§ Mr. Hugh Dykes (Harrow, East)I am very grateful to have an opportunity of raising the question of the future of the Royal National Orthopaedic hospital in Stanmore. I also appreciate the courtesy of the Minister in coming to the House to reply. I hope that he will respond positively to my remarks on the future of the hospital.
We all try to be alert, responsible and diligent constituency Members and we must bear in mind the inevitable relationship between local and national matters and the vital importance of a modern and expanding Health Service to all our citizens. I think that I was right to apply for an Adjournment debate at this stage on the future of the hospital, even though the Minister may say—with some justification—that no decision has yet been made, because over the past year more and more rumours have been swirling around in an alarming way which demoralises the staff of the hospital. The ominous word "closure" has been heard on the lips of far too many people. I hope that the work of members of staff at all levels, which has traditionally been excellent, will not be affected. However, for psychological reasons, I think that it is bound to suffer.
I am concerned in a general sense as a local Member of Parliament. Everyone in the area, and indeed in the whole borough of Harrow, is proud of what that institution means both locally and nationally. I should also declare a particular interest. I was a member of the independent board of governors, when the hospital was an independent unit within the National Health Service. Since its absorption into the Bloomsbury health authority, I have been chairman of the hospital's league of friends. The league of friends is unique. Its activities are somewhat different from those of other classic leagues of friends in other hospitals and it has raised much money over the years for the hospital. The hospital is at an interesting stage of development. There are lingering doubts about the value and worth of absorption into the Bloomsbury health authority. The disadvantages were pointed out at the time by many medical and lay experts. If the alarming rumours about closure are later followed by anything approaching a suggestion from the Department that closure should take place, people will feel that those doubts were justified.
I do not intend any criticism of those who run the authority. On the other hand, some recent events have raised morale. There was the recent visit from Princess Diana, and the opening of the spinal injuries unit. There is a feeling that the hospital could have a great future. However, optimism is outweighed by a growing pessimism. It is because of that that there has been correspondence in the press recently. I have a letter here from a number of distinguished professors and surgeons at the hospital who have formed an action committee to make sure that the hospital stays in existence.
Now that the Great Portland street town hospital has closed because of the expiry of its lease, the searchlight is on the Stanmore country hospital. Staff, medical experts, management, voluntary helpers and patients fervently hope that the hospital will continue, bearing in mind its distinguished reputation.
Time does not allow me to go into the hospital's detailed history but we should remember its origins, its 1414 links with the royal family and the fantastic work it did with pilots who were disfigured and burned in the second world war. It does phenomenally valuable pioneering work in a whole host of areas and is opening new frontiers in orthopaedic science and technology and surgical care. I hope that no one at Stoke Mandeville will be upset by my saying that our hospital has achieved more in new technology and rehabilitation. Of course, I pay tribute to the work of a well-known comedian and his followers who have attracted immense publicity on behalf of Stoke Mandeville. As one examples I should like to single out the work of Professor Scales on implanting metal pieces into limbs to enable people to walk again.
The action committee has been in touch with me to express its deep worry. I am glad that it is also contacting other Members of Parliament, including my right hon. Friend the Prime Minister, asking for support to help the hospital survive. The number of beds is one vital question to consider. As several new units and a patient centre have been established in recent years, it appears that the Department has a commitment to the hospital. It would look absurd and illogical if its existence were now threatened. Because of the complicated economics of running hospitals and the pressure on costs, there are fears that hospitals in park-like settings that are not conducive to being integrated into one large building to save costs might be threatened. Rationalisation to satisfy DHSS planners might be possible, but that is not the only important issue. I hope that the Department responds positively to what the action committee says.
I have not come to the House just to thank my hon. Friend the Minister for listening and replying to my speech. I should like him to give an unequivocal assurance that the hospital will not be threatened. Nobody can criticise the Department's responsibilities with regard to rationalisation, but the public and admirers and lovers of the hospital want to be assured that it is here to stay and, indeed, will be built up.
I should like to remind my hon. Friend of what has been said about the hospital. Mr. Wilson, a consultant orthopaedic surgeon who is a member of the action committee, gave me authority to quote a letter that he received from Philip Marnie, a great supporter of the hospital, who now lives in Australia.
