§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Neil Hamilton.]
10.25 pm§ Mr. Ivor Stanbrook> >(Orpington)Orpington hospital has its origins in a military hospital built with prefabricated buildings by the Canadian army for its troops during the first world war. Over the years, it has grown so that now it has, in addition to many of the original buildings, modern residential staff accommodation, a social centre and a substantial modern block, completed in 1982 at a cost of £9 milion and known as the Canada wing. It includes twin operating theatres and 264 of the hospital's 354 beds. The Canada wing is the most modern fabric of the entire Bromley health district, with all facilities for acute patient care. The entire hospital stands on a site of 38.8 acres, of which 12 are green fields. There is ample room for expansion. The whole site lies just off the A21, a main artery from London to Kent and the Channel ports, and only two miles from the M25.
The existing official plan for the hospital's future, as approved by the Government some years ago, is that it should be further developed into a modern district general hospital, providing all acute services and a full-time, 24-hour accident and emergency service, to serve the needs of the southern half of the London borough of Bromley and adjacent areas in Kent. The southern half is the growing half of the borough. The northern half is intended to be served by the expansion of Bromley hospital, a cottage-hospital style building presently standing on a site of only nine acres in urban Bromley.
The area served by the local health authority is coterminous with the London borough of Bromley. Besides Orpington and Bromley hospitals, it includes hospital buildings in Farnborough, Beckenham and Cane Hill. The object of the officially approved plan was to rationalise hospital services in the health authority area by concentrating acute services on the two main sites.
So far, so good. The Canada wing represented phase 2 of the development plan for Orpington hospital. My constituents and I were looking forward to the completion of the third phase, projected for next year, when it was anticipated that all the old hutted accommodation would be replaced and the rest of the services appropriate to a modern general hospital would be added. Successive Ministers in this House have assured me that Orpington hospital will retain its place in the plan.
However, we reckoned without the bureaucrats, administrative and medical, who have now screwed up that prospect and left us in a situation where the hospital is reduced to a shadow of what it could and should be: its status for the purpose of professional training removed, its provision for general surgery and intensive care withdrawn, its accident and emergency service, even on the scale of a minor injuries unit, abolished, its professional staff leaving and the morale of those remaining at its lowest.
The community health council has unanimously passed a vote of censure on the health authority. The general manager of the health authority, like his predecessor, has left to go further up the hierarchy, and the chairman has left office in somewhat mysterious circumstances. Both posts are now vacant. How the authority got into that mess is instructive. In 1987, the planners got it into their 1314 heads that the site of the existing Bromley hospital—nine acres—was too small to allow it to expand into a district general hospital to serve the northern half of the borough of Bromley.
They therefore proposed a deal—fashionable in those Thatcherite days—whereby the private sector could help to pay for the cost of a mammoth new hospital for all the acute services in the borough to replace both Bromley and Orpington hospitals. The new building, housing 820 beds and with parking space for 1,000 cars, would cost £100 million, which the planners of both the health authority and the borough council expected to raise by selling to private developers the surplus land at the other hospitals, which would be reduced to providing back-up services.
The idea would mean the death of Orpington hospital as my constituents know it. The prospect of the loss of that marvellous hospital on their doorsteps and journeying six to eight miles into Bromley is anathema to us all. Unfortunately, those in the north of the borough who formerly relied on Bromley hospital found the idea attractive, and they provide a majority on the council and on the health authority. The medical professionals also liked the idea, for they thought that it would mean greater opportunities for higher professional standards. The site proposed, which is owned by the borough council, is 21 acres of open space in the centre of the borough, where the traffic is often congested.
The idea seemed unstoppable when I raised the matter in the House on 30 October 1989. The then Under-Secretary of State for Health—my hon. Friend the Member for Kettering (Mr. Freeman)—agreed that his predecessors had given me assurances about the future of Orpington hospital. He was sceptical about the chances of £100 million being raised for the scheme, but he did not want to intervene then. However, there was a hitch. The site for that massive piece of concrete jungle was in the green belt. It appears to be incredible that that fact was overlooked by the planners, but it was.
