St. Bartholomew's and Royal London Hospitals (Hansard, 6 July 1993)

§ Mr. Brian Sedgemore (Hackney, South and Shoreditch)

The future of hospitals such as St. Bartholomew's raises questions about the very nature of civilisation. The doctors at the hospital are engaged in a war against disease, perhaps the noblest activity known to mankind. The Secretary of State and her acolytes, who plague the pestilential sewers of government, are engaged in a war against the doctors and their supporters, the patients and the public.

Rarely in politics can there have been an issue which so cruelly defines the difference between right and wrong and where the victims are the most vulnerably poor among us, while the persecutors are so arrogantly powerful.

Bart's was founded by a miracle in 1123, when the monk Raherer had a visitation from God. God has stood by the hospital. Amazingly, our greatest cathedral, St. Paul's, was denounced by the Secretary of State for praying to God to save the hospital. However, the Secretary of State, in turn, was denounced in excoriating terms by the Catholic priest who took the service which preceded this year's dinner at the medical college, at which I was the guest of honour. The Church of England and the Catholic Church may be divided on many things, but they are united in their ecumenical contempt for the Secretary of State.

It is just possible that we are on the verge of another miracle, and that the Secretary of State will be prevented from closing Bart's. I have spoken to a number of barristers and judges about the chances of success of a judicial review of the Government's actions. They are agreed that there is a prima facie case of improper and unlawful conduct on the part of the Secretary of State, on the part of Admiral Staveley, the regional chairman, and on the part of Sir Tim Chessels, chairman of the London Implementation Group.

Judicial review proceedings could be instigated by Bart's, by the community health council, by the City of London corporation, by Hackney, by Islington or by the Save Bart's Campaign, or by all of them together. They could also be instituted by the special trustees who administer the £100 million endowments to prevent those moneys, given by loving and grateful supporters of Bart's down the years, from being stolen by the Government. Perhaps the Minister will confirm tonight that, if Bart's closes—the Treasury wants that money—there would have to be legislation to make the theft of the endowments lawful.

Last week, along with Jeffrey Blum, a victim of the Baltic Exchange bomb, and Bart's cardiac specialist Dr. Duncan Dymond, I met Admiral Staveley to protest about the proposal to close the accident and emergency department. Mr. Blum, a shipbroker from the City, told the admiral that he would be dead if the Secretary of State had had her way earlier and shut the accident and emergency department. Many people feel that the Secretary of State has betrayed the City of London and given succour to the IRA, for whom the higher the body count the better is the publicity.

307 The consultation process on the proposal to close the accident and emergency department brought forth incandescent rage from the people of Hackney and the City of London. The admiral asked a mere 100 individuals and institutions for their views in the consultation process, but to his amazement received about 41,000 responses, including from every major financial institution in the city, every major company, almost every set of chambers and every firm of accountants. Such is the admiral's contempt for the democratic process that he complains that those people in the City have been got at.

No fewer than 99.95 per cent. of those who responded called for the retention of the accident and emergency department, but earlier this afternoon, at a meeting which I attended, the admiral, acting unlawfully on behalf of the Secretary of State, announced that he would recommend the closure of the department. Astonishingly, the admiral ignored the unanimous views of hon. Members, peers of the realm, local authorities, family health services authorities, general practitioners, community health councils, the Royal College of Physicians, the Royal College of Surgeons, the Royal College of Obstetricians and the local purchaser.

What we have witnessed is not consultation, but precision Stalinism on the part of people so ignorant that this afternoon I found myself involuntarily gasping with disbelief at what they were saying.

One must understand that the temporary reprieve given to the accident and emergency department pending the build-up of facilities elsewhere, including the Homerton —which is bound to take years—and the qualifications with which the closure decision is surrounded are essentially devices to satisfy the judges because the admiral expects to be taken to court. He knows that this is the second bogus consultation process on Bart's over which he has presided in the past year—the other involved the abolition of the trust. The courts have held that consultation is unlawful where decisions carried out are decided before the consultation process begins.

The City of London corporation has recently been talking seriously of setting up a private accident and emergency department at Bart's, through the use of private bonds. Will the Minister tell us tonight whether the charges of private accident and emergency departments in NHS hospitals will be regulated by the Government? I see that the Minister looks shocked—perhaps he will tell us whether patients from Hackney and Islington who cannot afford the entry fee will be refused admission, as in America.

A week ago, six distinguished old grey men in suits presented their paper plans for the future of London specialties. Their plans were, for the most part, designed to appease the Secretary of State. Like Neville Chamberlain, who had a little bit of paper to appease a great dictator, the six men were well intentioned, but foolish. The specialty review on cancer recommended that cancer services provided by Bart's should be moved to the Royal London site. Few recommendations in the history of medicine can have been as brazenly unjustified as that one.

Consultants John Shepherd, the oncology gynaecologist, Maurice Slevin, head of chemotherapy for solid cancers, Professor Andrew Lister, who looks after chemotherapy for blood cancers, and Professor Eden, who 308 deals with children, made that clear to me when I discussed the review with them, line by line. They are four of the best specialists in Britain—indeed, the world. They work in a unit of international renown which is admitted by everyone in the medical world to be superior in clinical facilities and research to the small unit that exists at the Royal London.

The data show that Barts gets better results of paediatric tumours than any other hospital in the country. Although the data are more difficult to interpret, the same is probably true of ovarian cancer. The head of the review team, Dr. Paine—a competent radiotherapist who is anxious to climb the greasy pole of administration—now intends to destroy the priceless asset.

