§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Portillo.]
12.36 am§ Dr. Ian Twinn (Edmonton)I am grateful for the opportunity to raise tonight the subject of the proposed closure of the radiotherapy cancer treatment unit at the North Middlesex hospital in my constituency. No other issue since I have been in this House has caused more public concern among a wide range of my constituents than the proposal of the North East Thames regional health authority to close this unit. All the political parties in Edmonton are united—as are the residents' groups and all the other representative groups in my constituency, including the local authority—in opposing this proposal of the health authority.
Nor is it just a parochial matter concerning Edmonton. This matter has concerned the hon. Member for Tottenham (Mr. Atkinson) and, in the borough of Haringey, my hon. Friend the Member for Hornsey and Wood Green (Sir H. Rossi). I am pleased to see on the Treasury Bench my hon. Friend the Member for Enfield, Southgate (Mr. Portillo), who, together with my hon. Friend the Member for Enfield, North (Mr. Eggar), have been particularly strong in ensuring that the wishes of their constituents are known to the Government and the regional health authority. I am grateful to them for the support they have given me in this matter.
This issue goes beyond the London boroughs of Haringey and Enfield. It affects also our neighbours in Essex and Hertfordshire—my hon. Friends the Members for Harlow (Mr. Hayes), for Epping Forest (Sir J. Biggs-Davison), and for Hertford and Stortford (Mr. Wells) and my right hon. Friend the Member for Castle Point (Sir B. Braine)—all of whom have been active in objecting to the ill-founded proposal of the regional health authority.
The Minister will be aware that this proposal affects the whole of the North East Thames region. It is proposed to decrease the number of radiotherapy cancer treatment units from nine to five. This has already provoked one Adjournment debate, when my hon. Friend the Member for Southend, East (Mr. Taylor) raised the whole question as it affects the county of Essex. I will not tonight go over the ground that he covered. Our problems are similar, though my constituency is affected more as a built-up area.
It is strange for the House to debate the Health Service and not to mention cuts, but no cuts are involved in this matter. Indeed, the region's plans would result in the expenditure of several million pounds extra in the short term, and probably increased expenditure in the long term. I would argue, however, that the region's proposals will lead to a cut in the standard of service to my constituents and to people in neighbouring constituencies. The firm medical opinion of consultants such as Dr. Maurice Sutton and his colleagues at the North Middlesex hospital, and other medical opinion, is that there is no proof that the extra spending which the region has earmarked will result in the better treatment of patients. If we are to spend extra money in the Health Service, it should be concentrated to the benefit of patients, not to the benefit of others in the Health Service.
906 Some specialists involved in the proposal suggested that the demand for radiotherapy will decline. The region has not put the case strongly, but we must argue against it. Drug treatment for cancer is popular in sonic areas, but there is no proof that it is especially efficient. Indeed, the toxicity of the drug means that more deaths may arise from its use. In the latest British Medical Journal, an interesting article suggests that the results of the drug treatment of cancer are disappointing.
Cancer will affect one in three people and will probably result in the death of one in four people. We have an ageing population, and it would seem that radiotherapy will be in increasing demand, not decreasing demand as some have suggested. Therefore, it is important to keep open centres that can provide a service to the population.
Why then has the North-East Thames regional authority suggested the massive disruption of cancer treatment provision in our area? It is difficult to say why it has done so, but part of the reason goes back to the DHSS itself. The Department's Standing Medical Advisory Committee suggested that every region should examine cancer treatment provision and suggested that larger units should be introduced. One can understand why the region undertook the review. However, the treatment already provided in the region is among the best in the country. If one was to produce a league table of survival rates of cancer patients, our region falls between third and fourth places. The Department cannot say that the provision in the region is poor or inferior, so we must find other reasons. We know that the change is not proposed on the ground of cost since the region's plans will be significantly more expensive.
Some people in the DHSS argue that larger catchment areas would be more efficient, and the figure of 1 million people has been bandied about. Yet there is no scientific evidence to support the view. It is an interesting and debatable opinion, but it is only an opinion. I suggest that it is the opinion of those who already work in large units and that it is based upon their experience, not upon hard evidence.
