Should A&E services remain local or will reorganisation plans save lives?

Growing concerns about the fate of A&E departments go to the heart of the debate on the future of the NHS and whether services should be centralised. In Parliament, Halifax MP Linda Riordan argued passionately in favour of the status quo while Jane Ellison, a Health Minister, insisted change was inevitable.

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FOR - LINDA RIORDAN

IN 2001, Halifax’s General and Royal Infirmaries merged with Northowram Hospital to become Calderdale Royal. Over the last decade, it has served the area extremely well. It has excellent, dedicated and well-qualified staff who provide a first-class service.

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It serves many diverse communities in Halifax and Calderdale, and its reach extends to the Lancashire border and to communities bordering Bradford. Therefore, a wide geographical area needs, and relies on, Calderdale Royal, and in particular its A&E department.

In recent months, as speculation has risen that the axe could fall on the town’s A&E, so has the sense of public outrage that such a short-sighted, unnecessary and unwanted decision is even under consideration. I know the Minister will say that nothing has yet been proposed, but nothing has been denied either.

All I have been told is that a strategic document is available on the future of local services. Frankly, my constituents do not need to read jargon-filled paragraphs about clinical decisions. They know when something is right or wrong, and they know that what matters in Halifax is the continuation of our good local health service, with an accident and emergency department free at the point of need. They do not want that service to be in Huddersfield, Dewsbury or Bradford. They want it where it is, in Halifax, serving the communities that I represent and those of Calderdale.

Let me be clear: the Government could and should have an important role to play in this decision. The buck should not be passed to local clinicians so that the Government can wash their hands of the matter.

The Government set the policies, and they must also take responsibility for any decisions that will affect the A&E in Calderdale. Also, there should be no hiding behind a public consultation. The question is quite simple: do the Government support the retention of the A&E department in Calderdale? If they do, there is no need for any consultation. If they do not, they should come clean and set out their position. This lack of clarity is causing a lot of worry, anguish and anger.

Last week, I organised a round-table meeting with interested parties at local level to discuss a way forward. The town is united in the need to ensure that Calderdale’s A&E stays put.

Let us imagine what would happen if the department were cut back or closed. I presume that the services would transfer to Huddersfield. For many of my constituents that would mean at best a 20-minute journey, but probably journeys of 25, 30, 35 or even 40 minutes along busy roads, past a motorway interchange, and into Huddersfield.

At the risk of using emotive language, such a move really could be a matter of life and death. Do health bosses think that people would stop using the other A&Es if they closed the one in Calderdale? I do not think they would. I also want to place on the record that this is not about Halifax versus Huddersfield; it is not about pitting one A&E against the other. This is about ensuring that people across West Yorkshire have access to good quality health care that is rooted in their local communities.

Since 2010, the Government has been systematically dismantling alternatives to A&E: a quarter of walk-in centres have been closed since the election; NHS Direct has been scrapped; the guarantee of a GP appointment within 48 hours has been scrapped; and fewer and fewer GP practices are open at evenings and weekends.

People in Halifax and Calderdale will have fewer alternatives, not more, if the A&E closes. If patients are waiting more than four hours for treatment, is the answer to close A&Es? I do not think it is.

This crisis is not due to a 
lack of education or people 
going to A&E with minor problems; it is more to do with cuts to social care budgets, meaning that more older people are ending up in hospital 
because there is no one else to take care of them.

If the Government’s answer to an A&E crisis is to close A&E departments, we really are in trouble in Halifax. Cutting back on services does not solve the problem; it just transfers it elsewhere.

The reaction of the public in my constituency has been an overwhelming “Hands off our A&E department”.

Anything else would be a tragic mistake of short-term thinking, and a failure to provide my constituents with a local hospital and a National Health Service fit for the 21st century.

AGAINST - JANE ELLISON

THE reconfiguration of health services is an important issue for all of us, and the future of A&E departments is particularly topical.

I understand that people have anxieties about change and, in particular, about change in the NHS, because it is such a greatly loved and respected institution, but it is vital that we do not play on those anxieties, especially for purely political purposes.

This Government is clear that the design of front-line health services, including A&E, is a matter for the local NHS. That is for good reason, because those local leaders, working closely with local democratic representatives, local government and the public they serve, can come to better conclusions about the services for their area than a Minister sitting in Whitehall trying to decide policy for the whole country.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible. That means planning ahead and looking at sustainability as well as safety. No party can escape the challenge of providing sustainable services, and I do not think that challenge is any different for the Labour front-bench team from how it is for the Government. The Labour Party made these points often when it was in government.

Reconfiguration is about modernising delivery of care and ensuring that we have the facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

If we look at an area in London, as I represent a London seat, we will see that exactly the same arguments were made against centralising stroke care, which was centralised in eight hyper-acute stroke units. They are now providing 24/7 acute stroke care.

Stroke mortality is now 20 per cent lower in London than the rest of the UK, and survivors are experiencing a better quality of life.

We must allow the local NHS continually to challenge the status quo. I do not accept the argument, which, as I understand it, is that nothing should ever change.

All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents.

The principles are enshrined in the four reconfiguration tests. They are support from GP commissioners; strengthened public and patient engagements; clarity on the clinical evidence base and support for patient choice.

A&E is obviously very topical at the moment. The NHS is seeing increasing pressure, but is generally coping well. We are meeting our four-hour A&E standard at the moment. It is the 32nd consecutive week the standard has been met. We are determined to do everything we can for the NHS to continue providing high-quality care.

We have allocated £2.3m for Calderdale and Huddersfield for winter pressures. That does not allow us to escape the fact that there are longer-term challenges. One million more patients have gone to A&E in the past three years, and there are the pressures of an ageing population. We have to address those long-term challenges, and the Government is trying to focus on some of the underlying causes, whether by having named GPs for the over-75s or changes to GP contracts; or, in public health, helping people to manage long-term conditions and to live well for longer; or the £3.8bn allocated to help to integrate health and social care, because we recognise how vital that process is.

With regard to Calderdale, the configuration of local health services is a matter for the local NHS, for the very good reasons I have given. Locally, I understand that the review is considering health and social care services with the point about ensuring that patients continue to receive high-quality and sustainable services at its heart. The work includes considering how best emergency care services and other acute services can be delivered.

No decisions have been made at the moment, and of course any plans for major service change would be subject to formal public consultation. Public consultation has to be real and robust. Commissioners know that, and at all stages of the process I would expect MPs to be involved, as well as local government. At this stage, the commissioners have not brought forward plans for consultation, but they will need to be assured that any proposals they make for reconfiguration and change will meet the strengthened tests I mentioned earlier.

At the heart of all this is the need to serve local people better.