The letter to our Australian colleague raised fears about the rationalisation of the hospital. His reply was:
'Rationalisation' occurred along similar lines for the Royal National Orthopaedic Hospital in Sydney over the past year and has been disastrous in effect. Sydney Hospital, the oldest hospital in Australia, at a central city location … which has units of worldwide reputation … has been cut from 400 beds down to 120 beds, and is now almost a Casualty Station … The careers of young men on the promotion ladder have been disrupted. The acceptance of Units into other hospitals has meant crowding and cramping of facilities in those hospitals with less than desirable results in patient care. Nursing staff, physiotherapists, occupational therapists and other technical workers such as radiographers and pathology technicians have all had to be relocated.I must not read too much of a letter that is about Australia, but one can imagine what might be the fate of similar staff at Stanmore if this matter were mishandled by the DHSS, which is anxious about costs, with the result that it neglected to bear in mind the need to keep open this great national facility.When the independent board of governors was wound up after the absorption into Bloomsbury, the acceptance by the governors of the need for this structural absorption 1415 was concomitant with an unequivocal assurance by the Department, and by Bloomsbury health authority, that it would mean strength in the future, expansion, solidity and confidence in this institution continuing. If that commitment is now transgressed, even with sophisticated new arguments about economies of scale, and the hospital's future is threatened, there will be a tremendous ground swell not just of resentment but of deep anger, not only in Britain but in the rest of the world. Recently we were glad to welcome the chairman of Bloomsbury health authority, who used to be a Member of Parliament, who expressed enthusiasm for the continued existence of the RNOH.
There is the inevitable complication of the connecting link between the closure of the town hospital and moving parts of the Great Portland street installation into Middlesex hospital. I quote from a letter published in The Times at Christmas last year by members of the medical staff committee and of the Institute of Orthopaedics, which is also connected with the hospital. Dr. Stoker, who is chairman of the medical staff committee, and others said:
The recent decision of the Bloomsbury Health Authority not to renew the lease of the Royal National Orthopaedic Hospital in Great Portland Street symbolises the culmination of years of neglect by the DHSS, which has managed to escape its obligation to provide the services needed by a national orthopaedic centre. We have accepted the need for an orderly transfer of in-patient services to the Middlesex Hospital in 1987. This plan allows for 50 orthopaedic beds with two operating theatres on the same floor, thereby preserving a recognisable identity for the Royal National Orthopaedic Hospital within that hospital.Bloomsbury HA has, against medical advice, decided to transfer only 44 orthopaedic beds to the Middlesex hospital in 1984.I miss out one part, not for any sinister motive but because of lack of time. The letter continues:The in-patient facilities which cannot be accommodated at the Middlesex Hospital are supposed to be transferred to the larger branch of the RNOH at Stanmore. There, the already inadequate provision of operating theatres will not be solved by the installation of one extra modular theatre.The RNOH has a national and international reputation in an expanding speciality. It trains more orthopaedic surgeons than any other centre in the United Kingdom. Until now it has been in the van in advances in treatment, particularly in crippling disorders of childhood, biomedical engineering leading to joint replacement in the elderly and infirm, and limb-saving surgery in the treatment of bone tumours. In the interest of patients the Great Portland Street site should continue to be occupied by our hospital.But, of course, that has now been overtaken by events. That makes it even more important that my hon. Friend reassures us today that, because of what happened to the town hospital, more emphasis will be laid on the future survival and expansion of the Royal National Orthopaedic hospital in Stanmore.I conclude by quoting from the latter part of the letter from our friend who is now in Sydney, Australia, Philip Marnie, who says:
I do recognise that I have an emotional attachment and a bias towards the Royal National Orthapaedic Hospital, having done my training there, but I think the shockwaves will spread throughout the whole orthopaedic world"—that is, if anything were to happen by way of closure.The Hospital probably plays a smaller part in the training of orthopaedic surgeons from Australia compared to twenty or thirty years ago as we now have our own training schemes in progress. I would suggest that anybody contemplating closure, emasculation or cutting down of the Hospital should go through the Journal of Bone and Joint Surgery for any one year over the past twenty to thirty years to calculate the proportion of work 1416 published in that Journal which has come out of Royal National Orthopaedic Hospital. Any reduction in the work and standing of the Royal National Orthopaedic Hospital must inevitably lead to a reduction in standing and status of orthopaedic surgery in Britain, and any such reduction would inevitably lead to deterioration in a facet of health care, which is a most important one, but all too often forgotten by administrators".That is the compelling end to this letter, which will be quoted by thousands of people who remember the past of the RNOH and are worried about its present and future. They want reassurance today and from now on from my hon. Friend.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)I welcome the opportunity that my hon. Friend the Member for Harrow, East (Mr. Dykes) has given us to debate this matter, and I am grateful to him for putting it with his customary clarity and care. I was particularly moved by the passage in his speech in which he expressed a concern about the evident decline in morale among some of the people who work in the hospital. I should like to do anything that I can this afternoon to reassure those people, even though I will not, and cannot, reassure them entirely. However, I am most concerned to hear of their worries.