My right hon. Friend the Secretary of State for the Environment called in the planning application. His inspector reported, inter alia, in paragraph 55 of his report:
I have come to the conclusion that whereas there is an undoubted need for new hospital provision in Bromley, the circumstances are not so very special as to overcome the strong presumption against inappropriate development in the Green Belt. There are to my mind other possible forms of development elsewhere which could achieve most of the objectives being pursued by the Health Authority.He also reported in paragraph 22:My conclusion on the evidence available is that the best prospect of locating the proposed new hospital elsewhere would be to combine a small development at the existing Bromley hospital site with a large development at Orpington".So planning consent for the super-hospital was rightly refused. Green fields are especially precious in urban areas such as central Bromley.Unwisely, the person who wrote to Bromley council to convey the decision of my right hon. Friend the Secretary of State for the Environment stated that the refusal was because the site was in the green belt and that there would be no objection if the green belt excluded it. As a result, the health authority chose not to take the sensible advice of the inspector and get on with making Orpington the major hospital in the district. It chose instead to persuade Bromley council to agree to an alteration in the boundary 1315 of the green belt so as to exclude the site. This rather disreputable manoeuvre is now under way. I hope that local conservationists will be up in arms about it.
The poor quality of management that was revealed by the error has been the cause of many of the health authority's decisions that have affected Orpington hospital. There is undoubtedly a reluctance on the part of the authority, which draws most of its members from the north of the borough, to give Orpington hospital a fair deal in respect of staff and other resources. I cannot count the number of times that I have frustrated efforts to change the official development plan to the detriment of Orpington by initiating Adjournment debates.
In the financial year just ended, Bromley health authority was well over its budget. Drastic cuts, masquerading as rationalisation plans, were made to save money. Where did the cuts largely fall? You have guessed it, Mr. Deputy Speaker—they fell largely on Orpington hospital. They leave it without any general surgery, intensive care units or a casualty service of any sort. 'There is not even a minor injuries unit. There are fewer wards and fewer beds. The Canada wing is in danger of becoming a white elephant. In these circumstances, a ghastly tragedy could occur at any time for want of on-site surgery, anaesthetists and inter-hospital transport. It should be remembered that the nearby M25 is the scene of many major accidents involving casualties on a large scale. We need surgery services at Orpington hospital.
It is ironic that the money that is sought to be saved by the cuts—£1.5 million in a budget of £82 million per annum—amounts to the same sum as that which is thrown away on surveyors and other expenses for the abortive super-hospital. As if to prove that it is indifferent to the waste of public funds, the regional health authority, South East Thames, whose general manager was general manager at Bromley when the bureaucratic scheme was launched, has recently given another £1.5 million to pay for continuing design fees and other expenses.
I have heard from one designer who is involved that the entire project is being scaled down because of escalating costs and falling land values. A 500-bed hospital is now being contemplated. Even if the hospital is built, the new Bromley hospital cannot be ready before the year 2000. What is to happen meanwhile? Orpington hospital has been truncated. The existing Bromley hospital is bursting at the seams. Queen Mary's hospital, which is just over the border in the area covered by Bexley health district, cannot cope.
Was there ever such a muddle? It is no wonder that, in January, the community health council passed unanimously a vote of no confidence in the health authority. It was alarmed at the authority's failure to consult and at the waste of management time and resources being spent on the new hospital before planning consent had been obtained. It said that the £1.5 million could have been better spent on existing services. The professional medical staff are extremely worried by what might happen in the present hiatus. They approved of the new hospital on the understanding that it would be under way before any rationalisation of existing services took place. We could be heading for the worst possible outcome—no new Bromley hospital because of insufficient funds and land, and no expansion of Orpington hospital, because the land available has been sold to private developers.
The people responsible for this muddle should have been sacked rather than promoted, and members of the 1316 health authority who condoned the inefficiency and faulty judgment involved and failed to correct it should be censured. It is a pity that nowadays the members of a health authority are not drawn from the ranks of the elected councils in the districts concerned, where they could at least be called to account.
