Steve Brine writes calmy and responsibly about Winchester's Royal Hampshire County Hospital, the new Foundation Trust and its proposed Critical Treatment Centre as well its impact on services locally ...
Since my election in May 2010 (and even before that as a candidate) I have made the local NHS my number one priority and I have bent over backwards to keep local services away from party politics because I believe these ideas should be discussed calmly, responsibly and above all, be led by clinical evidence.
Over many years, I have remained extremely close to NHS issues in the constituency and tried at every stage to understand the issues in their fullest possible context while listening to the clinicians as well as my constituents.
My party spent years in opposition saying we should let the clinicians - not the politicians - run the NHS and I think it's important we live up to that in Government.
I have no idea whether those reading this have a clinical background so forgive me if my medical vocabulary is not quite up to scratch as I try to explain how we arrived at today's position and why no decisions have yet been taken.
Organisation and legislation:
When I became the MP here in 2010 it was increasingly obvious the old Winchester & Eastleigh Healthcare NHS Trust (WEHCT) was not viable. It had huge debts and, put simply, didn't have enough of a population base to be financially viable.
The coalition's Health & Social Care Act 2011 (which I scrutinised in huge detail over some 14-weeks as a member of the standing committee alongside Liberal Democrat coalition colleagues) required all Trusts to get to Foundation Status and for WEHCT that was a lifeline.
Because it wasn't big enough to move to FT on its own (a viable FT needs to serve a population of circa 500,000) it had to seek a partner Trust. After much discussion that was concluded to be Basingstoke and North Hampshire Foundation Trust which was already a successful FT in its own right.
And so in 2012 they merged to form Hampshire Hospitals Foundation Trust (HHFT) operating two similar sized District General Hospitals (our own RHCH in Winchester and North Hampshire Hospital in Basingstoke) and the Andover War Memorial Hospital.
I most certainly supported the new organisation but as I said at the time that would likely "provide us with opportunity and require compromise."
It was very clear to me that there was just no way the new clinical model could let the new Trust do exactly the same things its predecessor had done or it would get the same result and eventually drag the successful FT to where the failing NHS Trust was before the merger.
New clinical model:
In the time since merger, the senior consultants have been constructing a new clinical model to work across the Trust. Its aim, and I sat with the Secretary of State in Winchester (pictured right) to discuss this at the outset alongside the Trust and its commissioners, was to design services which were (in this order) safe, sustainable and affordable over the long-term.
As long as I can remember, people have said Winchester Hospital is going to close, that the NHS is going to somehow desert us altogether and I believe passionately we have to move on from that if we're to move forward.
I think we have to build something here that is going to last and insulate itself from the inevitable ups and downs a modern acute Trust will experience in any political or financial cycle.
I also think, and have said publicly many times (as has the Chief Executive), that we have to stop worshipping the NHS - locally or nationally - as some faultless organisation that can do no wrong.
Yes, when you are acutely unwell the NHS is the best in the world but that doesn't extend across everything it does sadly. Nationally there is huge wastage in the organisation (read any Public Accounts Committee report of the last 20 years), we have cancer outcomes which are simply not good enough and we have scandals such as Mid Staffs which the last Government buried its head over and this Government has had to face head on.
Locally, we have a run-down estate which still for-instance, requires transfers across a car park between Florence Portal House (FPH) and the main wing. We have the largest building on the site - the iconic Butterfield wing - largely empty because it isn't fit for clinical use. We also have an A&E 'front door' which is just awful and falls well below the standards anyone expects of the modern NHS.
But we have made huge strides in recent years; the new frontage is a revelation (in every sense), we have the Burrell Wing now housing Outpatients (allowing us to close that ramshackle building which until last year housed clinical practice) and the Day Treatment Centre. We also have world-class scanning facilities which I personally opened in 2014.
We have Women's Services centred on FPH and one of the world's best breast surgeons, Dick Rainsbury, running the revered breast unit. This is a subject very close to my heart and you can visit www.stevebrine.com/breastcancer if you want to know more about that.
We also have a smashing children's ward, with Sophie's Place as the fantastic first assessment unit for kids and their parents entering hospital for the first time.
Why am I telling you all this? Because I think it's important to understand I am not just churning out leaflets with easy headlines.
I am trying to understand the health economy across our entire area and seeing how that fits together in the context of the newly fashioned NHS for the long-term benefit of the people I represent.
