§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kirkhope.]
2.31 pm§ Mr. Brian Sedgemore (Hackney, South and Shoreditch)In this debate I intend to thrust a stake through the heart of Professor Tomlinson's report and show that the professor has produced, as far as Bart's is concerned, a discreditable document which henceforth will be seen as such by fair-minded and clear-minded people.
I shall begin with three general points. First, the Bart's site at Smithfield lies in the constituency of the right hon. Member for City of London and Westminster, South (Mr. Brooke), the Secretary of State for National Heritage. I know that the right hon. Gentleman is extremely concerned for the future of the hospital.
Secondly, the much respected Dr. Brian Jarman, the professor of primary care at St. Mary's, has concluded that the Tomlinson report is flawed because there is no surplus of beds in London. Both Tomlinson and the King's Fund have misinterpreted the statistics.
Thirdly, when the Minister for Health went to Bart's eight days ago, he was given evidence by the North East Thames regional health authority that it was treating the consultation period as a mere formality. The question is whether Ministers and civil servants have put the region up to this disgraceful conduct or whether the region is acting in contempt of Parliament and behind Ministers' backs. How do Ministers justify putting pressure on Conservative members of the Select Committee on Health not to hold a full inquiry into the Tomlinson report but merely to hear only the biased professor? Are Ministers now reduced to rigging Select Committees?
The main point made by Tomlinson against Bart's is that the introduction of the internal market has shown that Bart's does not have enough patients to be viable. According to Tomlinson, Bart's has, and always will have, a deficit because it is in the wrong place. It is an extraordinary argument, and one which is 100 per cent. wrong.
The Minister for Health was told by Professor Mike Besser that the argument that Bart's has no patients is plain silly. Within a two-mile radius of the Smithfield site, Bart's serves 100,000 people from south Hackney and 100,000 from south Islington, as well as 314,000 daily commuters and 5,000 who live in the City.
Professor Besser says:
Our beds are full and there is no evidence to suggest that they will not remain so. During September this year Bart's hospital recorded its highest ever bed-occupancy rate of 96 per cent.As for the treatment of accident and emergency patients, Professor Besser has asked me to put the following point to the Minister:Bart's would like to know what would happen if there were another Cannon street train disaster, or St. Mary's Axe bomb, another Marchioness boat sank or if there were another artillery Guards bombing. Bart's would like to know where the 39,713 patients who attended Bart's at Smithfield's A & E department in the year to March 1992 would go.Professor Besser and everyone else at Bart's are angry that Tomlinson never bothered to find out to what extent money did not follow patients at Bart's or how, if it did, there would be a surplus rather than a deficit. He asked me 1158 to make the relevant figures public for the first time. They are contained in a note dated 28 October prepared by Mr.Dalton, the deputy general manager. He wrote:At 31 September, the Trust had exceeded its planned contract level with our 55 block contract purchases by 5,600 episodes.If this level of activity continued, accounting for the winter season, we will over-achieve by approximately 13,000 episodes or + 27 per cent. of our agreed plan.The problem is clearly not with our patient flows but with the failure of the 'market' to enable money to follow the patients.Mr. Dalton told me that if the money had followed the patients in those 13,000 episodes, and if the purchasers had paid the full cost of the treatment, Bart's would have received a staggering additional £22 million. If the purchasers had paid the marginal cost, which is one fifth of the total cost, and if Bart's had been prepared to allow the purchasers to do that where money was not following the patients, Bart's would have received an additional £4.4 million. That figure is almost exactly equal to the projected in-year deficit for 1992–93. In short, the figures show that the deficit would disappear, even though Bart's is in the absurd position of having to make a capital charge for every patient it treats based on current City land values—although the hospital was given the land 900 years ago by act of God.Patients wish and need to go to Bart's and their general practitioners want to send them there. However, the figures show that thousands of patients are receiving treatment at Bart's but the purchasers are refusing to pay for that treatment. They show that the internal market has broken down, that money is not following the patient, and that there is not a patients charter but only a contract-makers charter. The figures also show that the Secretary of State and the Minister have been misled by those who drew up the Tomlinson and King's Fund reports—the mad hatters and march hares of the bureaucratic medical world.
