HC Deb 11 February 1993 vol 218 cc1189-206

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

8.52 pm
Mr. Richard Burden (Birmingham, Northfield)

It is just 11 days since an announcement was made in the west midlands by the regional health authority and the South Birmingham district health authority. It was not made in the House. It was announced that the Secretary of State had decided that two hospitals in the South Birmingham district—the Woodlands Royal orthopaedic hospital and the accident hospital—were to close and that a third hospital—the general hospital—would lose its medical beds to make way for services transferred from the two closing hospitals.

The decision had been trailed for a long time. It had caused more controversy in my constituency and others than anything else that I can recall. People in Birmingham are asking why the hospitals are closing. I suspect that, when he replies, the Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville), will tell us, as a subsequent statement told the people of Birmingham, that it has something to do with improving hospital and health care services for the people of Birmingham, and something to do with ensuring greater access to higher quality health care. If the debate runs true to form, that is what the Minister will tell us today.

Not many people in Birmingham or the west midlands as a whole will agree with the Minister. The South Birmingham community health council has roundly condemned the proposals and pointed out the effect that they will have on patient care. The Audit Commission undertook a study which showed that if the two hospitals were closed and many much needed beds were taken in the general hospital, it would ensure that other hospitals in north and east Birmingham were overstretched.

Consultants have warned of the danger of cross-infection if a burns unit from the accident hospital and all the orthopaedic cases from the Woodlands hospital are put together in the inadequate surroundings that will exist in the general hospital. Perhaps most importantly, the local people who use the services have said that they do not want the closures but that they want the two hospitals to remain open.

Dr. Lynne Jones (Birmingham, Selly Oak)

May I remind my hon. Friend that it is not only the people of Birmingham but the majority of medical staff and consultants who are worried about the proposals? Only today I had a telephone conversation with a consultant worried about the relocation of the major injuries unit from the accident hospital to the general hospital. At present, the unit is located next to casualty on the ground floor. The new facilities will be on the second floor, requiring the use of a lift. That is for critically ill and multiply injured patients for whom every second counts. They will have to go up two floors, having got into the centre of the city at a time when major road projects will cause disruption. That is another example of how patient care will be affected.

Mr. Burden

I am grateful to my hon. Friend, who makes her point forcefully.

The argument that the closures will improve services does not stand up to close inspection, and if the closures are nothing to do with improving services, what are they for? It seems to me and to most people in Birmingham that the closures are to do with the lack of money. To put it simply, South Birmingham health authority is going broke under the Government's policies. Community services in South Birmingham are under strain.

A constituent has been told that her nine-year-old boy will have to wait six months merely to see about an appointment for occupational therapy. Another constituent is having to wait 91 weeks to see a consultant who will then decide whether he can go on a waiting list for treatment on an arthritic knee.

Mental health services are also being affected. Only the other day we heard that nurses who had trained in South Birmingham and who could have used their talents for the authority and given health care to the people there will not be able to get permanent employment in a Birmingham hospital.

Why are South Birmingham hospitals so short of money? Why is the South Birmingham health authority in such difficulty? At one level, the situation is a testimony to the underfunding that the Government have brought to the national health service. The latest waiting list figures were issued just the other day. Over the past few months, Ministers have alleged that they have been reducing waiting lists. This is something that they have trumpeted. It is true that, in the west midlands, there has been a reduction of 38 in the number of people waiting between one and two years for hospital treatment. On the other hand, there has been an increase of more than 5,000 in the number waiting less than one year—the second worst in the entire country. There are now more than 90,000 people awaiting treatment in west midlands hospitals. In other words, the good news is not quite as good as Ministers would have us believe.

But the problems in the west midlands do not arise just from underfunding. Some of us have severe reservations about the use to which the money that is available is being put. In the last few years, a series of financial scandals have gripped the West Midlands regional health authority.

There has been the scandal of Qa Business Services, formerly the computer division—full title, management services division—of the regional health authority. That service was privatised. How the decision was made nobody quite knows; who was involved in it nobody quite knows, but it happened. Qa Business Services went bust within 18 months of its formation. Its employees—people who had previously worked for the computer division—lost their jobs, and more than 130 of them will lose up to two thirds of their pension entitlement because, as they were informed just a few months ago, the pension fund that they had been told was secure cannot meet the liabilities.

Then there is a consultancy, known as URG, which was meant to bring value for money to the west midlands supplies organisation. In that case, millions and millions of pounds were squandered. There was not much value for money there. A system called Healthtrac—again connected with the west midlands supplies organisation, and meant to be an all-singing, all-dancing new computer system—is the subject of an Audit Commission investigation. All the signs are that the report will show that more millions of public money have been wasted. This was confirmed last night by the former chair of the regional health authority.

Financial Information Packages—another private firm set up through the West Midlands regional health authority—has acted as a kind of siphon for public money. Apparently a proposed development on the land occupied by the Rubery hospital will fund the health care programme for Birmingham in the years to come, but nobody knows what the terms of that deal are; nobody knows whether it will bring much money in; nobody knows the exact terms of the deal between the health authority and the developers, or even whether the developers are really developers.

