St. Cross Hospital, Rugby (Hansard, 15 December 1993)

§ Mr. James Pawsey (Rugby and Kenilworth)
I thank my hon. Friend the Parliamentary Under-Secretary of State for Health for so generously and courteously providing me with some of his time. His gesture is much appreciated by me, as well as by my constituents. I am delighted to see that I am supported by some of my hon. Friends, including my hon. Friend the Member for Daventry (Mr. Boswell), who wishes to be associated with the opposition to the consultative document issued by the Warwickshire health authority as it relates to St. Cross hospital. My hon. Friend the Member for Daventry knows Rugby exceedingly well, and has done so over a considerable period. I am delighted to have his support. I know that he represents several thousand of his constituents.
We are certainly not alone, because with us also is my hon. Friend the Member for Blaby (Mr. Robathan), who is sitting in his usual place. I know that, if he is fortunate enough to catch your eye, Madam Deputy Speaker, that he wishes to make a substantial and, I am certain, worthwhile contribution to our deliberations.
I wish to refer tonight to a consultation document produced by the Warwickshire health authority and the Warwickshire family health services authority that suggests that Rugby St. Cross hospital should be downgraded from a general to a local hospital. St. Cross has benefited extensively from recent health reforms. In the early 1980s, Rugby became a health authority in its own right—a measure for which I can take considerable personal credit. As a result, a new maternity unit was built, together with a new pathology laboratory, improved operating theatres and wards, a new boiler room and kitchens, and even additional facilities at Admirals Court for those who are mentally handicapped. The hospital was transformed.
Three years ago trust status was introduced and, not surprisingly, Rugby was once more in the forefront and was in the first wave. It benefited substantially with a £17 million extension in geriatric and psychiatric care. The hospital of St. Cross now provides an excellent service to my constituents and those of my hon. Friends the Members for Blaby and for Daventry. It serves a population of about 110,000 people.
I recently wrote to every GP who uses St. Cross and all, without exception, said that they oppose any reduction in the current quality and type of service. One GP said: I am heavy user of the St. Cross laboratory facilities. I, like you, feel the hospital of St. Cross is essential in its current format for the wellbeing of the local community". A second GP wrote: Our business plan from the very outset included specific wording in which we expressed our support for St. Cross and our intention to continue referring unless there were overriding other considerations. We did not believe that the quality of service would be particularly increased by sending patients further afield". Incidentally, I am delighted to see that my right hon. Friend that Leader of the House is now present for this important Adjournment debate. His presence does not surprise me, as I know that he is an assiduous listener on such occasions. I am delighted to welcome him.
A third GP writes: 1244 We are a fund holding practice and we use St. Cross for 76 per cent. of our in-patient activity and 96 per cent. of our out-patient activity, so you can see that any down-grading of St. Cross would seriously affect our patients. A fourth GP writes as follows: As a fund holding practice we make considerable use of St. Cross. The practice are very happy to support in whatever way we can the campaign to ensure that St. Cross stays open. A fifth tells me: If the proposed changes go ahead at St. Cross hospital, it will result in a vastly reduced standard of medical care for the people of Rugby and surrounding areas. I strongly support those informed medical views. The House will understand that here are doctors speaking, not simply members of the public. I do not say that in any disparaging way. I merely seek to draw the attention of the House to the views expressed by those who know best the importance of our local hospital.
I argue that the consultation exercise and the consultation document are inept. The document, which is interestingly entitled Tell us what you think about future health authorities in Warwickshire", was not sent to the Rugby NHS trust or, indeed, to Members of Parliament. I put it to the House that that was a studied act of discourtesy. The trust actually had to ask the local press for a copy of the consultative document, and I, in turn, only received my copy from the trust as a photostat. I put it to my hon. Friend the Minister that that scarcely constitutes helpful or efficient consultation by the health authority.
