HC Deb 29 January 1993 vol 217 cc1376-82

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

2.49 pm
Lady Olga Maitland (Sutton and Cheam)

My own interest in the future of the Royal Marsden hospital began some 25 years ago when a dear school friend, then just 29 years old, was a patient. My interest in the hospital continues to this day. Part of the hospital lies in my constituency of Sutton and Cheam; the rest is in the Fulham road. Many of my constituents are deeply grateful for the treatment that they have received in both sections of the hospital. What happens to the Fulham road branch of the hospital has every bearing on the hospital as a working whole. Therefore, I am committed to ensuring that all concerned come to the very best possible decision about its future.

It would be very easy for me to make an emotional speech on the work of this magnificent hospital. Cancer touches the lives of almost every family in the land. It is an illness fraught with fear but also success. That is why, alongside the Earl of Stockton, I was able to hand in to No. 10 a petition with more than 500,000 signatures on it. That is why I, and many Members of Parliament throughout the land, including even the Outer Hebrides, well away from London, have received hundreds of personal letters begging us to ensure that we examine very carefully indeed just what we plan to do with this hospital.

Our responsibility is heightened, in that we are dealing not just with another London hospital with a surfeit of beds but with an institution which is famous both here and throughout the country and overseas. I appreciate that my hon. Friend the Minister for Health is well aware of this hospital's fine reputation and understands its work, following his earlier career as a radiation biologist. Therefore, he needs no lessons from me on the uniqueness of this hospital. Hence the importance of putting to one side the emotional issues and concentrating on just one crucial point: whether the future of this hospital is being decided on honest economic grounds or—and this is the danger—whether it is to be made the scapegoat for bad decision making elsewhere. Is there not a danger of throwing out the baby with the bath water so that, in the end, nobody will benefit? Furthermore, we should all lose, for the sheer cost involved in moving the hospital would mean that less money would be available for urgent treatment elsewhere.

I welcome in principle the Tomlinson report. Very few would dispute the fact that London's health services need a radical overhaul, with primary community and health services rightly deserving more support and a fairer share. However, that does not mean that the report does not contain errors—some of them rather serious errors. They need to be dealt with before any damage is done.

Professor Sir Bernard Tomlinson has recommended that the Royal Marsden hospital, together with the Royal Brompton National Heart and Lung hospital, be moved to the Charing Cross hospital site or, if that is not acceptable, that the Charing Cross site be sold. There are number of reasons why I and many others more expert than I completely disagree with that recommendation.

Let me deal with the history of this hospital so that the implications can be understood. The Royal Marsden hospital was founded in 1851 by Dr. William Marsden.

Following the painful death by cancer of his wife, he decided to create a hospital—the first in the world to be devoted exclusively to the diagnosis and treatment of cancer. Today, it is a leading postgraduate teaching hospital, drawing students from all over the world for specialist training. For example, it trains 90 per cent, of Britain's cancer nurses. In collaboration with its associated Institute of Cancer Research, the hospital continues to play a world-leading role in developing new anti-cancer drugs, surgical techniques and new approaches to radiotherapy treatments.

No one has questioned the ability of the Royal Marsden to treat cancer effectively. Indeed, it is one of the largest comprehensive cancer centres in Europe and it constitutes a national centre of excellence for research, development, education, treatment and care in cancer.

The Government have recognised how vital the battle against cancer remains. The White Paper "The Health of the Nation" draws attention to that fact by placing cancer as one of its top priorities, alongside heart and coronary disease.

As a disease, cancer affects all ages, from babies upwards. A newly built children's unit in Sutton is due to be opened by the Princess of Wales next month. All sexes and all areas of the body are catered for. The successful treatment of this complex and diverse disease has led the Royal Marsden to become a multi-specialist centre with 16 distinct clinical units located on one or other of its two sites. Surely this is no time to allow anything to get in the way of such important work. Moreover, a reduction in the number of patients would mean a loss of the critical mass that is so essential for research of this nature. It makes no sense to dismantle an institution so well established and recognised by the International Union Against Cancer as a role model to ensure the best possible research and patient care.

Yet that is precisely the effect that Tomlinson's proposals would have by moving the Royal Marsden to Charing Cross. If moved, the Brompton and Marsden would lose nearly 170 beds between them and more than one third of their staff. The loss of beds would result in fewer patients being treated. Is that a price which we can afford? Do we really want to reduce the service on which we place so much importance?

