HC Deb 27 February 1991 vol 186 cc1091-8

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

11.55 pm
Sir Michael Neubert (Romford)

I have the great good fortune to raise for debate tonight the subject of Oldchurch hospital in my constituency. At a meeting of the Barking, Havering and Brentwood health authority tomorrow, a decision will be taken that could be critical for the hospital's future. The authority has proposed that, in the longer term, our district should be served by one general hospital on a single site at Harold Wood in the neighbouring constituency of Upminster. To his credit, my hon. Friend the Member for Upminster (Sir N. Bonsor), who unfortunately cannot be here tonight, is as opposed to the proposal as am I and my other Havering colleague, my hon. Friend the Member for Hornchurch (Mr. Squire) who, within the short time allowed, and subject to catching your eye, Madam Deputy Speaker, will contribute later.

The hon. Members for Barking (Ms. Richardson) and for Dagenham (Mr. Gould) are also very much opposed to the proposal, because large numbers of their constituents look to Oldchurch hospital for their medical treatment. Of the six hon. Members who represent the district, only my hon. Friend the Member for Brentwood and Ongar (Sir R. McCrindle) is other than categorical in his condemnation of the proposal. The majority of his constituents live closer to Harold Wood than to Oldchurch hospital.

It could be said that the proposal has few friends. During the consultation period, which expired at the end of January, the community health council, the London boroughs of Havering and of Barking and Dagenham, trade unions, doctors, patients, other organisations and members of the public have been loud in their disapproval.

The purpose of tonight's short debate is twofold: first, to bring home to the Minister, whose presence at this late hour is much appreciated, the strong feelings of people in the district on the proposal; secondly, to take a last opportunity, at the eleventh hour, to ensure that the health authority's decision tomorrow reflects the widespread opposition to the proposal. It would make a mockery of consultation were such a universal thumbs-down to be disregarded.

The reasons for the hostility of the public to the proposal are relatively straightforward. The Barking, Havering and Brentwood district is one of the largest in the country; from memory, I believe that it is the largest in London. It serves a population of 453,000 people. The Barking and Dagenham end of that district has an above average incidence of illness and a degree of social deprivation. In general terms, the population there has a high morbidity and a low mobility.

The combination of those two factors makes the prospect of people there having to go another four or five miles for hospital treatment unacceptable to them arid to many others. Such a distance may seem insignificant to people who live in country areas, but in highly populated urban areas it surely makes sense to provide services that are as close as possible to the people. That certainly holds true when the densest population coincides with the greatest need.

In seeking the retention of Oldchurch hospital, I am not speaking only for my constituents. However, I strongly believe that services should be local. Excellence is not the only criterion; convenience and accessibility are also important, and the right balance must be struck. Contrived formulas and artificial weightings have been devised to lead to the conclusion that there should be only one general hospital on a single site in our district. That is being challenged by my hon. Friend the Member for Hornchurch (Mr. Squire) and me.

The North East Thames regional health authority intends by strategic decision to approve a new district general hospital just across the western boundary in the neighbouring district of Goodmayes. That seems to pre-empt the opinion of people in our area about the provision of local hospital services. That opinion can broadly be summed up by saying that they would like to retain Harold Wood and Oldchurch hospital.

Oldchurch hospital is a Victorian workhouse-type hospital, but it provides a wide range of services, including regional specialties, to my constituents and to many other people in the area. It has attracted dedicated, high-calibre specialists who have been able to benefit from the interdisciplinary contacts that are established at Oldchurch. Despite being under constant threat from two quarters, they have engaged in many innovative and imaginative ventures. It is surprising that the success and popularity of the hospital should be so consistently challenged.

The first threat is from the London teaching hospitals, which resent the pretensions of Oldchurch hospital and would like to have its patients to boost their depopulated clinics. The second threat is from regional administrators, who cannot accept what they see as inadequate buildings and a cramped location but would prefer a brand new extension development to modern standards on a green field site. However, that would be at the expense of convenience and accessibility. In spite of those threats, Oldchurch hospital has prospered.