On receipt of the document, I immediately wrote to the chief executive of the Warwickshire health authority and to the Warwickshire FHSA. I reminded them that waiting lists at St. Cross are better than average and that the quality of health care is indeed much appreciated by patients and their families. I said that for St. Cross to be fundamentally changed in the way suggested by the Government would be an act of health service vandalism. I have not changed my declared view. The hospital would lose all emergency orthopaedics and trauma, and all emergency work in general surgery and gynaecology. The accident and emergency service would be reduced to a daytime-only minor injury service.
The document asks whether people in Warwickshire would be prepared to travel a little further. I suppose that everything hinges on how "little" is defined. In the case of my constituents, that would mean travelling to Nuneaton or Coventry or Leamington Spa—considerable distances in each case. Incidentally, the estimated additional cost to the ambulance service has been estimated by the chairman of the Rugby NHS trust as more than £500,000 annually. I will return to the question of added ambulance costs a little later in my speech.
I know that my hon. Friend the Minister will agree that there is a much more important issue than cost, and that is time. So often in health matters, speed is the essence of recovery; for my constituents, a longer journey to get to any one of three other hospitals could literally mean the difference between life and death. The document says that the length of time that people have to wait for hospital treatment might be reduced by concentrating some services in fewer locations. That is much easier said than done. It suggests that there is some spare medical capacity. If there is no spare capacity, new build will be required, which seems an inefficient way of using scarce resources.
I was interested to read in the document, under the heading, "Our Role As Purchasers": 1245 Our ability to influence services arises from the fact that we are a major purchaser of them. This is the big stick. So much for patient choice or for fundholder choice. It clearly does not matter what patients or GPs want; the health authority knows best. I can see my hon. Friend the Member for Daventry nodding in agreement. He and I know this hospital and many of the GPs involved. It would clearly be most unfortunate if the health authority were to decide which services were to be provided and where. That precept undermines one of the fundamental principles that has been laid down by my right hon. Friend the Secretary of State.
Elsewhere, the document says: We feel"— note the word that is used— that we cannot continue to buy the present level of hospital services in Rugby. The problem is that individual hospital specialties are relatively small and potentially more expensive than the same specialties provided in Coventry and Nuneaton. I ask the House to note the word "potentially". The authority clearly does not know what costs are involved, but that did not stop it issuing a document that has caused the utmost worry and concern to my constituents and to those of my hon. Friends the Members for Daventry and for Blaby. I should like to emphasise the strength of that concern.
The health authority, I was advised only this week, has so far received more than 13,000 letters all opposing its proposals. A petition has been raised and it bears more than 90,000 signatures. In addition, public meetings have been arranged and attended by literally thousands of my frightened constituents. I organised a meeting on 5 November and 750 people attended inside the hall—its maximum capacity—and a further 500 were outside. Of those 500, 200 were still present an hour and a half later when I went out to address them, having completed the meeting inside. A march was organised and attended by more than 3,000 people. I have received well over 600 letters on this one specific issue.
I was elected Member of Parliament for Rugby in 1979, 14 years ago. I have never known such a spontaneous expression of anger and outrage as that caused by the Warwickshire health authority's document.
I referred to the concerns that were expressed by GPs. They are not alone. Warwickshire county council carried an unanimous resolution expressing total opposition to any reduction in the range, level and quality of general hospital services in Rugby. Rugby borough council, at a meeting last night, approved the following: That this council totally opposes the implementation of all suggestions outlined for Rugby in the Warwickshire Health Authority's consultative document and furthermore requires that all services which are currently provided by the hospital of St. Cross be maintained. I should like to quote a letter from North East Warwickshire community health council. In its letter addressed to me and dated 29 November, it says: My council received the Discussion Document … and were unanimously of the view that essentailly they would not wish to see the present pattern of purchasing of health care changed within Warwickshire. St. Cross is close to the Ml, the M6, the M45 and the Al-M1 link. I need hardly remind the House of the incidence of motorway accidents, and the need to get victims to hospital as quickly as possible. The fact that St. Cross is likely to lose its acute services, and the fact that its accident and emergency services are likely to be 1246 substantially downgraded, will not help those who lie injured on motorways, even if they live or are outside Warwickshire.
