SAVE OUR HOSPITALS: Worthing MP Peter Bottomley fights his corner

Dear Peter,

Thank you for your recent emails.

I had hoped that my letter of 23 Aug would draw a line under some of the issues you have repeatedly raised.

I hope the following captures the main points you have raised and again that these answers will enable us to move the debate on.

I would like to begin by correcting statements you made in your email to me of 28 August.

John Wilderspin, as with all PCT Chief Executives nationally, was appointed following an extensive national process which included external assessment.

As you know, he inherited the Creating an NHS fit for the Future review from the transitional lead chief executive (Steve Phoenix) and has offered excellent leadership to the West Sussex NHS since his appointment.

The SHA and PCT have worked hard to make all this as open a process as possible and therefore I am particularly disappointed by your suggestion that I may have attempted to exert undue influence on him.

I should add that John is primarily responsible to his chair and Board.

As we have stated on many occasions both in private to you and publicly, the role of the SHA was to quality assure the process by which the PCT developed the options for the West Sussex consultation and to form a view on the appropriateness of the options developed by Primary Care Trusts.

In doing so the SHA Board considered three questions encapsulated by the objectives that we agreed with the PCT:

the proposals should improve clinical quality, safety and sustainability;

they should be affordable now and financially sustainable; and

access to health care for the population of West Sussex and Brighton & Hove should be maintained or improved

A full account of the SHA Board's role and how it exercised this duty can be found in the papers and minutes for the meeting of 25 June which are published on our website http://www.southeastcoast.nhs.uk/board/papers/Boardmeetingpapers31July2007.asp

You have questioned how recent the 300,000 population recommendation is.

You may be aware that the Royal Colleges have offered advice on catchment populations since the 1960s.

The PCT used several sources including advice from March 2006 when the Royal College of Surgeons stated:

"The preferred catchment population size, as recommended in previous reports, for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency medical and surgical care would be 450,000'“500,000'¦

"There needs to be, in the first instance, strategically planned re-organisation so that, where feasible, smaller hospitals are able to merge to achieve a catchment population of at least 300,000.(1]

Over the years advice on preferred catchment populations has risen and we expect this trend to continue as evidence linking lower patient mortality to higher volumes becomes clearer for some conditions and patients' needs.

The questions you asked about the calculation of the catchment populations are dealt with comprehensively by a paper on the PCT web-site: http://www.southeastcoastfff.nhs.uk/getdoc/f13692ca-ba1f-4b85-8b15-22d8cedd7036/Catchment-Populations-for-Acute-Trusts.aspx

Regarding the Nicholl paper you forwarded and the relationship between travel time and mortality, previously we have stated that we have not found any peer reviewed papers which establish a general link between these factors.

Interestingly the Nicholl paper itself states "Only a few studies have examined hospital accessibility and outcomes in the UK.

"Studies of road traffic crashes in Norfolk, all serious trauma in Scotland, and ruptured abdominal aortic aneurysms in West Sussex all failed to find any relationship between time to hospital and mortality."

Nicholl's paper claims to demonstrate a link between distance and mortality for patients and "did show a sharp increase in mortality in patients with respiratory problems".

We and the Primary Care Trust take this seriously and have no wish to simply rely on the limitations that the authors of the paper themselves describe.

We are committed to ensuring best outcomes for the overall population, and how any potential risks can be mitigated.

As I confirmed previously, the West Sussex Clinical Reference Advisory Group will be examining the implications of Nicholl further and have openly welcomed this evidence into their evidence gathering analysis.

HOSC referral of West Sussex PCT consultation

You have received a letter from the Secretary of State which I believe sets out the position comprehensively and I have seen your response.

Again, I would refute your assertion that the NHS is not listening to local clinicians and the public.

As you have witnessed, we have delivered the longest pre-consultative deliberative and engagement process the West Sussex NHS has ever undertaken.

The comments and feedback (which have been published) helped the PCT to form its options.

An extended public consultation is now being conducted by the PCT.

You have also asked about opportunities to discuss these matters with the Secretary of State.

If asked by the Minister's office we would support such a meeting but for the best chance of securing the meeting I would advise you to approach the minister who is responsible for the south east area, Dawn Primarolo.

Involvement of Sir Graeme Catto.

I understand Sir Graeme will be asked to review previously rejected options including the previous option 3 to which you refer and the 'no change' option.

The PCT are currently agreeing Terms of Reference with Sir Graeme and I am sure they will make these available in due course.

I understand the PCT will be asking Sir Graeme whether he will also be able to make opportunities to meet local MPs and other stakeholders.

In my previous correspondence I acknowledged that there was a range of clinical opinion locally including those who oppose the proposals, have mixed views and those who support.

I would however suggest, again, that you review the Clinical Reference Advisory Group papers posted on the PCT's web-site which clarifies which clinicians were part of the engagement process and how their views have been represented: http://www.southeastcoastfff.nhs.uk/Home/West-Sussex/Documents.aspx.