As it is just past midnight, I can announce that it is 17 years ago today that I entered the House. [HON. MEMBERS: "Hear, hear."] It is ironic that much of my time here has been spent in fighting threats to this much-loved institution in my constituency. There have been two proposals to close the neurosurgical unit, and two proposals to close the radiotherapy unit. On each occasion, a campaign was mounted to save the units. Now it is proposed that the whole hospital be closed, and that is a matter for regret.

I have received very few complaints about the treatment of patients at Oldchurch or about the standards of medical treatment or nursing. On the contrary, the vast majority of the complaints that I receive concern the fact that people cannot get an appointment or treatment soon enough. One imagines that that situation would not be improved by the closure of the hospital. Our case is that the hospital should certainly be allowed to continue its present service to the people of the area.

It is astonishing that, despite all the threats, the hospital's spirit is undiminished, and its confidence in its own future unflagging. Oldchurch has expressed an interest in achieving the status of a self-governing trust, and the Secretary of State has given approval for the further preparation of its plans. We must hope that the future will lie in that direction. In the meantime, we face the proposal that the hospital be closed, and the services provided on a single site elsewhere. As I have explained, that is not acceptable, either to the majority of Members of this House or to the majority of people in my area.

Our hope must be that the authority that runs hospital services in the area will take account of those views before making any decision. What the people in my constituency want is treatment of a good standard—not necessarily the very best—provided within a reasonable distance of their homes. Oldchurch hospital has provided such treatment in the past, and continues to do so, and any proposal that it should not be allowed to do so in the future will be vigorously and rightly resisted.

12.6 am

Mr. Robin Squire (Hornchurch)

As in the past, my hon. Friend the Member for Romford (Sir M. Neubert) has presented a sterling and forthright case in defence of Oldchurch hospital. I know he will agree that it is sad that this is not the first time we have had to defend that excellent hospital, which so many local people support in the most practical way possible—by going there for operations and medical treatment. It seems to me that that is the single most telling and lasting tribute to the hospital. It is sad that, whatever the structure of the health service, we have from time to time to put to Ministers points in defence of the hospital.

My hon. Friend sketched the background very well, and I do not want to be repetitious. However, I should like, in the short time available, to stress the breadth of opposition to this proposal. I shall do so in no particular order. Let me kick off with extracts from a letter from Mr. MacLellan, a senior consultant orthopaedic surgeon at Oldchurch hospital, to the services planning manager of the health authority. I think that the extracts, short though they are, will give the flavour. Mr. MacLellan says: The comments that you have made confirm in my mind the clearly held impression that the statistics prepared in your document 'A Blueprint for Better Health Care' are an attempt to give scientific or pseudo-scientific validation for a completely bogus exercise in health care planning. No objective data has been collected about mortality or morbidity related to the clinical services in Harold Wood or Oldchurch …. While there were representatives of both acute units at the meetings that gave rise to this document, these representatives were not briefed by individual departments within either hospital to speak on their behalf. No representatives of the trauma and orthopaedic service at Oldchurch were present, and since we carry the bulk of the trauma workload for the district it seems extraordinary that you believe yourself to be in any position to make judgments about quality of service at our site as compared with any of the other sites. As that was written by a consultant at the hospital, it might be said to be predictable. As has been said in other contexts over the years, "He would say that, wouldn't he?" Nonetheless, it is worth recording.

