HC Deb 31 October 1986 vol 103 cc633-47

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

11.57 am
Mr. Teddy Taylor (Southend, East)

Although I am happy that the Adjournment debate should have started so unexpectedly early, I am sorry that it means that I shall not be joined, as I had expected to be, by my hon. Friends the Members for Basildon (Mr. Amess), and for Rochford (Dr. Clark) as well as by my right hon. Friend the Member for Castle Point (Sir B. Braine). However, I hope that it means that my hon. Friend the Minister will have a little more time for her other important duties. I know that my hon. Friend the Member for Rochford was flying over from Germany especially for the debate, having thought that it would start later in the day. Obviously, I cannot speak for senior Ministers or attribute views to them, but I think that my hon. Friend the Minister will be aware that my right hon. Friend the Member for Southend, West (Mr. Channon), who is a distinguished member of the Government, has associated himself with this cause by attending a public rally in Southend, where he made a most distinguished and important speech of support. In short, I hope to speak today not just for myself, but for those who represent the area of Southend.

My hon. Friend the Minister will be aware that one of my few claims to fame is that I have been in the House for a long time—more than 20 years, which exceeds a life sentence. I can assure her in all sincerity that during that time I have never encountered an issue that has raised so much genuine alarm, concern and fear in one area as the decision of the North East Thames regional health authority to recommend that the radiotherapy unit at Southend general hospital should be closed, with patients being referred instead to a new centre to be established at Harold Wood hospital. This is not, in any sense, an example of the normal complaint from the unsuccessful area when decisions are made on the location of a Health Service facility, but a case of a substantial and growing area where the inhabitants believe with good reason that they have been consistently discriminated against by the regional health authority and that this final decision on vital cancer treatment services has been made unfairly, unreasonably, irresponsibly and in circumstances that reflect no credit on a vital public service.

If, as seems inevitable, the community health council lodges a formal complaint after the consultation period, the decision will have to be made by the Secretary of State. I should be failing in my duty as a constituency representative if I did not make the Minister aware at this early stage of the sense of outrage in Southend at the region's recommendation and at the circumstances in which the decision was made. This is reflected not only in the greatest campaign ever by the local newspaper, the Evening Echo, but in every section of the Southend community.

The Minister will be aware that the region's reappraisal of its cancer treatment services follows guidance from the Department's standing medical advisory committee which recommended that regional cancer treatment services catering for a population of about a million, with about 3,000 new patient referrals per annum, most of whom require radiotherapy, should he established because of the medical advantages of the concentration of medical expertise.

The regional authority commissioned Coopers and Lybrand to prepare a report which recommended the establishing of five regional units at Broomfield near Chelmsford, the Royal Free hospital, the Middlesex hospital, St. Bartholomew's hospital and the London hospital with the consequent closure of facilities at a number of hospitals, including Essex County, Southend and Oldchurch. The proposal caused so much concern and alarm throughout the area that the region, after careful and detailed consultations with the health authorities and with hon. Members, agreed to scrap the Broomfield proposal and to propose an alternative of six centres on a basis that inevitably would mean that one unit would fall below the desired 2,000 new patients per year. For example, it was agreed that Colchester should be retained because of the excessive journeys which patients would otherwise be obliged to make. Faced with the alternative of retaining Southend or Oldchurch the region opted for Southend because a major factor in the option appraisal was access to services for Southend residents if a centre were not established there.

On 4 July the Harold Wood option was disregarded because it was felt that the region would not wish to consider providing services on a new site at a large cost. We have a splendid facility in Southend and there is nothing at Harold Wood. However, members of the regional authority considered, for reasons which have never been clear, that there should be yet another reappraisal of the respective merits of Southend and Harold Wood. A detailed report of the final option, dated September, was prepared and in my opinion was a fair and objective summary. It pointed out that if Harold Wood attracted the same 50 per cent. local referrals which Oldchurch had secured it would have no more patients than Southend and that this was guaranteed on the basis of performance.

The report said that if Harold Wood attracted more than 50 per cent. it could have consequences for the already limited viability of Colchester. It said that to build an entirely new hospital would mean putting Southend and Oldchurch on a running down basis for five years which could have a serious effect on staff morale and the services provided to the community on the two sites.

More significantly, the report argued that the Harold Wood option would require expenditure of an additional £4.5 million to duplicate services already provided satisfactorily. The final recommendation seemed clear. If I had been a member of that authority I should have been influenced by what it said. The recommendation states: Given the high capital cost and uncertain success of the Harold Wood option, and the shortage of capital available to fund many other much needed service improvements in the region, the authority may decide that the Southend option would provide an acceptable pattern of services for cancer patients appropriate to the 1990s and beyond. Although that recommendation seems clear to me, the regional council disregarded it and chose the Harold Wood option.

