Orpington Hospital (Hansard, 30 October 1989)

§ Mr. Ivor Stanbrook (Orpington)

I have been privileged to represent the electors of Orpington in this House for almost 20 years. During the whole of that time I have had to fight for the retention of Orpington hospital's status as a general hospital. I have seen administrators come and go, each in his time having wanted to downgrade or close the hospital with preference for the building of an enlarged hospital with centralised services six miles away in Bromley.

Hitherto, all such challenges to the agreed status of Orpington as a second district general hospital serving the faster-growing southern half of the London borough of Bromley have been defeated. Local public opinion has been aroused, the obvious advantages of Orpington as the site of a district general hospital have been demonstrated and my right hon. and hon. Friends the Ministers concerned have always rejected such proposals on their merits.

I hope that tonight my hon. Friend the Minister will once again come to the aid of Orpington because the latest attack on the agreed existing plans for the hospital is more menacing.

Orpington hospital was built by the Canadian army for its own use during the first world war. Since then, as a result of serving a big and growing population, the original buildings have been gradually replaced and the services multiplied. It is to the credit of the Conservative Government of 1970 to 1974 and the then Minister of Health, Sir Keith Joseph, that a plan was devised, and funds allocated, for Orpington's development to the status of a medium-sized modern general hospital.

Stage one, involving new buildings and staff accommodation, was completed in the 1970s. Stage two, which included a large new modern block known as the Canada wing, and costing £9 million, was completed more recently. The original plan was to complete the whole rebuilding programme by 1992. Funds were available and the site, covering nearly 40 acres—much of it green fields —was ideal. It is on the fringe of urban London, close to the M25 and to the notorious southern sector, scene of so many accidents since the M25 was completed. It is plain stupid to put a big new hospital complex on a congested site in the middle of an urban area where the traffic is densest. Yet that is what the regional and the district health authorities are proposing to do in Bromley.

The excuse for this gigantic planning and medical folly is, as one might expect, money. The health authorities reckon that, by concentrating all acute services at one huge new hospital at Bromley, they can do better for the district than by spreading the resources between the two existing general hospitals at Bromley and Orpington. Moreover, they think that they can raise extra money for the project from the private sector, by formal sharing and co-operation services. For the same purpose—the unkindest cut of all—they propose to sell off the surplus land at Orpington hospital, thus preventing it for ever from becoming a fully fledged district general hospital providing acute services and a round-the-clock accident. and emergency service, which is the ultimate object of the present and adopted plan.

150 The fact that the new plan has already got so far is no surprise to me. The protagonists of a bigger and better hospital in Bromley, lay and professional, have continually tried to grab the major share of resources available for the district, despite the small size of their existing site, and of the proposed site, in congested Bromley. Dominating the district authority, they have succeeded in closing the accident and emergency services at Orpington hospital—using the expedient of "temporary" closure, which does not need ministerial authority, but which drives down morale locally and professionally—so that the Royal College of Surgeons, noticing the fall-off in professional resources at Orpington, has already withdrawn its recognition of Orpington hospital for training purposes. Indeed, the hospital is no longer regarded as a major casualty centre for the purposes of major emergencies such as might occur on the M25, just a little way down the road.

It is significant that the prime mover in the latest scheme—the general manager of Bromley district health authority—has recently been promoted to the regional managership, so there is little chance of help for Orpington from the bureaucrats. The community health council for the district, dominated as it is by representatives from the other parts of Bromley borough, and even some of the professional staff at Orpington are impressed by the idea of a super-hospital at Bromley with the resources to provide high standards of professional expertise—which, no doubt, will be of great assistance in professional terms to the people concerned—on one site for acute services, using Orpington and other buildings for ancillary purposes.

I stand for the rights of my constituents, whom the plan will rob of their own local general hospital and for whom the level of services available at Bromley will never match the acute and casualty services that were on their doorstep. That is primarily why I am against the plan, and it explains why my hon. Friends the Members for Beckenham (Sir P. Goodhart), for Chislehurst (Mr. Sims) and for Ravensbourne (Mr. Hunt)—all of whose constituencies are within the London borough and medical district of Bromley—are not supporting me on this occasion.

