§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]11.22 pm
§ Mr. Jerry Hayes (Harlow)
It is no exaggeration to say that health care in West Essex district health authority is probably worse than I have ever known it. We have some of the worst and longest waiting lists in the country; we are expected to have a deficit of some £2 million next year. Yet some people will still say that the problem is due to mismanagement by the district health authority.
I wish to refute that. Way back in 1984, plans were presented to reduce the deficit to the tune of £1 million a year. This debate is all about what happened on 24 September this year: that is the date on which my constituents—and those of my hon. Friends the Members for Hertford and Stortford (Mr. Wells) and for Saffron Walden (Mr. Haselhurst), who have a keen interest in the matters—were betrayed by North-East Thames regional health authority. That is the date on which the capital programme to centralise the Princess Alexandra hospital in Harlow bit the dust, along with the £40 million development plan involving a community hospital—St. Margaret's hospital, Epping—and others in Hertfordshire and Essex, despite the region's promises.
Let me briefly run through the chronology of events. In 1984, the major capital scheme was approved in the region's strategic plan for 1993. It was realised that it was ridiculous to have three accident and emergency departments in one district: it did not work, it was not efficient, it was not good for patient care or health, and it led to the haemorrhaging of over £1 million a year. West Essex health authority took the bull by the horns, and presented a sensible capital development plan.
On 19 April, Mr. Michael Chapman was appointed chairman of the health authority. He had the following brief:Persuade the public of the need to centralise acute services at Harlow …Develop the concept of community hospitals".That was an heroic task: it was not easy at all. The proposed closure of the Honey Lane hospital was challenged by judicial review by Epping Forest district council, and its application was defeated. The hospital—in the constituency of my hon. Friend the Member for Epping Forest (Mr. Norris)—was closed in July.
In October 1986, a regional report confirmed the cost of the scheme, compiled with current service planning and financial criteria, as £40.6 million. In early 1987, informal public consultation meetings were started by Mr. Chapman, and action committees to save the local hospitals in Epping and Bishop's Stortford had already been formed by local people. On 10 July 1987, Mr. Chapman made a presentation to the Herts and Essex hospital action committee meeting. All parliamentary candidates were present. My hon. Friend the Member for Hertford and Stortford quite properly publicly supported the draft plans. On 11 June 1987—how could we forget—there was a general election. On 18 September, approval was given in principle and documents were approved by West Essex district health authority. That was followed by staff meetings at all sites. There were more than 50 meetings, and they included meetings with the Essex family practitioner committee, all the district councils, 308 some of the town and parish councils and all general practices. There were community health council public meetings with both West Essex and East Hertfordshire district health authorities, plus other voluntary organisations. The district chairman, the general manager and a member of the consultant medical staff attended all meetings.
It was not a painless process. There was a great deal of local outrage and upset. At a public meeting in the constituency of my hon. Friend the Member for Epping Forest, the district chairman stated that we had a national health service and that the money from the sale of the local hospital—and it was the second to be closed—was to be used for the good of all the people in the West Essex district health authority area, at the district general hospital in Harlow.
In January 1988, the document that had been approved in principle was submitted to the Minister. It was supported by the community health councils—and that was not an easy task, even though an independent report prepared for the West Essex community health council favoured a two-site solution. It was supported by all the consultant medical staff of the district.
On 12 May, my right hon. Friend the Member for Braintree (Mr. Newton)—then Minister for Health—publicly announced at Harlow approval for the scheme to proceed. A project team was appointed with commercial project managers to ensure value for money. It was the first occasion when outside project managers had been appointed for a district general hospital scheme in the North-East Thames regional health authority area.
On 15 December, a by-election was held in Epping Forest. In the run-up to the election, my hon. Friend the Member for Epping Forest publicly supported the centralisation plans, even though that involved a change in the use of St. Margaret's hospital. Part of the overall plan was new buildings for the community hospital in Epping. I say with respect to my hon. Friend that that involved considerable political risk.