Southend residents and the entire staff of the hospital were unable to gather from the public discussion any good reasons why the appointed members of the regional council were prepared to disregard the clear message, the recommendation and the facts put before them. Anger and grave suspicion were added to outrage because before a final decision was made the Barking and Brentwood health authorty made a public offer of £2 million from future asset sales to reduce the additional costs, subject only to the unit being located in its area. The Minister has a duty to say whether she considers that such an offer or gift, which bears all the hallmarks of a bribe from public money, was a proper or acceptable action by a district health authority appointed by the Secretary of State. Capital receipts belong to the region. The region has a clear policy that £200,000 of every asset sale is provided back to the district. Yet a district health authority offered £2 million.

That offer of a gift by another health authority was bitterly resented in Southend because our district authority has been seriously underfunded by the region for years. In one recent year the shortfall was £7 million. Steps have been taken to reduce that differential by about £300,000 a year and the authority has repeatedly been advised by the region that the underfunding correction has to proceed slowly because none of the other authorities has a penny to spare. Despite that, it seems that one authority is able to pledge £2 million out of the air.

We have often reported the consequences of underfunding to Ministers and my hon. Friend the Minister will be aware from the extensive files that hon. Members such as myself and my right hon. Friend the Member for Castle Point (Sir B. Braine), my hon. Friend the Member for Southend, West and my hon. Friend the Member for Basildon, who has just rushed to get here, as well as my hon. Friend the Member for Rochford, have pressed the Government consistently to agree that something should be done about the underfunding.

The problem can be regarded in various ways, but I ask my hon. Friend the Minister to consider this fact. In Southend, the nursing cover per patient is 16 per cent. lower than the average for the whole region. The region's decision would have catastrophic consequences for morale at Southend hospital and for the comprehensive service that it provides. The general public in Southend are concerned and perplexed about what they see as a further sign of the region's callous disregard for Southend's health interests.

I am grateful to my hon. Friend the Minister for attending the debate, especially as it is taking place earlier than expected, and I ask her for the clearest assurance that she and her colleagues will bear the facts—they are not opinions—in mind when decision time arrives. I ask for a clear assurance that Ministers will visit Southend to meet consultants and representatives of the Southend community before a decision is made. I ask also for a clear assurance that my hon. Friend the Minister will look carefully into the circumstances of the £2 million gift offered by a health authority in the region on condition that the services were located in its area. Will the Minister consider issuing guidance on the propriety of such actions? I should also like a clear assurance that steps will be taken to prevent any regional health authority from discriminating consistently against any area within its region.

This is a vital issue. It is an issue of justice and of fairness which must be approached seriously, urgently and firmly by Ministers charged with the duty of maintaining our health services. I am grateful to the Minister for the careful attention that she has paid to my remarks and I hope that she can give me at least some of the assurances which I seek on behalf of Southend and areas near that town.

12.8 pm

Mr. David Amess (Basildon)

I welcome this opportunity to speak in support of my hon. Friend the Member for Southend, East (Mr. Taylor). I endorse every word that he uttered in introducing the debate. The region has made an extraordinary decision. If anyone cares to examine the matter seriously, he will find that there is no evidence that could have led the region to make such a decision. There is no evidence to support the decision on health grounds, the consideration that most concerns us, and there is no evidence that could justify the decision on financial grounds.

Anyone knows that when someone is told that he has cancer and that there is no treatment for it the traumatic and emotional consequences are extremely distressing. The region's announcement amounts to a sword of Damocles hanging above us, and we want it removed. The local people of Basildon have rallied round and are raising money to build a hospice — the St. Luke's — to treat those who, unfortunately, cannot be cured of cancer. The excellent facility that we have in Southend treats those whom we hope can be saved from cancer.

I tell the House that the Members who represent southeast Essex are united on this issue. I give warning that our constituents sustain us in our view on this matter. We are determined to stop the implementation of the region's proposal. We hope very much that the Government, when they come to the stage at which they have to give their views, will support the Members of south-east Essex.

12.10 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

First, I congratulate my hon. Friend the Member for Southend, East (Mr. Taylor) on taking the opportunity to initiate this debate. I am pleased that parliamentary circumstances have allowed us to have a rather fuller discussion than might have been possible. I thank my hon. Friend the Member for Basildon (Mr. Amess) for his remarks and for the effort and energy that he has expended to be in his place to represent his constituents this morning in the light of the changed circumstances of the debate. I appreciate the efforts that have been made by both my hon. Friends. They have represented the interests of their constituents both today and up to this point extremely well, and their constituents are lucky to have them. I am sure that they recognise that. The same can be said of other hon. Members to whom I shall be referring later in my remarks.

