HC Deb 13 January 1986 vol 89 cc898-904

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

12·30 am
Mr. Robin Squire (Hornchurch)

I begin in this inevitably short debate by welcoming my hon. Friend the Member for Romford (Mr. Neubert), within whose constituency lies the hospital of which I am speaking tonight and who, as hon. Members will be aware, is unable, due to his rank on the Treasury Bench, to contribute to our proceedings. I know from conversations with him that he echoes everything that I shall say tonight in defence of a proven and well-loved hospital and local unit.

Perhaps there is an additional reason for welcoming my hon. Friend, because back in April 1980 he initiated an identical Adjournment debate which reads as well now as I am sure it sounded on the occasion. Sadly, this is the second time in six years that hon. Members in the relevant health district have had to come to the defence of the radiotherapy unit at Oldchurch. I am pleased to say that my hon. Friend was successful in 1980, and I hope that I and other hon. Members pressing this evening for its retention will be similarly successful this year.

At the end of September last year the North-East Thames regional health authority published a report prepared by Coopers and Lybrand Associates, management consultants, which was issued, I stress, with the aim of improving the resources devoted to the treatment of cancer within the region. It is also important to stress that to date the report has neither been discussed nor approved by the regional authority. None the less, the central recommendation of that report is that the existing nine radiotherapy units within the region be reduced to five, four of these being in inner London and one at Broomfield, north of Chelmsford. Thus, the Oldchurch radiotherapy unit would be closed and we are led to believe by the regional officers that 90 per cent. of Barking, Havering and Brentwood patients would be expected to use Broomfield hospital.

The proposal to close that unit is simply unacceptable. It is unacceptable to the community health council and to the district health council, from whose reports I am tonight drawing considerable information. It is unacceptable to Barking and Havering local medical committee and to Havering borough council. Perhaps most important of all, it is unacceptable to the people of Barking and Havering who may have occasion to use the hospital and the unit and who, even more than in 1980, have demonstrated their support by signing petitions against its possible closure.

My hon. Friend the Member for Romford will remember that in 1980 we received some 60,000 signatures to retain the unit. Over the past few months 130,000 people have signed the petition in support of retaining the unit. One might therefore say that if my hon. Friend's persuasiveness, backed by those signatures several years ago, was sufficient, perhaps I should not say any more tonight, because the argument is overwhelming.

I emphasise tonight why opinion against this proposal is so united. It flies in the face of logic. Half of the regional population now lives in the region of Essex, and the regional strategy since 1978 has reflected the decline of the population in central London and the growth of the population in outer London and Essex. Despite this, the report proposes that four of the five centres should be in inner London, with only one centre for the whole of Essex. I can think of no better recipe for ensuring that a large number of people have to travel excessively long distances, and unnecessarily so.

Secondly, the original report was littered with errors—I have counted more than a dozen. The authority should be ashamed of that report, on reflection. It was wrongly claimed, for instance, that at Oldchurch hospital there was no planning computer or simulator. This is important, because the report referred to just such equipment to demonstrate the inadequacy of the treatment at Oldchurch hospital. However, both these pieces of equipment have been in use in the hospital for some time.

The estimates of the incidence of cancer in the North-East Thames area do not tally with those of the Office of Population Centres and Surveys, and, perhaps most important, the report's estimates of the times taken for journeys to the new centre are at best hopelessly inadequate, and in some cases simply untrue. This is, for many people, arguably the centre of the opposition of the report.

I have already said that it is expected that 90 per cent. of the people in the Havering and Barking district will be expected to travel to Broomfield. What will they face if they travel that way? The district health report says that if patients go by car from Barking to Broomfield they will take approximately 70 minutes in the most favourable traffic conditions. In the morning, late afternoon and early evening, travelling times can be very much longer.

By bus, people may go from Barking to Romford, taking 40 minutes, and then from Romford to Chelmsford—an hourly service—which will take approximately 55 minutes, forgetting the time that it takes to wait for the bus. The journey to Broomfield from Chelmsford is another 15 to 20 minutes, followed by a quarter of a mile to the hospital. The cost for that is £3.25 return. If they go by rail, simply from Romford to Chelmsford takes a half to three quarters of an hour, and then they have to get to Broomfield. If they come from Barking or Dagenham, they have to get to Romford first. The cost merely of going from Romford to Chelmsford is £3.80.

Hon. Members may wonder why I am quoting the cost, but pensioner constituents from Havering or Barking travelling outside London find that their concessionary fares do not operate, and they now incur an expense where one was not incurred before. I hope that hon. Members will recognise that that is a not unimportant factor for cancer patients, many of whom are elderly. The report specifically mentions, no doubt to recognise the excessive weight of travel, the provision of some 100 hostel beds at the Broomfield hospital. The implication of hostel beds that was made in the 1980 report has now been made a reality.

Hostel beds are no substitute for service at a local hospital near where one lives. I quote the Barking and Havering local medical committee, which says: Cancer sufferers particularly require the support of their families as a very important adjunct to the high technology therapy provided by the Cancer Treatment Centres and this can best be provided if the patient, while undergoing active treatment, and after treatment, can live at home with family and friends around. This support cannot be maintained in a hostel setting several miles from home with difficult access by public transport. It is not even equality of patient care.