My hon. Friend's constituents will know that he has been closely associated with the Royal National Orthopaedic hospital for many years, not only as the local Member of Parliament but as a former governor and present chairman of its league of friends. I hope that he, and you, Mr. Deputy Speaker, will forgive me if for 30 seconds I move away from the narrower subject of Stanmore to the wider one and pay tribute to the work of leagues of friends of hospitals all over the country. They amount to one of the great unsung armies in the NHS. I join my tribute with that of my hon. Friend to his local league of friends. Such leagues do much for their local hospitals all over the country.
I am aware of the concerns expressed about the future of the Stanmore branch of the RNOH. I have been reading dozens of letters about the hospital which have come from right hon. and hon. Members on both sides of the House and from the general public. The matter has also been recently raised in the other place. My noble Friend Baroness Trumpington answered a question from Lord Diamond and gave a preliminary Government view in a short exchange.
I can assure my hon. Friend of one thing. My Department takes a great interest in this hospital, both the town and country branches of it, and rightly so, because it is a centre of experience. I prefer not to use the term "centre of excellence", but not because I am egalitarian—I am not. There are centres of excellence in every hospital. None the less, this hospital is a centre of experience in particular forms of treatment and that is why our Department maintains a great interest in it.
Even though the management was transferred to Bloomsbury health authority in 1982, many of the facilities at Stanmore, as my hon. Friend has acknowledged, are centrally funded or organised. Therefore, we in the DHSS at the Elephant and Castle cannot stand away from the problem and say that in the first instance it is not to do with us and it is a matter for the district health authority or the regional health authority. We are deeply involved in central funding and some forms of central organisation. My hon. Friend will 1417 know exactly what they are. Indeed, he has referred to them himself. For the record, I mention the admirable limb-fitting centre, which is directly managed by our Department and is a great centre of experience in this difficult area. Indeed, some of that experience goes back to the war and another epoch to which my hon. Friend has already referred. There is also the excellent and brand new spinal unit which we fund and which was recently opened by Her Royal Highness the Princess of Wales.
My hon. Friend has no need to think that we are not concerned about the prospects of this hospital. That should be some consolation to the staff who work there and to the patients who have benefited and will benefit from care there. The concern and fears to which my hon. Friend has rightly referred are to a certain extent based on speculation about what might happen rather than on any specific proposals from Bloomsbury health authority on the future level, shape and form of services at Stanmore. However, I welcome the way in which he has raised this issue in the House at this early stage in order to enable me to do what I can to allay some of those fears.
The authority is currently reviewing the position at Stanmore, but no definite proposals have yet been published. The only firm decisions that have been taken so far on the RNOH concern the arrangements made to reprovide the in-patient services of the hospital's town branch in Great Portland street. Indeed, a scheme costing about £3 million, of great importance, has been introduced to make that reprovision possible. That, if anything, demonstrates the Government's commitment thus far to this hospital.
The decisions that have been taken were taken only after the fullest possible consulation and discussion. The Bloomsbury health authority's latest planning document—a stimulating document entitled "Towards a Strategy"—made it clear that the authority had not yet come to any conclusions or made definite proposals about the future of Stanmore, and did not envisage doing so for some time.
It is valuable that my hon. Friend has introduced this debate at this time to demonstrate to Bloomsbury district health authority, which is charged by us with taking the decisons in the first instance, the strength of local feeling and the arguments about Stanmore that have been deployed by those who work there—the distinguished consultant surgeons and others on the action group — and, indeed, by those who have written from as far away as Australia about the problems facing this hospital
I understand—I shall be grateful if my hon. Friend will pass this on to those in the hospital who have expressed their concern to him — that at present the Bloomsbury health authority hopes to conclude its internal discussions and then to conclude discussions with the north-east Thames regional health authority over the next few months. A public consultation document will be published towards the end of this year at the earliest and perhaps not until next year.