I congratulate the Southend Evening Echo on the considerable and detailed interest which it has shown in the proposed changes in Southend. It has given a considered, careful and highly intelligent lead to local people. I have read with great interest the cuttings from the recent editions of the newspaper.

There is no doubt that the issue which my hon. Friend the Member for Southend, East has raised has aroused considerable local interest. Ministers have received personal letters from all the local Members, including my right hon. Friend the Member for Castle Point (Sir B. Braine), my right hon. Friend the Member for Southend, West (Mr. Channon), my hon. Friend the Member for Rochford (Dr. Clark), and my two hon. Friends who are in their places, my hon. Friends the Members for Southend, East and for Basildon. We have received also over 100 letters from the general public. The Southend Evening Echo, which is running a campaign to save the unit, has held public meetings, issued publicity material and launched a petition to which over 40,000 signatures have been appended so far.

I hope that my hon. Friends will acknowledge the efforts of the regional health authority to keep all local Members informed. I am told that they have received copies of all the relevant documents. I am told also that two meetings have been held with local Members to brief them. I note the assent of my hon. Friend the Member for Southend, East as I say these things. I understand that he told the chairman of the authority recently that he was better briefed on this issue than on almost any other recent issue. Again I note his assent.

Mr. Teddy Taylor

I have no complaint about the way in which we have been kept informed. I think my hon. Friend will be aware that two meetings have taken place, which were extremely helpful. They took place, however, before the Harold Wood proposal was suddenly resurrected after having been rejected.

Mrs. Currie

I am sure that the region will note my hon. Friend's comment and will take it forward. We have the interesting circumstance that a member of my hon. Friend's family is a member of the district health authority.

Mr. Teddy Taylor

My wife.

Mrs. Currie

I suspect, therefore, that we can have a better informed discussion on this topic and on this part of the Health Service in this part of the country than perhaps would be possible in many other circumstances.

I must put on the record an apology to my hon. Friend the Member for Southend, East, who was concerned about the delay in ministerial replies to his parliamentary questions. I quote from the Southend Evening Echo of 22 October, which reports that my hon. Friend was angry and disappointed by the Minister's attitude. That was because my right hon. Friend the Secretary of State had been given more than a week to answer questions on the proposed closure of the cancer unit and had not answered in that time. That was my fault. I was not happy with the bland answers that were being offered and I took them back. I take full responsibility for that. I hope that my hon. Friend is satisfied with that explanation. I must apologise to him also for the delay in replying to his letter of 22 September. I have the reply in my hand and he is welcome to it, unless he would like me to take it back to the Department for another few days for redrafting in the light of today's discussion. When we received my hon. Friend's letter there was a backlog of about 1,200 letters at the Department. That is now being cleared very quickly, but some letters, such as that from my hon. Friend, to which I attach great importance, were not being dealt with as quickly as they might have been.

As a Minister, I have to reserve my Department's position subject to consultation on this issue. If the timetable, as I understand it from the region, is followed, decisions will come to Ministers next summer. It is important that I set out that all I can do is to take note of what is being said. I cannot comment or give any opinions. Some aspects of the important details that my hon. Friends have raised will have to lie on the table. All that I can say about some of the matters to which they have drawn attention is that I shall ensure that the regional health authority's attention is drawn to them and that they are taken into consideration.

I shall set out the timetable as I understand it. A consultative document is to go to the North East Thames regional health authority in December. Any proposal for change will go to the local district health authority at Southend in January. If it goes through the January meeting, it will be the subject of the statutory three months' consultation. It will then be sent back to the regional health authority and be sent onwards to Ministers in about April or May. That is assuming that the consultation process is completed as speedily as it might be. If there is any delay, that process will take longer to complete.

I realise that it might be disappointing to my hon. Friends if I am unable to give an opinion or to come down one way or the other for or against, or even to be neutral, but I have set out the legal position, and it would be a shame if the development of cancer services in Southend and elsewhere were jeopardised by a contradiction of that position.

I thank my hon. Friend the Member for Southend, East for his invitation to visit Southend. My right hon. and hon. Friends and I are doing our best to visit as many of the health authorities and districts as possible. My hon. Friend will be aware that there are over 190 of them. I shall take into account his invitation to visit Southend and I hope that we shall be able to accede to it before too long. I certainly look forward to visiting Southend.

