Orpington Hospital (Hansard, 10 February 1986)

§ Mr. Ivor Stanbrook (Orpington)

I am grateful for the opportunity to bring to the attention of the House the problem of the future of Orpington hospital. There is considerable anxiety in my constituency about the development of the hospital, and I hope that my hon. Friend the Minister will be able to provide reassurance on a number of points. I am grateful to my hon. Friend for being here.

The stages in the progress of Orpington hospital from its origin as a hutted encampment to its destiny as a full-blown district general hospital has been reported by me to the House in Adjournment debates from time to time and almost annually over the past five years. The history is one of erratic and slow progress marked by setbacks and changes of policy which have at times undermined the viability of the hospital as the intended district general hospital for the southern half of the Bromley health district.

The Government have proclaimed their attachment to the National Health Service, and one understands that the amount of public money being spent on the nation's health nowadays is in real terms greater than ever before. Unfortunately, that is not always the impression given locally when hospitals are closed or reduced in size or services on the ground of financial economies. I hope that my hon. Friend will be able to show my constituents that the problems arising for Orpington hospital are not in any sense due to an overall reduction in funding.

The origin of Orpington hospital was a military hospital built with temporary materials by the Canadian Government during the first world war. When the Canadians left, the 30-acre site filled with single-storey wooden buildings and Nissen huts was taken over to serve local needs. Comparatively little was spent on the buildings themselves for many years, but the hospital, because of the quality of the staff and the support of the local people, attained a high reputation.

In the 1970s capital funds were allocated for the rebuilding of the hospital and the replacement of the huts by fine modern buildings. The most recent development is the construction of a modern surgery block — the Ontario wing—which cost over £8 million and is part of an overall strategy intended to provide a district general hospital on the site. The strategy of the Bromley district health authority is to have two district general hospitals, located at Bromley town in the north and Orpington in the south, to be completed by 1993–94 and to centralise all acute, general and surgical services on them with 600 and 470 clinical beds, respectively. That is a satisfactory arrangement for Orpington.

The site is well placed to serve the fastest growing part of the health district. At present it serves a population and patients spreading far south into Kent and the constituencies of my hon. Friends the Members for Chislehurst (Mr. Sims) and for Sevenoaks (Mr. Wolfson) and my hon. and learned Friend the Member for Tunbridge Wells (Sir P. Mayhew). It is the nearest hospital in southeast London to the M25 motorway which, in the future, may be the source of casualties needing urgent treatment. The hospital stands on a healthy green field site of 30 or 758 more acres, so there is plenty of room for expansion, unlike the site of Farnborough hospital nearby, which is in 19th century buildings and is very congested.

Faced by a need to make ends meet two years ago, the district health authority adopted a number of economies, one of which was the overnight closure of the accident and emergency services at Orpington hospital. An average of ten patients per night were turned away from the hospital—for an estimated saving of £70,000 per annum. Emergency cases locally, including those arising in Kent, out of office hours, must now be taken elsewhere, six miles further on, to Bromley or Sidcup. As a result, the hospital lost its status as a major accident centre. When the horrendous pile-up in fog on the M25 occurred two years ago, with many casualties, they had to be taken virtually past the hospital gates into Bromley. The overnight closure of the casualty service at Orpington was provisional. It has not yet been confirmed by the Minister, and I hope that it will not be.

A full-time accident and emergency service is a prerequisite for a full-blown district general hospital. The absence of such a service is bound to have a depressing effect on staff and on the recruitment of highly qualified people.

More recently, however, we have had an astonishing proposal from the district authority. In an attempt to get its sums right, it saw fit to recommend the downgrading of Orpington hospital in favour of the hospital at Farnborough, which it recommended should be designated as the site of the proposed district general hospital. The suggestion seems to have come originally from the professionals at Farnborough, who calculated that the total outlay of public funds could thereby be reduced. There was, however, a violent storm of protest in Orpington. Petitions were organised and public meetings held. One that I attended, in the biggest available hall, was so large that hundreds of people were turned away. The strength of local feeling in support of Orpington hospital was amply demonstrated. Fortunately, the district health authority gave way and, with some help, or perhaps pressure, from the regional authority, reinstituted Orpington as the site of the district general hospital.

