§ Sir Anthony Grant (Cambridgeshire, South-West)I am proud to have the Papworth hospital within my constituency. It is, as is well known, world famous for heart surgery and treatment. It is long past the research and experimental stage of other transplant surgery and it has a proven track record. It has saved many lives and improved the quality of life for many others.
Papworth hospital is notable for the expertise and the exceptionally high morale of staff at all levels—consultants, doctors, nurses and all ancillary staff—which compares favourably with that at many other hospitals. Above all, and most importantly, patients are delighted with the treatment that they receive there. I do not think that I have met a single patient who has not been full of praise of the way in which he has been treated and the way in which he has recovered from a serious operation at Papworth hospital.
All, whether consultants, staff or patients, have one thing in common—they do not want to move to the equally famous Addenbrooke's hospital, also in my constituency. There are many reasons for that. I will not go into all the details, but they include staffing, parking of vehicles, accommodation for relatives and amenities, particularly for the long-stay patients, and the patients there are necessarily of a long-stay nature compared with those in a district hospital. All those are easier at Papworth than they are in Cambridge. Addenbrooke's, excellent hospital though it is, with some of the highest skills available in the world, is already much too large and ought not to become larger. That is the view I take, and it is the view that the people who work there and the customers take. It is also, I have to say, a view shared by my colleagues in the House who represent the county of Cambridgeshire.
But there is a serious problem, which is the reason why I have sought this Adjournment debate. Papworth has a waiting list of 900, double what it was nine months ago. I am told that patients are having to wait so long that when they are admitted they are already either urgent or emergency cases. Currently, more than 80 per cent. of the patients are thus classified. The remaining 20 per cent. on the waiting list have to wait an average of 11 months. That is not good enough. I am advised by those who know that the maximum waiting time for patients of that nature should be six months and that patients in that category should not make up more than 40 per cent. of the total.
During the last year, Papworth has received letters about the waiting list on behalf of patients from many Members of Parliament, including no less a person than the Prime Minister himself and, significantly, from my hon. Friend the Minister's boss, the Secretary of State for Health, who has had occasion to write to the hospital on behalf of patients who have been waiting too long.
The hospital is working harder than ever and has increased productivity, and there is a record number of operations using the same number of beds. The number of heart specialists has doubled from five to 10. However, despite all that admirable activity and work, the hospital is failing to match demand, which has doubled in 12 months. With new treatments and wider knowledge, there is no likelihood that that demand will diminish for the foreseeable future.
1151 Bearing that in mind, a new operating theatre will be available in 1992. Indeed, a few months ago I had the privilege of digging the first sod for the work on that splendid new operating theatre. In addition, a second angiography suite will be opened in 1992, thus enabling the workload to double, at a cost of about £3 million to public funds.
However, beds are needed if the new facilities are to be used and the waiting lists eased. The position is rather absurd. The only analogy that I can offer is that it is like a marvellous train standing in a station, with the most expert drivers and crew and a long line of passengers waiting and longing to get on board, but the train is unable to move because there are not enough coaches. It is no solution to tell people that they will have to move to another station: we need extra coaches.
What will the new wing cost?—a substantial amount, £1.5 million. How does one deal with the problem? One could ask the regional health authority, but it already has heavy demands upon its money, added to which it will not make up its mind because it says that the future of Papworth is uncertain. The uncertainty has been created by the regional health authority, in my judgment, because people in my constituency, and I myself, wish that Papworth should stay where it is. That uncertainty, which the regional health authority has not resolved, makes it reluctant to produce the money, even if it had it.
However, there is a simpler solution, which will not cost the regional health authority anything in hard cash, because at least four private companies are prepared to invest in the new wing, at no expense to the public, but they must be certain that they will get a return on their investment. If they could be certain that Papworth hospital would stay where it is for 10 years and that the new wing would be used for that time, they would get a return on their investment. However, if the wing is used for only six or seven years, they will not get an adequate return.
Therefore, we are in a Catch-22 position. The simple solution is for a guarantee to be given that Papworth will either stay as it is for at least 10 years or, in the event of the hospital being moved to Addenbrooke's hospital, the health authority will guarantee repayment to those who invest in the new wing. What are the benefits if that solution is adopted? I can think of three important benefits.
First and foremost, the patient waiting lists for cardiac services will shorten. Secondly, district health authorities will benefit. Papworth is in an excellent authority in the Hunts district which is run very efficiently by its staff—all of whom, from the chairman downwards, are dedicated people whose work I greatly admire. Such authorities will be able to purchase more services by virtue of the new wing, and, what is more, the income from private patients will enable them to do so more cheaply. Thirdly—this should commend itself not only to the Department of Health but to the Treasury—the taxpayer would see the £3 million already spent on the new operating theatre and angiography suite working to optimum capacity rather than its present 50 per cent.