My hon. Friend talked about the proposal from the Barking and Brentwood health authority, and he used the word "bribe". I am sure he realises that it is not necessary to impugn the motives of anyone concerned. The Barking and Brentwood health authority, in the same way as the Southend health authority and the North East Thames regional health authority, is looking for better health for all residents, as well as better health care. We try to run a National Health Service and I am sure that it is in the light of the considerations to which I have referred that the Barking and Brentwood health authority made its offer.

As my hon. Friend rightly said, the capital involved does not belong to the Barking and Brentwood health authority. It belongs to the regional health authority, and that has been the position for as long as I can remember. The North East Thames regional health authority has a policy of pushing decision-making down the administrative structure as far as possible to districts and, if possible, beyond that. That is commendable. A substantial proportion of capital receipts should be allocated to the districts from which the receipts are obtained, so that the districts will have some incentive to realise the receipts.

The region could rescind its decision at any time, however, either in general or in particular. The money belongs to the region, and it is not for the Barking and Brentwood health authority to regard it as its money or to be possessive about it. If the region wanted to take capital money from one district to spend it in another, the region, like any other region, would have an absolute right so to do. It may well take that into account in the plans that it has for cancer therapy.

I am informed that the regional health authority chairman told the region, when the matters were discussed in September, that no consideration was to be given to the proposed allocation of funds from Barking and Brentwood, and that the decision was not to be influenced by an offer made in respect of a district away from Southend. I have had that assurance from the regional health authority chairman in person this week and I am prepared to accept it, as I hope my hon. Friend will.

My hon. Friend asked why there was so little money to spare for Southend and for RAWP, when suddenly £2 million appeared out of the blue. I am sure he is aware that money has been short in the regional health authority for some time—I shall explain that in a moment—because of the way in which the RAWP formula works. The Barking and Brentwood proposal concerns new money which is to be achieved through receipts from capital sales. In other words, it is in the form of a cheque in the post. The money has not been realised or received. Whatever may have happened to this date is quite unconnected with what may happen from this point onwards if that district health authority or any other is able to achieve an increase in its resources through capital sales. I am sure all hon. Members hope that that will happen.

I think that my hon. Friend may have confused the capital element and the revenue element. The Barking and Brentwood health authority offered capital money. My hon. Friend's concern was the revenue allocation over recent years to Southend. We recognise that concern. As my hon. Friend knows, the RAWP formula is under review and we are taking advice as to whether it is functioning in the way we hoped. I venture a guess that, when it was set up 10 years ago, it all looked a lot easier than it turned out to be. What we have tried to do over the 10-year period is to improve the resource allocation to those parts of the country, mainly outside London, which have been seriously under-funded over a long period. That has meant holding back resources to the four main regional health authorities which cover London, one of which is the North East Thames regional health authority.

This year most of the regional health authorities are close to target. However, it remains the case that the four London regional health authorities are above the RAWP target. The remainder continue to be those authorities outside London. My right hon. Friend recognises the particular problems of London, and this year has allocated additional moneys to the four London regions, which, in the case of two, has taken them further away from the RAWP target. That has become a matter of concern to other regions.

We must consider the RAWP targets with great care and ensure that they continue to reflect not only population movements but different patterns of need, so that we can be sure that people in Trent receive a service comparable with those in Southend and that, if possible, people in the south-west are happy they are receiving the same level of service as people in central London. That cannot be done overnight. It is in the light of those discussions that the funding of Southend and the efforts of the regional health authority to improve that funding can be regarded.

The region tells me that it recognises the under-funding of Southend. As my hon. Friend said, it has attempted to put that right by an additional allocation to Southend of several hundred thousand pounds over and above the direct proportion that it might have had, and intends to continue to do so. I hope that the way in which the matter is recognised will be acceptable.

Dr. M. S. Miller (East Kilbride)

I am interested in the comments and promises that the hon. Lady has made about cancer therapy. Will she confer with her right hon. Friend the Secretary of State for Education and Science and impress on him the necessity for Britain to maintain an extremely close connection—in fact, to increase the connection — with CERN, the Geneva-based research centre? There could be a connection between what it is doing in particle physics and its understanding of the causation of cancer. I am sure that it would be a profitable and fruitful field if the hon. Lady directed her considerable abilities towards insisting that the British input into CERN remains as it is or is increased.

Mrs. Currie

I am not sure that I have reached cancer therapy services in Southend. I am aware that I have made no promises of any kind. However, 1 take the hon. Gentleman's point seriously about CERN and particle physics. My hon. Friend the Member for Buckingham (Mr. Walden), who is Parliamentary Under-Secretary of State for Education and Science, has taken a close interest in CERN. This year, he has visited most of those departments in Europe which are concerned with it. I am well aware that my right hon. and hon. Friends in the Department take the matter seriously. There is no doubt that improvements in atomic physics and nuclear physics have been one of the main areas of help to cancer patients.