I come now to the South Birmingham health authority, whose formation involved a merger with the former Central Birmingham health authority. That merger was opposed by local people and by clinicians and others involved in the health service, but it was pushed through at the insistence of the region, with the collusion of Ministers. The result is a multi-million-pound deficit in South Birmingham. When one mixes into that equation the impact of the Government's so-called health reforms, one has a financial crisis such as that which now grips the health authority, whose managers are sending to staff circulars saying that it will not be possible to pay bills.

What has happened to those who are responsible for such financial crises? Just yesterday, the Public Accounts Committee of this House asked some pretty searching questions about that matter. The answers are quite instructive.

Mr. Chris Watney, the former director of regionally managed services of the West Midlands regional health authority, is the person who seems to have been most closely involved in the tie-up with the consultancy firm URG, which promised the people of the west midlands savings of up to £50 million but ended up costing them £4 million. Those costs included expenses running to about £350,000 for such items as leased houses in London for the firm's executives and their wives, the hire of aircraft to come to work, and lavish entertainment. What happened to Mr. Watney? Was he sacked? No. He received a redundancy pay-off of more than £80,000. It was subsequently discovered that he had been overpaid to the tune of more than £40,000. So much for Mr. Watney.

Then we have Mr. Martin Davies, the former director of finance of the West Midlands regional health authority, who, the former chair of the authority said, had signed the authorisation to go ahead with the URG contract without his approval. What happened to Mr. Davies? He resigned. Despite the fact that he had not been sacked, he received pay in lieu of notice. Then we have Mr. Ken Bales, the former chief executive of the West Midlands regional health authority. He too appears to have been well involved in a number of the major projects of that authority. No action was taken. He resigned, in the normal course of events, not very long ago.

Then we come to Sir James Ackers, who was the chair of the West Midlands regional health authority, the man whom the Secretary of State stood by through thick and thin. His name also crops up in the URG scandal. The Audit Commission had something to say about what it discovered about his involvement in that consultancy. He attended a dinner. I shall quote what the Audit Commission said about that dinner, at which the details of the contract, which lost the people of the west midlands £4 million, were apparently discussed: The details were … explained at a dinner (after the work had started) given for the Director (RMS), the RHA Chairman, the Director of Finance and the Chairman of the Members' Panel. The consultants said that this meeting was specifically to meet the RHA Chairman, to outline the cost and to ensure that the Director (RMS) had full authority to proceed. Afterwards the RHA Chairman said he did not realise that a firm agreement to do the work had been reached. So he attended a dinner; the details were apparently explained; that led the next day to an authorisation being given, but he did not realise that a firm agreement had been reached.

What happened to him? There were calls for his resignation. Finally, he resigned just last month, in January. The Secretary of State accepted his resignation with these words:

You have supported the reforms of the NHS and have overseen their successful implementation in the region. In addition, you recently initiated some important movements in the managerial structure of the region. Underpinning all this has been your personal commitment to the health service and its patients. I should also acknowledge your valuable contributions as chairman of all the regional chairmen, and as a member of the NHS Policy Board which has advised successive Secretaries of State. We discovered yesterday that what Sir James Ackers has contributed had been acknowledged by the Secretary of State, because we were told at the Public Accounts Committee that the Secretary of State had decided not to take action about the losses incurred under the stewardship of Sir James Ackers but to grant him a discretionary payment of an undisclosed sum.

So no action appears to have been taken against any of these people. We heard yesterday, however, of one person who is still employed by the West Midlands regional health authority who was given a telling off for what happened. That is the man who apparently was responsible for the overpayment of more than £40,000 to Mr. Watney. That man is the regional director of personnel, Mr. Mel Nock. He is an important man in the regional health authority to this day.

We have heard very little of Mr. Nock in the course of the story so far, but we need to know not just how he came to overpay Mr. Watney to the tune of £40,000 but what he knew of the other things that had been going on in the west midlands. He is the director of personnel, an important man. Apart from anyone else, the pensioners of Qa Business Services should know what the man responsible for personnel had to do with what happened in the regional health authority.

All this shows incredible double standards on the part of the Government. Let us imagine what would have happened if such financial scandals had involved not a health authority but an elected local authority. If a local authority had been involved, Ministers would have been screaming from the rooftops about surcharges and allegations about left-wing councils. What a difference we see when it is their boys who have been responsible for the scandals. When it is their boys who are involved, Ministers seem to take pride in avoiding answering questions from Members. There has been a series of reports on what has been going on, but very few of them have been published.

Just before Christmas, the district auditor sent a management letter to the senior management of the regional health authority. It detailed the stage which the district auditor had reached in his investigation. The letter was not confidential, but I have yet to see it; it has not been published. Indeed, in a question a short time ago, I asked whether the Minister would direct that the report be published. I was told in reply that there was no such report. I checked again, knowing that the document had been sent, and discovered that it was known technically as a management letter. I tabled another question asking whether the management letter could be published. I received the inevitable response—the sort of answer I have received often in recent months—that it was a matter for the regional health authority.