The horrifying question now being asked by the people of London is why Tomlinson did not even consider that matter, which constitutes the critical point of his inquiry as it relates to Bart's. Was it through ignorance or laziness, or were more malign forces at work?
To balance the books, Bart's now proposes to turn away thousands of patients. Mr. Dalton writes:
The projection report I commissioned reveals that if we only undertook emergency admissions from now to 31 March and stopped all elective cases, then to live within our contract plans we could only admit 465 elective patients (21/week). This compares with our volume for the first six months of the year of 11,500 (422/week).If purchasers refuse to pay then we must carefully and sensitively notify the patient's GP (and patient) that the hospital wishes to treat the patient but is being prevented from doing so by the purchaser.This contract management system is bound to be controversial but the principle remains: purchasers must pay for the service they wish us to provide. I hope therefore that the system will be a catalyst for the release of additional funds to us and enable a fuller debate on getting the market to work properly.What a wicked scandal it is that the Secretary of State has produced a system that forces one of the best hospitals in the world to turn away patients. If the Minister has any decency left, he will inform Parliament today that the proposal to close Bart's will be swiftly consigned to the dustbin of medical history. I keep reading that, because Bart's is nigh on 900 years old, it is a conservative institution which is resistant to change. What nonsense!1159 In the past five years, £60 million has been spent on Bart's, providing, among other things, new children's and cancer wards. Bart's has an operating theatre complex which is the most technically advanced in Europe and a day centre surgery which meets the highest standards. The medical college has an international reputation for excellence in teaching and research. At Charterhouse square there is one of the best medical research centres in Europe, with 400 researchers.
Tomlinson declined to visit the research centre. I understand that when the Minister for Health went there he asked whether the continuation of the work at Charterhouse square depended on the juxtaposition of the hospital. He was told unambiguously by Professor Lesley Rees, the dean of the medical school, that that was the case. Changes in the undergraduate medical curriculum at Bart's even pre-empted the General Medical Council proposals for the modernisation of medical education in Britain.
The King's Fund organisational audit, which was carried out only a few weeks ago, showed that Bart's had cracked the problem of multi-disciplinary work, especially in its linking of hospital work with GP work and community care.
Yesterday, Dr. Lesley Southgate, a local GP in a group practice and the only female professor of general practice in the United Kingdom said:
I agree that primary and community services are under-developed but evidence shows that if money is spent in these areas in deprived places such as Hackney hospital referral rates will go up as more illnesses are diagnosed as requiring hospitalisation.A cross-section of GPs from Hackney to whom I spoke on Monday were united on two points: first, they want to remain generalists; and secondly, although they want more money for primary care, they do not see that resulting in a fall in the demand for hospital beds. My own GP, Dr. Janet Kirton, who works in one of the most deprived areas in Hackney, and hence Britain, warns of dire results if Bart's closes. Tomlinson does not know. She knows. She is bright, young and progressive.The Minister for Health knows how innovative Bart's can be. When he visited the hospital eight days ago I understand that he was completely thrown by the fact that he was presented with a new strategy for Bart's, Homerton hospital and St. Mark's. It must be obvious to everyone that Bart's has drawn up an alternative proposal, because it has concluded that the Government will never allow the creation of a system in which money genuinely follows the patients. Bart's has concluded that purchasers will always and for ever be allowed to rig and distort the market, even if it is against the best interests of patients.
The new plan provides for savings of £22 million at Smithfield. Even the Secretary of State must see that as innovative. I stress that, with or without this plan, there is no rational argument for closing Bart's on medical or financial grounds.