After that, the planners went back to their calculators. They produced a new plan, accepting the emergence of Orpington ultimately as one of the two district general hospitals by 1993–94; but, pending the capital investment needed to implement the strategic aim of having two district general hospitals at Bromley and Orpington, they proposed to save revenue by running down Orpington's general medical services and transferring them to Farnborough.

That plan is inconsistent with the ultimate objective of district general hospital status for Orpington, and it has not found favour with the regional authority, which has promised more co-operation in solving Bromley's temporary financial problems. There are a number of steps that the regional authority could take to help Bromley district health authority, besides making capital development funds available. If, for example, it would be easier and less costly to run services when they are concentrated on the two sites, any repayments of loans and any impositions of the regional RAWP formula should be adjusted to the latter part of the period of redevelopment rather than spread equally over the whole period.

I conclude by asking my hon. Friend the Parliamentary Under-Secretary three questions. First, will he confirm 759 that Orpington hospital will be developed as a district general hospital once and for all? Secondly, will he tell us what will happen to Farnborough hospital? Thirdly, will he confirm that whatever changes are made elsewhere, Orpington's general medical and surgical services will not be run down meanwhile? If I can have his assurances on those points, I am sure that my constituents will rest content and endure stoically the minor changes and economies that may be forced upon the authority by the redevelopment. Changes and economies there always have to be, but please do not let us have any that will put the future of Orpington hospital into doubt once again.

§ The Parliamentary under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I hope that in responding to my hon. Friend the Member for Orpington (Mr. Stanbrook) I shall be able to offer assurances to enable him and, more importantly, his constituents to rest content. I am glad to have the opportunity to spell out the future position of Orpington hospital as we understand it in the Department. I congratulate my hon. Friend on the constant attention that he pays to the health provision, as with all other provisions, of his constituents about whom he is intimately and passionately concerned.

My hon. Friend mentioned the national expenditure on the National Health Service, and quite rightly, because it is important. In all the concerns about the changing and improving pattern of the delivery of the NHS, it is forgotten all to often that, in real terms, increasing amounts of taxpayers' money is devoted to the Health Service. We are proud of the fact that, since we came to office in 1979, there has been an increase of more than 20 per cent. In 1986–87, spending will increase by £650 million and not by £670 million, which I quoted incorrectly in a debate on 5 February. The increase of £650 million represents an increase of 6.7 per cent., which is about 2.2 per cent. more than the forecast rate of inflation. Further increases are planned in the following two years and also further increases in capital spending. As my hon. Friend rightly said, in total, national spending on the Health Service is increasing in real terms. The question is how that affects our constituencies and its impact on our constituents.

My hon. Friend referred to the now famous RAWP—the resource allocation working party. The policy of redistributing resources between different parts of the country will continue. Those regions which have historically received less than their fair share of resources or which have rapidly increasing populations will receive the larger increases, ranging up to 8 per cent. The decisions on the 1986–87 allocation reaffirm our commitment. As regions move closer to their targets, it becomes increasingly important that the targets are themselves a reasonably accurate measure of need. We have therefore asked the NHS management board to review the operation of the formula, in particular the way in which relative needs in different parts of the country are measured, taking account of such factors as the patterns of illness across the country, and the special problems of the inner cities. I mention that, because it is important to understand that the RAWP allocation is carried out in a sensitive manner while trying to take the best possible account, within a steadily increasing global total, of the special demands and requirements of each district.

760 South-east Thames, in which my hon. Friend's constituency falls, is a RAWP loser—as the jargon calls it. It was 13 per cent. above target when RAWP was introduced in 1977–78 and in 1985–86 it is 5.6 per cent. above target. However, its position is better than originally assumed following the December statement made by my right hon. Friend the Secretary of State for Social Services. It will be receiving an increase of 5.8 per cent. compared with forecast inflation of 4.5 per cent.

One priority task that the region has set for the strategic period up to 1994 is the correction of the gross imbalance of funding within its districts. Sadly, that is not good news for Bromley, which is a RAWP loser. Its current revenue funding is 105.7 per cent. of its RAWP target and it is planned to reduce that to 100 per cent. by 1993–94. Therefore, there is no doubt that the district is facing financial problems, and a fundamental cause of that is the high number of acute beds in the district, scattered over as many as four sites. That inevitably leads to an inefficient use of resources and a needless drain on revenue that is in heavy demand in other parts of the NHS.