The Secretary of State has power to direct the publication of such documents, but she has chosen not to exercise it. Instead, the people of the west midlands, including hon. Members, are being kept in the dark. When scandals come to light, Ministers sit on their hands, especially if their boys are involved.

The chief executive of the NHS, Sir Duncan Nichol, attended yesterday's meeting of the Public Accounts Committee. He was asked what action he had taken to improve matters, in view of what had come to light, in the west midlands. He said that he had sent a letter to the various health authorities.

The problems in the west midlands still exist. We have a new chair, Sir Donald Wilson, brought in from Mersey regional health authority. He has said that there would be a new regime in the west midlands, that an audit committee would be set up and that new auditors would be appointed. Since his appointment, no further reports have been published.

My requests for publication of the management letter were made both before and after Sir Donald's appointment. I am told that, while what was said at the last regional health authority meeting was not confidential and that the reports could be published, they could not be published just yet, not while a Public Accounts Committee hearing was coming up and its discussions might be prejudiced by the publication of such documents at this stage.

What a load of rubbish. Those reports are still under wraps, and Ministers owe it to the House and the people of the west midlands to publish them. We in South Birmingham still have our deficit, and there is disagreement over how much it is. We were told a couple of weeks ago that it was under control and was less than £1 million. A couple of days later, we were told that it was between £2 million and £2.5 million. We do not know the causes of the financial crisis, and the report by consultants KPMG Peat Marwick has not been published. It was finished last summer, and when we ask Ministers to publish it, they reply that it is a matter for the West Midlands regional health authority.

What has been done to solve the problems of the west midlands? The only action of substance to have been taken in recent weeks is the decision to shut the hospitals. The managers do not suffer; they appear to get glowing tributes and pay-offs. The patients and those who work in the NHS suffer. Nurses are told that after their training they will not receive jobs, not because they are not needed in the area—we in south Birmingham need more nurses—but because of a shortage of money.

As the problems of the west midlands still exist, ask the Minister tonight to come clean and say exactly why our local hospitals are closing. When will the Secretary of State and others in the Government start listening and responding to what people in the west midlands are saying about the way in which their health services are being run? When will they respond to the three fundamental questions that we have been putting?

First, may we have a full, independent public inquiry into what has been going on, revealing all the facts, not just those that Ministers want published? Secondly, we want to know exactly who is to blame for the financial crisis. Whoever is to blame—the West Midlands regional health authority or South Birminham—it is not the fault of the patients, so they should not be forced to suffer. Therefore, South Birmingham should receive the financial injection it needs to maintain local services and to ensure that patients do not suffer.

Thirdly, why is it so difficult for Ministers to say that regional health authorities should be open and accountable to the people whom they are supposed to serve? The health service is meant to be a service for people free at the point of need, but we are not seeing very much of that in the west midlands at the moment. I hope that, if the Minister is serious about improving health services in this country, he will change direction today and provide us with the cash we need. I hope that he will insist on openness, insist that the reports be published, and insist that accountability and democracy return to the health service in the west midlands.

9.15 pm
Dr. Lynne Jones (Birmingham, Selly Oak)

As my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) said, there is apparently a requirement that health authorities and trusts conduct their business in as open a manner as possible. However, as we have heard, the reports on the activities of West Midlands regional health authority and South Birmingham health authority remain unpublished. Elected Members of Parliament such as my hon. Friend and I have been unable to see the reports, while decisions have been taken against the wishes of the people of Birmingham.

In Birmingham, we have seen hospitals proposed for closure and campaigns against the closures. Hon. Members and elected councillors have expressed grave concern about what is happening in our health authority. On 25 November, I wrote to the Secretary of State expressing concern about the impact on patient care of the proposals to close the hospitals. I asked the right hon. Lady to intervene, because she had said that she was concerned about patient care. We hear a lot from the right hon. Lady about how much she cares, and I took her at her word—I thought that she did care.

On 5 January I wrote again, reminding the Secretary of State that I still had not received a reply to my letter of 25 November and explaining further concerns that had come to light, some of which have been described by my hon. Friend the Member for Northfield. Those concerns arise out of reports by the Audit Commission and by neighbouring health authorities, which are most concerned about the effect of the hospital closures on the people they are trying to serve. I still received no reply. I tabled a parliamentary question, but despite further reminders, including a conversation with the staff of the private office of the Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville), and although I faxed a copy of my original letter, only today did I receive a reply.

It is too late. As my hon. Friend has said, the decision was taken last week. Neither the Secretary of State nor the Department of Health informed us of that decision, although they were polite and sensible enough to apologise to us a day later for the fact that they had not responded to our requests for a meeting with the Secretary of State and had not bothered to inform us before announcing publicly that they had decided to go ahead with the hospital closures.

My hon. Friend has explained the background to the decision—the financial deficit in South Birmingham health authority after the merger. We still cannot get to the bottom of exactly how big the deficit is; estimates vary dramatically. We know that letters went out to all members of staff informing them that, even now, bills presented after 28 December could not be paid. It seems that the financial crisis has still not been solved, yet the plans to solve it involve the closure of our hospitals. The rationale for these closures has always been that somehow it is an interim measure in the progress towards the grandiose plans with which we have been presented, entitled "Building a Healthy Birmingham". Like so many decisions from health authorities in the west midlands, those plans have been opposed by the majority of people for whom they are supposed to provide better services.