So that leaves the question of how Tomlinson managed to get it so wrong. The most likely answer lies in the complete absence of methodology in the Tomlinson report. One expert in health economics described the report as being of slovenly intellect. Another put it more prosaically when he said:
I wouldn't close a corner shop on the basis of this report, let alone one of the best hospitals in the world at Bart's.1160 The Tomlinson report contains no statistical analysis, costings or financial underpinning of its arguments. It uses no known scientific method, unless the making of didactic statements is deemed to be such.The proposal to close Bart's is a proposal to tear up history, throw away precious medical research and science and deny some of the most deprived people in Britain of a first-class hospital service. The proposal has left the local community, patients, hospital staff and the medical college bewildered and angry. At Bart's we have irreplaceable human and capital resources and an incomparable reservoir of knowledge, medical care and love. Surely, there is no other country in the world that would even dream of destroying such a magnificent asset.
The poet Tennyson wrote:
For I dipt into the future, far as human eye can see Saw the vision of the world and all the wonder there could be.With Bart's it is somewhat different. It has been part of our island story since time immemorial. It represents all that is fine and noble in the human spirit. It is a wholly good institution in a world where goodness is in short supply. Bart's matters because it is part of the vision of the world.It is inconceivable that Parliament should allow it to be destroyed. We all expect the Minister to lift the dark and menacing cloud that hangs over our hospital today and so enable us to rejoice in the next 900 years of its existence.
§ Mr. Chris Smith (Islington, South and Finsbury)I am grateful to my hon. Friend for allowing me to speak briefly in the debate to back up his powerful, moving case. I bitterly oppose Professor Tomlinson's suggestion that Bart's should close. I urge the Government to keep Bart's open in its entirety, with all its expertise and experience and the services that it provides—especially to my local constituents.
Not only does Professor Tomlinson suggest that 900 years of history should be dismissed in seven paragraphs; not only does he suggest that a centre of real medical excellence should disappear—a centre of excellence which even in recent years has improved and developed, with improvements ranging from new facilities for the treatment of HIV and AIDS to new facilities for child oncology—he also suggests that the local hospital, which serves thousands of people in the southern part of Islington and Finsbury, should be simply wiped from the map.
This morning I spoke to a general practitioner, who has a list of 6,000 local patients who look to Bart's as their local hospital. It is suggested that they should go to Homerton hospital, the Royal London hospital or somewhere else. Many of the people who look to Bart's as their local hospital are elderly and frail and find it difficult to imagine, let alone make, the journey half way across London to so-called alternative facilities. I hope that the Government will think again about Professor Tomlinson's proposal. The experience, excellence, work and service that Bart's provides are too precious to too many people to throw away so lightly.
My hon. Friend referred to the King's Fund organisational audit of Bart's. It gave glowing praise to the work that Bart's does. I finish by drawing attention to just one factor of that praise. The report said: 1161
They were also struck by the loyalty of staff to the organisation and the way everyone seemed to be working together. They commended these as very special qualities which should be cherished.Professor Tomlinson's way of cherishing those qualities is to force them into complete oblivion. We do not want to see that and nor do local people. I urge the Government to save Bart's hospital.
§ Madam Deputy Speaker (Dame Janet Fookes)Order. The usual arrangement in an Adjournment debate is that the debate is between the hon. Member who raises the subject and the Minister. Another hon. Member may speak only with the premission of the hon. Member who introduced the debate. I have been informed of only one hon. Member who had permission to speak from the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore).
§ Mr. SedgemoreI am willing to allow the hon. Member for Wimbledon (Dr. Goodson-Wickes) to speak.
§ Dr. Charles Goodson-WickesI am extremely grateful to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) for allowing me to make a brief contribution to his Adjournment debate. I register an interest, having been trained at Bart's. However, my arguments are based not on sentimentality but on sound, practical grounds. Believing as I do in the excellence of the national health service generally, every member of my family—my wife, two sons, one of whom was born at Bart's, and I—has received superb treatment at Bart's.
