§ Motion made, and Question proposed, That this House do now adjourn.— [Mr. Portillo]
2.31 pm§ Mr. Guy Barnett (Greenwich)I am grateful to have this early opportunity in the new Session to raise the subject of the proposed closure of the neurosciences units at the Brook General hospital.
A week ago I presented to the House a petition on behalf of the people served by, and the staff of, the unit at the Brook hospital. The petitioners were praying against the South-East Thames regional health authority's proposal to move the units to a large new centre for neurosciences which is to be built at Denmark Hill and linked to the Maudsley and King's College hospitals.
I mentioned last week that the petitioners had also presented on the same day a petition to the Secretary of State for Social Services that was signed by 200,000 people. The Minister for Health, who is to reply to the debate, may have seen that petition. I thank him for his presence today and congratulate him on his new appointment.
The Minister should be made aware straightaway that this is a major issue, not just in my constituency, not just in the borough of Greenwich and not even just throughout the boroughs of Lewisham, Bromley and Bexley. It is a major issue throughout the region, especially in Kent.
I cannot believe that the regional health authority has made a proposal that has met with such universal hostility — and yet perhaps I can believe it, because a few years ago the South-East Thames regional health authority proposed that the cardiac unit at the Brook should be closed. That proposal also met with universal hostility, and I am glad that the present Paymaster General, who was then the Minister for Health, had the good sense to reject that proposal. I earnestly hope that the new Minister will follow his example in this case.
Suffice it to say in this short debate that the community health councils of Bexley, Canterbury and Thanet, Lewisham and North Southwark, Camberwell, where the Maudsley hospital is situated, and Lewisham and Greenwich have all come out against the proposal. So, significantly, has the South-East Thames Regional Association of Community Health Councils. I believe that many hon. Members from all parts of the House representing constituencies in the region are also opposed to the proposal. I am pleased to see that the hon. Member for Bexleyheath (Mr. Townsend) is present. He has told me of his opposition.
Why all this opposition? Many of the letters that I have received, some from people living far beyond the borders of my constituency, express a real fear. I have had quoted to me the comment of a parent of one patient:
Today is my son's 24th birthday, an event that would not have occurred but for the skill of doctor Sharr and the neuroscience department of the Brook hospital … The journey from Queen Mary's hospital to the Brook was less than 10 minutes and in a further 10 minutes he was in the operating theatre. I was later advised that any delay would certainly have left him handicapped for life, if not dead.The Greenwich and Bexley family practitioner committee has rightly described the major problems of accessibility to the Denmark Hill site. It stated:The road network around Denmark Hill is almost continuously congested; parking facilities in the area are 866 almost non-existent and rail access to Denmark Hill is not possible during the late evening or at weekends to the majority of people living in Kent.That imposes an almost insuperable problem for patients, relatives and staff. In contrast, the Brook General hospital is almost ideally located and will become, within a year or so, even better located. The completion of the Rochester Way relief road and the major improvements currently being made at the London end of the A20-M20 and the M25 mean that, on grounds of accessibility alone, the Brook hospital wins hands down.Lives can be saved which would otherwise be lost and handicap, as a result of head injury, can be reduced. The Minister might note that the very existence of the motorway network regretfully may bring the possibility of accidents involving head injury for which the facility at the Brook hospital is already strategically placed.
The thousands of people protesting against the proposal are right in their belief that the neurosciences unit should be sited close to the population, especially for the younger element which it will serve. That is true of the Brook, but it is not true of the Maudsley. Population is likely to increase in Greenwich, Bromley and Bexley and throughout Kent, whereas there is little or no population growth in the inner London boroughs.
It is quite clear that the Maudsley unit does not, in the main, serve the region. Some 38 per cent. of its patients are not resident in the region and a further 35 per cent. are residents of the teaching districts. However, almost all the patients admitted to the Brook units are residents of the South-East Thames region.
The South-East Thames regional health authority's recommendations are based upon a report by the option appraisal team. It was set up after years of indecision in the region that resulted from a lack of agreement by the relevant authorities and financial difficulties stemming from the harsh application of the RAWP formula to the region and to the special health authority. I fully appreciate the difficulties under which the RHA has been labouring over the past decade or so. However, it is at least relevant to remind the RHA of the principles upon which the RAWP formula was based:
Health care is for people and clearly a primary determinant of need must be the size of the population.Of course, that posed a problem for the London medical schools which are located in areas of static or even declining population. However, where a courageous decision was taken—like that to remove St. George's hospital, near Hyde Park, to Tooting—it resulted in a secure and successful solution to the problem.The Flowers committee underlined the wisdom of maintaining and developing hospital facilities in outer London and beyond. It spelt out the inevitability that some of the London teaching hospitals should merge and even that one should close. Again, the London Health Planning Consortium, on the specific issue of the debate, decided that two neuroscience centres were required for the South-East Thames region and recommended that the regional unit at the Brook should be rebuilt, preferably at the Brook, or at Queen Mary's hospital at Sidcup. The unit at the Maudsley, it said, should be retained but did not require substantial investment.