On Tuesday, Labour Members representing constituencies in the west midlands had a meeting with Sir Roy Griffiths. He confirmed that those plans have now hit the skids, as there are insufficient resources available. He told us that there was a capital moratorium and that, in his opinion, the health authority would get better value for money by tackling the maintenance backlog than by implementing the major new building programme that had been proposed.

Our hospitals are now being closed and facilities moved into the general hospital, on the basis that it will provide better services because the accident and emergencies services and the orthopaedic services would be better provided within a district general hospital. There is one problem with that argument and that is that all the services in the general hospital that give it its name—the general surgical and medical services—are moving out. The arguments about patient care do not stand up to examination.

At the last minute, in response to those valid criticisms, the health authority said that it would retain one consultant position and one consultant surgeon. Inquiries today reveal that the consultants being kept on are those who are due to retire, so, yet again, this is a temporary sop to attempt to justify an unjustifiable decision to decimate our services in Birmingham.

We are not opposed to changes in the configuration of our hospitals. For example, there is much support for the building of a new children's hospital and for the rebuilding of the elderly services block at Selly Oak hospital in my constituency which was condemned as long ago as 1978; yet it is still there and there are still no plans to replace it. Yes, there is scope for investment in our hospitals, but, for goodness' sake, why do not the Government intervene to ensure that the health authorities consult the city council and the elected representatives? Unelected, Government-appointed people have been riding roughshod over the views of elected representatives of the people of Birmingham, clinicians and others who know about our health services.

At the meeting with Sir Roy Griffiths, he accepted that there had been problems and that there was a need for greater consultation with the city of Birmingham and its elected representatives. He said that those responsible for problems in the past had now left the health authority. Sir Roy Griffiths and his adviser were somewhat embarrassed when they were asked under precisely what terms those people—Sir James Ackers, Mr. Ken Bales and Mr. Martin Davies—have left the authority.

As my hon. Friend the Member for Northfield explained, the manner in which they left also causes great concern. They left not under a cloud, accepting responsibility for the manner in which they had run the health authority, but with very nice amounts of money, which I hope will be revealed. The people of Birmingham should know exactly what the financial arrangements were for the payouts to Sir James Ackers and the others who have been mentioned.

In the United Kingdom, we now have Government-appointed, non-elected representatives running our health authorities and health services. Obviously, that is the direction in which other public services are moving. As my hon. Friend the Member for Northfield said, if elected councillors had taken the same decisions as those non elected representatives took, they would have been rightly condemned.

I should like the Minister to respond in a way that gives the people of Birmingham and the west midlands confidence that people will be accountable for their actions and will intervene and listen to the views of the elected representatives and the people of Birmingham in future.

Our hospitals in Birmingham have not yet closed. There are still arguments about the effects of such closures on patient care. It is clear that the decisions were taken on financial grounds, not on the basis of improving facilities for the people of Birmingham. It is not too late for the Department of Health and Ministers to sit round the table and talk to the elected representatives to see whether they can find a way forward so that we can have confidence in the future and a pattern of hospitals which serves the people of Birmingham. They should ensure that decisions are not taken for short-term financial reasons.

9.26 pm
Mr. Terry Davis (Birmingham, Hodge Hill)

I thank my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) and the Minister for allowing me to take part in this debate. I congratulate my hon. Friend on taking the initiative and managing to get this opportunity not only for himself but for other hon. Members from Birmingham to put to the Minister our serious concerns about the way in which the West Midlands health authority has behaved not just in recent weeks or months but in recent years.

My hon. Friends the Members for Birmingham, Selly Oak (Dr. Jones) and for Northfield have referred to the session of the Public Accounts Committee yesterday. As a member of that Committee, I shall not comment on yesterday's proceedings, because, as my hon. Friends will appreciate, we are considering our report, which will come out in due course.

The Public Accounts Committee has asked for further information before we report. We have asked for copies of some of the secret reports to which my hon. Friends have referred, because one of the features of the West Midlands health authority recently has been the series of secret reports which have been prepared but not published. Those reports have not been made available to hon. Members in the House and certainly not to the public. We know about the report of the National Audit Office on which the Committee took evidence yesterday, but that is only the tip of the iceberg in terms of reports.

We know that there is a series of reports from the Audit Commission. The Audit Commission told us that not only the contents but the subjects of the reports are confidential. We cannot even be told what the National Audit Office has reported on or found it necessary to investigate. There is a total shroud of secrecy. We have had some internal studies done. We have had the so-called Carver report which has not been made available to Members of Parliament or the public. I understand that we have had a report by Peat Marwick, which is secret.

I sometimes think that the West Midlands health authority is drawing up more reports than it is treating patients. As my hon. Friends have said, it is essential that we have a public inquiry so that all of us who live in and represent the west midlands, especially the city of Birmingham, can see exactly what is happening.

