30th October 2008

Dear Secretary of State,

Referral to the Secretary of State for Health

Fit for the Future proposals by the West Sussex PCT

I am writing in connection with the Fit for the Future (FFF) proposals made by the West Sussex Primary Care Trust, and the impact of those proposals on my constituents, and beyond.

You will be familiar with the referral by the West Sussex Joint Health Overview and Scrutiny Committee to your Department (letters of 25 July and 1 September 2008) for review of the proposals for reconfiguration of acute hospital care services in the county of West Sussex. On receipt of that referral you forwarded the matter to the Independent Reconfiguration Panel (the IRP) for an initial appraisal. That appraisal came to you by letter dated 15 September 2008.

Since July of this year two of the acute hospital trusts involved in possible change (those based in Chichester and in Worthing) entered into talks to explore the possibility of merger, and to evaluate the impact of such change on the delivery of local services. As a consequence, you decided not to proceed with the substantive referral to the IRP, but instead (as you wrote to the Vice-Chairman of the Joint Health Overview and Scrutiny Committee on 13 October) to defer the whole IRP process until the trusts’ discussions had produced some form of consensus.

I am writing to you now to express my very grave concern about that decision. Although I appreciate – as do my constituents – that any review of the FFF proposals at national level needs to take into account the latest local developments, there are significant dangers in this process for the Princess Royal Hospital (the PRH) in Haywards Heath. That hospital is a fully functioning district general hospital delivering acute hospital services to the populations of central Sussex, ranging across Horsham and Crawley to Wealden and Lewes, with Mid Sussex district at the hub.

For reasons that are still far from clear, when the West Sussex PCT embarked on its FFF programme, it decided to include the PRH within its service reconfiguration appraisal. The original proposals for the PRH were in every sense draconian – none of the options presented to the public involved retaining this mainstay and modern hospital in its present form, and all involved a measure (some very significant) of downgrade. That proposal (made concrete back in June 2007) caused alarm and concern throughput central Sussex. What was particularly peculiar about the PRH’s inclusion within the review was that it was (and is) part of a much larger acute hospital trust – the Brighton and Sussex University Hospitals NHS Trust (the BSUH Trust) – which delivers tertiary hospital services to a significant population base and which has accredited medical school status. Within the BSUH Trust the PRH is a key provider of acute services, especially elective surgery, orthopaedic work, and obstetrics and neo-natal care, and the hospital works with its larger partner the Royal Sussex County Hospital (the RSCH) in Brighton in such a manner that the two provider units operate as a single hospital on two sites. The operation is integrated and effective, and many of its services are national exemplars.

By contrast, the significant Queen Victoria Hospital (the QVH) (a successful foundation trust) based in East Grinstead, also within West Sussex and with which the BSUH Trust has links via a concordat for service delivery, was omitted from the FFF review.

But the principal concern which I need to draw to your attention is this.

Whilst the IRP review is on hold, the FFF programme for the whole of West Sussex comes to a halt, and the future of services at the PRH in Mid Sussex remains uncertain. Over the past many months of consultation and deliberation the PCT has come to accept that the PRH should not be downgraded and should retain local general hospital-plus status (LGH-plus). This status is almost akin to district general hospital status, with one variant. All acute services would remain intact at the PRH, with the single exception of maternity. Emergency surgery and trauma services are unaffected; they were transferred to the RSCH some time ago.

Under the proposals now lying on the table, consultant-led obstetric services would be fully relocated to Brighton, leaving no form of maternity service at the PRH for central Sussex. To put it bluntly, there would be no obstetric service between the coast and Redhill in East Surrey. That, we believe, is entirely unacceptable for reasons both of safety and of patient accessibility.

There is the possibility that if, or when, obstetrics were to leave the PRH, there would be left in its place a midwife-led unit. But that unit could cater for only 350 non-complex births as opposed to the almost 2,400 births presently handled at the PRH by a dedicated and capable team of obstetricians and neo-natalists. Even this minimalist option, though, is by no means a foregone conclusion. On the advice of Sir Graeme Catto, the PCT set up a North East County Review panel to look at primary and secondary care services in West Sussex, principally because the real focus of the FFF exercise had been on the south coast. It had become increasingly clear that the northern and eastern parts of the county had been inadequately considered in the substantive review process. The future of Worthing and Chichester hospitals (and the location of the major general hospital (the MGH) for West Sussex) was really the purpose of FFF.