My hon. Friend has mentioned the scatter of beds in the health authority area. The Farnborough hospital is about two miles from Orpington and there is some duplication of services in general medicine and surgery. Not surprisingly, patient throughput, or the efficient use of beds is very low, with a death and discharge rate of 36.7. That is also the national figure on that NHS performance indicator. The corresponding figure for Bromley is 31.2. Nearby, Maidstone shows what can be achieved by the efficient use of services. It has a figure of 41.7.

The health authority was required to look for remedies, both short term and long term. Those remedies have come into conflict in Orpington and led to the turbulence that my hon. Friend described.

Detailed options are still being discussed, but there is agreement between the region and the district that Farnborough hospital should close within the strategic period, or not too long thereafter, and that beds should be concentrated at Bromley and Beckenham in the north of the district and at Orpington in the south. The overall number of acute beds in the district would reduce from the present 659 to 566, bringing about a considerable and lasting saving of resources, without any sacrifice of patient care. That is an important point.

As for the short-term future, several rationalisation measures have been proposed. There has been a history of abortive consultations and it would be complicated and perhaps pointless to go into details, but in December, those measures and others taken under the urgent temporary procedure in the spring of 1985, together with further measures still to be implemented, were presented as a package to the health authority. These measures, and others as yet unimplemented, have been the source of the latest contentions.

One proposal was the transfer of gynaecological and orthopaedic services from Beckenham which would have concentrated wholly on the care of geriatric patients. That was seen as workable and worthwhile, but trouble arose over the suggestion that gynaecology beds should be transferred to Farnborough hospital, where all acute beds in the south of the district would be concentrated, and that the number of acute beds in the district should fall drastically from 659 to 529.

Reaction from the region has been felt, although the proposals have not been officially presented to the region. 761 I understand that there was a meeting of the regional chairmen and the chairman of the district on 15 January when it was agreed that the proposals affecting Farnborough and Orpington hospitals and the massive reduction in acute beds were simply not acceptable. I understand also that the district has accepted that view.

The region has tried to be positive in suggesting other ways in which savings might be made, for example by rescheduling repayments of capital, deferring schemes jointly financed with the local authority, rationalisation at Cane hill hospital and other measures. The district can expect to come within about £500,000 of its expected 1986–87 shortfall — a sum which, with firm management, should be achievable without sacrifice of patient care.

The region's suggestions will be discussed fully at the district health authority meeting in February. Should it be necessary for the DHA to consult formally local interested parties or others on its proposal, and if the Community Health Council objects, the matter may have to come to Ministers for a decision. If that happens, I assure my hon. Friend that we will take into account all factors, including those that he has mentioned.

My hon. Friend kindly advised me of the three particular points that he wished to put to me. He asked whether the future of Orpington hospital was secure as the district general hospital serving the southern part of the district. My answer is a firm yes. There has been some recent speculation that acute services may be centred at Farnborough hospital, leaving Orpington to concentrate on the care of elderly and orthopaedic patients. That speculation resulted from proposals that had strong medical backing put to the DHA meeting in December. Those proposals will, however, categorically not be put into effect. At a meeting between the regional and district 762 chairmen and their senior officers on 8 January, it was agreed that the proposals ran counter to the district's longterm strategy to close Farnborough hospital within the strategic period and focus district general hospital facilities at Orpington.

My hon. Friend asked about the future of Farnborough hospital. It is the district's long-term intention—10-plus years—to close Farnborough hospital, which is only two miles distant from Orpington. If that does not happen, Farnborough may be transferred into a smaller unit specialising in the care of elderly and elderly severely mentally infirm patients.

My hon. Friend's final question was whether I could confirm that acute services at Orpington will not be run down. Again, my answer is the affirmative. The district's long-term plan is to concentrate acute services at Bromley hospital in the north of the district and at Orpington in the south. Bringing acute beds together on two rather than the present four sites may mean a reduction in the district's current overall number of acute beds, but, with careful rationalisation, that will not entail any sacrifice in patient care.

I hope that I have said enough to reassure my hon. Friend about the future of Orpington hospital and the keenness with which the district, the region and the DHSS have followed the discussions on the provision of services, recognising the undoubted pressures that exist, but which apply, as my hon. Friend would be the first to say, to the NHS as a whole. Within the national resources that are increasing in real terms, I am convinced that the health care available to my hon. Friend's constituents will continue to improve in quality and, where appropriate, in quantity.