I shall not comment on the allegations and criticisms which have been made about Sir James Ackers and some of the former officers of the West Midlands health authority for the reasons which I have already explained. I expect that there will be some comments about those matters in the report which my colleagues and I will eventually publish on behalf of the Public Accounts Committee.

Other aspects of the affairs of the West Midlands health authority are already public knowledge. My hon. Friends have referred to the public report, endorsed by the West Midlands health authority and eventually approved by the Secretary of State for Health, ridiculously entitled "Building a Healthy Birmingham". My hon. Friends have described some of the proposals in that report, which, frankly, can be summarised as concentrating as many services as possible on one site—the Queen Elizabeth hospital.

When Sir James Ackers, as chairman of the health authority, was called upon to explain the reason for and motivation of the proposals, he used—in my hearing and more than once—a very revealing word. In describing the proposals to centralise services as much as possible on the Queen Elizabeth site, which is grossly inaccessible to most people in Birmingham except the middle-class people who live nearby, he used a most revealing word: he said that he would give us an excellent "campus". That is the only time I have ever heard anyone, or any Member of Parliament of any party, use the word "campus" in discussing hospitals. The proposal is not about treating sickness, disease and disability among the people of the city of Birmingham and the rest of the west midlands: it is about creating a university of Birmingham medical school. That was the motivation behind the scenes.

The health authority wanted to put as much as possible on one site near the university of Birmingham, so that students and consultants would not have to travel but the patients would travel to them. That is the wrong purpose behind the planning of hospitals. The people of Birmingham said so. Their elected representatives, city councillors as well as Members of Parliament, said so. Indeed, the local newspapers, which are not friends of the Labour movement, said that the strategy was appalling. I have yet to find anyone except the university of Birmingham medical school and the health authority who believes that the proposals in "Building a Healthy Birmingham" are good. I must add, of course, that the Secretary of State for Health approved the proposals.

Perhaps the most revealing aspect of the sad saga was the attempt to manipulate public opinion. I use that word deliberately. I am a resident of Birmingham. I live in my constituency, as my hon. Friends live in theirs. I was surprised to receive a glossy leaflet through the letter box urging us to support the proposals in "Building a Healthy Birmingham". It was signed by the chairman of the East Birmingham health authority. It did not surprise me that he was in cahoots with Sir James Ackers, but it surprised me that, when I went to see the chairman of the district health authority, at his invitation, to discuss the proposals, he criticised them.

I told the chairman of the district health authority that I found it difficult to understand why I had received through my letter box a leaflet saying that the proposals were good when he had said that they were bad. He said, "I had to do it—it was written for me." All he did was put his name on the leaflet. It was written for him by the West Midlands regional health authority, and we shall never know what threats were used to make him put his signature on that leaflet.

The leaflet boasted about the improvements to come, which had already been approved. For the purposes of political propaganda, they were attributed to "Building a Healthy Birmingham". The leaflet said that a new maternity unit would be built as a result of the report, but that proposal had already been approved, and the money was there. There were several other examples like that.

A clear attempt was made to manipulate public opinion, but the health authority failed to do so—just as it failed to persuade the local people in my constituency and neighbouring constituencies in the East Birmingham health authority area that the proposal to have the first opt-out or trust hospital in Birmingham was a good thing. It failed to persuade not only the Labour party, which organised petitions against the proposal. To my certain knowledge, those petitions were also signed by supporters of the Conservative party; they agreed with us that the proposal was a bad thing, and wanted to keep East Birmingham hospital as it was.

The consultants had a ballot about the proposal to opt out. They did not like it. They did not want a trust. Other doctors at the hospital had a ballot. They did not want a trust. The nurses and other staff had a secret ballot. They did not like the proposal, either. They were opposed to it. But the health authority said that it knew best. The local people were overwhelmingly opposed to the proposal to opt out. The community health council, which represents local people, unanimously opposed the proposal for a trust at East Birmingham hospital. I declare an interest because the chair of the council is my wife.

Most significantly, one group of people opposed the proposal who could not be accused of having vested interests or not understanding the issues. I respect the opinions of that group most of all. They are the local family doctors. They were not consulted by the regional health authority. They were consulted by the health authority, but they were consulted on the initiative of East Birmingham community health council, which found that the family doctors were overwhelmingly opposed to the trust as well.

I was not surprised, but I was very sad, when West Midlands regional health authority rejected all our propositions. "We know best," the authority said, and the Secretary of State for Health rubber-stamped the decision in her turn—or was it his turn? The right hon. Lady's predecessor may have been in office then, but it makes no difference: the policies do not change just because the bottom on the seat changes. Anyway, the trust went ahead despite the opposition of doctors, nurses, national health service staff, local people, family general practitioners and all their representatives—again, on the basis of secret reports.

When I said that I did not know whether it was a good idea, and that I wanted to look at the business plan, I was told that I could not do so, because the plan was financial and therefore secret—like so much to do with money in the West Midlands regional health authority. No one outside the inner circle is allowed to know the financial realities until it is too late and wards and hospitals start to be closed.