§ Mr. Steve Norris (Epping Forest)
I am grateful to my hon. Friend for allowing me briefly to intervene. Like my hon. Friends the Members for Hertford and Stortford (Mr. Wells) and for Saffron Walden (Mr. Haselhurst), I am here because of my concern about the very parlous state of the finances of our health authority. My hon. Friend the Member for Harlow (Mr. Hayes) was right to say that it caused me a great deal of embarrassment during the by-election to stick by the capital programme, which I took to be the right programme. I believed that then and I believe it now.
My hon. Friend will agree that while the decline in capital values in the property market generally has undoubtedly had an effect on the region's finances—and that was inevitable—it is a crude response simply to abandon all the carefully thought out programmes for which many of us have fought hard. Although I have, on occasions, been critical of the district for failing to meet its expenditure targets from time to time, to suggest that it will be in a position to think not only about what it will do without the new capital programme, but to deal with a revenue cut of the size being contemplated of £2 million is to demand too much even of the most vigorously effective health authority.
§ Mr. Hayes
My hon. Friend makes his point well. The region is saying that falling land values prevent the spending of the money. The truth of the matter is that £20 million worth of that money was raised through land sales in my hon. Friend's constituency. It is not the region's money. My hon. Friend the Minister will rightly say that that is the way in which the health service is financed regionally, but this is money which belongs to my hon. Friend's constituents and to the West Essex district health authority and it should be spent for the district.
It is not just my hon. Friend who took political risks and who is severely embarrassed. My hon. Friend the Member for Saffron Walden also played a major part.
§ Mr. Alan Haselhurst (Saffron Walden)
My hon. Friend has missed out one date in his chronology, and that is June 1985, when the Government took a decision that Stansted airport was to be developed into London's third airport. Those of us who said that there may be a need for further hospital facilities to be maintained in Bishop's Stortford were pushed aside on the basis that a major district general hospital at Harlow would be the right way to deal with the needs of the airport and the growing population that would come with it. The Government have willed the appearance of the airport, albeit built with private money, but what will they do now about the demand for health services in the area that will accompany it when the district general hospital is cancelled?
§ Mr. Hayes
It is not just my hon. Friend who is concerned. My hon. Friend the Member for Hertford and Stortford, despite considerable local difficulty, did his best for the Herts and Essex hospital. But part of the deal in the considerable risk that he took was that there should be a community hospital in the heart of Essex. That was all part of the deal and my hon. Friend will tell the House what happened.
§ Mr. Bowen Wells (Hertford and Stortford)
Not only was there a promise of an up-to-date modern community hospital to take care of the 95 per cent. of the hospital needs of Bishop's Stortford, but it must be remembered that a second hospital in Bishop's Stortford, which had been contributed by the townspeople of Bishop's Stortford, had been sold. Therefore, in addition to the £20 million from Epping Forest, some £7 million, plus interest, I hope, is owing to the people of Bishop's Stortford as a result of the sale of that hospital. I have come to the conclusion that all the money will be sucked out of our district. We shall never get a fair deal for our people while the district remains in the North-East Thames regional health authority or any other London-based region. Our constituents will not get the level of hospital service that other places expect and enjoy while we administer the district through a London-based hospital system that absorbs all our money and retains it in the capital.
§ Mr. Hayes
My hon. Friends make their points well. This is not a health authority riven with difficulty and division, with politicians fighting each other. This is a health authority where consultants, community health councils, staff, patients and everyone else have pulled together, with the encouragement of Ministers and the regional health authority. That is why there is so much outrage and anger that the plan should have been cancelled.
310 It may be helpful if I continue the chronological order of events because it is only right and proper that that should be put on record. In 1989, after long negotiations with Epping Forest district council, planning and other problems were overcome and the site of Waltham Abbey was ready for sale. On 16 March 1989, the district chairman wrote to the regional chairman expressing concern at the sale price and the regional difficulties being experienced with the capital programme.
The sale proceeded at £20 million, with the first payment balancing the region's capital programme for that year. Assurances were given that the money would be made available in west Essex when needed. In April 1989, improvements were made to the plans contained in the consultation document because the designers were able to deliver a functional solution with the cost advantage of a shorter building period.
