HC Deb 23 July 1993 vol 229 cc724-30

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

4.26 pm
Mr. David Mellor (Putney)

My right hon. Friend the Foreign Secretary suggested that, now that the boil of Maastricht has been lanced, we have the opportunity to look to the future. I am glad to be the first to accept that invitation and to direct the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), who has drawn the short straw and must remain a little longer on a Friday afternoon, to the future of London's health service. I do so, conscious of the fact that our brief debate, like most Adjournment debates, has not drawn a large audience. Outside the House, however, many people in the streets of London will be more concerned about the future of London's health services than the future of the Maastricht treaty. The Government have, thank goodness, got the problems of Maastricht out of the way, but it does not mean that there is not a range of other serious issues to be discussed.

I shall make two observations, the first about the future of London's health services and the second specifically about the future of Queen Mary's University hospital in Roehampton in my constituency and, in particular, its burns unit.

As a former Health Minister, I am bound to accept and welcome the fact that there has been a great transformation in the national health service in recent years. In the past decade, the national health service has for the first time become a truly national service in the sense that we now have a pattern of primary and secondary hospital acute care across the nation. It is no longer necessary for significant numbers of people to come to London from outside for treatment, as used to be the case in the old days due to the relatively underdeveloped state of services outside London.

That clearly has implications for London, and conclusions are being drawn. There is little doubt that conclusions have to be drawn about the future of London's health services. Conclusions can be drawn about whether the balance is right between acute care and primary health care. There are certainly far too many elderly GPs with lock-up shops practising in London. It is disgraceful that the British Medical Association has never taken any interest in that issue. The BMA is, of course, a trade union, so the BMA's concern for the patient becomes less obvious at that point.

One is aware of the dilemma that the Government face. I am certainly not one of those, particularly after the responsibilities I held, who would begin to say to those of my right hon. and hon. Friends now charged with one of the most onerous responsibilities in Government that change may not be necessary. However, it is appropriate to try to be wise before rather than after the event about the extent of that change.

There are too many cooks stirring the broth. The Tomlinson report, which in itself was enough of an agenda without anything else, proposed the closure of two household-name London hospitals—Charing Cross hospital and St. Bartholomew's hospital. Following fast and furious on the heels of Tomlinson, there has been a proliferation of reports from something known as the London implementation group. Every week that passes seems to bring a new report, or the threat of a new report.

One of the problems with the great range of advice being offered to the Government is that it tends to run in contradictory directions. The Tomlinson report suggested the effective denuding of Charing Cross hospital's responsibilities. Once the nonsensical proposition of moving the Royal Brompton and Royal Marsden hospitals to the Charing Cross site was rightly knocked out by Ministers, the London implementation group's specialty reviews appeared to wish to move any available portable specialty to Charing Cross hospital.

I do not believe that the Government can afford to have too extensive an agenda on London's health services. Some of the things that the London implementation group is advising Ministers to do would be difficult to achieve, even if this were the most popular Administration ever invented and if every bit of open land in London was being cleared for the purpose of erecting statues to various leading figures in this Administration. Even if this were a popular Administration, some of the so-called experts are setting a challenging agenda for the Government.

In the Lobby just now, a fellow London Member of Parliament who today presented a petition concerning a hospital in his constituency said to me, "It's the Government that's in intensive care at the moment, not the health service." Ministers ought to bear that in mind when making their dispensations. My judgment is that the future of the London health service—[Interruption.] I trust that I am not already boring my hon. Friend the Under-Secretary of State.

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

No—carry on.

Mr. Mellor

If the Whip were to move away from my hon. Friend and they ceased their conversation, it would be much easier to deal with this matter. If my hon. Friend is going through some of the experiences that I went through when I was a Minister in the Department of Health, he might find some of this profitable.

