HC Deb 01 July 1993 vol 227 cc1209-16

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Michael Brown.]

10 pm

Sir Michael Neubert (Romford)

The headline on the front page of the Evening Standard on Wednesday 23 June was: Hit list dooms nine hospitals". Oldchurch hospital in my constituency was one of those identified for closure. Therefore, I am glad to have this early opportunity to register my strongest opposition to that proposal.

This is not the first time that Oldchurch hospital has been threatened. During the almost 20 years that I have served in the House there have been regular and repeated assaults by the establishment on different aspects of our local hospital. Exasperating as it is, I am ready for the challenge to return to the fight for that hospital. I am encouraged by the support of my immediate neighbour, the Under-Secretary of State for the Environment, my hon. Friend the Member for Hornchurch (Mr. Squire), who is present for the debate but is obliged to maintain ministerial silence.

We are also supported by my hon. Friends the Members for Upminster (Sir N. Bonsor) and for Brentwood and Ongar (Mr. Pickles) who are strongly against the proposals. I am also encouraged by the good will of my hon. Friend the Member for Erith and Crayford (Mr. Evennett) who has good reason to be thankful to Oldchurch hospital as he was born there.

I shall preface my speech by mentioning two matters. First, it must cause concern that the Tomlinson report on the problems of the national health service in inner London has, by the setting up of six speciality reviews, been extended to outer London. It seems that the problems of inner London are to be solved at the expense of outer London, and that is unacceptable.

For decades, as the population of inner London has declined, we in outer London have watched the teaching hospitals draw on our outer-London constituents to fill their emptying clinics, with the result that, in general terms, we on the periphery have been starved of resources. It is unacceptable that once again it should be suggested that to make good the lack of patients in the centre of the city we should lose some of our facilities.

Secondly, review committees dominated by professionals must be expected to favour centres of excellence. It is natural that professional people should want to achieve the highest standards and advance the frontiers of medical knowledge, and that they should favour the most advanced technology, the most lavish facilities and, of course, the highest paid consultants and administrators.

I accept that the proposal for Oldchurch hospital would be subjected to proper consultation. If the public who pay for the service were asked, most of them would say that they preferred the comfort, convenience and assurance of an excellent local hospital. For all its outdated, Victorian workhouse appearance, Oldchurch hospital is just that. It has some pretensions to excellence and I sometimes think that that is the reason for resentment by those who are perhaps better placed in other parts of London.

However, the fact that the teaching hospitals are concentrated in the centre of London is an accident of history, and it does not necessarily follow that they need always be there, and that there might not be a case for a hospital on the edge of London such as Oldchurch hospital itself becoming a teaching hospital. That may seem fanciful, but in principle there is nothing wrong with the idea.

The proposals are related to the provision of cancer services and neurosciences. Both the units at Oldchurch hospital have been threatened twice before, and my hon. Friends and I have been involved in saving the cancer unit on two previous occasions.

The most important factor is that cancer is a terrible disease. If it can be treated locally, that is by far the best solution. There will always be unusual cancers which perhaps need certain specialist treatment, but it is desirable that people should not have too far to travel for general cancer treatment. That is an important factor, although there is also the question of investment in equipment already established at Oldchurch hospital. Those were the main factors, and I hope that they will prevail again.

The regional neurosciences unit has had considerable investment over the years. One of the major factors against change has been that the unit at Oldchurch in Romford is placed at the heart of a very convenient and effective road and rail network. People can get there quickly and, although it is a local facility, it has regional importance and about 75 per cent. of its work comes from the county of Essex. Those are the principal reasons against proposals to close those two aspects of Oldchurch hospital.

Like the cancer unit, the neurosciences have been threatened twice in the past 20 years but each time closure has been fought off and for good reason. There is no particular proposal that Oldchurch hospital should close, despite the headline with which I began my speech, but it is clear that the removal of two important parts of the hospital would call into question its viability.

In particular, neurosciences depend on the interaction of different disciplines within the hospital and that is greatly valued by the consultants themselves who would look upon Oldchurch hospital as a very different place if there were no facility to cross departments and seek advice and assistance and the use of equipment from other parts of the hospital for their particular specialty. That is an important consideration.