Anyway, when HHFT brought forward their ideas for a new clinical model working across the three sites, I spent a great amount of time understanding it and discussing it with the doctors and consultants involved. That was not just the Trust management but, discipline by discipline - consultant team by consultant team - with the people involved on the frontline because I wanted to hear their clinical arguments for change. I also wanted to hear why, in their opinion, the status quo was not an option.
As you know, the centrepiece of the ideas being put forward included the creation of a new Critical Treatment Centre (to care for the sickest 15% of patients) with the kind of 24/7 consultant care not available anywhere in the Trust today (including in maternity care) and a new Cancer Treatment Centre. For the record, that's the 'opportunity' part I spoke about when the Trust was formed.
Of course, and this is the 'compromise' part, it would remove certain acute services from both the RHCH and the North Hampshire. Andover doesn't have any acute services to remove.
That means if you have a stroke anywhere in the Trust area you will be taken by ambulance to the new hospital (not the RHCH which currently houses the hyper acute stroke unit) to receive the urgent assessment and care needed to ensure your outcome and ultimate chance of recovery is greatly increased.
That means if you have a cardiac arrest you will be taken, by ambulance, to the new hospital (not Basingstoke which currently houses the cardiac ICU) to receive your initial acute care/stent and then be transferred when well enough to Clarke Ward in Winchester for your inpatient recovery phase.
And that means, a 24/7 consultant covered co-located maternity and obstetrics service at the new facility with midwife-led units in Winchester, Basingstoke and Andover. To be clear, and I am disappointed this has not been acknowledged anywhere else, we do NOT currently have anywhere near 24/7 consultant care at RHCH.
I discussed these early ideas at great length with the Trust as you'd expect, with NHS England but also with the Secretary of State and successive Health Ministers to be clear where this local model fits (or not) within the national policy context. I also wanted to see where, if anywhere, this model is currently a reality. The answer is Northumberland and I will come onto that.
I have discussed it with GPs across the area because, as the new local commissioners, they have to agree to any reconfiguration before it's even put forward formally. They are not there yet is the truth.
Finally, I have discussed them with charities and support organisations such as the NCT, the Maternity Services Liaison Committee and countless young parents at nurseries or children's centres I have visited or just as I go about my everyday life. Given my age and stage that was not difficult as you will appreciate.
Survey and public meetings:
Early in 2014, I produced a major health survey to raise the profile of these plans (I didn't think they were anything like well-known enough) and to hear what my constituents had to say on this and a wide range of health matters.
It was the biggest survey exercise I've ever done and produced a massive response; I hope in-part because the people I represent know of my consistent work on the NHS locally and genuine understanding of it.
Clearly it's complex with a great deal of qualitative data being returned but, suffice to say the response from constituents in respect of the reconfiguration of local health services, and a new Critical Treatment Centre as proposed, was not to dismiss it out of hand but wanting to know much more. That was especially true in respect of maternity care which I asked about directly in the survey.
I reported all of this back to the Trust in the Summer of 2014 as I undertook to do on the survey's covering letter.
The second part of that survey and profile raising exercise of the Trust's plans was a public meeting, held in March, as part of my ASK the ... series. I organised and chaired the meeting.
It was held in the United Church, Jewry Street on 27 March 2014 and considered the global picture of local tertiary care, including why the Trust here ever considered the idea of building a new hospital.
The panel couldn't have been more senior; we had Mary Edwards (Chief Executive of HHFT), Chief Medical Officer Dr Andrew Bishop, Caroline Brunt (Associate Director of Midwifery and Women's Health), Claire Iffland (Clinical Director for Women's Health) and Dr Nigel Sylvester from the West Hampshire Clinical Commissioning Group.
And then, in September of 2014, I organised and chaired a second open meeting. This one was held on a Saturday morning (to maximise the chances of young parents and working families being able to attend) and was exclusively focused on obstetric care and maternity services.
This event took place on Saturday 20th September 2014, again at the United Church, and featured a panel including HHFT Chief Executive Mary Edwards, consultant paediatrician Simon Struthers, Head of obstetrics across the entire Trust, Michael Heard and Caroline Brunt, Head of Midwifery.
Again, you can catch-up here.
As I said at both these meetings, and it has been reported widely since in the press, I was not in a position to give my support to the new hospital because we had not been told at that time exactly where it was proposed to be located. What I did say at the March (and September) meeting, and it was reported in the local press at the time, is that I could not support the centralisation of acute services on the Basingstoke site. My view hasn't changed.
