Dear Peter,

Joint Health Overview and Scrutiny Committee’s

Meeting on the 23rd July 2008

West Sussex Primary Care Trust Fit for the Future proposals

As you know, we are the Members of Parliament who represent constituencies served by the Princess Royal Hospital (PRH) in Haywards Heath, which acute hospital has been (and continues to be) the subject of West Sussex PCT’s review proposals.

We are aware of the painstaking work which you and your Joint Committee have undertaken in recent months, and the culmination of that work in the formal response the Joint Committee made to the PCT after the Committee’s meeting on the 25th June. That response was considered by the PCT Board on the 10th July. The Joint Committee raised with the PCT a number of concerns relating to the delivery of maternity and paediatric services in West Sussex and, more particularly, the proposed loss of consultant-led maternity units (CLUs) at the acute hospitals which were not to be designated a major general hospital.

In the context of the Princess Royal Hospital, your committee expressed the view (rightly in our opinion) that the PCT had failed to demonstrate that closure of the existing and successful CLU within that district general hospital (DGH) – and the substitution of, as yet, unknown alternative maternity facilities – would meet the needs of the population in central and northern parts of the county. You cited five specific grounds:

• the potential changes to maternity services in East Sussex (flowing from the proposed closure of the CLU at Eastbourne’s DGH)

• the potential population growth in central Sussex

• the potential pressures on the CLU at the Royal Sussex County Hospital (RSCH) in Brighton

• the opportunities for innovative staffing arrangements given the PRH’s links with the RSCH in Brighton

• the existing and innovative service provided by the Advanced Neonatal Nurse Practitioners (ANNPs), which should be retained,

and your Joint Committee urged the PCT to work with the Brighton & Sussex University Hospitals Trust (BSUHT) to find alternative ways in which a CLU could be sustained at the PRH.

We endorse your five concerns, which were considered by the PCT on the 10th July, but which were dealt with in a wholly inadequate manner. The pending North East County review does not purport to address the issue of consultant-led obstetrics, and it provides no guarantee of even a MLU at the PRH. We are gravely concerned by this situation.

In addition to the five factors you highlight, three other issues need to be put into the equation.

First, early in June the BSUHT announced that PRH maternity services are very much ‘open for business’ and are in the course of being strengthened in the following ways:

• through investment by the Hospitals’ Trust in ten more midwives for the PRH

• by the Trust’s intention to recruit a fifth permanent obstetric consultant

• by the creation of a single consultants’ rota across the PRH and the RSCH, so that the maternity service will operate as a cohesive hospital operation across two acute sites.

This announcement underpins the determination of the BSUHT to run a maternity service at the PRH which continues to be safe, and which will remain sustainable.

Secondly, it remains the case that the service reconfiguration proposed by the PCT will undermine accessibility for patients, both mothers in labour and their unborn babies. It is self-evident that the distance between Brighton and Redhill (where the principal obstetric services will be based) is far too great. That is regularly demonstrated by the harrowing news reports of mothers who, but for the existence of the PRH maternity unit, would have had their babies in unsafe and uncomfortable circumstances without medical care. The positioning of an intermediate obstetric unit in one of the more densely populated corridors of Sussex (running north-south) is critically important.

Thirdly, your Joint Committee will be aware of the work undertaken in connection with the East of England by the NHS. In the clinical vision report Towards the best, together, the Strategic Health Authority builds on Lord Darzi’s national review work and seeks, in the context of maternity and newborn care, to deliver “more choice and support for women with guarantees never before made by the NHS”. The solution proposed is premised on the basis of “ensuring services are delivered locally where possible, but are centralised when appropriate”. The localisation theme is carried forward in the SHA’s determination to retain and enhance the four smaller obstetric units in the region by pairing those units with larger units, and by co-locating midwife-led units alongside them. Those four units each have an annual birthing throughput of between 1,900 and 2,300 babies, which is at a level lower than the 2,400 presently handled at the PRH. The SHA sees this solution as providing a mechanism for delivering a safe birth for mother and baby in the right location, using managed clinical networks. As the document puts it, the pathway “is the least that women expect for themselves and their babies”. That can only be right.

Against this backcloth, and in the light of the PCT’s unfortunate intransigence on this issue, we believe that the only appropriate course now open to the Joint Committee is to refer the Fit for the Future determination to the Secretary of State for consideration and evaluation by the Independent Reconfiguration Panel.

In so doing, we are anxious that the gains which have been achieved for the PRH (in the form of retention of A&E services, acute medicine and ITU at level 3) remain in place, but that the outstanding issue of obstetric and maternity services be revisited. It is our belief that the Princess Royal Hospital should retain a full obstetric service, supplemented by a co-located MLU, for the long-term benefit of patients across central Sussex.

We should be grateful if you would ensure that this letter is seen by all members of the Joint Committee before the meeting on the 23rd July. Thank you for your serious consideration of our genuine and continuing concerns.

Yours sincerely,

Nicholas Soames (signed on behalf of his colleagues)

Nick Herbert,

Norman Baker

Charles Hendry

Members of Parliament

Councillor Peter Griffiths,

Chairman,

Joint Health Overview and Scrutiny Committee,

C/O Helen Kenny,

West Sussex County Council,

The Grange, Tower Street,

Chichester,

West Sussex. PO19 1RQ