My hon. Friends have described the position vividly. The closure of Woodlands hospital and the accident hospital, and the proposed closure of Birmingham General hospital down the road, have been overwhelmingly opposed—not only by local people who depend on those hospitals, but by the people of Birmingham in general. Their opposition, however, has been to no avail. Whatever else may be said about the affairs of the West Midlands health authority, it does not care about the views of local people, and it certainly does not represent local people.

My hon. Friends are right to criticise the authority's lack of accountability, and I support their call for a public inquiry into what has been going on in the authority. If that is too embarrassing for all the people involved, why do they not simply resign? It is not enough for Sir James Ackers to go, although he has headed the authority—and bravely said yesterday that the buck stops with him. He has not been alone: what about all the other political appointments to the authority—the faceless men and women who have acted as rubber stamps for the Government's policies? They, too, should go—and until they do, the people of the west midlands will have no confidence in their regional health authority.

9.37 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I am glad to have this opportunity to respond to the hon. Member for Birmingham, Northfield (Mr. Burden). Not surprisingly, the hon. Gentleman has concentrated on the difficulties faced by the West Midlands health authority rather than on its considerable achievements. Perhaps he should consider how to convince his audience that he is interested in health, rather than being concerned merely with the political and media appeal of the series of supposed conspiracies with which he appears to be obsessed.

We are talking here about health services, and there are good stories to tell about the health service in the west midlands—let us not forget that. The regional health authority is the largest in the country, comprising 19 districts and covering a population of some 5 million. Its financial allocation for 1993–94 is very large compared with the regional average: this year's allocation represents a 5 per cent. increase in real terms over that of the previous year. That increase, together with the commitment and dedication of the authority's staff, has enabled the authority to deliver a continually improving service to the population of the region.

In the past 10 years, under the active leadership of Sir James Ackers, treatment levels have risen dramatically. The treatment of in-patients has risen by 25 per cent. and that of day cases by 141 per cent.

In the past year alone, the total number of patients waiting more than one year for treatment has been reduced by 42 per cent. There is no longer anyone waiting more than two years for treatment, and more than 60 capital schemes have been completed by the authority since 1979. In south Birmingham, a new cardiac unit was opened at the Queen Elizabeth hospital in 1991 at a cost of £2 million. This year, the £13 million Queen Elizabeth psychiatric hospital received its first patient. Birmingham also leads Europe in providing the first quick and early diagnostic centre—a purpose-built facility at the Queen Elizabeth medical centre for the rapid diagnosis of cancer. Those are a few of the many notable achievements of which the region can be justifiably proud.

However, we must not forget—I have not been able to forget it this evening—that a number of issues in the west midlands have required serious attention. I shall outline some of them, together with the action that has been taken to resolve them.

Hon. Members know that the financial position of the South Birmingham health authority was the subject of an earlier Adjournment debate in the summer. It is not worth repeating all the details of the deficit, as we have already spent much time doing so. However, I remind the House that, in response to the problems of the deficit in south Birmingham, plans were produced that centred on removing the signicant duplication of services between the five major hospitals in the district—Selly Oak, Queen Elizabeth, Birmingham accident, royal orthopaedic and Birmingham general. It was proposed that the overspending would be removed not by cutting services, but by removing the costs of duplication of services and providing services more efficiently.

The main point of the plan that the regional health authority agreed last June was that services currently provided by the royal orthopaedic and Birmingham accident hospitals should be transferred to the general hospital and that most of the acute medicine and general surgery provided by the general should move to the Queen Elizabeth hospital.

The regional health authority followed the procedures laid down when closure or change of use for health buildings are proposed. There was a consultation period of more than three months, when the plans were widely circulated and everyone had an opportunity to comment.

Mr. Burden

Is the Minister aware of the distinct unhappiness among staff at the Birmingham accident hospital—one of those scheduled for closure—at the fact that they were not directly consulted about the closure plan? Has he been misinformed about that? If he has, does he now feel that the closure plan should be reopened if it is proved that not everyone who should have been consulted was consulted directly?

Mr. Sackville

I have no doubt that all the proper consultation procedures were carried out. I cannot claim that everyone was, or will be, in agreement, but the procedures were carried out.

Ultimately, as in all cases when the local community health council cannot agree with the health authority's plans, the final decision rests with my right hon. Friend the Secretary of State for Health. After careful consideration of all the evidence presented, I agreed, on behalf of the Secretary of State, the proposals put forward by South Birmingham health authority to close the Birmingham accident and royal orthopaedic hospitals and transfer the services to the general hospital in Birmingham. I notified the regional and district health authorities, as well as the hon. Members for Northfield and for Birmingham, Selly Oak (Dr. Jones), and letters were sent to the House on the day of my decision. Hon. Members representing other Birmingham constituencies were notified the following day.

For the benefit of hon. Members, I shall outline my reasons for the decision.

First, I see the closures as the best option for the continued and improved provision of accident and emergency and orthopaedic services within the district until such time as the new facilities at the South Birmingham medical centre become available. Secondly, they are a necessary step along the path to securing financial balance within South Birmingham health authority. Another factor is the age, condition and layout of the buildings of both hospitals. The high costs of meeting clinical, statutory and safety standards all speak against the retention of the hospitals.