Let us look, as I hope my hon. Friend will do, at the actual cost. I quote again from the community health council submission: The actual cost of providing a six week course of treatment at Oldchurch is approximately £100 per week—a far more economic way than by means of hostel treatment plus the necessary treatment at a centre elsewhere. All this is for patients who, by the very nature of their illness, are facing treatment that is debilitating and tiring and which, perhaps more than the treatment for many other illnesses, requires them to be treated close to where they live, rather than engage in unnecessary and lengthy transport. In the words of the report, Oldchurch hospital is the only centrally located regional cancer unit within the North-East Thames region. It is exceedingly well served by road and public transport, whether bus or rail, from virtually anywhere within Barking and Havering.

The hospital has a department which works closely with the neurosurgical, gynaecological and ENT departments, all of which are at present on the Oldchurch site, and none of which as yet exist on the Broomfield site. Hon. Members who were present at a lobby here a few months ago will remember how consultants stressed the importance of the link between such departments and the treatment of cancer service, not least because often patients who attend one department are found to have potential cancer needs, and vice versa. It is important that we take advantage of the existence of those departments on the present site.

The report states that attention should be given to the need to specialise for certain rarer types of cancer treatment. Hon. Members recognise that need, but let it not be at the price of requiring the large majority of patients who are suffering from the more common forms of illness to travel long distances. It does not have to lead to that. To suggest that specialisation requires the closure of local hospitals is a false and misleading theory.

Oldchurch is a much loved and supported hospital. The voluntary support which sustains it is considerable. Last Thursday the radiotherapy unit took delivery of a new £1,500 computer which was bought entirely from voluntary funds. That is a tiny fraction of the £45,000 collected by a prominent local personality, Mrs. Nellie Sims, from outside her local florist shop, all of which has gone to provide equipment or furniture for the unit. Those figures give an indication of the popularity of the hospital and the way in which the community supports the existence of the present unit.

Since May an appeal has been launched for £1 million to buy a body scanner for the hospital. The appeal is headed by Steve Davis—a well-known international snooker player. In seven months the appeal has raised £250,000, and by Easter those concerned expect to order the scanner. Those are tremendous sums and are a great tribute to the community. That would not happen if the hospital were not regarded as an integral part of the community.

Time will not permit me to go into all the alternatives. The district authority has submitted plans for an enlargement of the Oldchurch site, which should be considered closely as a more credible and reasonable alternative. I welcome steps to increase the funding for radiotherapy in the North-East Thames region in general, but not at the price of closing Oldchurch hospital.

I have two personal reasons for feeling strongly about the matter. My father-in-law has just finished a course of treatment at the radiotherapy unit and, like all other patients at the unit, is full of praise for the care and attention which he received. I would hate to see him at 77 having to spend such a large amount of time each and every day for five or six weeks travelling backwards and forwards on long journeys unnecessarily. Similarly, I would object on behalf of all my constituents who faced a similar journey.

Secondly, my hon. Friend the Member for Romford and I remember standing out in the cold on Budget day 1980 to receive the petition organised by, among others, a lovely and vivacious lady called Brenda King, herself a cancer sufferer. We undertook to do what we could to save the radiotherapy unit at that time and we succeeded. A year or two later, Brenda King died. She is commemorated by a stone at the hospital, but the best commemoration for her would be not just for us to see off the threat to our local unit once again, but for my hon. Friend the Minister and the regional health authority to find a way to remove the periodic threat faced by a local service which, as I hope that I have shown in this short debate, is needed, is well supported and must continue.

12.45 am
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I congratulate my hon. Friend the Member for Hornchurch (Mr. Squire) on taking the opportunity of the first Adjournment debate of 1986, on a day which has been of considerable interest in the House, to raise a subject of crucial importance and concern not only to my hon. Friend and his constituents but to a number of other Members present today and their constituents. Following the exchange in the House on 10 December, when I answered a question from the hon. Member for Tottenham (Mr. Atkinson), I am aware that the subject has caused a great deal of controversy not only in Essex but in north-east London. I also look forward to the Adjournment debate on Wednesday when my hon. Friend the Member for Rochford (Dr. Clark) will be discussing the future of the radiotherapy unit at Southend. If, in the time available to me today I am unable to cover all the points raised by my hon. Friend the Member for Hornchurch, I hope to do so in writing after the debate.

It is important to place the issue in perspective and I am grateful for this opportunity to do so as we must all take careful account of the concern caused by the North-East Thames regional health authority's review of cancer services. Some of the reactions in the region generally, and perhaps in my hon. Friend's constituency, have involved a certain amount of misconception about what is at stake. It is right that the issues at stake should be debated fully, but we must set the terms of that debate on a fair, clear and sound basis, as my hon. Friend the Member for Hornchurch sought to do in his contribution today.

Mr. Frank Dobson (Holborn and St. Pancras)

Not on the Coopers report.

Mr. Whitney

The hon. Gentleman may have his own views about that report, but I am responding to the contribution of my hon. Friend the Member for Hornnchurch to today's debate.