It is clear that the South-East Thames regional health authority, by proposing one unit combining the Brook and Maudsley on the Denmark Hill site, ignored the advice of the London Health Planning Consortium and the Flowers 867 committee. It is not for me to dilate on the reasons that lie behind the RHA decision. However, I can only guess that the members believed that combining the Maudsley and the Brook would achieve a degree of rationalisation. This can only be a solution based on a superficial appraisal.
The Minister may know that the option appraisal team was divided on its recommendations. The recommendations which were made and embodied in the regional health authority's proposals are seriously flawed for the following reasons. First, a simple consideration of the geography of South-East Thames should show an unbiased observer that a single unit, wherever placed, could never match the capabilities of the existing separate units. Secondly, each unit supplies functions which, although superficially similar, are distinctly different. The Maudsley scientific services have an accent upon teaching, research and psychiatry, for which they possess an international reputation. The Brook units are there primarily to serve regional neurology and neurosurgery patients in South-East Thames.
The extreme irony of the business is that, in making its proposals, the regional health authority is cutting off its nose to spite its face. It has no jurisdiction over the Maudsley and little over the teaching hospitals. It can control only the units at the Brook hospital, which it proposes to close. Its proposal is extravagant and involves an estimated cost of £30 million—a matter that will be of some interest to the Minister.
On all counts, I strongly urge the Minister to heed the advice of the London Health Planning Consortium and the Flowers committee, both of which recommended leaving the centres where they are. Thus, the taxpayer would be saved a huge sum of money, and serious disruption and disturbance would be avoided.
§ Mr. Deputy Speaker (Mr. Ernest Armstrong)Has the hon. Gentleman sought leave to intervene in the debate?
§ Mr. BarnettYes, Sir.
§ Mr. Deputy SpeakerI should have been informed.
§ Mr. BarnettI am sorry, Mr. Deputy Speaker.
§ Mr. TownsendAs my constituency boundary is only a few yards from the unit, I appreciate the opportunity of linking my constituents with the admirable case that has been made by the hon. Member for Greenwich (Mr. Barnett). I wish to tell my hon. Friend the Minister for Health of the deep feelings that the issue has aroused in my constituency and in the other two constituencies in Bexley. On medical and economic grounds, the hon. Gentleman's case is overwhelming.
§ The Minister for Health (Mr. Tony Newton)May I respond to the kind initial remarks of the hon. Member for Greenwich (Mr. Barnett) by congratulating him on having secured this Adjournment debate and the support of my hon. Friend the Member for Bexleyheath (Mr. Townsend) in raising this matter, which has caused considerable anxiety in his constituency. That anxiety was underlined by the way in which the hon. Gentleman spoke in this short debate. Of course. I am aware of the issue because of representations already made to Ministers by right hon. 868 and hon. Members and because of the wealth of material that has been sent to us by members of the public to express their interest in the matter. Indeed, although "Save The Brook Neuroscience Unit" is probably not the world's catchiest slogan, it has registered with the DHSS and will continue to make an impact in the period ahead.
I understand why such strong feelings have come into play. Big new developments are taking place in the neurosciences which hold out a real promise of alleviating some old and intractable health problems. After all, it is only a decade since computerised tomography gave us the first pain-free insight into the workings of the brain and nervous system. Now, those CT scanners are in their second and third generations and have been joined by magnetic resonance imaging, on which I was privileged to listen to a short lecture in Sheffield two or three evenings ago and which I understand shows in more detail the soft tissue of the brain.
Many people stand to be helped by those new developments. They include the young child with febrile convulsions, youngsters with head injuries — head injuries cause no less than 15 per cent. of deaths among 17 to 25-year-olds, many of which are a result of motorcycle accidents—and all those with brain tumors, Parkinson's disease and other forms of intractable pain.
After the difficulties that we were exploring in the previous debate on AIDS, it is encouraging to be taking part in a debate which, whatever else, is a part of health care where there is a great deal of optimism and the excitement of so many new possibilities for treatment or care.
I am sure that this is appreciated, at least as a general proposition, by the hon. Member for Greenwich and my hon. Friend the Member for Bexleyheath. In medical science, as in any endeavour, resources must be concentrated and used to the best effect. That is particularly so at times of accelerated movement, as there is at the moment in neural sciences. If efforts are unfocused they will tend to dissipate, and the results for which we are looking will take that much longer to achieve.
It is not just a question of money, although, with something like a magnetic resonance imager costing about £2.5 million, there is a need to take value for money into account. Primarily it is a matter of skill and expertise. As the hon. Member will know, a consultant will today specialise not just in neuro surgery but in paediatric neuro surgery, anuerism or tumor surgery, or on the problems of intractable pain. The demand for such specialists is competitive and international. That gives some signal of why, in general terms, we think it important for each regional health authority to employ its resources of manpower, no less than its resources of capital, or revenue for other purposes, to achieve the best possible results.