There is no understanding among the public of the real challenge that faces those who run the health service. Experts may say that London is over-bedded, but that is not the view of the public at large. If one goes to Bart's, as I did the other day, one does not find empty beds. One finds plenty of work going on there which people are not disposed to regard as being readily portable elsewhere. There being no understanding of the basic evidence, it is fair enough to make the assessment that public confidence in the Government's ability to manage London's health service hangs by a thread—a thread which in my opinion the Government would be wise not to break.

A limited agenda for change, therefore, designed to move London's health service in the right direction but shorn of some of the more extraordinary proposals of the siren voices that have been let loose on these various studies and groups, might be the best advice that I could tender to the Government, as one of their loyal supporters. I have been through the maelstrom of the Department of Health and I know all too well what the public think and how readily the public can become agitated about an issue of this kind.

With the benefit of hindsight—and perhaps with a little more than that—the Government might have been better advised not to let loose quite so many expert committees. This is a classic example of people being given power without responsibility. They have the power to blight great institutions by recommending that they should either be closed or shorn of important responsibilities, with vital services transferred from one institution to the other. That is the power to blight, to cause widespread public unrest and to stimulate professional concern, as doctors and nurses wonder whether they have a future within an institution in which they may have spent a working lifetime.

I certainly should not care to be the Minister who tried to take through the wide repertory of ideas being thrust forward with such frequency by these folk who, above all. do not have the responsibility of maintaining public confidence in the health service while their proposed changes are implemented. That is a classic example of why, far from being the voices of wisdom, so many of these specialist committees' suggestions are siren voices trying to lure the ship on to the rocks.

It is extraordinary that even on matters of which one would expect them to have some sensible grasp they seem to be wanting. I draw the attention of my hon. Friend the Minister—I dare say that he is already familiar with it—to the meeting of the Select Committee on Health on 14 July, before which three leading figures from the London implementation group appeared. One of the points that emerged was this, and I quote from a note that was made of the meeting: it was acknowledged that the Tomlinson report and the speciality reviews had not considered in any depth the financial implications of their recommendations. That seems a perfect piece of nonsense. How on earth, when the whole raison d'être of the exercise is fitting patient care to the principles of affordability, can a group of people be charged with that responsibility when they acknowledge that Tomlinson had not considered in any depth the financial implications and nor had the speciality reviews?

Having made that point, I turn to the issue of Queen Mary's University hospital. It is a popular hospital. A survey in The Independent ranked it as one of the 10 most popular hospitals in the country. It is highly regarded in our community and it has a partcular reputation for dealing with trauma. It has the largest, and perhaps the only, burns unit in London—certainly in an area with a London postal code. Its advanced plastic surgery unit is a legacy of the war years when plastic surgery was performed on those who were horribly disfigured in service in the Royal Air Force. Since the first world war, it has been the nation's foremost centre for dealing with artificial limbs. Indeed, Douglas Bader and victims of tragedies in the Falklands war or IRA bombs have all been treated there. Sir Ranulph Fiennes is a strong supporter of the hospital, which does not lack friends—another material point for the political consideration of this matter—and when he had to have a couple of toes amputated following his historic walk across Antarctica, he had the operation performed at Queen's Mary.

The burns unit was opened in 1985 at a cost of just over £3 million: I know, because I lobbied hard that it should be. Eight years on, the geniuses that the Department has asked to advise it suggest that it should be shut and that two others—one in Tooting and one in Guildford—should be opened. That leads one to scratch one's head and say, "But Queen Mary's University hospital has just been made a trust hospital"—and I am grateful to the Department for doing that, in the teeth of opposition from the regional health authority.

The unit is extremely successful. I have supplied my hon. Friend the Minister with the facts about its workload, so I shall not weary him by repeating them. Suffice it to say that the workload has increased 10 per cent. in the financial year. It is a popular and successful unit which treats a significant number of people from overseas who have the worst burns imaginable. I defy anyone to visit a more haunting place than a burns unit containing patients who have suffered extreme burns. It requires particular dedication to care for them. Why on earth does the implementation group propose closing a unit which is eight years old and cost more than £3 million, and to establish two in its place? If the aim is to produce value for money, no one outside that small circle would believe that such a proposal is credible. The logic of the lunatic asylum is being brought to bear.