I deplore the way in which the word "nuclear" is increasingly used as a term of pejorative abuse. It is a matter of fact that nuclear physics have helped and have given life to many thousands of people in this country. Not long ago the Derby Evening Telegraph decided to have a scare about radioactive material in Derby and demanded that lists be published of the 70 sources of nuclear radiation in the Derby area. The vast majority of them turned out to be in hospitals treating cancer patients. The issue was then resolved. I take seriously the point that the hon. Gentleman has made and I shall draw it to the attention of my right hon. Friend the Secretary of State for Education and Science.

Radiotherapy is provided at nine hospitals in the North East Thames regional health authority. They include the London hospital, the Middlesex, the North Middlesex, the Royal Free hospital, St. Bartholomew's, and University College in London. The hospitals outside London include the Essex County, Oldchurch, and Southend. Official advice to the Department, which we have accepted, considers that a modern radiotherapy centre should serve a population of about 1 million. North-East Thames has nine centres, for a catchment population of 4.4 million, including about 700,000 patients from North West Thames. One does not, therefore, have to be a mathematical genius to work out that, in the light of departmental advice, North East Thames has too many centres and they are too scattered.

The overall strategy of the regional health authority, as I understand it, is to concentrate radiotherapy in a smaller number of modern centres. The overall strategy was discussed at the May meeting of the regional health authority, and I believe that it was accepted with some enthusiasm. The next question was, which of the various parts of the region should have the new major centres?

I understand that there was some lobbying, including by hon. Members here, for the new regional centres to be in one or two places, including Southend. I may be wrong about that. The broad strategy of the region should be set against the background of departmental and medical advice of the highest level and against the background of its general acceptance. That was the overall philosophy, and that is what the authority wanted to do.

I propose to leave aside the provision of radiotherapy services in London and concentrate on those in Essex. It is worth remembering that between 5 and 10 per cent. of cancer patients travel from Essex to London units for specialist treatments, including radiotherapy. That is a choice for their GPs and for those involved in their care. We are happy for that to continue.

Patients in the Southend health authority area are served by two units, the Southend hospital and the Rochford hospital, which together form a twin-site district general hospital. It is a major acute hospital with 453 beds and an accident and emergency department. The unit's work is well respected and is of high quality overall. There is no doubt that Southend and Rochford hospitals are held in the highest regard by local people, who have written expressing their confidence in the staff at the cancer unit.

Right hon. and hon. Members have seen the regional strategy documents, and I believe that they have had an opportunity to discuss them. They have seen the departmental advice on the provision of radiotherapy centres. I shall be happy to provide appropriate extracts if it would he of assistance. Perhaps my hon. Friends will let me know.

There has been some misunderstanding about what might happen at Southend. The majority of services for cancer patients will continue to be based at district level, including Southend. These services will include surgery, some chemotherapy, certain other treatments, diagnostic and screening work and, of course, terminal care. Only radiotherapy and other related specialist treatments would require attendance at the proposed regional centres. The regional cancer treatment centres, where radiotherapists, their equipment, and oncologists would be based, are, I understand, intended to provide a high level of medical expertise as locally as possible. The local element is regarded as important, but the removal of radiotherapy facilities from a district should not entail the downgrading of its other cancer treatment facilities.

I understand that, in the case of Southend, in effect only the radiotherapy equipment would be affected, leaving most of the other cancer treatment facilities to continue. Therefore, we hope that the removal of a radiotherapy machine would not substantially affect the provision of these other services. I hope that the regional health authority will take into consideration the fact that radiotherapy is a factor in attracting top quality medical staff to the unit at Southend, and that any change should be so arranged as not to damage the career prospects of the staff concerned.

I make it clear that Southend's cancer unit will not close, as suggested by the Southend Evening Echo. Only radiotherapy and associated facilities are the subject of discussion. The people in Southend have been wrongly informed that all local cancer facilities will cease. It is not the case that the cancer unit will close. I hope that I can make that as clear as possible.

Mr. Teddy Taylor

I note the presence of my right hon. Friend the Member for Southend, West (Mr. Channon). The removal of the radiotherapy treatment will force people to travel about 40 miles. Is the Minister aware of the hardship, inconvenience, pain and distress that would be caused to the large number of patients who would have to travel this distance? Does she suggest that a unit without radiotherapy treatment would in any sense be a comprehensive treatment unit?