All the arguments point to the solution that I have suggested. I think that it is in the interests of patients, doctors, staff and everyone else who is concerned with this remarkable hospital. I do not expect the Minister to make 1152 a decision this afternoon; Ministers cannot be expected to construct policy on the hoof. I merely wish to alert the Government and the public to an important health problem, and—perhaps equally important—to point out that there is a relatively simple solution, if only those in charge will grasp the facts, make a firm decision and remove all uncertainty.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)I hope that my hon. Friend the Member for Cambridgeshire, South-West (Sir A. Grant) will forgive me if I begin by saying that I was a little concerned to discover yesterday that I would be answering a debate in which he would be putting the questions. Having witnessed the effectiveness of his questioning of the Opposition yesterday, I did not want to find myself in the same position.
My hon. Friend has not let his constituents down. He has presented a very effective espousal of the case of those concerned about future investment in Papworth hospital, and those who support his solution. As well as highlighting the appealing simplicity of that solution, he has left no stone unturned in his cogent presentation of the arguments.
If my hon. Friend had been present earlier, he would know that only an hour ago I was describing the dramatic advances that we have achieved in the national health service: the expansion of the transplant programme, and the enormous health benefits that the improvements in modern medicine have unleashed. I was replying to a speech made by my hon. Friend the Member for Newbury (Sir M. McNair-Wilson), who has benefited from a different kind of transplant from those with which Papworth is primarily concerned—but that transplant is another manifestation of the importance of the programme to which Papworth makes such a distinguished contribution.
As I told my hon. Friend the Member for Newbury, before I became a Health Minister last May my exposure to transplanting in general, and heart transplants in particular, had been that of a layman. I vaguely remembered the flickering black and white television pictures from the Groote Schuur hospital in Capetown in the late 1960s, when Dr. Christiaan Barnard first performed a heart transplant operation. I thought of heart transplantation as a major technical advance that was still very much on the leading edge of technology. I did not think of heart transplants in the context in which they now take place. They are now routine operations in the national health service. Thousands of people who are walking the streets of this country have benefited from the surgery that has been developed to such a high pitch at Papworth hospital. It is one of the major benefits of modern medicine, and it has been provided to the people of this country through the agency of the national health service.
At the beginning of his speech my hon. Friend was keen to put on record the very considerable achievements of his constituents within Papworth hospital and to draw attention to the fact that he has the privilege of representing two hospitals, both of which have international reputations, earned from very successful clinical records and the exploitation of medical advances. Since 1979, the number of heart bypass operations 1153 performed at Papworth hospital has increased by nearly 300 per cent. That is a measure of the advance that has been made possible by modern medicine at Papworth hospital.
The hospital is to receive £250,000 from the East Anglian regional health authority's waiting lists fund to do 70 more bypass operations next year than were previously planned. Apart, therefore, from Papworth hospital having a distinguished track record, it has also received support from the East Anglian regional health authority to deal with the waiting list problem that my hon. Friend identified as one of the managerial issues that the hospital has to face.
Furthermore, as my hon. Friend briefly mentioned, the hospital has also benefited from a significant capital expenditure programme that is currently under way. It is a £2.7 million scheme for a third operating theatre at the hospital, which is due to open in April 1992. No one could argue that Papworth is not a major success story within the national health service, or that its success story has not been reinforced and supported by national health service management in general and the East Anglian regional health authority in particular. Due to its success and reputation, both nationally and internationally, Papworth hospital has received the letters to which my hon. Friend referred from my right hon. Friend the Secretary of State for Health and my right hon. Friend the Prime Minister, both of whom are concerned about constituents who are on the Papworth hospital waiting list because they wish to benefit from the surgery that that hospital can provide.
I am grateful to my hon. Friend for drawing my attention to the fact that, apart from having to guard myself against the effective questioning of which he has so recently shown himself to be a master, I must ensure that whatever I say will read well in the constituency press both of my immediate boss and of my ultimate boss. In responding, therefore, to my hon. Friend's speech, I have to choose my words extremely carefully.
My hon. Friend argued vigorously that the current waiting list problem at Papworth hospital could most effectively be addressed and reduced by accepting the offer of private capital to provide an additional ward, thus increasing Papworth hospital's capacity. To adopt the metaphor used by my hon. Friend this afternoon and in a recent letter to my right hon. Friend the Secretary of State for Health, it would add an extra coach to the train.
Whether the extra ward is funded by the regional health authority or by private capital, the issue clearly needs to be examined to find out whether the additional ward would provide the relatively low marginal cost benefit to patients on the waiting list. I shall certainly ensure that the proposal is carefully examined. If it is true that for the relatively modest expenditure involved in providing an additional ward in the hospital the rest of the resources, not least the £2.7 million new third operating theatre coming on stream in April 1992, could be used more effectively to produce a lower average cost per operation and to treat more patients within the hospital as a result of having an additional ward, that is clearly a powerful argument which those responsible for the routine front-line management of the health service in Cambridgeshire will have to address.
