HC Deb 15 January 1986 vol 89 cc1183-90

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

11.1 pm

Dr. Michael Clark (Rochford)

I wish to discuss an issue of great importance to south-east Essex. I start by expressing appreciation to the local press, which has shown a great interest in the matter, and to the senior surgeon of Southend hospital, who has done the same.

Southend health authority includes Rochford in my constituency and is under North-East Thames regional health authority, as is Oldchurch, the hospital that my hon. Friend the Member for Hornchurch (Mr. Squire) talked about on Monday evening. So far during 1986 two thirds of the Adjournment debates have been on this one subject. It is significant that North-East Thames regional health authority has come under so much criticism.

At the beginning of my speech I should like to thank my hon. Friend the Member for Southend, East (Mr. Taylor) for his support this evening. I know I speak for him in many of the things I have to say. Southend health authority is gravely underfunded to the tune of about £6 million a year. Yet it is in a region that is overfunded. That is causing much concern in Southend. How can we manage when we are £6 million short per annum?

To give a little background to the North-East Thames regional health authority, it has five medical schools, more than any other region. Because of boundary changes in 1974 and 1982, the Middlesex hospital, University College hospital and the Royal Free came into that health region. As a result, we have nine radiotherapy units and we have had many staffing problems with senior registrars. It is the London end of the region, not the Essex end and not Southend in particular, that needs sorting out. It is totally wrong that, through an accident of history and boundary changes, Essex should suffer and London should not be sorted out. Essex comprises half the population of the North-East Thames health authority and south-east Essex comprises half the population of Essex.

I referred earlier to the underfunding at Southend. That is due to the region's inability to tackle the problems in London. It is now ironic in the extreme that the region, in trying to rationalise, rather than closing hospitals in London, is proposing to remove the radiotherapy unit from Southend. I know that my right hon. Friend the Member for Southend, West (Mr. Channon), the Minister for Trade, will agree with my comments. I am delighted that he is present this evening. I realise fully that his ministerial office precludes him from speaking on the issue this evening. However, I believe that I shall be saying many of the things that he would wish to say.

With nine centres for radiotherapy treatment, six of them lie in a four-mile radius on the western edge of the region. The two that lie to the east are Southend and Colchester. It is clear that these locations are not ideal, but the North-East Thames regional health authority proposes to keep four out of six of the London radiotherapy centres and to close both the Essex centres. It is proposed to open a new one at Broomfield near Chelmsford. Perhaps we need to have a radiotherapy centre in the middle of Essex, and perhaps at Broomfield, but not at the expense of Southend.

The four units that will be left in London provide treatment for patients in the North-East Thames region and for patients in the three other Thames regions that join with it. I understand that 75 per cent. of the Middlesex hospital's patients come from outside the region. Perhaps it would be fair to conclude that the underfunding that the Southend health authority has to endure is caused to a large extent by the fact that on the western edge of the region we are treating patients from other regions and not receiving any recompense for so doing.

What is the solution to the problem? I believe that it is to have a full cancer treatment unit at Southend. However, it appears from the report that the Southend option has not been evaluated fully, despite the fact that the team points out that the least expensive option would be to maintain and improve a centre outside London.

The centres that it is recommended should remain open are the ones which involve patients having to travel a long way to receive their treatment. Patients have to travel 61 minutes on average to receive treatment at the Middlesex hospital. The average travelling times for patients receiving treatment at the London hospital, St. Bartholomew's and the Royal Free are 55 minutes, 47 minutes and 37 minutes respectively. Yet the North Middlesex hospital, where the patients in the catchment area have to travel only 33 minutes, will be closed. At the Southend hospital, with patient travelling time of only 35 minutes, the radiotherapy centre is also proposed for closure.

It is proposed in the report that the patients from Southend should be transferred to Broomfield or to London. It is acknowledged that such transfers will involve long journeys because it is proposed in the report that hostels should be provided for those who have to travel these long distances.

It is also mentioned in the report that if the centre were at Southend it would be difficult for half the people in the catchment area to reach the hospital. The converse is that half of those in the catchment area find it very convenient to travel to the Southend hospital. The proposals will merely reverse the two halves of the catchment area.

The report has been described by the medical consultants at the Southend hospital as a waste of £80,000 of public money. It is riddled with errors. There are pages of errata and I can still find some factual and numerical errors that are not listed. It is said that the exercise is not a cost-saving one. If it is not, goodness only knows what its advantages are.