Mrs. Currie

I acknowledge the presence of my right hon. Friend the Member for Southend, West. I am pleased that he is able to represent his constituency in this important matter. I am sure that the regional health authority is taking into account the travel required. I emphasise again that, if Southend people believe that their cancer unit will close, they are incorrect. The only discussion is about the machinery with which the radiotherapy treatment and related facilities are directly associated. Only a small number of staff associated with radiotherapy facilities might be transferred from Southend. The majority of the staff at the cancer unit will remain to provide other services for local patients. As we develop services for local patients, some other work will become so much more important.

Mr. Teddy Taylor

The Minister has been very kind and courteous. Does she seriously suggest that a unit with cancer diagnostic facilities and terminal care but with no treatment facilities is a cancer treatment unit in any sense?

Mrs. Currie

On the contrary, as my hon. Friend will know, radiotherapy is part of cancer treatment. However, it is not the only form of treatment. Surgery and chemotherapy are important, and we expect chemotherapy to become more important in years to come. For a patient receiving treatment for a year or more, radiotherapy may form only a small part of that treatment. It depends on the case and the circumstances.

I hope that my hon. Friend does not in any way denigrate terminal care or long-term care. Some cancer patients may require that for many years when radiotherapy has proved to be unsuitable or no longer satisfactory for them. Radiotherapy is a part of cancer treatment, but by no means all of it. I am sure that the staff who work in other parts of the unit involved in surgery and chemotherapy would want the care that they provide for patients to be taken into account.

As part of the preparation for today's debate I asked whether I could be informed about community services for cancer patients in the Southend area. I am pleased to say that not only will the community services for cancer patients in Southend continue, but that they will be improved under the proposed arrangements. Southend has a private eight-bed hospice supported financially by the district health authority. In Southend there are two home care nurses who provide a similar service to Macmillan nurses. I understand that there are advertisements for a further two nurses, so the service will be doubled. A combined terminal illness care team will be functioning by the end of the year. All those are services for cancer patients, especially for those for whom care has come too late or those for whom an apparent cure at some earlier stage proved to be inadequate.

Dr. M. S. Miller

I apologise for referring to something which the hon. Lady mentioned a few moments ago, but my attention was distracted. I return to the point made by the hon. Member for Southend, East (Mr. Taylor) about the size of the catchment area. I hope that the hon. Lady and her advisers will reconsider that. I accept that nine centres are too many for a population of about 4 million. However, I do not accept that there should be one radiotherapy centre for 1 million people. We should be able to do a little better than that.

Although the hon. Lady is right in saying that there are many other treatments for cancer, radiotherapy is still applied and will, in all probability, become even better in the future. In my opinion, in areas where there is one centre for 1 million people it may mean that many cancer sufferers will have to travel long distances. The hon. Lady's Department should be considering something better than that, perhaps one centre for 700,000 or 800,000 people—certainly more—than one per million.

Mrs. Currie

The hon. Gentleman speaks from a background of medical knowledge. If he has evidence to support the points that he is making perhaps, he would be kind enough to write to me or to my right hon. Friend the Secretary of State so that we can ensure that full consideration is given to the general points that he has made.

The North East Thames regional health authority's original proposal would have had five centres for 4.4 million people. Its revised proposal now has six centres for 4.4 million people and, should the representations of colleagues from Southend be taken into account, it may well mean seven centres. There comes a point where one simply gets back to nine centres, and I hope the hon. Gentleman will agree that nine centres would be too many. The adequate number is a matter for the regional health authority and my right hon. Friend the Secretary of State in the light of representations made, if necessary, later on.

Mr. Teddy Taylor

I appeal to the Minister to look seriously at the advice that she is being given. Who told her that the Southend hospice is funded by the district health authority? I am the president of the hospice, and I have to engage with my right hon. Friend the Member for Southend, West (Mr. Channon) and my hon. Friend the Member for Basildon (Mr. Amess) in raising vast sums. The hospice is funded, not by the district health authority, but by voluntary donations. Where is the Minister getting the information from? I appeal to her to check on it. We are providing home care services in the hospice because of the disappearance of Macmillan nurses. It is not a district health authority function. We are doing that with voluntary funds, raised by lotteries, functions, sponsored walks up Big Ben—everything under the sun. I appeal to the Minister to check on her sources of information about the Southend hospice. I am president and attend every meeting. I can assure her that it is not funded by the district health authority.

Mrs. Currie

I am grateful to my hon. Friend, who speaks from a position closer to the circumstances than I do. I should like to thank him and all those in Southend who raise money for the hospice, and indeed hospices such as the one mentioned by my hon. Friend the Member for Basildon. There is no doubt that the hospice movement, which grew out of urgent local need and has tapped a source of local generosity and wholeness of spirit, has shown the Health Service how to do things, but my understanding is that some of the money for the hospice — some of the running costs — is found within the district. I am happy to check on that and I shall write to my hon. Friend the Member on that point. However, I am sure my hon. Friend will accept that the community services for cancer have not been as good as they could have been in Southend, and perhaps as a result of the current discussions the district health authority and the regional health authority are giving attention to that. We should see a substantial improvement within a matter of months. I am sure that my hon. Friend will not only take careful note of that, but will ensure that those promises are fulfilled.