There may, of course, be a hidden agenda. It may be part of a process eventually leading to the closure of Oldchurch hospital, but that certainly would be resisted by those who work there. It is a fact that I personally regret and express to my hon. Friend the Minister that such uncertainty obviously undermines the confidence of the public in the national health service and the morale of the staff working in the hospital, and we have enjoyed more than our fair share of uncertainty in recent years. I consider that to be unfortunate, but it may be inevitable.

It is only a matter of months since the most recent threat to the hospital was lifted, with the setting up of a trust based on two hospitals—Oldchurch and Harold Wood—and a twin-site strategy. Only months later, Oldchurch hospital is once again under threat.

An important factor which is not sufficiently taken into account in all these exercises is what I call the patient-visitor factor. Financial equations are set up to match the revenue and capital investment and consider the concentration and co-ordination of services and see some saving or better use, but rarely does the unseen factor of convenience and accessibility come sufficiently into question. It is rarely costed, but I can assure my hon. Friend the Minister that there is a very real cost, which should be respected.

His predecessor, our hon. Friend the Member for Loughborough (Mr. Dorrell), answering my Adjournment debate on 27 February 1991, said: Convenience and accessibility are important factors in deciding the pattern of health care in any locality."—[Official Report, 27 February 1991; Vol. 186, c. 1096.] I strongly believe that that is true.

I recently learned in my own surgery of the human cost of people having to travel long distances to see consultants and to receive treatment. One of my constituents explained the problems that she had encountered taking her elderly father, ill with cancer, to the Royal London hospital—which is one teaching hospital proposed for a concentration of resources under the review.

When she and her father—a frail, sick man who had to be left at the hospital entrance—arrived, she found that there was nowhere to park and had to find somewhere nearby. She parked in a place that she thought was safe. She saw a warning notice. but thought that it applied to a British Telecom depot. When she returned to her car, she found that it had been towed away.

She was forced to get a taxi to return to the hospital to collect her father, who was in great pain, and suffering considerably. Treatment often induces nausea, but even travel and seeing a consultant is painful for someone in that condition. That lady then had to return to the pound to reclaim her vehicle. All that, so that a patient living in my constituency could receive the treatment he needed. He has since died.

That example illustrates the human experience of patients having to travel longer distances than otherwise are necessary. I urge that those financial costs be entered into the question because they make the outcome look very different.

It is clear from the review documents that the financial implications of the proposals are virtually non-existent. The Evening Standard reported that the leaders of the review teams were very nervous when defending their plans. They admitted that their knowledge of the financial consequences was virtually zero and that they could make no meaningful comparison between one department and another.

The same report mentions the concern of my right hon. Friend the Chief Secretary, who himself represents a London constituency. I am not surprised at his concern, because the review is something of a pig in a poke. There is very little figuring to it. My experience of all NHS changes is that a great deal of money is needed up front and that they depend on other factors, such as the value of vacated sites—which, in the present climate, is not a reality.

Any suggestion, for example, that the NHS could capitalise on the Oldchurch site in Romford would be rather diminished by the fact that only last year Romford brewery closed after nearly 300 years, leaving a 20-acre site awaiting some useful development. Creating another such site just across the road would not have much value and would represent the unwise disposal of a public asset. All those factors come into the question.

The reviews are based on certain factual errors. I shall quote from a critique of the two review documents prepared by the hospital trust, because it is important to read it into the record and to show that in the review committee's haste to reach conclusions and to make recommendations to my right hon. Friend the Secretary of State, it may have laboured under a misapprehension.

On cancer services, reference is made to page 115 of the review. The trust comments: The Trust is currently reviewing how all of its existing services should best be located, using both the Oldchurch and Harold Wood sites for the foreseeable future. Centralisation of all specialties on to one site is not an option due to the volume of patients currently treated and the excessive capital implications of such a development. Oldchurch Hospital has a comprehensive range of general hospital services on site. These include General Surgery, Urology, Orthopaedics, Medicine, Oral Surgery, Ophthalmology, Intensive Therapy, Paediatrics, Accident and Emergency, Medicine for the Elderly, Rheumatology, Radiology, Nuclear Medicine and others. This can hardly he described as a restricted range. Recruitment difficulties for physicists and radiographers are not thought to be any more problematic at Oldchurch than similar centres. The trust says of paragaraph 102 on page 24 of the neurosciences paper: Oldchurch has been successfully running a Neuroscience Nursing course for some years. No mention is made of this, although plans to develop such a course in other units are referred to. It says of paragraph 103: A Senior Registrar rotation scheme exists in Neurosurgery, linked to' St. Barts. The report overlooks the wide body of research work undertaken in Neurology. This includes, beside the Neuro-care team, clinical trial in Parkinson's Disease and research into Alzheimer's Disease, Essential Tremor Disease, and Chronic Fatigue Syndrome (ME). Funding for this work in 1992–93 exdeeded £100,000. It says of paragraph 104: This incorrect assumption is similar to that detailed above in the Cancer Review."— that is, that there will be only a single site.