My hon. Friend the Minister for Health told me a day or two ago that she has appointed a new chairman for the Bromley health authority, a Mr. Alan Cumming. She seems to have plucked him out of the air. I was not informed or consulted about his appointment. However good he is, he will not have the authority, let alone the experience, to do what is required to stop this nonsense. The Minister herself should intervene and tell the authority that it should stick to the existing plan and in any event get on with building up Orpington as a district general hospital without further delay.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)My hon. Friend the Member for Orpington (Mr. Stanbrook) has, for many years, been a doughty fighter for Orpington hospital. In preparing for the debate, I looked over the speeches that he made. Both my immediate predecessor, my hon. Friend the Member for Kettering (Mr. Freeman), and his predecessor, my hon. Friend the Member for Wycombe (Mr. Whitney), were called to account by my hon. Friend for the way in which the health service has been planning the hospital facilities for his constituents in Orpington, and quite properly so. On both those occasions, and again this evening, he expressed vigorously and clearly the views that I am sure are widely held in his constituency, and did so in a way that leaves us with no option—nor should we have an option —but to take them seriously.
Before I deal with the substance of what my hon. Friend has had to say about the circumstances in which the NHS finds itself in Orpington I shall set it in the context of the way in which the NHS has to be managed. You will know, Mr. Deputy Speaker, that the NHS is a vast organisation that cannot be run on the basis that every significant decision within it is made by one of four Ministers sat in Richmond house. It is, I believe, the largest organisation in the world in terms of the number of people that is employs, with two exceptions—the Red Army and the Indian railway, both of which made the mistake of over-centralising to an extent that we are determined to avoid in the management of the NHS.
For that reason, we have set up and recently reinforced a management system within the health service that delegates responsibility to district health authorities and, within health authorities, to the management teams within the hospitals, in order to ensure that the people who are responsible for using taxpayers' money to provide a health care system in each locality feel that they are responsible for the way in which the cash is used in the particular unit in which they work. That commitment to delegation, and then to accountability, which is the other side of the same coin, is something that we in the Department hold as a key objective in the evolution of our health service policy.
My hon. Friend, in talking about the impact of that on Bromley district health authority, regretted the fact that the passing of councillors from the health authority meant that, as he saw it, there was no local accountability to the local authority. I do not apologise for that, because, 1317 although we have a commitment to delegate, the NHS is ultimately accountable to my right hon. Friend the Secretary of State and, through him, to the House. That is why my hon. Friend is entirely right, despite that commitment to delegation within the management system of the health service, to call Ministers to account in the House for the way in which taxpayers' money is used within the health service and the solutions that are arrived at by that delegated system of management.
There is a nice balance to be struck within the management of the health service. Ministers stress the importance of delegating decisions so as to ensure that resources are used effectively in each locality. Despite the fact that we emphasise the importance of that delegation, we do not duck our accountability for the decisions that the bureaucracy ultimately reaches. It is right and proper that the issues that are of obvious and continuing concern to my hon. Friend's constituents should detain the House this evening and that he should bring them to our attention.
The way in which my hon. Friend presented his constituents' concerns highlights the fact that there are two issues affecting the provision of health care in his constituency. Those issues can perhaps be run together, but they are nevertheless separate. The first issue is whether it is right to centralise acute care on a single site, in this case, the Elmfield site to which my hon. Friend devoted a considerable part of his speech.
My hon. Friend suggested that there was an official plan that called for the continued provision of acute care on two sites within the health district. I think that he will accept—although he may disagree with it—that for some time, it has been the established preference of the health service management in Bromley and within South East Thames to centralise acute care in Bromley on a single site. To describe the policy of providing acute care on two sites as the official policy of the health service management is no longer accurate.
The reasons why health service managers in Bromley have sought, or wish, to centralise acute care on a single hospital site in my hon. Friend's constituency, or serving his constituency, are not dissimilar from those in other parts of the country. They are familiar arguments. Advances in modern medicine provide us with a great opportunity, which we must seize and use properly, to provide an improving quality of acute care while, at the same time, employing fewer acute beds. There is a long-term decline—not merely in this country, but throughout the developed world—in the demand for acute beds and acute hospital space in the provision of an advanced health service. That argument, coupled with the increased dependence of acute care on high technology, has resulted in a pressure to centralise acute care into high-tech centres of excellence, not only in my hon. Friend's constituency but elsewhere.
That is one side of the argument, but my hon. Friend was right to stress the other side, which is to ensure that as acute care is centralised into centres of excellence, it is not allowed to become too divorced from the communities that it is supposed to serve. He was also right to stress the importance of considerations of local access, clinical viability and the development of centres of excellence.