Mr. Amess

May I make two points before the Minister concludes—

Mr. Deputy Speaker (Mr. Ernest Armstrong)

Order. The hon. Gentleman must be brief. He cannot make another speech.

Mr. Amess

With regard to radiotherapy treatment, I understand the point about the closure of the Southend unit. I emphasise that for the people in south-east Essex the continuation of radiotherapy treatment is crucial. Some 60 per cent. of cancer patients in Basildon receive radiotherapy treatment at Southend. This is the final thing that I want to ask the Minister. I realise that it is difficult in this debate for her to say anything positive before there has been full consultation, but before any decision is reached will she please ask her right hon. Friend the Secretary of State for Social Services to receive a deputation of south-east Members, obviously including my right hon. Friend the Member for Southend, West (Mr. Channon)—the Secretary of State for Trade and Industry — and my hon. Friend the Member for Southend, East (Mr. Taylor)?

Mrs. Currie

I hear what my hon. Friend says. It has just occurred to me that it might be more useful to wait and see what consideration the regional health authority gives to the representations that are being made. When the consultation document is published and the formal statutory consultation prodedure is undertaken, it may be possible to consider that. I need to take advice on that, as I am sure my hon. Friend will appreciate. I am always glad to meet hon. Friends, particularly those who are making the effort to improve health services in their neigbourhood, and who put to us the case of improving those services. I shall attempt to be as helpful as I can to my right hon. Friend the Member for Southend, West and to my hon. Friends the Members for Southend, East and for Basildon.

I want to ensure that we put it on record today that the radiotherapy unit is not the whole of the cancer unit. The radiotherapy treatment is not the whole of the cancer treatment. I was moved to read the comments in the Evening Echo of 20 October, in which the circumstances of Mr. and Mrs Jim Mullan of Northview Drive, Westcliff were described. I understand that, sadly, they spent seven years watching their daughter Elizabeth Pollard battle against cancer, a battle that she lost in April 1984 at the age of 35. I quote from the newspaper: Mrs. Mullan … said 'It was hell, but thanks to Southend Hospital centre Elizabeth was allowed to die in dignity and reasonable comfort. Towards the end she found it difficult to breathe, there was no way she could have travelled for treatment.' There is no suggestion whatever that Elizabeth or anyone like her will have to travel for treatment. Hospice care, terminal care, long-term care, surgery, chemotherapy and many other aspects of care for cancer patients for whom radiotherapy has proved to be ineffective will continue to be provided at Southend in the caring and responsible way in which it has been provided so far. The unit and the treatment that it provides in these areas can continue to command the confidence and, I hope, support of local people for many years to come.

I want to consider the pattern of referrals in the neighbourhood. It has been estimated that at present the radiotherapy unit at Southend attracts some 93 per cent. of local referrals. It also attracts a high proportion of local referrals from the district and patients from Basildon and Thurrock. The unit at Oldchurch has a comparatively low local referral rate. Only about 50 per cent. of patients from Barking, Havering and Brentwood go to that unit; the rest travel to London. No doubt that is a factor in the regional health authority's consideration of where to locate a possible regional centre.

The completion of the M25 has some influence on the area. Those hon. Members with constituencies a great distance from the M25 will be interested to note the major economic and social changes which the completion of this important capital programme will bring to the south-east.

Worries have been raised about travelling to other areas for treatment. I was sad to read an article in the Evening Echo on Tuesday 21 October, which implied that people would not seek treatment elsewhere. The article stated: Cancer patients will give up and die rather than make the 60-mile round trip for treatment at Harold Wood, a hospital consultant claimed on TV last night. On BBC's London Plus Southend hospital's Dr. Colin Trasker said: 'There is no doubt people will just give up their treatment and not go.' Interviewer Antonia Higgs said: 'You mean they'd die sooner rather than make the journey?' Dr. Trasker agreed. I hope that my hon. Friends will join me in urging all concerned to make use of facilities—especially facilities for cancer patients — wherever and in whatever circumstances these may be provided. I hope that we never discourage patients from seeking the treatment that they need. That may entail travelling to the other ends of the country for treatment for rare conditions. While every effort is made to provide services as locally as possible to the patient, I hope that all concerned with the care, treatment and advice to patients will encourage them to make use of facilities wherever they may be.