Turning to the subject of cost, which is at the heart of my argument, in evidence to Professor Tomlinson, the North West Thames regional health authority suggested that to close the Brompton and Royal Marsden hospitals and move them to Charing Cross would cost only £10 million. One might ask whether even that sum could be justified in the present climate, but an independent study by Ernst and Young, the management consultants, has subsequently reported that that sum is hopelessly inaccurate. Ernst and Young suggests that, in fact, the move would cost at least £47 million and up to £62 million. It could be even more. Moving the Royal Marsden is not the same as moving a house, and it certainly is not the same as moving any other type of hospital; it is much more complex.

I should like briefly to show why costs are so high. It would cost, for instance, £4 million to move four radiotherapy machines, each of which is placed in a purpose-built concrete bunker weighing up to 4 tonnes with walls up to 3 ft thick to provide radiation protection. The machines operate to a fine degree of accuracy. Experience of machines that have been moved shows that they are very unlikely to operate sufficiently accurately again for the effective treatment of patients.

There is a unique operating theatre where radiation is carried out under open surgery. That requires 3 ft thick walls. To move the theatre and bunker and rebuild them in Charing Cross is impossible because the theatres at Charing Cross are high up on the 14th floor. The building is simply not structurally strong enough to be able to hold a bunker that high up. It would mean rebuilding elsewhere.

It would cost £650,000 to move five single wards, which again have 3 ft thick walls and are designed for low-dose radiation treatment. The task of building it into the existing Charing Cross wards in a tower block would be a nightmare, if not technically impossible. I have given just a sample of reasons why moving such a hospital site would not be so easy.

The proposals mean that £62 million would be spent juggling hospitals around and, in the process, destroying the important national services which they currently offer. What possible gain can there be for the patient, let alone the taxpayer?

The Tomlinson report and the submission by the North West Thames regional health authority base much of their economic argument on plans to use land sales to finance such a move, despite the collapse in the property market. That would appear to be a high-risk strategy at a time when property values in London are still falling. In any event, Ernst and Young showed that potential income to the Exchequer from land sales is almost identical to the cost of moving the hospitals: £27.5 million would be spent at Charing Cross and £28 million would be gained from the sale of the two hospitals in Chelsea.

Moreover, there is the risk that no sale will take place for a long time. Large sites in London simply are not selling. The need for expensive borrowing to plug the gap while the hospital move went ahead would be crippling. While I do not wish to be churlish about the opening of the Chelsea and Westminster hospital last week, it is interesting to note that the recent National Audit Office report slammed in no uncertain terms the North West Thames regional health authority's decision to go ahead with building the Chelsea and Westminster.

The report highlighted the severe financial problems that have arisen with the project as a result of difficulties in recouping the expenditure through land sales. Capita and Touche Ross have been asked by the Department of Health to provide the financial costing of Tomlinson's proposals. I understand that, far from agreeing with the original estimate submitted by the North West Thames regional health authority and accepted by Professor Tomlinson, the costings tend to endorse what Ernst and Young reported. Is my hon. Friend the Minister in a position to confirm that?

I wonder whether there is a hidden agenda and the Tomlinson report has been used for other purposes. I have already mentioned the inaccurate figures supplied by the health authority to Professor Tomlinson, who felt unable to challenge them. Indeed, why should he? He said that costings were not part of the brief. Why should he not accept the advice of the local health authority, which ought to know the facts and figures? Let us not forget that this is the same regional health authority which built the Chelsea and Westminster hospital. It decided to go ahead and build a huge new hospital even though the Charing Cross hospital, which is only 20 years old, is just down the road. The new hospital was redundant before it ever opened.

The health authority grossly underestimated the costs of moving the two hospitals. The original estimate of £110 million to build the new Chelsea and Westminster hospital has risen to almost £236 million. More simply, each bed will cost about £300,000, while hundreds of other health projects in the region have to be cancelled or postponed.

In view of the escalating costs, why on earth compound the error by incurring unnecessary costs in making the Royal Marsden and Royal Brompton hospitals move? As Nurse said, it is a case of going from bad to worse. It would also appear that the North West Thames regional health authority, faced with two hospitals—Charing Cross and the Chelsea and Westminster—is using the Marsden and Brompton as scapegoats; or, to use a medical metaphor, it appears that the hospitals have been stitched up. The health authority should have the courage to recommend that the Charing Cross hospital be closed.

I take this opportunity to ask my hon. Friend the Minister another equally important question; it is a moral issue which should not be ducked: has any consideration yet been given to the legality of ordering the demolition of facilities and buildings paid for by charitable donation? The large proportion of such donations is from grateful patients who are far from wealthy. They have given what I can only describe as the widow's mite.