1318 That nexus of substantive issues is important and cannot be ducked, for it should concern anyone who is interested in the development of an efficient, modern system of health care.
The second set of issues that my hon. Friend mentioned involve planning issues related to the green belt. Quite reasonably, he quoted from the report of the inspector, who appeared to support the proposition that if acute care is to be centralised in Bromley, it should be centralised on the site of the Orpington hospital in my hon. Friend's constituency. As a distinguished lawyer, my hon. Friend will know the danger of relying on judges' obiter dicta. The question that the inspector was asked was not, "Where should the hospital be?" but, "Should the hospital be built at Elmfield?" Although my hon. Friend is entitled to pray in aid the inspector, I think that my hon. Friend will agree that the passage that he quoted from the inspector's report was of the nature of an obiter dicta. I am not sure what the singular of obiter dicta is. It was an obiter dictum, presumably.
It is not a factor on which we should put too much weight. Our planning system does not allow inspectors to tell us where we should build things; it asks inspectors whether a particular proposal—in this case a proposal to build the hospital at Elmfield—should be allowed. It must be right that the local authority, as the planning authority, and the health authority that wishes to build the hospital should retain the power of initiative in deciding planning questions. The inspector can dispose, but he should not be able to propose.
As my hon. Friend said, the London borough of Bromley, will vote on a proposal to change the nature of the green belt in the borough on I May, so it would be wrong for me to pre-empt what the council may say about a proposed change in the arrangements. It would also be wrong to pre-empt anything that may happen as a result of the change in the limits of the green belt.
However, it is fair to say that a decision on a major investment, such as has been envisaged by the health authority at Elmfield, would ultimately come to Ministers. Although this evening we can have a discussion that may illuminate some of the issues, I would not wish—it would be quite wrong to do so—to pre-empt the decision that my right hon. Friend the Secretary of State would make if a revised Elmfield proposal, which it was realistic to expect could be built because the planning law had been changed, came to him. There are a number of conditions in that sentence, all of which would have to be satisfied before a Minister could be asked to approve that proposal.
My hon. Friend has raised a substantive set of issues around the question of whether there should be a single-site acute care provision in Bromley. There are many hurdles still to be gone over before Ministers could be asked to make a specific decision. My hon. Friend's debate has served to remind us of his continuing interest in the outcome of that decision and of the strength of his feelings and those of his constituents about the outcome of that decision, when it is made.
The second issue is the temporary closures announced by the health authority in January this year. It has always been part of the management model of the health service that we consult before we make substantial changes, but that the health authorities reserve the right to make changes without consultation when financial pressures require urgent action. That was precisely the position in which the health authority found itself in January.
1319 However, if a health authority makes such a temporary, short-term decision under financial pressure, it remains under an obligation to consult before the decisions are made final. That is why the health authority has issued the consultation document on the proposals and why the consultation is currently going ahead on the proposals that were implemented by the health authority in January.
My hon. Friend will recognise that the health authority believes that, as a result of the changes, it is still offering the same basic level of service measured by activity or output measures, but on a different pattern around the district which, I can understand, is less popular with my hon. Friend's constituents than the pattern that previously prevailed. In considering whether the changes should be made permanent, it is legitimate to consider not only the fact that there is a £l million revenue saving for the health authority as a result, but the question of access for my hon. Friend's constituents to the health care that is provided.
As my hon. Friend will know, if the community health council chooses to sustain its opposition, which it has expressed clearly in its letter to my right hon. Friend the 1320 Secretary of State on 24 January, and to put forward an alternative proposal for the management of health care in Bromley which can still deliver the underlying objective for each health service manager, which is to live within the budget, the temporary closures could come to Ministers for them to make a decision. Once again, it would be wrong for me this evening to pre-empt any decision that my right hon. Friend may make as the result of such an appeal by the community health council.
My hon. Friend has taken the opportunity this evening to draw the attention of the House to difficult issues in his constituency. Both the long-term question of the centralisation of care and the short-term question of the changes implemented in January could ultimately come to my right hon. Friend for decision. I assure my hon. Friend that his arguments to the House this evening would be taken seriously into account in any decision that my right hon. Friend made in those circumstances.
§ Question put and agreed to.
§ Adjourned accordingly at five minutes to Eleven o'clock.