I turn now the Barking and Havering family health service authority, which has taken the trouble to submit its own formal comments, such is its concern at the nature of the document. Again, my hon. Friend the Minister will be pleased to know that I intend to be brief. It states: No analysis of the need for secondary care services is provided. The document gives the appearance of a provider not needs led plan, concentrating reasons for change as it does on buildings and management problems. A needs based analysis might have significantly influenced the weighting in favour of a more accessible site in the district. The document did not include an analysis of the impact of the proposals on primary and community care. It is the FHSA opinion that these will be substantial. Under the heading "Conclusion", the document states: The document does not provide information on developments in community support services that will be essential if the services are centralised irrespective of the site. A substantial development is needed to support the existing services. The FHSA is concerned by the lack of analysis of the impact on primary health care services. The planning of a new hospital provides major opportunities to consider the best mix of services that are needed to ensure optimum health of the population. As it rightly says: This cannot be done by looking at the hospital services alone. What we have is an isolated discussion document looking purely at the physical structures, without looking at the way in which health should logically develop over the next 10 years. It is worth highlighting the fact that both the major local authorities in the area—the London borough of Barking and Dagenham and the London borough of Havering—have produced documents setting out precisely why the document is a bad one. In particular, Havering stresses that, for many people in Havering, let alone in Barking and Dagenham, to site a hospital at Harold Wood at the eastern end of the district health authority can only provide major problems for many of the patients who would need to get there.

Word has reached me during the past couple of days of concern at Oldchurch hospital that there is to be a review by the district health authority of the acute units, and that a possible management restructuring is in the air which, if it proceeds—no consultation is required for that—would produce one overall unit amid great fears that Oldchurch and Rush Green hospitals would be run down, presumably for the general benefit of Harold Wood. That is not the way to proceed.

I ask the Minister not only to deal with our initial fears, but to consider carefully whether a telephone call tomorrow morning to the district health authority, to tell it to desist from this unnecessary, irrelevant and expensive exercise, would not save a considerable sum of money for the health authority.

12.12 am
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

My hon. Friends the Members for Romford (Sir M. Neubert) and for Hornchurch (Mr. Squire) are to be congratulated on raising this subject this evening on behalf of their constituents, and on delivering to the House a clear message that no one reading this debate could have any reason to misunderstand. It is no more than I would have expected from my hon. Friends, both of whom have been colleagues for a long time and co-campaigners in various campaigns.

My hon. Friend the Member for Romford was a senior, experienced and distinguished Whip when I first joined the Whips Office three and a half years ago. He used to have a notice by his desk which said, "This year Romford, next year the world," or words to that effect. This evening, he has given the House a demonstration of the effectiveness of his thinking on behalf of his constituents and of his campaign over 17 years to ensure that the importance of Oldchurch hospital in the health care of his constituents is understood by those who need to know.

I am grateful to my hon. Friend for raising the subject today, because not only has that allowed him to celebrate his 17 years in Parliament by continuing to campaign on behalf of his constituents; it has also allowed him to ensure that the members of the health authority go to their meeting tomorrow with his words and those of our hon. Friend the Member for Hornchurch ringing in their ears.

They thought that the consultation process ended on 31 January, and this will come as a reminder of the views of my hon. Friends, both of whom have written to the health authority to express their views formally. Their speeches this evening should have served to dispel any remaining doubt in the minds of members of the health authority.

This evening's debate allows me to say that I am sorry that I was unable to fulfil the engagement that I had a few weeks ago in my hon. Friend's constituency, I think at the hospital. I hope that it will be possible to reinstate that. I have no doubt that if it is reinstated the message that my hon. Friends have brought to the House this evening will once again be reinforced.

My hon. Friend the Member for Hornchurch suggested that I could spend some time tomorrow morning on the telephone communicating further the messages of my hon. Friends and adding to it a message of my own that the health authority should not proceed tomorrow with the proposal that we are discussing. I hope that my hon. Friend will understand that I shall not be doing that, not because there are no circumstances in which I might find it in myself to agree with my hon. Friend but because—this is an important principle—the only good way to manage an organisation which employs a million people and absorbs £30 billion of public expenditure is through a management structure, within which we encourage management decisions to be taken as far down the line as is practicable.

We run a delegated system of management, and if that policy is to have real effect, it is important that managers are encouraged to make real decisions and to carry responsibility for them without feeling that their every decision is subject to Ministers looking over their shoulder and jogging their elbows. Therefore, I shall not be ringing the health authority tomorrow morning to communicate the message that my hon. Friends would understandably wish me to.