Gratefully given, it should not be scorned and thrown away. Let us not forget that public affection for the Royal Marsden resulted in £25 million being raised in the midst of a recession and spent on new state-of-the-art clinical facilities. An entire new clinical block has been built, containing four new operating theatres, a unique radiotherapy unit and four new wards. The work has only just finished and the last lick of paint went on only a few weeks ago.

I implore the Minister to have the courage to reject those aspects of Tomlinson that do not add up. As I have made clear during the debate, too many costs are attached to the proposal to uproot the Royal Marsden and Royal Brompton hospitals and to force them into the Charing Cross site. As much as I attach importance to the Tomlinson report, whose ideas are important and far-reaching, it is vital that we maintain a sense of balance. It is not in our character to be doctrinaire for the sake of it. If the proposal is sound, we must go for it; if it is not, we must take courage and say no. The idea may seem attractive on paper, but in practice it does not make sense in human or economic terms.

May I make a plea that the decision making should judge the Royal Marsden on its own economic terms? The decision should not be allowed to become embroiled in any views held by other parties, especially the North West Thames health authority, which has powerfully demonstrated its interests at the expense of others.

My abiding image of the Royal Marsden is of an utterly loyal following of patients from far and wide, together with dedicated doctors. They deserve the highest consideration. Like my neighbour, my hon. Friend the Member for Carshalton and Wallington (Mr. Forman), I join in their hopes that they will be able to take full advantage of the Government reforms to gain trust status next year, on their present site and in their present form. I have no doubt that the Royal Marsden will not only succeed but will go on to flourish.

3.7 pm

The Minister for Health (Dr. Brian Mawhinney)

I congratulate my hon. Friend on her good fortune in getting the Adjournment debate on the way in which she made her case so cogently. She has done it a service by not indulging in the sort of emotionalism that she eschewed at the beginning.

My hon. Friend is right to say that I have some personal knowledge of that aspect of the Royal Marsden that is in her constituency. As I recall, I was sitting in an office in that very building when I was told by one of the professors that I had become a doctor of philosophy, after he had given me my viva on my thesis. It was out of that building that my first post-doctoral job emerged—teaching in the university of Iowa medical college in the United States.

As my hon. Friend was kind enough to acknowledge, I have some knowledge and understanding of the issues with which she dealt. What she did not say—I will put it on the record for her so that her constituents can be even more impressed by her assiduousness as their Member of Parliament—is that she came to see me in the Department a few days ago to make the same case that she made so eloquently today. I assure my hon. Friend that what she has said, and the issues that she has mentioned, will all be taken into account before the Government make a final decision on matters that relate not only to the Royal Marsden but to the other aspects of health care and its delivery included in the Tomlinson report.

The Royal Marsden Hospital is one of the eight special health authority London postgraduate teaching hospitals and its prime role, in partnership with the Institute of Cancer Research, is research and development, ranging from basic science to clinical research and health services, dissemination of good practice to the wider health service and the postgraduate and post-basic training and teaching of doctors, nurses and others. In recognition of that special role, and unlike other provider units, the hospital is managed and funded directly by the NHS management executive.

In recent months many issues have arisen that might affect the hospital's future. My hon. Friend touched on the Tomlinson recommendations and on the Marsden's intention to apply for trust status. The third factor is the decision to look to the future funding of special health authorities in the new NHS market. I was pleased to hear my hon. Friend express her support for that market because that will have a bearing on the future of the hospitals, wherever located.

My hon. Friend rightly focuses on the recommendations of Sir Bernard. I assure her again, as I have assured so many others in the past three months, that Sir Bernard's report is advice to the Government. It does not represent the Government's view. My hon. Friend will know that I have spent the past three months visiting all the hospitals that were mentioned for significant change in Sir Bernard's advice. I have visited 24 of them. In addition, I have met a variety of national and professional bodies, about 30, not to mention politicians, all of whom have been kind enough to give me their views on the various aspects of the Tomlinson report. I hope that my hon. Friend will be encouraged by the fact that the Government are taking that advice so seriously and want to probe it in such depth before we come to any conclusions.

Sir Bernard was effectively seeking to reconfigure health care in London. He recognised the inadequacies and the patchiness of family doctor health services and some community services. He recognised the achievements of the great teaching hospitals and their international standing. He also recognised that, in the market, medical excellence, which used to be available only in London, is now available more widely across the country. My hon. Friend and I will be pleased about that. As a result, those who once had to come to London to be treated at those hospitals no longer have to do so. Contracts are now being placed elsewhere. All those facts must be taken into account.