I fully appreciate the strength of feeling for well-loved hospitals and my Department has received many letters praising the work of the royal orthopaedic hospital in particular. We must, however, take this opportunity to ensure that buildings meet the needs of modern health care and match the quality of medical and nursing care that takes place within those buildings.

There has been talk of cross-infection. The concerns about it have been considered and have been fully taken into account. As the hon. Member for Northfield knows, the burns unit will be housed in a self-contained unit with dedicated theatres. It will be located in a separate block away from orthopaedics. I can reassure the hon. Gentleman about that.

Emergency cover at the Birmingham general hospital has been raised. I remind the hon. Members for Northfield and for Selly Oak that the South Birmingham acute unit has stated that 24-hour medical and surgical cover will be available at registrar level. It will be provided on a rota basis from the Queen Elizabeth and Selly Oak hospitals. Additional consultant cover during normal working hours will be provided from the out-patient and day-case surgeries at the general hospital. Outside normal hours, dedicated consultant cover will be provided, and I am glad to be able to reassure the hon. Lady on that point.

Dr. Lynne Jones

We have been told that patient service could be improved by the relocation of the specialty hospitals in the district general hospital setting, yet the Minister is telling us that the relocation to the eneral hospital will result in cover being provided from the Selly Oak and Queen Elizabeth hospitals, which are much further from the general hospital than they are from the present location. That does not square with the idea of an improvement in patient service.

Mr. Sackville

I can only seek to reassure the hon. Lady that adequate cover will be maintained. It is a matter that I have discussed with Sir Don Wilson. It is a point of considerable concern that must be considered, and I have received assurances. I shall personally monitor the continuing situation.

The hon. Member for Northfield concentrates very much on the problems that have occurred and he focused on the various doubts about the financial transactions that have been carried out by the region. Let him concentrate also on health services and on the efforts of all those who work for the health service in the west midlands so that he is able to take full account of the excellent work that is done.

I shall refer to some of the achievements within the west midlands. If we concentrate only on matters that are the subject of inquiries, a one-sided picture could be presented of health services in the west midlands. There are many positive features.

I point, first, to an interest of my own, which is the West Midlands ambulance service. It provides a good example. It is one of the largest ambulance services in the country. It has received accreditation to BS 5750 on the basis of a total quality service. It was the first ambulance service to introduce paramedic motor cyclists. It is currently leading the way in ensuring that all ambulance services have a trained paramedic included as part of their front-line teams.

This is one of the great success stories of the modern health service. Soon, the public in the west midlands and elsewhere will know that, every time an ambulance attends an emergency or accident, it will contain a paramedic as part of the crew, who will have been trained to a high level. The paramedic will have been trained specifically to resuscitate and support life in the pre-hospital period.

The West Midlands ambulance service has also just won the United Kingdom transplant support service contract, which commenced this month, for transporting teams and organs nationwide—an important and topical development.

Despite an 8 per cent. increase in emergency activity, the West Midlands ambulance service is an example of an efficient organisation with resources channelled towards patient care. All emergency vehicles are under six years old, and nearly all are now equipped with defibrillators.

Dr. Lynne Jones

I hesitate to intervene again, but the Minister has raised the issue of the ambulance service. I welcome his announcement about the involvement of paramedics, but information that I have received from a number of general practitioners in my constituency shows that all is not well with the West Midlands ambulance service.

For instance, the Minister should consider the case of the man who had to wait three hours for an ambulance which should have arrived within the hour, and who ended up having to have his leg amputated. I was also told of another two cases in which, in the end, patients took taxis and, if they had not done so, would have suffered a similar fate.

I have heard from other general practitioners that the ambulance service is not as fast as it used to be, so we have concern there as well. I am sorry to have to tell the Minister that, once again, he is out of touch with the reality on the ground.

Mr. Sackville

I have visited the ambulance service within the last two weeks, and I was extremely impressed with what I saw. I was aware of considerable dedication among staff, crews and management. It had one of the most impressive control centres that I have ever seen, and I have visited a large number in recent months. I am assured—I saw the figures to prove it—that response times are improving fast. In a large ambulance service—this is the second largest in the country—there will always be problems from time to time. All that I can say is that the quality of commitment and what has been achieved by the West Midlands ambulance service is striking.

Mr. Terry Davis

Did the Minister, during his visit to the west midlands, take the opportunity not only to visit the ambulance service but the head office of the West Midlands regional health authority in Hagley road to talk to its members? Was he impressed by that?

Mr. Sackville

I made a specific visit to the ambulance service, which is one of my particular interests. It is one of the success stories for which it should be given credit.

Mr. Davis

Has the Minister ever visited the office of the West Midlands regional health authority? Has he ever talked to its members? Does he not want to?

Mr. Sackville

I have not had the honour of visiting the offices of the West Midlands regional health authority. I have visited a number of hospitals and other health facilities in the West Midlands in recent months, and that is the important thing. It is what happens on the ground that matters.

The paramedic skills in the Staffordshire ambulance service should not be overlooked. Two members of the service were included recently in the team drawn mainly form the North Staffordshire trauma centre at the request of the Prime Minister to travel to what was Yugoslavia to provide help and paramedic advice to the people of that troubled country.