I pause for a second to reflect on the role that private capital could play in the provision of that additional ward space. It is quite explicitly one of the benefits that should flow from the reformed structure of the NHS that comes 1154 into effect next Monday and the introduction of the concept of purchaser-provider that we should be more open minded about the employment of privately funded capital stock for the treatment of health service patients.
The burden of my hon. Friend's argument was not only that a relatively small additional investment would yield large benefits for patients if placed at the Papworth hospital, but that the health service need not expect to finance that investment because private capital is available. It makes my hon. Friend's approach that much more attractive, and is a clear and timely illustration of the benefits of an effective and flexibly managed health service from the employment of the principles of purchaser-provider that come into effect next Monday.
Those reforms concentrate the mind on the core activity of the NHS. We must remember that the NHS should not be principally about running hospitals. It exists to provide equal access to health care for patients. It is an enabling mechanism to ensure that access to health care is determined on the basis of clinical need and not ability to pay. If that can best be done by using public funds through the agency of a purchaser district health authority to purchase health care from a privately funded provider, that is an entirely benign result which I am sure every patient on a Papworth waiting list would applaud with vigour.
I pause to reflect upon the significance of my hon. Friend's suggestion and to stress that not only are we open-minded towards it but we embrace the concept of a privately funded facility if the benefit is to enhance the quality of patient care to health service patients waiting for treatment at Papworth hospital. I find that aspect of his argument extremely attractive.
My hon. Friend went on to express concern about what he felt was the potential uncertainty about the future of Papworth hospital. I should like to address that concern directly; it is clearly critical to the viability of the privately funded ward for which my hon. Friend was keen to argue this afternoon. Clearly he is right in believing that we shall not be able to recruit private capital to a hospital when its future is limited to a relatively few years.
I wish to explain in more detail the current position on the future of the hospital. Papworth hospital was built in 1928 as a tuberculosis sanitorium and chest hospital. The surroundings of the hospital are attractive, but the existing capital stock of the hospital is relatively old and fragmented and the running costs for the buildings are relatively high.
The management of the health service believes that for the hospital to remain viable for the practice of high-tech open heart surgery and transplantation a significant rebuilding, expansion and investment programme will be needed to ensure that the buildings in which the high quality clinical care is offered are able to provide the security and conditions in which high-tech medicine can be properly and best offered. Such a programme would also ensure that the buildings were not wasteful in terms of the revenue expenditure which is necessary to keep them operating. It would be crazy to have a high-tech hospital where money that should be spent on high-tech medicine was spent on propping up extremely low-tech buildings.
After some initial appraisal work, the regional health authority invited Huntingdon district health authority in April last year to consult locally on options for the future of Papworth services. Having done so, it asked it to submit its recommendations to the regional health authority for a 1155 decision. I can now tell the House that the district health authority expects to issue a document for consultation about the future of Papworth by mid-April. It is currently in draft form and has yet to be formally agreed by the district health authority, but it is likely to include a detailed appraisal of four main options.
The first option is to extend Papworth and upgrade the existing buildings on the Papworth site. The second is to build a replacement building on the site. A third is to provide a new building on the site of Hinchingbrooke hospital in Huntingdon. A fourth—which my hon. Friend was concerned that the House should realise was the subject of significant local opposition—is to construct a new building on the site of Addenbrooke's hospital in Cambridge. I understand that they are the four options that are likely to be canvassed in an entirely neutral way in the document to be published by the district health authority in a few weeks.
The document will also state what the key criteria against which those options will be assessed should be. First, it is important that the patient has reasonable access to the health care. Secondly, it is important that the environment in the hospital is congenial and appropriate for the offering of the type of health care for which the hospital was designed.
§ Sir Anthony GrantEspecially long-stay care.
§ Mr. DorrellMy hon. Friend is right to remind me that it must be appropriate for the offering of relatively long-stay care. I pause slightly over the use of the term "long-stay", because, to a Minister with responsibility for mental health services, it tends to mean something slightly different than it would in the context of cardiothoracic care.
We might deal with the problems of staff recruitment and retention. Furthermore, we must ensure that, whatever form the new Papworth facility takes, it is able to recruit and retain the staff that it needs. We must also consider clinical integration, teaching, research and the relative cost of the different options. We must also seek to ensure that the facilities that we provide are flexible and can expand and contract to meet the demand for the facilities offered in the new hospital and that they do not commit successor generations to a capital stock that they are unable to mould to emerging needs. We must also bear in mind the adjustment cost during the implementation phase of any capital investment programme and ensure that disruption is kept to a minimum in that period.
Those options will be canvassed as a result of the consultation document. Following that, I hope that we shall be able to arrive at a decision about how the excellent health care available at Papworth hospital is ensured for the future. I hope that that decision is reached in an orderly and not excessively time-consuming manner.
The Government and the health service are committed to maintaining intact the infrastructure which is Papworth hospital. The question is how we design our capital investment programme to ensure that that institution and infrastructure is available to the best advantage of patients for the lifetime of the capital investment which we are making in the future of that centre of excellence of British medicine.