Media in hospitals.

I'm not quite sure what you are driving at with your email of 13th September about media in hospitals.

The SHA has not employed the services of a public affairs agency in any regard and I am not aware of any formal written guidance that has been issued to SHAs from DH or to hospital trusts from SHAs, other than during national or local election periods.

We expect hospital and other health facility management to use common sense when considering requests from the media for filming.

We do not wish to see patients or staff inconvenienced or distracted and any informal guidance is designed to protect their privacy and dignity.

You may recall that when the Secretary of State visited Brighton in July last year, filming took place on the Brighton seafront, outside the hospital setting.

Decisions about media and filming are of course a matter for the hospital/facility management themselves, although I hope you will agree that it is not in the interest of patients to have a media circus wandering the wards.

Discussions with staff

The PCTs and trusts have been working together on the Creating an NHS Fit for the Future review and subsequent formal consultation processes for some time.

Throughout this process they have all been acting in accordance with the NHS code of conduct of accountability, and section 11 and 7 of the Health and Social Care act 2001, to be open with the public, patients and staff.

There have been regular planning meetings at board level and operational level to ensure that patients, the public and staff have every opportunity to participate in the review and the subsequent consultation process.

There are regular staff briefing sessions and ongoing means of involvement through the NHS intranet, newsletters, the summary leaflet, consultation document, website, roadshows, co-design meetings, workshops and clinical reference groups.

It is an important part of the overall communication and engagement strategy for each health community, and one on which each NHS trust and PCT is collaborating.

Ministerial visits and deliberative events

I believe you spoke with one of my team about the visit from Lord Darzi and David Nicholson on 11th September and about the deliberative event on 18th September. However, I thought it might be helpful to say something about these in the interest of clarity.

The venues for the visit by Lord Darzi and David Nicholson were decided on the basis of options submitted by PCTs. East Kent (which has seen considerable change in recent years) and East Sussex (where public consultation on maternity services has recently finished) were chosen because they offered excellent sites to visit and, in terms of logistics, enabled the most geographical coverage during the day.

You may be interested to know that Ara and David were enthused following their day in the South East Coast area.

As you know, there are many superb examples of excellent practice here although much still to do to achieve our ambition for the best health and health care.

The deliberative event in Maidstone on the 18th September is being organised by Opinion Leader Research on behalf of the DH and they have been responsible for identifying the groups of stakeholders who should attend.

I am writing today to all MPs in the South East Coast area about this event.

I hope this is helpful. I am copying this letter to John Wilderspin and the Secretary of State.

Candy Morris

Chief Executive

South East Coast Strategic Health Authority

Thank you.

1. I do not recall knowing you were reshuffling PCT chief executives.

2. Quality assurance: here is an extract from maternity CRAG:

'What are the implications for maternity services if West Sussex had a single major general hospital with a supporting non MGH unit(s).

What would need to be in place to make the services clinically safe and sustainable?

Additional advice is also provided on the drivers for change in maternity services and the safety and effectiveness of mid-wife led units.'

That does not look to me as through the clinicians were allowed to put forward the safety, deliverability let alone the affordability of keeping consultant led maternity and emergency services in two south coast hospitals in West Sussex.

3. The only doctor I know who supports the limiting of options by the PCT is Dr Andrew Foulkes who was a member of a CRAG group that explicitly opposed the limited nature of their role.

4. The way the PCT consultation questions start and carry on would never have passed me or any group on which I served as "quality assured".

5. Without becoming personal, how can the PCT chief executive's role be described as excellent leadership if the holder of that office constantly talked of clinical support for the three options when the asked-for list of supporting local clinicians is not given?

6. On travel times and mortality, I should expect a list of conditions for which there is an obvious link.

I gave one in Parliament.

I expect another to be given by a mother on 15 October.

Are you serious in saying the NHS at SHA level has not got much of an idea?

7. When were the CRAG papers posted on the PCT website?

Have they had to be disclosed under Freedom of Information rules?

I received them this morning by another route and have them printed out.

Can I assume the PCT and SHA had not, when the Consultation has its curious launch, thought of making them available then to MPs, local campaigners and local elected councils?

I know the anguish facing many of the CRAG members; some agreed to their names being subscribed to reports on the basis that they were an accurate record of discussion, not that they agreed with the limitations or conclusions.

This is not intended to be a comprehensive response.

To illustrate what is at stake, please look at the relative safety of maternity at Worthing and ask yourself what quality assurance can have passed the two out of three options to discard, to downgrade consultant led maternity at Worthing, the largest town in Sussex, brilliantly served by our clinicians.

I assure you of my willingness to help improve services; be assured there will be complete opposition to proposed changes that make services worse and to processes that are unfair or inadequate or which have the effect of including bias.

To avoid suggestions of selectivity, I copy your complete letter to others.

Peter Bottomley MP