First, we must consider the motives that led the regional health authority to decide upon a reveiw of its cancer services. I am sure that my hon. Friend recognises that it was not a matter of looking for savings as a result of some financial straitjacket. My hon. Friend will appreciate the considerable expansion that has taken place nationally with the devotion of an increase of some 20 per cent. in real resources to the Health Service generally, supplemented in the coming financial year by an increase significantly higher than the projected rate of inflation. That is a reflection of the concern manifested by the Government and by the Department in providing adequate health services.

Cost-cutting was not the purpose of this project. The aim was to consider the way in which services, including radiotherapy, were provided for people suffering from cancer and to ascertain the methods available to the region to improve their quality. That was the mainspring of the exercise.

It is not for me to judge whether the report got the project right. I hope that hon. Members agree that setting such a review in motion was a justifiable venture by the regional health authority. The need was clearly set out in the regional strategic plan, which was published in July 1984. I hope that hon. Members agree that it must be right for regional health authorities constantly to take hard looks at the services they provide, or services will stagnate and we shall not improve patient care.

The proposals involved in these reviews are often unsettling and difficult to accept. We should as a principle recognise at the start that it must be right for the Health Service and the health authorities to debate these issues. There cannot be a sensible and constructive debate if we instinctively attribute reasons for a proposed change to a desire to save money. I hope that my hon. Friend the Member for Hornchurch recognises that.

Mr. Dobson

Will the hon. Gentleman give way?

Mr. Whitney

I recognise that the hon. Gentleman will always achieve that particular misattribution. I hope that he will be brief.

Mr. Dobson

I think that I speak for hon. Members on both sides of the House. I have heard no one suggest that this exercise is intended to save funds. I think that the concern in north-east London and in Essex is that the exercise is based on an extremely shoddy, second-rate and inaccurate estimate of people's needs. No one is accusing the health authority of trying to save funds.

Mr. Whitney

If we have achieved acceptance by the hon. Member for Holborn and St. Pancras (Mr. Dobson) that in this instance it is not a matter of saving funds, we have already made progress in the debate.

The report argues the medical case for concentrating specialised cancer services, including radiotherapy, in specialised centres. It believes that that would improve the quality of care and service provided to patients. Is the report right in proposing that the north-east Thames region needs five such specialised centres, compared with the present nine radiotherapy units? More controversially, if there is agreement on five of these specialised centres, where should they be located? I note the point made by my hon. Friend the Member for Hornchurch about the concentration in London, leaving just one centre in Essex. The report maintains that its proposals would improve services to patients in the whole region.

These are intrinsically difficult issues. They are not made more difficult or controversial by the report.

One of the points that always arises is that of accessibility. Many of the services required by cancer patients can and should he provided in every district, as my hon. Friend said. As I understand it, the report is clear on that point. More specialised services cannot be provided, not because there are insufficient resources but because it does not make medical sense to provide them.

Services such as radiotherapy must be established to serve a relatively large population so as to attract sufficient patients to enable clinicians to sustain and develop their expertise. If there is too wide a dispersal of facilities and staff such expertise is not developed, and that is detrimental to good patient care.

The issue in the case of North-East Thames is not just the number of centres but their location. In an ideal world, everyone would have immediate access to all the services that they need. For the reasons that I have given, that would not be medically feasible, even if we had unlimited financial resources.

With specialist care we must draw the balance between poorer access to a more distant but potentially better service. Those are the issues raised in the report. It is not for me to judge the arguments for or against those or any other points. The position is clear. As my hon. Friend said, the report was put out to public consultation in September 1985 and the comments ended on 31 December 1985.

The health authority's working party has now been charged with reviewing the report, and its findings will be considered in die spring by the authority. I have no doubt that the points made so effectively by my hon. Friend will be taken fully into account when the authority comes to consider the report and the working party's findings.

Should the region agree to changes in the way that cancer services are provided either those recommended in the report or those arising after full consultation and debate—there will then be, as my hon. Friend is aware, full local consultation in the usual way. If the proposals for changes or closures are opposed by the relevant community health councils the matter will be referred for a decision via the region to my right hon. Friend the Secretary of State.

The views of the Barking, Havering and Brentwood DHA to any proposal to change the nature, size or location of the specialised care currently given at Oldchurch hospital will plainly be important. The RHA will no doubt pay close attention to them. The location of regional specialty services has however to be discussed on a wider basis to see what is finally in the best interests of all the region's patients. The effect on the hospital as a whole of any proposed closure of the Oldchurch hospital unit will need to be assessed. It would not be appropriate for me to prejudge the issue except to say that there are innumerable district general hospitals which do not have this service.

I am sure that the regional health authority will take full account of the worries that have been expressed, but I hope that my hon. Friends will convey to their constituents, who are anxious—I recognise the depth of their anxiety—that as I understand it this proposal was designed for and committed to the improvement of those vital services and to the development of specialised cancer treatment services within the region and the area. I hope that the debate will be carried forward on a firm understanding of the principles and without—

The Question having been proposed after Ten o'clock on Monday evening and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at One o'clock.