I am also concerned, however, about the possibility that the Minister will make a terrible mistake if he agrees to locate a new super-hospital to provide all the district's acute services on one site in Bromley town, rather than continuing the present duopoly. If there has to be one site, let it be Orpington—which is much larger and has better road and air communications, is nearer the M25 and has no traffic congestion—rather than the comparatively small site at Elmfield which is on only 21 acres and well into urban Bromley, where traffic conditions are notoriously bad. Imagine the difficulties involved in ambulances reaching the proposed new hospital at Elmfield during the day when the traffic is extremely heavy around Bromley town.

If it makes sense to keep acute services at Orpington, let it develop in accordance with the existing plan, even if, for financial reasons, they have to be spread over a longer period. Let us have our full-time accident and emergency services back, along with the professional staff needed to restore standards to the required level. Let us give Orpington self-governing status, as in the Secretary of State's proposals for the reorganisation of the health services, to show what Orpington can do with its great reserves of professional talent, land and good will among 151 the local community. We are fortunate in that the notable philanthropist, Sir Philip Harris, has donated vast sums for the benefit of Orpington hospital and the services that it provides. The hospital is well served and is held in high regard by the local community.

A super-hospital in Bromley may be only pie in the sky in view of the current economic downturn and the difficulties involved in financing and finding the necessary space for such a giant plan. Let us not destroy our existing plans and resources or sell off the land at Orpington until the planners and bureaucrats have at least proved that their hospital, when built and operating, is even better for the residents of Orpington than the one on their own doorstep.

§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

Although the hour is late, my hon. Friend the Member for Orpington (Mr. Stanbrook) has demonstrated yet again his commitment to Orpington hospital and to the health care of his constituents. His interest in both goes back over 20 years, and I know that he has raised the question of the future of Orpington hospital several times on occasions such as this.

To put the debate in context, I will explain the responsibilities of district health authorities. The local district health authority has responsibility for developing plans and consulting on the future arrangement of services within its district. That is not something that central Government can or should do. District health authorities have the necessary local knowledge of the health needs of their residents. Bromley health authority's plans have not yet been formally submitted to Ministers. We shall have to consider in due course any proposals for a new district general hospital, as Ministers must consider and approve any new major capital project.

The district's planning responsibility must be borne in mind when considering comments made to my hon. Friend in the previous Adjournment debate in 1986 and in subsequent correspondence. My hon. Friend reminded me that there were Adjournment debates on the subject even before that date. I am well aware of the assurances given by at least two of my predecessors that acute services would remain at Orpington hospital and that it would be developed as a district general hospital for the south of the district, while Bromley hospital would be developed as the district general for the north. As my hon. Friend will know, the best laid plans can be affected by factors outside one's control.

In August 1987, the local planning authority raised objections about development on the Bromley site—the northern site—and the following month the London borough of Bromley offered to sell the health authority a 21-acre green field site, known as Elmfield, at the centre of the district. In those circumstances, it was essential that the health authority review its plans, which it did by appraising a number of different options, including the new Elmfield site. It concluded that its preferred option was to build a new, single district general hospital of about 800 beds on the Elmfield site. This hospital would include most of the acute in-patient care for the district, with a number of acute rehabilitation beds at Orpington. There would remain a very important role for Orpington hospital 152 in providing in-patient and day care for elderly and mentally ill people, as well as a wide range of out-patient clinics.

I emphasise that point because, quite properly, my hon. Friend will wish to draw to my attention commitments given by my predecessors in past Adjournment debates. I have read the record carefully, and their comments were made in the context of a two-site district general hospital —one in the north of Bromley, and the other in the south at Orpington. Enhancements of facilities in Bromley have been prevented by local planning decisions. To that extent alone, I invite my hon. Friend to consider that there has been a change in circumstances since those commitments were given.

I know that Bromley health authority consulted widely on its new plans at the end of 1988. As well as inviting comments from a number of organisations, it issued a leaflet to every household in the borough, and two public meetings were held. I am advised that the majority of those who responded, including the community health council, local medical and nursing committees, the London borough of Bromley and others supported the proposal.