Late in 2014, the Trust revealed their preferred site (directly adjacent to the M3 at J7) and are seeking outline planning permission. I can support this site and, as I've said widely since, I continue to support the concept of such a facility.
No MP in their right mind would close his mind to a proposed £160m investment in brand new world-class NHS facilities for his constituents. Whether any of us support the project at a final clinical consultation is dependent on the case the Trust make and the service mix between new/existing hospitals as well as things such as travel to and from the site.
Earlier I mentioned Northumberland (pictured left) which is where HHFT took much of the inspiration from for their Critical Treatment Centre.
You can read all about it here - www.specialistemergencycarehospital.co.uk
I have personally spoken to many of the MPs locally (Labour, Conservative and Lib Dem) and they are very supportive as you'd expect; not to mention more than a little proud to be leading the way with their new hospital which will open this Summer.
From all I have read, it's seems to me this concept is very much the future of the NHS. It's not been dreamt up overnight either; the whole approach is as set out by Sir Bruce Keogh (NHS Medical Director) in his landmark Urgent and Emergency Care Review.
The review, which you can find online, called for larger Major Emergency Centres with the right facilities and expertise in order to maximise chances of survival and a good recovery.
The work of Sir Bruce has been based on a wealth of clinical evidence also. In June 2013 the NHS Confederation, National Voices and the Academy of Medical Royal Colleges report "Changing Care, Improving Quality" identified the key principles for most reconfiguration plans.
And a succession of royal college reports - including from the highly respected Royal College of Obstetrics and Gynaecology - have highlighted strong consensus and compelling evidence for the need to concentrate various specialist services into fewer centres with trained clinicians on duty 24 hours a day and 7 days a week.
You can download the October 2014 NICE guidance on Intrapartum care 'care of healthy women and their babies during childbirth' as supported by Royal College of midwifery and obsterics.
The concept of midwife led births is of course hardly a novel one within the NHS. Birthing centres such as Andover or The Grange in Petersfield are well used and much loved. Indeed I recall a huge campaign to 'save' both when their future was uncertain a few years ago.
What the Government wants to see, and I don't know anyone who wouldn't agree with this, is real choice for expectant parents.
That means making a practical reality of choosing a home birth, delivery in a midwife led unit, a co-located unit or via a consultant-led (ie; a medical) delivery.
If we are ruling out deliveries in a midwife led unit in this country (which we are most certainly not) presumably we would not even allow low risk home births either?
I well remember when we had our two children at the RHCH in recent years, sitting down with the ante-natal team to discuss our options and to assess risk. It would not be appropriate, or fair on my wife, to expand on this but suffice to say we made an informed decision based on what was available and above all, the medical advice.
My family has actually had children at the RHCH in recent years and that experience allows me to combine personal experience with the clinical evidence.
HHFT are pressing ahead with developing its plans for the new hospital and are seeking planning for the identified site near junction 7 of the M3.
But, and this is critical, NHS England and the GP commissioners locally have not signed off on this yet and won't until Summer 2015 at the earliest so we are some way still from any formal consultation.
For my part, I think the concept of larger Major Emergency Centres as envisaged by Sir Bruce Keogh in his Urgent and Emergency Care Review is the future and believe we will see more follow the Northumberland example.
Whether that is in our area remains to be seen but the stark fact I try to keep in mind is the point made to me by so many clinicians locally, namely that the status quo is not an option without serious consequences of its own for safety, sustainability and affordability.
I am trying to approach this issue responsibility and from a credible evidence base. I think that's what my constituents expect of an experienced Member of Parliament.
I want us to understand the health economy across our area and to see how that fits together in the context of the NHS for the long-term benefit of those constituents.
I am of course interested in the concept of a multi-million pound investment in local NHS services and world-class services for those I represent. The new critical treatment hospital model makes sense, especially for stroke, cardiac, ICU care, but I write it no blank cheques. Like many of us, I have anxieties about the possible change in maternity services, not least because of my own personal experience of the care provided at Florence Portal House.
My challenge to the Trust is to go on making their clinical case for change and to explain to us why they believe status quo offers a diminishing return and why what they offer in its place is better. For as long as I am in this job I will go on doing everything in my power to inform my constituents of that case.