This evening, my hon. Friend the Member for Daventry handed me a letter that he had received from the Two Shires ambulance MHS trust. It is dated 6 December. I was interested to read the following: There are large sections of the motorway"— the M1, that is— the A5 and A45 where road accidents are taken to the Rugby hospital. From an Ambulance Service point of view, it would mean that when an emergency crew is deployed to be patient in the north of the constituency, it would be committed much longer to taking the patients to either Coventry, Nuneaton or Stratford on Avon. This would mean that additional emergency crews would need to be employed at an approved cost of £150,000 which needs to be considered against the savings made by reducing the service at St. Cross. I remind hon. Members that £150,000 is additional to the figure of £500,000 that I mentioned earlier, which was quoted to me by the chairman of the Rugby NHS trust.
So far, I have met Ministers—here again, I must acknowledge the courtesy that I have received from my hon. Friend the Minister, who has been very helpful. My hon. Friend the Minister of State has also given me advice, and has listened to my arguments: I am grateful to him for his courtesy. I have met the chairman and chief executive of Warwickshire health authority, and the chairman of the regional health authority; I have condemned the health authority's ill-considered proposals absolutely. Let me make it abundantly clear that I will oppose them in every way I can, both inside and outside the House.

§ Mr. Andrew Robathan (Blaby)
I welcome the opportunity to support my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey). I also welcome the presence of my hon. Friend the Member for Sheffield, Hallam (Mr. Patnick), who has a special interest in the issue: I believe that a friend of his was in the hospital concerned.
As the House will know, my constituency stretches from the outskirts of Leicester in the north to the Warwickshire and Northamptonshire border in the south. In the north, we have three excellent hospitals, all of them in Leicester: Leicester royal infirmary, Leicester general and the Glenfield. All three have become NHS trusts in the recent past and are now progressing extremely well. Indeed, Leicester itself is very well served by its hospitals. I have visited Leicester general and the Glenfield in the past month and was greatly impressed by all that I saw of the new trust hospitals.
The south of my constituency—parts of which are some 25 miles from Leicester—is a largely rural area. There, it is a very different story. There is an excellent local hospital in Lutterworth, but, for a general hospital dealing with accidents and emergencies, my constituents look to Rugby.
In the south-west of the constituency, many villagers and residents have Rugby telephone numbers. They shop in Rugby; they use Rugby station; and, of course, they use St. Cross hospital in Rugby. If the accident and emergency service is taken away, my constituents will have to travel not the five miles—perhaps—to Rugby, but as many as 20 miles to Leicester, Coventry or Nuneaton, which is even further. That is not acceptable, either in regard to the time 1247 factor—people should not have to rush to deal with some acute necessity in an emergency—or as a service to the local community.
If the Government's NHS reforms are to be successful, they must be perceived to be successful. The Rugby NHS trust—St. Cross hospital—was in the first wave of NHS trusts. It has been a great success and an example to the country. A parish councillor wrote to me saying: I myself spent a considerable time as an inpatient last year in St. Cross hospital and I was very impressed, not only by the enthusiasm of the staff for their newly acquired trust status but also by the professional and caring attitude shown. There is no doubt that St. Cross is a success as a hospital for the area and as a trust.
As a Leicestershire Member, I would not presume to dictate to Warwickshire health authority how it should run its affairs. My role is to speak for the needs and interests of my constituents in south-west Leicestershire. Their interests are undoubtedly best served by a first-class general hospital in Rugby.
The proposals to downgrade the hospital to local status are unwise. I hope that my hon. Friend the Minister will join me in asking Warwickshire health authority to reconsider the proposals and keep St. Cross as a general hospital for all the people in the area—for those in Rugby and also those in the south-west of my constituency.