Aside from the ENT Department, the most recent capital investment at Harold Wood was Phase 1 of the nucleus development, some 7 years ago. Whilst the lack of on-site MRI (Magnetic Resonence Imaging) is described as a deficiency for Oldchurch, similar absence at other sites (such as Hirstwood Park and the Maudsley) is not mentioned. No reference is made to our current bid to fund MRI within Havering Hospitals. The operating theatre mentioned is dedicated to the exclusive use of Neurosurgery. The Oldchurch service is criticised for the lack of linked specialties"— I have already illustrated the range of specialties available— when it is better supported than other centres, such as Atkinson Morley and the National Hospital for Nervous Diseases. In particular Maxillo Facial (Oral) Surgery, Ophthalmology, and Orthopaedic Services are on the same site, together with the wide range of other clinical services mentioned above. Finally, it says of paragraph 107: The Oldchurch centre is described as a local service. In fact it currently serves 75 per cent. of the Essex population, and ME patients are referred nationally. The statement that the unit does not have the facilities that should be available to a major general hospital is clearly wrong. A recent specialist advisory committee report on Neurosciences was quite satisfied with the general range of services. Oldchurch hospital has a high standing in the community. It serves a large district—previously 453,000 people—and even now, with the detachment of Brentwood, it serves an important part of London's population. Part of that population in the Barking and Dagenham end is, to a degree, deprived and has a high incidence of health need. The population generally can be characterised as having a high morbidity and a low mobility rate. Both those factors point to the need for the continued existence of Oldchurch. It has served the population very well.

In April this year, three months ago to the day, I unveiled a plaque at the opening of the new Havering hospitals trust. I was confident in my comments that it was a new chapter in the national health service in Romford. I hope that at the end of this latest exercise my confidence and that of my constituents will not prove to have been misplaced and that Oldchurch hospital will continue to serve the community that values it so highly.

10.17 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I am pleased to have an opportunity to respond to my hon. Friend the Member for Romford (Sir M. Neubert). I congratulate him on his success in the ballot. It has given him the opportunity, on behalf of his constituents, to voice his concern about the future configuration of health services in the area. Both he and my hon. Friend the Member for Hornchurch (Mr. Squire), who is in his place on the Front Bench, have written to the Department expressing their concern. I know that there is widespread public interest, not least because my right hon. Friend the Secretary of State has received many letters on this subject from members of the public.

Havering hospitals NHS trust was launched in April this year. It consists of the old Barking, Havering and Brentwood health authorities' acute units—the Harold Wood, Oldchurch and Rush Green hospitals. The trust is large and serves a local population of more than 440,000.

It may be appropriate for me to put into context the recent press reports about possible changes in cancer services and in neurosciences, to which my hon. Friend referred. The reports of the cancer and neurosciences review teams are independent advice to Ministers and to the NHS. They are not policy, and they will certainly not alone determine the future pattern of services.

The London Implementation Group, set up in response to the Tomlinson inquiry, will consider the recommendations of the review teams alongside the central London hospital site option appraisals already under way, the review of the special health authority research due to be published in mid-July and the views of purchasers and academic interests.

The London Implementation Group will also ensure that the implications of all those elements are fully assessed at local level. Following that process, proposals for the future configuration of services in inner London will be presented to Ministers in the autumn.

In making their recommendations, the review groups have sought to improve quality of services for patients well into the next century. Their advice with regard to Oldchurch hospital will now be considered and assessed by the North East Thames regional health authority, by local purchasers and by the trust itself.

The immediate need for change is, of course, in central London. If proposals to alter services in outer London are presented to Ministers, we should need to be convinced that they offered real benefits to patients and value for money before taking them forward. There will, of course, be full public consultation, as my hon. Friend has said, on major changes to services and on any services that involve transfers between NHS hospitals or from hospitals to community services.