When the team set about reviewing therapy treatment in the North-East Thames region, no consultant surgeons were on the review team, nor a consultant haematologist, despite the fact that both groups of medical experts provide a considerable proportion of the cancer treatment in Southend and elsewhere. It is not surprising that the report was rejected unanimously by the medical staff at Southend hospital.

There has been no consideration given, as it appears in the report, to cancer treatment overall in London. As I have said, in London four regional health authorities come together. It would surely be sensible to consider the London provision in total rather than a quarter at a time. Yet we learn that the same team from Coopers and Lybrand will be undertaking another survey for North-West Thames, again in grand isolation. One performance index that is used in the report is the number of radiotherapy courses that each hospital provides, and conclusions are drawn from that. However, no account is taken of the fact that each hospital has a different number of linear accelerators. If we consider the number of courses per linear accelerator, we find that Colchester, which is to be closed, is top of the list. Southend is third or fourth. St. Bartholomew's and Middlesex, which are to be kept open, are at the very bottom. St. Bartholomew's has a usage of its linear accelerator of only 37 per cent. of the usage of all the other hospitals, when averaged out. It is clearly the wrong decision to keep these four London units open and to close Southend.

It is also assumed that we can have a regional cancer unit only where there is a CT scanner and so Broomfield is chosen, but that CT scanner is fully loaded and a new one will be needed soon. By the time the transfer takes place in 1991, it is thought that the CT scanner will be obsolete and that nuclearmagnetic resonance scanners will be used instead. So why can Southend not make a bid for one of those and keep the unit at Southend?

The report also assumes that 97 per cent. of Southend's patients will go to Broomfield and that 3 per cent. will travel to London, and yet all the communications in Essex are east-west, or from mid-Essex are radial into London. It is not practical to have communications between Chelmsford and Southend. For example, at present only 4.5 per cent. of patients from mid-Essex come into the Southend area for treatment.

The report ignores the fact that withdrawal of radiotherapy from Southend will have a detrimental effect on acute services at Southend hospital, indeed rendering some of them non-viable. Those of us who take an interest in Southend hospital are very worried that a loss of centres of excellence will mean that Southend hospital will no longer attract top consultants, not only in radiotherapy but in other medical specialties too.

There are no plans in this report to have gynaecology or ear, nose and throat units at Broomfield, but the report does say that the impetus which the regional cancer unit will provide should lead to fresh evaluation of these plans, meaning, presumably, that gynaecology and ear, nose and throat units will be provided at Broomfield in due course, again, perhaps, at the expense of Southend.

The report also says that the unit to be established at Broomfield will be of such a size that it will be twice as big as the units established in London. The Broomfield unit will, in fact, be as large as St. Bartholomew's and the Royal Free put together—far too large and impersonal.

So what conclusions do we reach? What should we do? I am certain that we should have a unit at Southend. We should obtain this by perhaps closing the radiotherapy unit at St. Bartholomew's or at the Middlesex hospital. By all means let us have a radiotherapy unit at Broomfield, but let it be the same size as the units that will exist in London: in other words, half the size proposed in the report. We can then retain the radiotherapy unit at Southend where we already have ear, nose and throat, gynaecology and haematology specialties.

Paragraph 33 of the report draws together criteria on which the location of the cancer treatment unit should be based. It says that there should be sufficient patient throughput"; an adequate range of services including radiotherapy and medical oncology"; modern machinery"; it should be on the site of a district general hospital; it should avoid excessive travel for patients"; it should be on a site where clinical trials, teaching and training go on. Southend meets every one of these criteria. The report is not acceptable, and should not be accepted.

I would like to read a few extracts from a letter that I received only yesterday. I have received many letters on this subject, as have, I am sure, my hon. Friend the Member for Southend, East and my right hon. Friend the Member for Southend, West. Many have come from old people; many have come from those who have assisted others to travel for radiotherapy treatment but this letter is from a young mother of 31. I shall quote extracts from the letter of this cancer sufferer who attends Southend general hospital. She says: I am 31 years old and have two children … The proposed move of the Southend Radiotherapy Department to Broomfield has just added to the stress and anxiety that I and fellow patients have had to endure. I live five miles from the hospital and am fortunate to be able to drive myself to and from daily treatment. The total travel time is approximately thirty minutes which is endurable. I could never have coped with the ninety minute journey to Broomfield each day. I also have to arrange for my children to be cared for in my absence. I can only manage this with the kindness and goodwill of friends, as I have no relations living nearby. She implies that, if she were away from home longer, she might not be able to find people to look after her children.