North Middlesex hospital has one of the best buildings for radiotherapy in the country. It is modern and purpose-built and no adaptation costs are incurred for the machinery. It is a pleasant building for patients. It is light and airy and not down in the dungeons where one normally finds radiotherapy treatment in hospitals. Some radiotherapists elsewhere are envious of the facilities. It is a shame that the facilities at the hospital should be declared redundant and that new facilities will have to be duplicated elsewhere—perhaps at the Royal Free hospital or at St. Bartholomew's hospital.
The region's proposal has already cost money. About £41,000 has been wasted by the region because a linear accelerator was on order for the North Middlesex hospital but it was cancelled at the 11th hour, 59th minute, by the region. I presume that the region had to pay the cancellation fee and many thousands of pounds for the adaptation and removal of one machine to make room for a new machine.
My main objection to the proposal is that it ignores the patients. The Coopers and Lybrand report, commissioned by the North-East Thames region, might be a fine piece of intellectual property. I have read the volumes and they make sense. I can understand the rational argument. Bigger centres can be appealing, particularly for a medical administrator, because all the people are in one place. It 907 is appealing for specialists in the teaching hospitals. Larger centres, more machinery, more ancillary staff and more patients add to the status of a department. It might be useful to specialist researchers who might find it convenient to be associated with a radiotherapy treatment centre. All such arguments must be weighed in the balance.
Unfortunately the proposals do nothing for the patients. They might do a lot for medical specialists, but they do nothing for the patients. The position of patients will become worse if the proposals are implemented. Patients who need radiotherapy are usually seriously ill. They might have only months to live. That will be true for many lung cancer patients. Any journey will be painful and trying, and will make many patients anxious. The North Middlesex hospital is easy to reach. It is directly off the North Circular road, it is within a 10 minutes' drive of the M25 and it is on the A10 main arterial road.
My constituents from Enfield and Haringey and others from Essex and Hertfordshire can get to the hospital by private transport or by ambulance relatively easily. If they have to go to the Royal Free hospital or to St. Bartholomew's, travel will be difficult. They can be collected by ambulance only in the morning—12 patients per ambulance—and be returned after dark. It would be difficult to justify the cost of doing more than that. There are no parking facilities near the Royal Free hospital or St. Bartholomew's hospital. Journey times will be at least double. I find that worrying.
Members of the regional health authority are not united on the proposal. The working group reported in March 1986 to a closed meeting. I have seen its private report, and paragraph 101 recommends that the centre should be established at the North Middlesex hospital for three reasons: it is close to the centre of population; it will reduce travelling time; and there is space for expansion.
In a mysterious way, those recommendations have disappeared from the published report. The region has not justified that and it has not seen fit to answer the criticisms. I found the region's attempt to justify the decision afterwards very mysterious. The region's statement entitled:
A review of cancer treatment services in the North East Thames Region.claims:One of the major considerations in the Review is the importance of avoiding excessive travelling time of patients undergoing treatment for cancer…accessibility to services will generally be improved across the Region.However, the only way in which the region can justify that perversion of the truth is to provide hostel accommodation for patients. Instead of living at home in the last few months of their lives, my constituents will be forced to live for five nights a week in central London away from home, or they will have to endure nasty ambulance journeys in central London. The region's argument is a perversion of the true position.The region has been over-influenced by fashion. It has been tempted by the idea that big is better, whereas there is no proof that that is the case with cancer treatment. Although I cannot prove it, I suspect that the region has been influenced strongly by the lobby from the teaching hospitals which would like to concentrate all the new resources in those hospitals, away from the district general hospitals. The problem is that the population exists close 908 to the district general hospitals while the teaching hospitals are concentrated in the de-populated areas of central London.