There are presently two reviews of services in the area, and it is essential that each takes account of the views of those who live in the area. Barking and Havering health authority has instituted an accident and emergency services review to look at the emergency services that it commissions from local hospitals. That is quite proper, and the health service has made it clear that it seeks to improve the service available to its residents.

The health authority will look at the current use of the accident and emergency service, and especially at the most important issue of access and travel time. The London and Essex ambulance services will both be invited to provide evidence to the review.

At the same time, Havering hospitals trust has launched a major review of services and is actively seeking reviews of the community health council, of GPs and of patient groups. The review is considering the configuration and delivery of large areas of the trust's acute work. The main objective is to ensure that the trust can best meet the demands of health care purchasers to the greater benefit of patients.

My hon. Friend will know that, a couple of months ago, my right hon. Friend the Secretary of State approved the health authority's proposal to relocate services from Rush Green to the Oldchurch and Harold Wood sites and to close Rush Green hospital by 1996. She made the decision on the understanding that alternative services are in place at Harold Wood and Oldchurch hospitals prior to the closure of Rush Green. Her decision should greatly Improve the opportunities for Havering hospitals trust to reorganise acute services to give a more effective and efficient service to patients.

The trust aims to achieve excellence through the provision of a balanced range of services to meet the needs of the community. The trust is committed to pursuing quality, efficiency, staff development and financial viability. Considerable challenges face the trust, but I have great confidence in the new structure of the NHS which devolves management to a local level and introduces the incentive to excellence of the purchaser-provider split.

As it prepared for trust status and during the early months of the trust, Havering hospital, despite a fall in the number of beds, achieved much in terms of efficiency—that is, in treating more patients. In the last 18 months, the total number of patients waiting for treatment has fallen by 15 per cent. Perhaps more significant is the fact that no one now waits more than 18 months, and 89 per cent. wait less than one year.

The trust has undertaken a detailed internal review, by specialty, of workload against planned contracted activity. Resources will be matched to patient needs expressed through purchaser demand, and not issued according to historical patterns of spending. I am delighted to say that this approach—putting money where it can best help patients—has won Audit Commission approval.

I could give a number of other examples of initiatives that have been taken by the trust. There have been a number of quality initiatives, such as the initiative on the nutritional intake of patients, with the implementation of various other patients charter initiatives, which have been characterised by a great deal of imagination and enthusiasm.

May saw the launch of the trust's patients charter for children, which aims to ensure that children are treated in an environment appropriate to their age and needs.

I am grateful to my hon. Friend the Member for Romford for giving me the opportunity to highlight some of the trust's achievements, and also the challenges that it now faces. I listened with great interest to some of the concerns that he expressed and, in particular, to what he said about the historical problems as between inner and outer London, and what he saw as the unnecessary concentration of teaching in inner London. I was interested also in his idea of the hospital becoming a teaching hospital.

I noted what he said about the recent proposals, which do not include the closure of Oldchurch hospital. However, I agree that such reviews produce uncertainty. On the other hand, there is an historic and continuing problem in London with regard to duplication of specialties which has to be solved.

It can be solved only through the medium of reviews by those most qualified to decide the future of services in London. These reviews have to be published. They will, almost by definition, induce periods of uncertainty, but I hope that my right hon. Friend the Secretary of State will be in a position to take steps to limit this.

Sir Michael Neubert

My hon. Friend has very fairly said that there is a major problem in London, which we all accept. It is most frequently expressed by saying that 20 per cent. of national health services resources go to London, with 15 per cent. of the population. That is not challenged, but people like myself and my colleagues in outer London say that that problem is not spread equally over London.

The imbalance is to be found, as I believe that my hon. Friend acknowledged, very largely in central London. It would be unfair and inequitable if the problem that arises in central London were to be spread, with an evenness of misery, over the whole of London, to the detriment of outer London's interests.

Mr. Sackville

I certainly take that point, but these are problems that are not peculiar to London. All over the country, services need to be rationalised in order to balance the ever rising demand for health care, and the greater activity and expense of health care for each patient, with what is available. That sometimes requires some very hard decisions.

I noted what my hon. Friend said about the virtues of accessibility and convenience, and about people needing to be treated, as far as possible, near to their homes. I agree that finance and factors such as land sale are not everything, but these are all factors that need to be taken into account.

There are no decisions on this matter. We have had advice from an independent committee. There will be consultation if there are to be any major changes in service. I congratulate my hon. Friend again on raising this matter. His contribution tonight will be a major factor in any decisions that are taken in the future.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.