She says: I have received excellent service at Southend General from a very caring team of professionals … To have to stay in a hostel, as is proposed for Broomfield, away from those I needed most, would have considerably increased the anguish and distress I suffered … The travelling time for already very ill and distressed patients would be increased, bringing misery and hardship. I feel that the level of patient care would fall dramatically due to the size of the new unit. This will surely outweigh any financial benefits that a centralised unit would offset … I have not read one press report or spoken to any individual to date who is in favour of the scheme of moving cancer treatment miles away from the most heavily populated area of Essex. Neither have I. I have not come across a constituent, medical specialist, Member of Parliament, press reporter or anyone else who thinks that this is a good idea. I call upon my hon. Friend the Under-Secretary of State to reject the report, to think again, to leave the unit at Southend and to boost it.

11.16 pm
Mr. Teddy Taylor (Southend, East)

rose—

Mr. Deputy Speaker (Mr. Harold Walker)

Order. The hon. Member needs the, consent of the hon. Member for Rochford (Dr. Clark) and the Under-Secretary of State to intervene. If it is given, the hon. Member may proceed.

Mr. Taylor

I congratulate my hon. Friend the Member for Rochford (Dr. Clark) on raising this important issue. I assure the House that all hon. Members who are covered by the Southend health authority agree absolutely with everthing said by my hon. Friend.

I appreciate that this is a matter for the region. I am sure, however, that the region will bear very much in mind the views of my hon. Friend the Under-Secretary of State. I hope that he will confirm that the Government believe that health care is an exercise not just in accountancy but in the care of people. I hope also that my hon. Friend the Under-Secretary of State is aware of the profound resentment over many years about underfunding. That resentment will increase if this proposal is accepted.

I thank my hon. Friend the Under-Secretary of State for giving me a minute to say those words.

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

I am happy to have the opportunity to reply to the powerful points put by my hon. Friend the Member for Rochford (Dr. Clark) and the effective points graciously and briefly put by my hon. Friend the Member for Southend, East (Mr. Taylor). I am grateful to my right hon. Friend the Member for Southend, West (Mr. Channon) for being here tonight. I recognise the vows of silence and virtues that his position requires of him.

My hon. Friend the Member for Rochford pointed out that two thirds of the Adjournment debates so far this year have focused on the backwash of the review of cancer treatment services that has been commissioned by the north-east Thames region. Had I not been aware of that concern before, I certainly would be by now. I ask my right hon. and hon. Friends to pass on my assurance to their constituents that their concern is recognised and to pass on also my points about the situation, as I understand it, on the basis of a review called for by the region. I should like to correct a number of misconceptions.

It is important to understand why this review was put in hand. My hon. Friend the Member for Southend, East in his succinct remarks made reference to the financial issues. I hope it is accepted that the idea that the review was instigated simply to save money is not correct. The basis for the review was to look at the way in which the services, including radiotherapy, for people suffering from cancer are currently provided within the region's area, and to see whether those services could be improved. I take the point made by both my hon. Friends about the quality of service to their constituents being the point at issue. This is why the review was launched, and the review and then the region must achieve the best solution.

At this stage it is not for me to say whether the report has got it right. I am well aware that some people hold the view that the report has not got it right. I am bound to say I am not too impressed by the fact that my hon. Friend the Member for Rochford suggested that one or one or two press reporters said the review had got it wrong. I am not impressed by their opinion, but I am impressed by the worries expressed by my hon. Friends and their constituents and it is important for that to be taken into account.

Dr. Michael Clark

And the medical profession.

Mr. Whitney

I will certainly come to that: that must be taken into account. I have no doubt that our proceedings tonight and on Monday will be taken into account by the regional health authority. The need for a review of the service was clearly set out in the regional strategic plan published in July 1984. I hope my hon. Friends will agree that this approach as a principle must be right.