My hon. Friend the Minister knows that I generally welcome the Tomlinson report, but today we are debating a narrower but highly important issue. I hope that the report will not be simply rubber-stamped without being critically re-examined.
Bart's is justifiably proud of its 900-year history. It has always looked to the future, and only in that way has it maintained its international pre-eminence over the years. Before Tomlinson, at a time when Bart's was told that it was not under threat, it had already established a strategy group to change and adapt to present-day needs in line with Government policy.
It was proposed that Bart's at Smithfield, which serves the constituents of certain Opposition Members as well as residents of the City, should take as its theme three aspects highlighted in "The Health of the Nation"—cancer, heart disease and AIDS. Combined with that, on a contracted site, was to be a city health centre to care for the 300,000 people who commute to the City daily. Bart's serves half a million people during the day, yet Tomlinson claims that it will be all too easy to move patients suffering from heart attacks or strokes across the river to Guy's, St. Thomas's, the Royal London, or University College hospital. I imagine that those of my constituents who work in the City would, like me, be extremely unhappy about the time involved in travelling to receive expert care.
Bart's has shown over the years that its policies work. Contrary to recent assertions, consultant episodes, in-patient activity and day cases have improved dramatically. Surely we cannot allow a savage prescript ion to be administered without further examination. The 1162 suggested solution of co-operation with the Royal London hospital linked to the disposal of the magnificent site is flawed—medically, statistically and financially. The most important thing of all is not Bart's history but proper treatment of national health service patients in future.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)I am grateful to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) for this opportunity to debate the future of St. Bartholomew's hospital. In publishing Sir Bernard Tomlinson's report on London's health services last month, the Government made clear their intention that there should be a period of reflection and discussion before key decisions are taken. This afternoon's debate is a valuable part of that process.
I listened carefully to the views that were expressed, and all that was said by the hon. Member for Hackney, South and Shoreditch will be carefully considered. I assure the House that the Government will take those views into account in presenting our detailed proposals for change in the light of the Tomlinson report.
No hospital has a longer or more distinguished tradition of caring for the sick than Bart's. Many of the country's doctors and nurses began their training there. A great many more benefited from the expert treatment that they received at Bart's.
§ Mr. Dennis Skinner (Bolsover)Is the Minister going to save the hospital? Yes or no.
§ Madam Deputy SpeakerOrder. The Minister should be allowed, in the short time available to him, to make progress with his speech.
§ Mr. SackvilleIt is entirely understandable that a hospital with such an eminent history attracts fierce loyalties and that the prospect that it might cease to provide services on the Smithfield site—its home for several hundred years—arouses strong emotions.
Many of those feelings were clearly expressed today by the hon. Member for Hackney, South and Shoreditch and by my hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes). but we must understand the context in which this debate takes place. The real issue is not the future of Bart's, St. Thomas's, the Middlesex or any of London's other institutions. The issue is the future of London's health services as a whole and how we can secure a better NHS for Londoners.
Just over a year ago, the Government asked Sir Bernard Tomlinson and a small team to carry out an inquiry. We did so because of the widely held view that, despite the very large sums that had been spent on the NHS in the capital, London's health service had become increasingly poorly matched to the needs of the people who live there. We believe that the time was ripe to take a fresh look at London's existing patterns of health care provision and at how they might be improved.
Sir Bernard's advice to Ministers was published last month. His report clearly points to the need for a major shift in the focus of health services in London to meet the city's current and future health needs. Understandably, much public and media attention has concentrated on his recommendations for individual hospitals; but this is emphatically not a report just about the hospitals. It is 1163 about the changes that are required to enable the NHS to provide a service that is better attuned to people's current and future health needs.
The heart of the report addresses a familiar problem: over a period of decades, resources have been swallowed up by the large hospitals. to the growing detriment of other health services. The House will be familiar with Sir Bernard's main conclusions, but let me repeat them. He found that the trend in hospital practice for shorter in-patient stays, coupled with the growing number of conditions that could be treated outside hospital altogether, meant that progressively fewer hospital beds would be needed; that acute hospitals dominated the scene, and that not enough attention was paid to health services delivered in the community by GPs, health visitors and others through surgeries, health centres and in patients' homes; and that expensive specialist services were needlessly duplicated in London and were in urgent need of rationalisation.