If the decision is allowed to be implemented, there is a danger that the consumers in the Health Service will be ignored, that many millions of pounds will be wasted in satisfying the desires of those producing the service and that no benefit will accrue to the patients. When my hon. Friend the Minister considers these decisions, if they eventually arrive on her desk, I hope that she will take all these factors into account.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)I congratulate my hon. Friend the Member for Edmonton (Dr. Twinn) on his success in the ballot for today's debate. I have had cause to be impressed twice by his efforts on behalf of his constituents in the past two days. He came to see me yesterday to discuss the Cry-Sis organisation that helps families with crying babies. Then, as now, he put the case for his constituents with dignity and in detail in a way that would have greatly impressed them.
My hon. Friend referred to an Adjournment debate of my hon. Friend the Member for Southend, East (Mr. Taylor) on 31 October. He was right to state that representations have been made on the issue by numerous hon. Members, specifically my hon. Friends, the Members for Enfield, Southgate (Mr. Portillo) and for Enfield, North (Mr. Eggar). I must enter the same caveat as I entered previously.
I am obviously a little restricted in the scope of my reply to my hon. Friend the Member for Edmonton, because if, following consultation by the district health authority on the proposal to close the unit, any of the local community health councils concerned object to the proposed closure and the district and regional health authorities confirm it, the proposal will indeed be referred to Ministers for a final solution. Because of that, it is absolutely essential that I do not anticipate the outcome of such consultation by stating a view. My hon. Friend will therefore recognise the unusual circumstance of this Minister having no opinion whatsoever and merely serving this debate by listening carefully to what has been said.
As my hon. Friend said, the North-East Thames regional health authority has reviewed its cancer services. The review is not a cost-cutting exercise. As my hon. Friend rightly said, if fully implemented it would cost more money. It is intended to benefit patients not just in one part of the region, but in the entire region, as has been repeatedly demanded in parliamentary questions on this subject. If the proposals come to Ministers for a final verdict, my hon. Friend can rest assured that any decisions taken will ensure that the best overall service to patients in the region is provided.
It may help if I describe the timetable to my hon. Friend. If matters proceed as planned, the region expects to provide districts with a consultation document for issue in January 1987. The districts would then submit detailed proposals to the region with the results of the consultation. If the local community health council has objected, the matter will come to Ministers for a decision. We are therefore talking about a substantial period of time, even if matters proceed as planned. I can assure my hon. Friend that nothing will be done in a hurry.
909 If the radiotherapy unit at the North Middlesex hospital were to be closed, it would be the subject of full public consultation. Local people would have the opportunity to express their views, and I have no doubt that, with the assistance of their excellent Member, they would do so with force and in the appropriate detail.
The intention is to set up regional cancer treatment centres. Departmental guidance is contained in the report of the standing sub-committee on cancer, entitled "Acute Services for Cancer", which was circulated two years ago under cover of Health Notice (84)23. If my hon. Friend has not seen a copy, I shall gladly ensure that he sees either it or the relevant bits of it. He will find that it is a question not of fashion, but of careful consideration of how cancer patients should be treated, not only in the 1980s but well into the next century.
The report recommended that radiotherapy centres should normally serve a population of not less than 1 million—equivalent to about 4,000 new cases of radiotherapy a year. North East Thames regional health authority serves a population of about 4.4 million and has a resident population of about 3.7 million. On straightforward population criteria the region would require only four units. However, the region is also required to consider geographical matters, travelling patterns, and so on. On that basis the original proposal was for five centres, and following further review it decided on six. Unfortunately, there are at present nine centres. If the broad overall strategy is to be accepted, it follows that some will have to close. That is the crux of the matter.
I understand that it is suggested that the special cancer facilities are concentrated on six regional cancer treatment centres at the London hospital, the Middlesex, the Royal Free and St. Bartholomew's in London, and Colchester and Harold Wood in Essex. Those centres would provide the full range of cancer diagnosis and treatment.
As a result of the region's proposals, the existing radiotherapy units at the North Middlesex and University College hospital in London, and the Essex County hospital, Oldchurch at Romford and Southend in Essex would be subject to closure. The region tells me that it believes that the proposed regional centres would be of sufficient size to make the best use of both human skills and physical resources and to encourage staff to develop specialist expertise, particularly to aim for expert knowledge of particular cancers and thereby to add to the list of cancers that are now curable.