Arising from that, the Government do not have an option not to consider change. Change is taking place now—rightly so, and to the benefit of health care delivery to Londoners. I stress to my hon. Friend that that is an important part of our considerations. Whenever we emerge from this process we want to be able to say that it has benefited the health care of Londoners. We shall take that factor into account.

As my right hon. Friend the Secretary of State has said, the Government welcome the broad conclusions reached by Sir Bernard. There is some evidence that there are areas of duplication in some specialties in London and we are therefore considering the need to establish, as Sir Bernard recommended, a series of specialty reviews, including cancer. We firmly believe that there is need to consolidate and thereby strengthen specialty provision in the capital. Only by doing so shall we ensure that London will continue to have world-class centres of excellence in the next century.

As my hon. Friend explained, Professor Tomlinson recommended that the Royal Marsden's services on the Chelsea site should form the basis of an integrated and rationalised west London cancer service at the Charing Cross site, and also recommended that the Sutton site should be left as at present organised. Sir Bernard formed the view that by concentrating a greater number of patients on the one site there could be significant benefits for teaching and research, thus strengthening the special health authority's essential role in increasing the effectiveness of research and development within the NHS.

I stress—I am sure that my hon. Friend will agree—that Sir Bernard recognised the excellent work done by the Royal Marsden and its specialist teams. I stress, too, that he has not recommended that teams should be broken up or their services closed down. However, centres of excellence are not found only in London: they have now been established throughout the United Kingdom.

The Government recognise that many of the London postgraduate teaching hospitals are highly rated by patients, by the Universities Funding Council and by many others. Indeed, I congratulate the Royal Marsden's partner, the Institute of Cancer Research, on achieving such high ratings in this year's Universities Funding Council research rating assessment exercise which has recently been published. In part, that rating depends on the facilities provided by the special health authority, which is currently not part of the NHS market.

My hon. Friend has spoken eloquently and passionately about the need to ensure that the Royal Marsden hospital remains on its present sites and I have sympathy with her view. Indeed, it will be taken into account when the Government reach their conclusions on the details of the report. As part of the programme of visits that I mentioned earlier, I visited the Royal Marsden late last year when the hospital, the Institute of Cancer Research and the chairman were able to put to me their views on the proposed move. Since then, some of them have made further comments to me. Therefore, I hope that my hon. Friend will accept that we are making every effort to take account of the opinions of those affected before reaching conclusions. I must, however, stress that the position of the Royal Marsden is no different from that at any other institution covered in the Tomlinson report. As with the rest of London, the Government seek the best solution to safeguard the health and health care interests of London and Londoners.

To show how seriously we take the issues of research and teaching, we have also started a comprehensive review of the special health authority's research programmes. The Royal Marsden, in line with the other special health authorities, has been asked to provide evidence to an independent review group of both national and international experts, set up by the Department.

It has been Government policy for some time that the special health authorities should join the internal market, which will happen in April 1994, but we wish to ensure that that move does not put the high-quality research at risk. I mentioned earlier that the research review conducted by Professor Peckham will report in the summer. We have also instructed a consultancy group to look at the excess costs of the authorities over comparable hospitals. The study has now reported and the findings are being discussed with the relevant authorities.

Trust configuration is a separate issue from closure or change of use of hospital sites, and does not imply prior acceptance of any recommendations about the use of hospital sites. Once we have made a decision on the future of the Royal Marsden we shall be in a position to consider its trust application. When I say "made a decision", I stress that my right hon. Friend the Secretary of State will make proposals on which there will be statutory consultation.

The Government value tradition and recognise the respect and affection in which the Royal Marsden is held both nationally and internationally. But it is not sufficient to rest on past glories. I am conscious that the authority, supported by many charitable sources, has invested millions of pounds in new equipment, and in bricks and mortar. However, the Government cannot let that fact drive the need to change. If, after consultation, hospitals; are closed, it is hoped that much of that investment can be used elsewhere.

We are determined to maintain and, indeed, reinforce the best research and teaching of postgraduate students of all disciplines. Much of the NHS work in the special health authority meets specific patient needs and can be funded in part through the internal market with support for the extra service costs of research and teaching. I can assure my hon. Friend that we shall exercise the greatest care in ensuring that the new arrangements reinforce the best research in those centres while allowing high-quality institutions, both inside and outside London, to benefit from NHS support for research.

Question put and agreed to.

Adjourned accordingly at eighteen minutes past Three o'clock.

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