Nor am I in a position this evening to be able to make clear what the Government's attitude would be if in certain circumstances the proposal ended on a Minister's desk. I will explain briefly why that is. I have explained the importance that we attach to the system of delegated management: the result of that is that a decision of this nature ends up on a Minister's desk only if it has proved impossible for the different agencies within the health authority locally to reach agreement on how the proposal should proceed.

If, therefore, the health authority were to confirm its proposal to concentrate health care on the Harold Wood site, it would be for the CHC to decide whether it wished to lodge its firm opposition to that proposal. If the CHC were to take that course, the disagreement between the health authority and the CHC would go to the regional health authority for a further opinion. If the regional health authority were to support the district health authority but the CHC maintained its opposition to the united view of the regional and district authorities, the proposal would come to a Minister for a decision.

I am sure that my hon. Friends will understand that, if a Minister had to make a decision between the CHC proposal and the management proposal, he would want to do so without having a commitment given in the House hanging around his neck, making it impossible for him to approach the subject with an open mind, as he should.

I give my hon. Friends the clear undertaking that, if it proved impossible for the various agencies that I have described to reach a decision locally, I would go to considerable trouble to ensure that the responsible Minister fully understood the concerns of my hon. Friends' constituents as well as the arguments advanced by the health authority. Therefore, I am not able to describe precisely this evening how my right hon. Friend the Secretary of State would use his discretion if the proposal came before him for a decision.

I can comment on one or two of my hon. Friends' comments. My hon. Friend the Member for Romford was particularly concerned that the convenience and accessibility of health care is considered a relevant consideration and that the creation of ivory towers is not a sufficient argument by itself to support a particular policy. I give my hon. Friend an assurance that we agree. We run the health service for the benefit of its patients, not for that of its doctors—still less for the benefit of the academicians. Convenience and accessibility are important factors in deciding the pattern of health care in any locality.

My hon. Friend stressed the dangers that are attached to grandiose ambitions, as opposed to the more humdrum development of health care in a particular locality. It is one of the sins of traditional health service management that it has regarded capital as a free good. It is to address the problem of excessively grandiose schemes not firmly based in local needs that we are introducing from 1 April the principle of capital charging, which will ensure that any addition to the capital stock of a particular district is recognised to be the cost that it is, so that any authority planning to absorb more capital in the provision of health care will take account of the capital, as well as revenue cost, that it incurs from its investment decisions. I hope that will reduce the attractiveness of highly capital-intensive solutions to particular local problems.

My hon. Friend the Member for Hornchurch stressed the importance that he attaches to a firmly based local assessment of health needs in planning for the future. He quoted in support the views of the local FHSA. Again, not only do I agree, but that is one of the basic propositions on which the Government's reforms from 1 April are founded. My hon. Friends should need no reassurance from me, because the definition of local health need and the use of the contracting system to design a pattern of provision that will meet identified local health needs is written into the statute for which all three of us voted last year. Those are the criteria that management will increasingly use in their areas.

I will enter a caveat by way of balance, and stress that, as we think about the development of provision over the health service as a whole, we must acknowledge that a constant factor is the declining need for acute beds. Modern medicine allows us to treat more patients, more quickly, with fewer acute beds. Merely because traditional medicine needed 500 or 600 beds in a particular locality, that does not mean that, in the next 10 years, we shall continue to need the same level of acute bed provision. Many conditions that once required three weeks' hospital stay can now be treated either on a day case basis, or without the need for surgery or hospitalisation at all. That must be borne in mind, particularly when considering major capital investment that will commit the health service to capital costs for a generation ahead.

Another factor that makes more complex the situation in which my hon. Friends' constituents find themselves is that both Old Church and Harold Wood hospitals are preparing applications for trust status. They are expected by the end of April, and I should emphasise that nothing that is happening as a result of the consultation process launched by the district health authority can limit the discretion of my right hon. Friend the Secretary of State to accept either or both those applications or——

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-five minutes past Twelve o'clock.