The difficulty with the North Middlesex hospital arises from the choice between it and the Royal Free. The regional health authority undertook an option appraisal on the two hospitals which showed that a regional cancer treatment centre at the Royal Free would be better placed to serve the catchment population and to provide the back-up specialist facilities required to support such a centre. I am told that it looked at referral patterns, the viability of centres and the impact of losing radiotherapy on either hospital. On that basis, the Royal Free was its preference.
The only factor favouring the North Middlesex, to quote from my brief,
was patient travelling difficulties, particularly for residents of Enfield Health Authority.Obviously, I express no view, but I have heard with interest my hon. Friend's comments.910 The broad overall strategy of introducing regional cancer treatment centres, which has been departmental strategy now for several years, was accepted by the regional health authority early this year nem. con. The strategy is accepted and not regarded as a fashion or a fad. it is regarded as the right way to run cancer treatment in future. The difficulty comes with how one applies it in practice. In other words, the principle is accepted, but the practice is a different matter.
I note what my hon. Friend said about teaching hospitals and the influence of consultants on large units. However, they have led the way in research on this important illness and demonstated methods of ensuring that cancer is no longer the killer that it used to be and that there is hope for sufferers.
I understand that the other cancer services will remain district-based. The regional health authority's intention is that the bulk of cancer treatment will continue to be provided at district level, that serices for chemotherapy, surgery, counselling, diagnosis and screening and health promotion will all be district-based. Consultants from the regional cancer treatment centres will hold clinics at local district general hospitals to enable their specialist expertise to be made available locally and to minimise as far as possible the travelling required for specialist treatment services.
I have inquired about community services for cancer patients in the Haringey district health authority area. I am told that they are quite good and are being further improved through advertisements being placed for two more MacMillan nurses who will work with cancer patients at home. They will be in addition to the existing nurse who is at present supported by district nurses. That arrangement will continue. Therefore, my hon. Friend's constituents can look forward to an improved service, particularly for those patients who are recovering from this illness at home.
My hon. Friend spoke about one or two aspects of treatment and compared chemotherapy with radiotherapy. I defer to his considerably greater knowledge on some of these subjects, but I can tell him that all these treatments are under constant review. Any assertion that a treatment works means that the treatment has to be rigorously tested on patients who are already ill, especially if those treatments are dangerous and produce side effects. That is true of both chemotherapy and radiation treatment, and we need to be absolutely assured that a treatment has benefits that outweigh any of its possible disadvantages before it is offered to a patient.
My hon. Friend spoke about survival rates. I agree that the record of his local health authority on cancer treatment centres is excellent, but I am sure he would agree that it also depends a little on how early in the progress of the disease patients present themselves. There is some evidence to suggest that in some parts of Britain where general practitioners and perhaps health promotion services actively encourage people to come early, that is exactly what they do and their survival rate, particularly for illnesses such as cervical cancer, are thereby much improved. We want to encourage that practice everywhere, and I am sure that my hon. Friend will agree about that. In response to his earlier comment, perhaps I should add that we do not have Health Service hospitals with dungeons. At least I hope we have not. If we have, I should like to hear about them.
911 The National Health Service is changing all the time and must respond to change. Shifts in population have considerably affected all the London regions. There are alterations in the patterns of illnesses affecting our ability to deal with them, and there are improvements in medical practice. As radiotherapy equipment becomes more sophisticated and as radiotherapy treatments become more refined, it is right that the provision of radiotherapy should be restricted to a few centres. The question which then arises is: which ones?
912 The rest of the cancer services in the North-East Thames region, comprising the majority of treatments, will be improved under the regional health authority's proposals, and that should command some acceptance. We appreciate the deep feelings of local residents which my hon. Friends, including my hon. Friend the Member for Edmonton, have represented to us. If we are required to take a decision on this matter, I can guarantee to my hon. Friend that we will take those feelings firmly into account.
§ Question put and agreed to
§ Adjourned accordingly at three minutes past One o'clock.