Under these plans, Orpington hospital would not remain a district general hospital, as the description is commonly understood, so I fully understand why my hon. Friend is opposed to the new plan. He has lobbied strongly for the development of acute services at Orpington hospital, and he has made his views known very strongly tonight.

The building of the new district general hospital will be subject to not only planning approval—my hon. Friend is aware of the complications of securing planning approval for such a major proposal—but to the approval of the Department for this £100 million project. As my hon. Friend will know, the financing elements of that proposal involve what we call unconventional finance—the facility whereby the developers constructing the new hospital will in part, or ideally in whole, be financed from the capital value of sites released from the other hospitals.

In any unconventional finance project, the Department of Health must ensure, as the Treasury would wish, that it represents the best value for money—that is to say, that it is a better deal for the taxpayer than if the health authority had spent taxpayers' money initially on constructing the hospital and subsequently receiving receipts from the vacated sites. I am sure that my hon. Friend will appreciate that there is some way to go before the proposal is completed.

Although services at Bromley hospital might change, the health authority still sees it as having a very positive role, because 164 in-patient beds would be provided for the younger chronic sick—a service which the district does not currently have—and for elderly and mentally ill patients, including terminal and respite care. The range of out-patient clinics for all the main acute specialties would be increased and improved and would include for the first time an antenatal clinic.

Many new developments in the National Health Service are in community care. Orpington hospital already has a day hospital for the elderly, a day centre for people with Alzheimer's disease and a voluntarily managed hospice. My right hon. and learned Friend the Secretary of State hopes shortly to visit the hospice project. The plans for Orpington hospital would build on these community developments by providing day hospitals for the mentally ill and the elderly mentally infirm. The prefabricated wards 153 on the site would be demolished and there would be extensive new developments to supplement services from the modern Canada wing. The health authority feels that these developments would provide the local community with a range of services, particularly out-patient services, within easy access and in modern buildings. As my hon. Friend will know, about 85 per cent. of hospital visits are paid for out-patient services.

My hon. Friend refers to Orpington hospital seeking NHS trust status. He will know that Bromley's managers have expressed interest in forming an acute services trust which would encompass the whole of the district acute services and associated community services. That would eventually comprise the proposed Elmfield site, together with the Orpington and Beckenham sites. This reflects the district's plans, which we have already discussed. I understand that the sponsors of the proposed Bromley trust are now preparing an application to form an NHS trust. They will decide in due course whether formally to apply to my right hon. and learned Friend the Secretary of State.

I fully understand the reasons why my hon. Friend may wish to seek NHS trust status for Orpington hospital in its own right. It is open to any unit to apply for trust status. If a bid is to be successful, it must meet a number of criteria. It must first show how the proposed trust will benefit patients and the local community of the particular unit. If the sponsors decide formally to apply to set up a trust for Orpington hospital, they should demonstrate that the quality of services to the people of Orpington would be enhanced.

An application must also demonstrate that it has suitable leadership and management arrangements and the commitment of key staff. Equally importantly, it must 154 demonstrate that it has the capacity to win and deliver contracts with purchasers of health care; in other words, it must be able to offer quality health care and remain financially viable.

Clearly, it is Bromley's view that the proposed Bromley acute services trust—that is, a trust including the Elmfield site and Orpington hospital—can best achieve those goals and my right hon. and learned Friend the Secretary of State has agreed that it should prepare an application. However, it would be possible for Orpington hospital to seek trust status separately if there were sufficient support within the unit and the local population, and if it could meet the criteria I have described. My right hon. and learned Friend would then have to decide between the two proposals on their merits as he saw them.

I am grateful to my hon. Friend for bringing his views and the views of those whom he represents so clearly to the attention of the House and the Department of Health. I will give him an assurance that if —I stress the word "if" —and when a submission is made to Ministers for the proposed new district general hospital, I or a Minister from the Department of Health will visit Orpington hospital and Bromley health authority specifically on this issue before a final ministerial decision is made.

I am sure that, in the meantime, my hon. Friend will wish to continue his discussions about these matters with the health authority. I hope that he receives an excellent turnout at the public meeting that he has arranged for 10 November to discuss the future of the hospital, and that this debate will help to inform those discussions.