We are looking for a continually improving Health Service and that is why we continue, in real terms, to put more of the nation's resources into the Health Service. Since 1979, 20 per cent. more in real terms has been devoted to the Health Service, and the projection for the next financial year is that our increase will probably be 2 per cent. above the rate of inflation. Our commitment to devoting an increasing amount of resources to the Health Service is clear, but we must also look at the way those resources are used, or the service will stagnate. This often means that changes are required and, of course, changes are unsettling and sometimes difficult. I hope that none of us will feel that the Health Service has no right to debate such issues. That must be what a sensible service is about. This review was to look at exactly the sort of service that is needed.

The report argues the medical case for concentrating the specialised cancer services. I suggest to my hon. Friends that it is important to accept that concentration of specialised services, including radiotherapy, into specialised centres. The report believes that would improve the quality of care and the service to patients. That is the first issue to be debated: is the report right about that?

It may be that some of my hon. Friend's medical consultants and specialists in Southend did not agree with the conclusions. I would certainly not say they are wrong, but it is fair to recognise that the medical chairman of the review team, Professor Whitehouse, is a distinguished specialist in the field. He is the professor of medical oncology at Southampton university. His conclusion and the conclusion of his team was that there should be five specialised centres, compared with the existing nine radiotherapy units. Should there be five? I am not saying whether there should be or not, but if so, where should they be?

That leads us to yet another difficult issue. There are special cases which have the problems of accessibility to which my hon. Friend the Member for Rochford referred tonight and to which my hon. Friend the Member for Hornchurch (Mr. Squire) referred on Monday night. That matter will be taken into account when the regional health authority considers the results of its working party.

Many of the services needed by cancer patients can and should be provided in every district. The report is clear about that. My hon. Friend the Member for Rochford read a letter from his lady constituent. I do not know the details of her case, but to reassure her I ask him to tell her that this is not a matter of the elimination of a service.

We are talking about specialised services, and by definition, they cannot be everywhere. It is not a matter of resources. It makes no more medical than economic sense to provide the degree of specialisation about which we are talking. Services such as radiotherapy must be established to serve a relatively large population to attract sufficient patients to enable clinicians to sustain and develop their expertise. Too wide a dispersal of facilities and staff, and such expertise is not developed and the increasingly high standard of patient care for which we are looking is not achieved. That is one of the problems that must be tackled by the RHA. It is one with which the review team sought to deal, but clearly not to everyone's satisfaction.

I hope that my hon. Friends accept that a valid exercise was conducted. A balance must be struck between poorer access with greater travel problems and a better service. This is not merely a matter of finance.

It is not for me or my right hon. Friend to make a judgment on this case. My hon. Friends will recognise the process. The report was put out to public consultation in September 1985 and the period for comments finished at the end of the year. The health authority's working party has been established and the health authority will consider its findings in the spring.

If the RHA agrees to changes—those recommended or others arising from the full consultation and the debate, of which this is part—then in the usual way there will be local consultation on any changes to local services or closures. Again, in the usual way, if any of the proposals are opposed by any of the relevant community health councils then the matter will be referred, via the RHA, to my right hon. Friend the Secretary of State for a decision. In those circumstances, I am sure that my hon. Friends understand that it would not be appropriate for me to comment in detail on the proposals at this stage.

It must be right that regions can launch reviews and examine better ways of producing a higher standard of specialised patient care in any faculty.

My hon. Friends the Members for Rochford and for Southend, East referred specifically to Southend's financial position. In resource allocation working party terms, Southend is an underfunded district in an overfunded region. My hon. Friend the Member for Rochford referred to £6 million. I understand that that figure is the amount by which it is estimated that Southend is below its target. In other words, it is 17 per cent. below its target. The latest revision shows that Southend is about 5 per cent. below its target, or £2 million below it on an allocation of £40 million. Be that as it may, the region is firmly committed to the policy of securing a fairer distribution of resources between its districts. I understand that in the financial year 1985–86 the region has allocated extra funds—about £500,000—to Southend. I hope that that is accepted.

My hon. Friend the Member for Rochford referred to London needing to be sorted out. Perhaps it does need that. The movement of RAWP towards ensuring that there will be greater equality in terms of services and provision is recognised and accepted, but it has to be brought about at a measured and tolerable pace, otherwise the consequences, even within an expanding budget, given the increase in the number of doctors and nurses and the increase in pay levels, in real terms, that we are achieving—

The Question having been proposed after Ten o'clock 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 twenty-nine minutes to Twelve o'clock.