lost the argument. All three of its
original options are flawed. They must now be formally abandoned without
further delay.
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