The West Midlands is making excellent progress on health promotion—the key theme of the White Paper "The Health of the Nation". I opened and addressed a conference on the health of the nation in Birmingham recently.

In Sandwell, a health fair and open day to promote healthy lifestyles has been organised by the family health services authority. Westminster now provides parents and children with regular health and safety advice. The priority health unit in Dudley is working with the FHSA and local GPs—

Mr. Burden

The Minister's comments are fascinating, but they are not the subject of this debate. Could I ask him to comment on this: Sir James Ackers, when he was the chair of the West Midlands regional health authority, stated that the "Building a Healthy Birmingham" plan, which, from what the Minister said, is still on the go, was not compatible with the creation of hospital trusts in the South Birmingham area. He said that until the "Building a Healthy Birmingham" plan was well down the road, the region would not support the creation of hospital trusts.

Since that time, expressions of interest have come in from the acute unit in South Birmingham. That is also a matter of some concern to my constituents. Will the Minister, in this review of the situation in the west midlands, tell us whether he looks with favour on those expressions of interest, or whether he agrees with Sir James Ackers that they are incompatible with the "Building a Healthy Birmingham" plan?

Mr. Sackville

I am absolutely in favour of the creation of trusts if the organisations and health facilities that wish to attain trust status are deemed suitable. There are some very successful health trusts in the west midlands. I had hoped that the hon. Member for Northfield had got past having to oppose trust status on political grounds, because the BMA and many other people have got past that stage. I think that he is living in the past.

I want now to mention the priority health unit in Dudley, which, working with the FHSA and local GPs, provides professional advice and care to patients requiring chiropody and audiology services through GPs' surgeries or in mobile units. Virtually all Coventry GPs are now involved in some form of positive health promotion, including well-woman clinics, heart disease prevention and advice on alcohol control and on how to stop smoking. Hereford, Worcester and North Worcester district health authorities have all appointed, for example, anti-smoking facilitators to work with GPs and to give advice to people who want to give up smoking.

For their own staff, West Midlands regional health authority recently held a health-at-work workshop to promote healthy lifestyles and to provide practical advice on how to achieve that.

That is what this debate is about; it is about health services in the west midlands, and if hon. Members are concerned only with what has gone wrong and what are the supposed scandals or problems in the financial management of the regional health authority, they are not interested in health.

Mr. Terry Davis

These are not "supposed" scandals. The Comptroller and Auditor General told the House that senior officials of the West Midlands regional health authority have shown a cavalier disregard for proper procedures and for proper standards of public life. Does he not understand that these are serious criticisms? Will he stop sheltering behind people working in the national health service? My hon. Friends and I have not criticised people working in the national health service. We have criticised the people running the service in the west midlands, the people appointed by this Minister and his Secretary of State. What has he to say to defend them?

Mr. Sackville

The net effect of the constant criticisms is to denigrate the efforts of all those who work in the health services in the west midlands. What the hon. Member and his hon. Friends need to do is spend a little more time seeing what is happening on the ground—

Mr. Terry Davis

Who spends more time on the ground—him or us?

Mr. Sackville

He will see that there are tens of thousands of dedicated people working for the health service in the west midlands who deserve a little praise and encouragement from time to time.

Mr. Burden

If the Minister agrees with me, as he seems to, that thousands of staff who work for West Midlands regional health authority, component hospitals and district health authorities are dedicated and need a fair deal, are not they entitled to know, as we are, the causes of the scandals in south Birmingham, to see the KPMG Peat Marwick report, to read the auditors' report and to find out and be told why millions of pounds that could have gone into improving health care has gone down the drain because the people running the health authority have mismanaged it? If he believes that they have the right to know that, will he today direct the publication of the reports to which I and my hon. Friends have referred?

Mr. Sackville

The hon. Member is obsessed with publication of reports. The matters that have been referred to tonight have been properly investigated. Any action that is due will be taken. He has my assurance on that.

In conclusion—

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Sackville

In conclusion, I want to respond to what the hon. Member for Selly Oak said about giving people in the west midlands confidence about their health service. They can have the confidence of knowing that the things which have given rise to inquiries will be properly investigated and all the proper action will be taken. Where there are doubts as to finances and financial problems, such as in South Birmingham, action plans will be followed through which will bring those matters into balance.

I ask the hon. Gentleman and his hon. Friends, as well as asking me for that assurance, to help to give that confidence to people in the west midlands and to ensure that financial problems are not the only things that they read about with regard to health in the west midlands; that they read also about the dedication and the work—[Interruption.] The hon. Gentleman has twice received letters from my right hon. Friend the Secretary of State suggesting that he come into the Department to discuss these matters. I had a very constructive meeting recently with the community health council, which he did not attend. He is welcome any time to come into the Department to discuss these matters with me; I hope that he will take me up on that.

I reiterate what I have been saying in the past few minutes. There have been great achievements in health in the west midlands which should not be ignored. They are achievements of which any region could be justly proud. They underline the region's enormous investment in and commitment to patient care and patient services.

Question put and agreed to.

Adjourned accordingly at two minutes past Ten o'clock.