South-East Thames regional health authority is no exception to this. At present it is fortunate in having no fewer than four neural science centres serving people in Kent and south London. There are neuroscience beds at St. Thomas' hospital as part of its teaching complement and neuroscience and surgery beds at Guy's, some of which form part of that hospital's famous paediatric unit. Then, and this brings us immediately closer to the issue that has been concerning the hon. Member for Greenwich, there are the two major centres of neurology and neuro sciences at the Brook hospital and the Maudsley and 869 King's college hospital, known jointly as Denmark Hill. The population of east Sussex is catered for by Hurstwood park hospital in the South-West Thames region.
Four such centres, competing for skilled staff and resources, appeared to South-East Thames regional health authority to be more than can be justified to serve a 3 million population in Kent and south-east London. So, in 1984–85 it undertook an appraisal of development operations which would carefully weigh different factors to arrive at a choice for the siting of neuroscience centres to serve that area. All the factors weighed were those touched on by the hon. Member for Greenwich. They were relative travelling times, the state of the buildings, timing and potential disturbances and, most importantly, the integration of the service.
Against that general background, there would probably be no disagreement in principle that it was not unreasonable for the regional health authority to undertake such an exercise and that it would be the right body to undertake it, since it is for the health authorities, within broad policy guidelines set by the Department, to decide on the pattern of local health care. I have only a relatively limited experience as Minister for Health, but I have considerable experience in the DHSS. The Government would be in a hopeless position if they sought to take to themselves detailed decisions about the pattern of health services in every local area. The whole system would rapidly break down if we sought to do that.
South-East Thames regional health authority is responsible for providing a neuroscience service, one way or another, to its catchment population. Out of the corner of my eye I have caught sight of a former member of the regional health authority, my hon. Friend the Member for Canterbury (Mr. Crouch). In the light of what was said earlier, my hon. Friend may be relieved that he no longer has such responsibilities on his plate. But I am glad to note the continuing interest in these matters of a former member of the regional health authority. That authority is responsible for providing a neuroscience service in one way or another to its catchment population. It funds the service for Kent and south-east London to the tune of more than £7.25 million a year, which represents just under 1 per cent. of its total annual revenue budget. That running cost is quite apart from the enormous cost of purchasing capital equipment, such as the magnetic resonance imager.
As a result of that appraisal of development options, the authority has produced a scheme to centralise its neurological service, together with the bulk of neurology beds and other appropriate back-up services, at Denmark Hill while still supporting the teaching commitment at St. Thomas' and Guy's. As a consequence of that scheme, the proposal is that the neuroscience unit at the Brook hospital in Greenwich should be closed.
I know that the hon. Member for Greenwich and my hon. Friend the Member for Bexleyheath will understand that it is not for me this afternoon to pass judgment on the 870 region's proposed schemes. I am fairly confident that they would not expect me to do so, for a reason that will become clear in a moment. If I had not known, I would have been made well aware in this debate that the Greenwich health authority feels the proposed loss of the neuroscience unit at the Brook hospital very keenly. I fully understand the reasons for that. But the region's proposal is at present exactly that — a proposal. It is not just about to be put into effect, and it will not be until some very well-defined procedures are observed. I refer to precisely those procedures that make it impossible for me to express a personal or ministerial view this afternoon.
Local consultation on the proposed closure of the Brook neuroscience unit has just ended. Several local interests felt strongly enough to respond. Because of the opposition of the Greenwich community health council, the proposal will automatically be referred to the regional health authority and will, I believe, reach it in January. I should stress that it is the members of the regional health authority who will consider the proposal and the comments received on it. I have no doubt that the hon. Member for Greenwich and my hon. Friend the Member for Bexleyheath have made their views known to the regional chairman, but if by chance they have not done so, I urge them so to do. The chairman will certainly ensure that they are conveyed to the authority's members.
If the regional health authority cannot reach a solution that is acceptable to Greenwich health authority and to the Greenwich CHC, the matter will be referred to Ministers for a final decision. It is at that point that I and my colleagues would have to make a judgment. I should make it clear that Ministers do not see their role as simply rubber stamping the many proposals that arrive on our desks for final decision. We have to make a judgment, taking account of all the factors, including those that swayed the health authorities in putting forward the proposals in the first place. But I can assure the hon. Member for Greenwich and my hon. Friend the Member for Bexleyheath that their views, which were so ably and eloquently expressed, as well as those expressed by other local interests such as the Greenwich health authority and the Greenwich CHC, will be looked at carefully and balanced against the case put to us, if such occurs, by the regional health authority.
In many ways, it is helpful to have a debate of this sort, as it at least ensures that we are aware of the strength of feeling and of the considerations that have led people to believe that a wrong decision is being made, so that we can take them fully and properly into account if the matter comes to us for decision. It may seem slightly odd for a Minister who has been detained in the House for a further half hour at the end of a long day's debate on a difficult and complex subject to say this, but, as I said at the beginning of the debate, I am grateful to both hon. Members for the trouble they took to bring this issue to my attention.
§ Mr. BarnettI thank the Minister for his reply.
§ Question put and agreed to.
§ Adjourned accordingly at six minutes to Three o'clock.