In June 1989, further savings were identified and agreed with the design team. From April to December 1989 there were weekly meetings between the design team and sub-groups with the consultants and other staff, and at the end of the briefing stage a full report on the major capital scheme was submitted to the region in December 1989.
On 6 February this year, the region reaffirmed the capital scheme and gave instructions to proceed with the plans and design work. On 17 September, plans and costings were submitted to the region—and all were within budget and on time.
Here comes the rub. On 24 September, the regional health authority cancelled all its capital schemes where contracts for building had not started. In addition to the major capital scheme, those affected included schemes for the Epping community hospital and for Bishop's Stortford hospital.
Can that be called poor management on the part of the district health authority, which followed Government policy to the letter and was encouraged by Ministers? All of us involved, quite properly, lobbied Ministers and secured their active support and encouragement, as well as that of the region—and then we were told that the money had been spent elsewhere.
My constituents and those of my hon. Friends are angry and outraged. The health service is not just about statistics. It is also to do with relieving pain and suffering, and with offering speedy operations where they are needed. When constituents have to wait two or three years for a hernia operation, a year or more for a cataract operation, and much longer in other cases—and that situation will not improve unless there is a resolution to the problem—they have every right to be angry and outraged.
Perhaps these are only the opening shots in a war—although I hope that it will not be a terribly long war. Later this week, my hon. Friends and I will be meeting my right hon. and learned Friend the Secretary of State and my hon. Friend the Minister, so I do not expect my hon. Friend the Minister to say too much tonight. However, the very least that we expect——
§ Mr. Hayes
Never mind an apology, although my hon. Friend is right to seek one. We want some money—and what is more, we want our money. We want the money that was raised locally through sensible land sales to provide decent health care, which has been denied to us 311 and of which we have been robbed by North-East Thames regional health authority—and that is totally unacceptable.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
I was relieved to hear at one point in the very effective speech of my hon. Friend the Member for Harlow (Mr. Hayes) that he did not intend that there should be any political infighting. He congratulated the members of West Essex health authority on the ground that they were not the prisoners of political faction and had attempted over many years, and were attempting now, to run their area health service effectively and without regard to party political considerations. I hope that we shall be able to approach the undoubted problems affecting the delivery of health care in my hon. Friend's district in the same spirit, both this evening and at my meeting with my hon. Friend the Member for Harlow and other hon. Friends later this week.
I congratulate my hon. Friend the Member for Harlow and my hon. Friends who represent neighbouring constituencies. They have not only raised the matter on the Adjournment; they are to raise it with me in a meeting later this week and, perhaps more important, this is merely the latest stage in a long campaign that they have waged to ensure that the problems of their health district have remained very much to the fore in my mind and in the minds of my predecessors and present colleagues at the Department of Health.
Sometimes, when I reply to an Adjournment debate, I approach the subject fresh and with a newly prepared brief——
§ Mr. Dorrell
As my hon. Friend rightly says, the brief on this issue is becoming somewhat dog-eared. The ground has been well ploughed and, although this is the first occasion on which I have had to answer a debate on this subject, it is certainly not new to the officials who have been discussing it with me today. The effect of my hon. Friend's campaigns over the years has been to ensure that those in the Department who are responsible for these matters are fully aware of the strength of local feeling on them.
As some of the interventions in the debate have illustrated, although our main purpose was to concentrate on the capital programme in West Essex, that is not the only issue that arouses public concern—or, indeed, the only issue that health service managers in the area must address. There are also difficult questions associated with the revenue budget of West Essex, and it is perhaps unrealistic to expect to approach either topic in isolation.
My hon. Friend the Member for Harlow underlined the fact that the approval in principle for the Princess Alexandra hospital dates back to 1985. That programme was clearly intended as a major investment in improving the delivery of health care in the West Essex district. For that reason alone, one might have expected the project to be popular with and looked forward to by local people and consequently that any decision to postpone or shelve the proposal would arouse real concern.
312 I recognise that that concern is compounded by the fact that we are not talking merely about another health service investment—the kind of investment of which there are many currently in train in the health service—to improve the delivery of health care in the district. The proposal was the cornerstone of the district's and the region's strategy for the delivery of health care in West Essex over the intervening period of five years.