I want to try to reassure my hon. Friend, and through him those who work at the hospital, that there will be no chance of a ministerial review of any decision taken by the Bloomsbury authority going by default. I give him that pledge today. No decision will be taken by the district or regional health authority without Ministers being deeply involved in the final decision. If necessary, should any decision be made, we shall examine it in the Department.
1418 I can assure my hon. Friend that if, as a result of the review, the authority proposes any substantial variation in the services currently provided at Stanmore—I stress that—let alone any proposals for closure or anything of that sort, and if the proposals are opposed by the relevant community health councils, they will be referred to Ministers for final decision.
Any fears at the moment are groundless and based on speculation. We shall request the opportunity to take a final decision on any such proposals that are put forward by a health authority, even if local interests do not oppose them, although from what my hon. Friend has said it is extremely unlikely that local interests will not oppose them and ask for them to be called in. I give that pledge, very far ahead of the game, and rather unusually for a Health Minister, because we recognise the national importance of the hospital. From this Dispatch Box, I would not normally pre-empt any later ministerial decision by giving a pledge to call in decisions, whether or not there is local opposition. However, in this case I am pleased to do so, because of that hospital's national importance.
It is certainly right that there should be a review of the position of Stanmore and of all the other hospitals managed by the Bloomsbury district health authority. It is very important to keep the services that we provide continuously under review, because the NHS is going through a period of great structural change, particularly with so many activities once lodged in hospitals now being transferred to the community. There is a period of enormous structural change and flux, and the Bloomsbury district health authority is right to look at its services.
The consultative document "Towards a Strategy" mentions the major problems that have to be faced by the authority with regard to the hospital. In his role as a Member of Parliament, my hon. Friend will be familiar with some of those problems, including the very poor condition of some of the buildings, as I understand it, although I have not yet visited the hospital. Some of them were temporary structures, built 40 years ago. Different ways of using resources must be considered to ensure that the hospital remains at the forefront of the speciality of orthopaedics in terms of service and, very importantly, in terms of teaching and research. Indeed, I was glad that my hon. Friend referred to that latter point.
I assure my hon. Friend that the Bloomsbury health authority will consult as widely as possible both in drawing up any proposals and in subsequent consultation. Perhaps I can go over what would happen in the consultation process, so that, if any recommendations for substantial change are made, my hon. Friend can advise hi .s constituents and those who work in the hospital of that consultative procedure. It would certainly include consultation with the north-west Thames regional health authority.
§ Mr. DykesBefore my hon. Friend touches on those very important aspects, will he confirm that there is no danger that the Bloomsbury authority psychologically regards the Stanmore hospital as a bit of a nuisance and as something that is not within its normal field, and that it is taking a proper positive attitude towards its future development?
§ Mr. PattenThe Bloomsbury district health authority welcomes the fact that it has the Royal National Orthopaedic hospital in its district health authority area 1419 and that it manages—albeit extra-territorially, to use DHSS jargon—a hospital in another health authority's hospital area. Naturally, any consultation following any recommendations of the Bloomsbury district health authority will involve consultation with the regional health authority and the Harrow health authority, in whose district Stanmore is located.
I should like to reinforce what I said about what I know of Bloomsbury's perception of the problem. I have not yet discussed the matter with the chairman or members of the authority, because there has been no need to do so, as there have been no proposals. However, I know that Bloomsbury is as keenly aware of the national importance and international reputation of the hospital as we are. There is, of course, a ministerial commitment to the Duthie, report on the provision of orthopaedic services. That excellent report was produced by Professor Duthie who, incidentally, is a resident of my constituency.
The RNOH probably has the greatest concentration in this country of medical teaching and research activities in orthopaedics. I assure my hon. Friend that the authority will consider very carefully the implications for medical education of any proposals that are finally put forward. Because we are so concerned about medical education, in terms of medical manpower planning, and ensuring that the orthopaedics speciality is as well staffed as possible, we shall take a particular interest in the hospital. I say that not just because it is another hospital which may or may not be threatened—we do not even know whether any proposals will be put forward—but because it provides an invaluable research and training facility for young doctors. We shall be giving every consideration to any proposals that come forward from the Bloomsbury district health authority, should any happen to come forward in future, because of the nature of the work that is carried on at Stanmore, the international and national standing of the hospital and the great role that it plays in medical research and training. I give that clear undertaking to my hon. Friend.