The report recommends a programme of mergers and closures of several hospitals over the next few years, preserving the best from each in a way that will maximise efficiency and quality of service. Savings arising from hospital rationalisation, Sir Bernard argues, should be ploughed into community-based services and into much-needed improvements in general practice and primary care.
The Tomlinson report presents a compelling case for radical change in London's health service; but, of course, Sir Bernard's is not the only study to have reached that conclusion. A detailed review carried out last year by the independent King's Fund—in which the hon. Gentleman's colleague in another place, Baroness Hollis, played a leading role—adopted broadly the same view. If anything, the King's Fund report suggested changes on a greater scale than those recommended by Sir Bernard and his team.
The need for a fundamental shift in the balance of health services in London is widely recognised across the political parties. I remind the hon. Member for Hackney, South and Shoreditch that his party's health spokesman has made a number of statements on the subject, including —on 15 October—the statement that
the status quo is no longer an option.Following an interview with The Times, it was reported thatMr. Blunkett indicated that Labour would not necessarily oppose closures.I know that, since then, the hon. Member for Sheffield, Brightside (Mr. Blunkett) has made a number of statements that directly contradict that view.In a recent statement to the House, my right hon. Friend the Secretary of State for Health explained how the Government would handle consideration of the Tomlinson report. This is the most important part of what I have to say. Ministers are currently engaged in an intensive period of discussion with the many interested 1164 parties involved—health authorities, hospitals, the professions, London university and others. As part of the process, my hon. Friend the Minister for Health is visiting the institutions most affected by the report to listen to their views. We expect to present early in the new year detailed proposals in the light of those discussions.
Let me repeat the assurance given to the House at the time of my right hon. Friend's statement: no major decisions—particularly about closures or mergers of individual hospitals—will be made without proper consultation, and I entirely reject any suggestion that employees of regional health authorities or others seek to prejudice that consultation. None the less, we accept that London has too many hospitals and that extensive rationalisation will be necessary. We also accept the need to improve London's primary and community services— an issue also highlighted in the King's Fund report. Often, services that are taken for granted in other parts of the country are second rate in London. That needs to change, and we shall be exploring Sir Bernard's recommendations for improvement as a matter of urgency.
Sir Bernard's report makes several recommendations that bear directly on Bart's. Reference has been made to the fact that he has made it clear that he does not believe that there is a long-term future for the hospital on its present Smithfield site; that services between Bart's and the neighbouring Royal London hospital should be rationalised and that the two hospitals should merge on the Royal London site—
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)So that the site can be sold.
§ Mr. Sackville—and that their medical schools should proceed quickly towards full integration. He also recommends that the Homerton and St. Mark's hospitals, both of which are currently part of Bart's acute unit, should be separated from it. In his view, the Homerton should be managed as an independent unit and become eventually an NHS trust, while St. Mark's would relocate to Northwick Park. Harrow.
I have already told the House that we cannot take any decisions at this stage. The hon. Member for Hackney, South and Shoreditch knows that I am unable to make any commitment of the nature that he asked for today. However, may I tell my hon. Friend the Member for Wimbledon that the Government's response will be taken in the light of everything that has been said today. It will not be a rubber stamp of the Tomlinson report.
§ Mrs. DunwoodyIt will be a whitewash.
§ Madam Deputy Speaker (Dame Janet Fookes)Order. The hon. Lady must contain herself.
§ Mrs. DunwoodyI have not started yet, Madam Deputy Speaker.
§ Madam Deputy SpeakerOrder. I do not expect remarks of that kind from a seated position.
§ Question put and agreed to.
§ Adjourned accordingly at one minute past Three o'clock.