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I congratulate my hon. Friend the Member for Rugby and Kenilworth (Mr.. Pawsey) on securing the debate in the ballot and on getting this far procedurally. I came to the House at 6 am yesterday. One of the more excitable Conservative Members used the procedure known as "I spy Strangers" and we ended up with no Adjournment debate. That was the end of my sleep. My hon. Friend the Member for Rugby and Kenilworth was confronted by the same problem this evening, but he defeated that ploy as a result of the large number of hon. Members around the House who were waiting to hear his debate. I congratulate my hon. Friend on that.
My hon. Friend the Member for Rugby and Kenilworth has described the importance of the matter to him and to his constituents. My hon. Friend the Member for Blaby (Mr. Robathan) also explained the importance of the hospital for his patients who use the hospital.
The purchaser, the health authority for the county of Warwickshire, has issued a discussion document in which it raises the possibility, as my hon. Friend the Member for Rugby and Kenilworth said, of downgrading Rugby hospital. Let us recap briefly on a purchaser's role.
The activity of purchasers has now been entirely separated from hospital management. The job of the bodies with the budget for the health needs of the people in their areas is to purchase the health services required by the people in that area. The purchasers have to take decisions based on that. They are now powerful bodies as the have most of the purchasing budget.
Budget-holding GPs also have influence, but the main influence on health services will increasingly be the purchaser, health authority or health commission in each area, as my hon. Friend the Member for Rugby and Kenilworth said. As my right hon. Friend the Secretary of 1248 State for Health has said, the abolition of health regions places an even greater onus on the smaller number of health authorities now that there are more mergers of health authorities.
The purchaser's duty is to balance the needs of residents in each area in terms of access and proximity to general hospitals or other health services with other matters, which will sometimes include questions of cost.
My hon. Friend the Member for Rugby and Kenilworth pointed out, quoting from the discussion document which has led to the debate, that costs have increased. My hon. Friend pointed out also that it has said that the costs of the Rugby hospital, specialties being relatively small, are potentially more expensive. That is the key word, because it has obviously taken the view that there could be an element of costs involved. Those matters have to be balanced by the people who have to make such choices.
The fact that my hon. Friend has said that fund-holding GPs wish to use the hospital and do use the hospital, and of course have the same cost pressures on them, is important because they are taking decisions to use the hospital, which might be a very good sign. However, when such matters come to Ministers, that is not always the case. It is only when there is a major change of services and there are objections from the local community health council that we see such proposals and have to balance all those factors.
My hon. Friend has made a strong case for his constituents who wish to continue to use the hospital and that is an important factor which must play a central role in any discussion of the nature and location of services in an area. I congratulate him on having put the case so strongly.
As my hon. Friend said, and as I have repeated, it is a discussion document, not a statutory proposal. The health authority, in its wisdom, has decided that it should have an additional stage in the procedure. Instead of just coming up with a proposal and putting it out for statutory consultation, it has come up with a document which raises certain possibilities and it has asked people to comment. People have clearly commented—my hon. Friend commented tonight. He has received a great many letters on the subject and I can confirm that we also have received an unusually large correspondence. Those matters must be taken into account.
My hon. Friend will understand, I hope, when I tell him that I cannot comment in detail on this matter because it has not come to Ministers for consideration, but I should like to make two general statements about it. First, my hon. friend, as the local Member of Parliament, has an important voice in the matter and he has used that voice to great effect tonight. Secondly, in any matter to do with intentions, health authorities—this is not just about Warwickshire, it is about others—cannot just act in isolation and come up with ideas that they have plucked out of the air; they must take people with them and that includes local Members of Parliament.
I am sorry to hear that my hon. Friend was not sent a copy of the document. That was remiss of the health 1249 authority. I have no doubt that it has taken steps to make amends. The health authority has to take local Members of Parliament and other representatives with it. I assure my hon. Friend that I am certain that the health authority will listen very hard to local voices and that what has been said in the House tonight will be an important contribution to that debate.