Dr. Paine's criticism that the cancer services are too dispersed is plain silly. As I was shown round every inch of them, I realised that what Bart's has is not only state-of-the-art medicine, but state-of-the-art management and organisation. It is a pity that Dr. Paine did not compare what exists at Bart's with what exists at the London.

Dr. Paine becomes incomprehensible when he writes of a less complete range of regional specialties than is available at the London. Bart's deals with every kind of cancer, and has all the specialties in addition to cancer which any major hospital has. Ultimately, the cancer review comes down to the idiotic argument that, as Tomlinson says that Bart's should close and the Secretary of State is besotted by this lunatic idea, the services at Bart's will have to be moved to the London hospital in order to save them.

The same false argument can be seen more graphically on page 7 of the executive summary of the neuroscience review prepared by Mr. Rab Hide. I was seven years old when I first realised the logical fallacy behind that sort of circular argument. Later, when I studied logic at university, I learned how to formalise the fallacy. My correspondence with Mr. Hide and his protestations of innocence on television only serve to suggest that he is guilty as charged of lack of independence.

Worse, Mr. Hide has got his facts wrong about the financial position of Bart's. I assume that the London Implementation Group has deliberately misled him, as it was misleading Ministers a few months back.

The cardiac review proposes shutting down another famous department of excellence at Bart's. It says that, as Bart's has the smallest unit, its services should be moved to the London. It is a pity that Professor Smith, who headed the review, got his database wrong. Despite the fact that Bart's has marginally fewer facilities than the London, it carries out more cardiac procedures—that is to say, it gives better value for money, and, I might add, better treatment.

In 1991–92, Bart's carried out 1,249 diagnostic coronary angiograms, compared with 946 at the London. Professor Smith does not mention this. Bart's carried out 216 balloon dilatation procedures—angioplasty—compared with 140 at the London. Professor Smith does not mention this. Bart's carried out 442 pacemaker procedures and electrical investigations, compared with 247 at the London. Professor Smith does not mention this.

When it comes to the grand total of angiograms and balloon and electrical procedures, including pacemakers, the figures are 1,907 for Bart's and 1,333 for the London. These figures are achieved with slightly fewer beds at Bart's. It is true that, in 1991–92, the London performed 309 789 open heart operations, compared with 627 at Bart's. Bart's has approval and funding for a third heart surgeon, but, because of the uncertainty created by the Secretary of State, no appointment can be made at the moment.

Dr. Duncan Dymond has written to me, following my talk with him, about what he describes as "crass errors" in the cardiac review. I challenge the Minister to challenge Dr. Dymond. For example, the review's figures for coronary bypass operations are hopelessly wrong. Moreover, as regards quality, the review takes no account of the issue that matters most—a comparison of the condition of patients when they enter the hospital with their condition when they leave. Dr. Dymond has offered to debate these matters publicly with Professor Smith. Professor Smith should now put up or shut up.

Professor Raine, head of the Bart's renal unit, told me yesterday that Professor Mallick, who headed the specialty review team, has not been able to give a single reason coming within his terms of reference for moving the Bart's unit to the London. Indeed, Professor Mallick, for the review team, admits that Bart's has better clinical facilities and a better academic record than the London.

However, Professor Raine criticises the review team for failing to report that, whereas Bart's has provided satellite units for 15 years, and recently opened one at Wanstead, the London hospital, which is still living in the past, has none. Nor did the review team point out that, in Richard Wood, Bart's has the only professor of surgery in central London who is a renal transplant specialist. What–1 must ask Professor Mallick, through the Minister tonight—are the reasons for these curious omissions?

Professor Raine, who is scornful of the access arguments in the review, added: I am not what you'd call a Bart's man. I come from Oxford, so I can view these things dispassionately. Whilst I am prepared for change, and would be able to work with people from London, the case for moving facilities from the London to Bart's is much stronger than the case for moving facilities from Bart's to the London. Moreover, on quality, Professor Raine, in a letter to me, points out that Bart's is the only renal unit in central London for all dialyses to undergo urea kinetic modelling, which is the accepted standard provision for adequate dialysis and is recommended by the pending Renal Association quality of care guidelines.

With regard to the children's review, Professor Eden tells me that the closure, in east London, of Bart's arid the Queen Elizabeth, hospital would produce a major beds shortfall of 120 to 140 in one of the most deprived areas of the country, where nearly one quarter of the population would be affected.

However, all is not lost. The smirks are about to come off the faces of those at the London hospital who have been telling me recently that the Bart's Smithfield site will be cleared within two years. That was the Secretary of State's plan, but Sir Derek Boorman, who is to be chairman of the new merged trust, and Gerry Green, the new chief executive, realise that this is impossible without creating chaos in the national health service in the east end. I have discussed the future with Sir Derek.

Even if the Secretary of State accepts the recommendations of the specialty reviews, and even if it is decided to close Bart's eventually, there will now be a medium-term strategy for five to eight years, during which some facilities will move from the London to Bart's and some from Bart's to the London. Effectively, Bart's has been reprieved until the end of the century, while the Department of Health 310 begs the Treasury for cash to invest in new facilities for the east end. Hundreds of millions of pounds could be involved, which this bankrupt Government simply do not have.

A steering group from Bart's, the Royal London and the London Chest has been set up to negotiate the medium-term strategy for the merger. Some, like the Secretary of State, will see the strategy as a prelude to the closure of Bart's, but I suspect that she will be long forgotten before it has worked its way through. Others will see it as a breathing space during which Bart's can regroup. On this side of the House, we must pledge ourselves to ensuring that that is the case, and show that it is not only in films and novels that good can triumph over evil and strength can be built in adversity.

Meanwhile, my message to Ministers tonight from Bart's, its patients and supporters is a time-honoured one —"We won't let you bastards grind us down."