It is a fact that 80 per cent. of patients attending the radiotherapy treatment department at Southend travel by car. Generally, patients in Essex drive or are driven to hospital for radiotherapy treatment, rather than use public transport. The ambulance service will continue to be provided for those cancer patients who require it. However, it is worth remembering that many radiotherapy patients are not ill at all and are therefore capable of driving or travelling to the hospital under their own steam.

Dr. M. S. Miller

Does the hon. Lady appreciate how that service works? The service is voluntary and patients sometimes travel as far as 30 miles. More than one patient may be involved in each case and sometimes three or four patients may travel in one car. The first patient to be collected travels in the car for a considerable time in a journey to and from hospital. It might be an idea to examine that service. I speak from personal knowledge, as I had a sister who died of cancer last year. She lived about 30 miles outside London and had to travel to Middlesex hospital. That was a gruelling journey if she was the first to be picked up and the last to be dropped off.

Mrs. Currie

I note the hon. Gentleman's point. I should like to put on record my Department's appreciation of all those people involved as voluntary drivers in that service. It is an important and valuable provision. The ambulance service is available if required and I hope that, where appropriate, it will be used.

I want to mention the details of equipment under consideration in Southend. The current radiotherapy equipment at Southend consists of a linear accelerator, —a Linac—a cobalt machine, a deep X-ray machine, a simulator and a planning computer. The Linac was bought in 1982, at a price of £350,000, and required a further £140,000 to install. The other equipment has been purchased since 1980. I understand that the cobalt machine was a reconditioned unit and may therefore soon reach the end of its useful life.

In preparation for the debate I asked for information on the percentage usage of radiotherapy equipment in Southend. I understand that the number of patients treated there is reasonable and typical for a unit of that size. The expected number of "fields"—single treatments—per day for such equipment is about 30 to 50. Southend's average is 43 for the Linac and 50 for the cobalt machine.

One factor that we must bear in mind is the efficient use of expensive equipment. I am taking advice on how many patients could or should be treated on the more modern equipment now available, especially as more of our patients are still active during the period of their being treated, and therefore have responsibilities to their employers and families. In the recent past capital has been the limitation, with few staffing problems. However, as capital and equipment have become available, some of the limitations have involved the numbers and availability of qualified staff. Some of our discussions now have to take place against a rather different background from that appertaining 10 years ago.

I understand that the region's intention is that the radiotherapy equipment currently at Southend should be transferred to the new regional cancer treatment centres wherever possible. I express no opinion on that; I am merely trying to set out the proposals. The region has advised that it is probable, but not certain, that equipment currently in use at Southend will be transferred to Harold Wood. That will depend on the timing of the prospective closure and development. The proposed radiotherapy unit at Harold Wood will be able to provide up to 3,000 new courses of treatment per annum by virtue of its greater population base. That would meet the requirement for a regional centre. Indeed, we expect that it will attract between 1,700 and 3,000 new courses per annum, depending on whether it establishes itself as a centre for excellence, which I am sure we all hope will be the case. It is then proposed that the Harold Wood centre should be linked with Basildon, Thurrock and Southend districts. I understand that to be the broad basis of the proposal.

I wish to mention other service improvements in Southend that will help not only cancer patients but others. Additional services for patients include a 20-place day hospital for the elderly at Westcliff hospital and an intensive care unit for mentally ill patients at Runwell hospital. As part of caring in the community, there are community care centres on Canvey Island and in Southend for the mentally ill; homes for mentally handicapped people in Benfleet and Shoeburyness; a team of staff, including six nurses, to care for mentally handicapped people in the community; and a group home for former psychiatric patients in Rochford. There are also planned major developments for Rochford hospital costing £5.5 million to build and £1.1 million a year to run, comprising a rehabilitation department, four wards with 96 beds for the elderly and three day hospitals for the elderly, elderly mentally infirm and the mentally ill. We hope that they will be completed by 1988. I hope that my hon. Friends welcome those improvements and changes, which I am sure they will agree show that the NHS in their constituencies is very much safe with us.

The North East Thames regional health authority is anxious to improve its services for cancer patients. The strategy report that was accepted in May was ambitious and broad ranging. Whatever it decides to do, whatever views the local district health authorities may take, whatever decision the Secretary of State may be asked to take, I am sure my hon. Friends will agree that the objective of the regional health authority is to provide the best possible cancer services for the people whom it is charged to serve with multidisciplinary teams, with a full range of diagnostic equipment, with better links for the local community and with better care for those whose cancers have defeated us.

I hope that all concerned will accept that the regional health authority and the district health authorities are operating from the very highest motives and are concerned only to achieve the best service for all, including those in Southend, Basildon and elsewhere.