The NE County Review will be reporting back to the West Sussex PCT board early in the New Year. But now it has a dilemma.

Its recommendations for the delivery of acute services – which include the permutations for maternity care – will need to be founded on a pattern of service (especially at the PRH) which has been fixed by the pre-existing FFF review. It will only recommend the retention of midwife-led services at the PRH if it is clear that obstetric services are to leave that hospital. If the position is left in the air there is a real risk that it will recommend placing the midwife-led unit elsewhere (for example Crawley), leaving the Mid Sussex and surrounding areas with no form of baby-delivery service.

It is essential that the future of the PRH is determined sooner rather than later. The people of central Sussex have already had to wait far too long for resolution. The BSUH Trust needs to be able to get on and to plan the continued delivery of its diverse and high quality range of services across two sites. Indecision hampers this process, and it is not in the wider public interest.

I am also greatly fearful (a fear shared by the indefatigable Support the Princess Royal Hospital campaign group) that the concessions which have already been made by the PCT in this process may be vulnerable. I cannot seem to get straight answers in writing from the PCT on this issue. The people of Mid Sussex and beyond need to be assured as quickly as possible, and in totally unambiguous terms, that their full range of acute services at the PRH are – in the eyes of the PCT – safe and secure. The BSUH Trust has already made clear that it wishes to continue delivering a full range of elective surgery and acute care services (including level 3 ITU) at the PRH, but the PCT has been decidedly reticent in this matter. The LGH-plus model would ensure the retention of these key services at the PRH, but nothing is set in stone until the IRP determination has been made. We also firmly believe that when the IRP reviews all the evidence (particularly the RCOG guidance on smaller maternity units published in May this year) it will form the view that, not only should the PRH function as an LGH-plus hospital, but that consultant-led obstetrics should remain at the PRH, perhaps augmented by a co-located midwife-led unit to handle the less complex cases.

When the IRP wrote to you with its initial view in September it was at pains to underline two matters to you. Firstly, it noted the four reasons for the original referral by the Joint HOSC, including the concern that alternative options for the delivery of maternity services in West Sussex had not been fully explored (as was the case also in East Sussex). Secondly, it indicated – even on the limited evidence before it – that it wished to explore the issues of safety, sustainability and accessibility which underpin the FFF proposals. I, and those whom I and my fellow MPs in the county represent, very much support that holistic approach.

Finally, it is important to say this. At no stage have the people of central Sussex, or the BSUH Trust, sought to bid for major general hospital status for the PRH. The hospital functions well within its present remit and for its wide catchment, and its services are greatly enhanced by working in close concert with the RSCH in Brighton. Our concern is to ensure that the PRH is able to consolidate and build upon its achievements within that trust. It has significant potential for service expansion (such as step-down post-operative rehabilitation) and for sharing in the hosting of outpatient and treatment services presently delivered from the RSCH in Brighton and the QVH in East Grinstead. Geographically and operationally it is best placed to exploit its existing strengths for the wider public benefit – and it needs to be allowed to get on and do that job.

Against this backcloth I am asking you now to find some mechanism by which the PRH element within the FFF proposals can be forwarded to the IRP for its urgent attention. The local community and I believe that the issues surrounding the future of the PRH can be divorced from those relating to Worthing-Chichester and location of the MGH. It is important – to put it bluntly again – that the PRH is removed from the equation intact, and that the BSUH Trust is allowed to proceed with its service integration untrammelled by the wider politics at play here. Whatever happens, it would be entirely wrong to allow the future of the PRH to hang in the balance for perhaps another year whilst the other hospital trusts in West Sussex and the PCT get their respective houses in order.

I know you will give this your most careful and earnest attention, and for that I am most grateful.

The Rt Hon Alan Johnson MP,

The Secretary of State for Health,

Department of Health,

Richmond House, 79 Whitehall,

London. SW1A 2NS