It was the approval in principle of the Princess Alexandra scheme that provided the framework for the concentration of acute services on a single site—moving away from the wasteful delivery of such services across three sites in what is by no means the largest district in the NHS, although it is certainly not the smallest. Clearly, the prospect of being able to deliver acute services from a single site, and in a more efficient manner, was particularly important in the context of planning the future of West Essex, given the pressures—to which several of my hon. Friends have referred—on its revenue budget. Both the region and I are fully aware of the real and understandable public upset voiced by my hon. Friends this evening.
It is important to consider the implications of what the regional health authority decided on 24 September and where we go from here. The first decision that the authority made is wholly incontestable. It decided that its capital programme at 24 September was undeliverable because it was too ambitious; the programme was over-committed It also decided that, against an over-committed programme, the only sensible action was to shelve any scheme for which it had not signed a fixed contract and to reappraise the remaining schemes in the programme. I am sure that that was the correct decision. Any other decision would have involved leaping to ill-considered conclusions about the relative priorities of schemes which had been included in the over-committed programme.
The regional health authority is now committed to that complete reappraisal of the capital programme with the objective of developing a new approach to the planning of new national health service building which, against the pressure on the capital programme, will ask all district health authorities in the region to achieve acute sector rationalisation quicker and with less reliance on capital investment. That is being encouraged throughout the health service. It is not unreasonable to require that people in charge of a capital programme should satisfy themselves that they are using the capital as efficiently as possible. That is an entirely proper pressure for a region to place on those who espouse a particular capital scheme.
I have already said that I understand that that decision was hardly likely to be popular in West Essex or in the other districts affected by the region's decision of 24 September. However, I do not believe that the region had any realistic choice once it found itself in that position. It is unrealistic to expect the NHS investment programme to escape unscathed the implications of falling land values. That pressure applies right across the economy, and the NHS cannot expect to be exempt from it.
Any institution with a capital programme must face up to the implications of the falling values of the assets that it has for disposal. The region is entitled to some credit for having faced up to the implications instead of trying to hold out unrealistic prospects which it would later have to dash. It is far better to face up to the implications, address the issues and make a series of rational and ordered decisions than to try to fudge the decisions away.
313 The region's decision will give it the headroom to make decisions about proper priorities within the scheme once the deficit caused by the existing contracts on the over-committed programme has been cleared. We expect that deficit to be cleared by 1993.
Reference has been made to the £20 million raised by the sale of the Honey lane site. It is important to understand the principle that the NHS does not regard the resources raised by the sale of capital assets as district-specific. It would make the NHS quite unreasonably inflexible if we were to resile from the principle that capital raised by the sale of assets is a resource which should be redistributed through a proper mechanism within the NHS.
It is also fair to point out that, against the £20 million which has been raised from a site within West Essex, we must weigh the £11 million capital investment programme; nearly £2.5 million for refurbishment at the Princess Alexandra; over £1 million for the elderly day hospital at Saffron Walden; and a further £3.3 million for various projects for mentally handicapped patients. It is not as if it is £20 million out and nothing back.
With regard to the prospects for the capital programme, the district has made clear its belief that the Bishop's Stortford community hospital project may well be able to be financed in conjunction with a developer. 314 Therefore, hopes for that scheme have not been entirely dashed by the pressures that apply across the rest of the investment programme.
I recognise the disappointment which people understandably and properly feel about the implications of the region's decision about the future of the Princess Alexandra hospital. We must consider how best to develop realistic and deliverable plans to achieve our objectives for improving health care within West Essex.
§ Mr. Dorrell
No. I have only a minute left and I prefer to make a final point.
The analysis which determines that the single-site delivery of acute services is the most efficient use of resources has not been abandoned. The task that now falls to all those who are willing and able and want to consider the future delivery of health care to the people of West Essex within the resources that are likely to become available and within a realistic timescale is to consider the new circumstances and how best that objective can be delivered with regard to the most efficient use of capital in the context of West Essex. That is the——
§ The motion having been made 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 eight minutes to Twelve o'clock.