It is not a Conservative approach to life to decide that a unit that is growing and has existed as part of an institution for many years can be uprooted, moved, root and branch, and planted elsewhere without losing something. The fact that the unit will be replaced with another unit is not at issue. What matters is the unit's long history in the context of a hospital with an international reputation for treating serious trauma of all sorts. The unit passes all the tests that are set on the need to integrate a specialist unit into the range of other services that are sometimes needed. It is only on the renal unit test that Queen Mary's does not pass muster—I think that four patients—no more—in the past decade have had to be moved out of the burns unit for specialist renal work.

If, on its own merits, there is no reason why the burns unit should be moved, we must ask whether there is a hidden agenda—a thought which is exercising a number of my parliamentary colleagues in London. It is thought that some other motive lies behind the proposal involving the hit list of hospitals to be closed, that perhaps those charged at official level and so-called expert level have decided who shall be the quick and who shall be the dead. If there is no logic in the proposal to move the burns unit of Queen Mary's University hospital away from that hospital, there must be another reason.

There is only one reason for doing so apart from sheer perversity—which cannot be ruled out, but is unlikely—or professional jealousy. The reason is that it is thought inappropriate for a regional speciality to be continued in a hospital which may not have a future. The thinking is that perhaps Queen Mary's University hospital has had its time. Applying the logic of the proposal, it seems that that may be the reason.

I totally exonerate my hon. Friend the Minister of any blame—the committees have been established and are responsible for what they say—but the proposal cannot be justified on its own merits and it is deeply controversial and unacceptable to the public. Other hon. Members—including my hon. Friend the Member for Richmond and Barnes (Mr. Hanley), who, as a Minister, cannot take part in this debate—are extremely concerned. As the subject involves a recommendation to the Government rather (Ilan from the Government, however, it is not bound by collective responsibility and I have my hon. Friend's authority to say how concerned he is. A number of other hon. Members whose constituents have been treated at the unit are equally worried.

I do not envy my hon. Friend the Minister the task of trying to steer London's health services safely through the shoals which lie ahead. In view of the problems that exist in a wide context and the problems that we know exist with key London health services such as the ambulance service, which are still a long way from being got right, I urge on my hon. Friend the need to confine changes that will cause public uproar in relation to the closure of valued units and the closure of whole valued institutions to the bare minimum necessary to reshape our health services. I urge my hon. Friend to have confidence in the trusts that have been created. The Queen Mary's trust is not asking for no change—it is ready for change and is already thinking about a strategy that will involve change—but there is all the difference in the world between evolutionary change and change imposed by the arbitrary will of committees such as the specialty review.

Although I do not expect my hon. Friend to repudiate the proposal today, I think it only fair to tell him how I feel so that when, as I hope, in the autumn the Department returns to the topic, it will reassure some of us that it understands the sensitivity of the matter. I hope that it will have an agenda far smaller and across a far narrower canvas than the agenda that some of its experts, who carry no responsibility for the consequences, wish to impose upon it.

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

I congratulate my right hon. and learned Friend the Member for Putney (Mr. Mellor) on raising this important topic which is clearly of enormous importance to his constituents. The hospital in question is well loved and respected. Many of my right hon. and learned Friend's constituents and people living in south-west London and beyond have no doubt been treated at Queen Mary's. My right hon. and learned Friend has given us a flavour of the hospital's long experience and of the respect in which it is held.

My right hon. and learned Friend knows, because he is a former Health Minister, that many reports have been published over the years about the need for change in the provision of acute services in London. There have been more than a dozen; Tomlinson is just the latest and its birth was accelerated by the fact that we have separated the provider from the purchaser. We expect the various units to live within budgets, to budget carefully, and to project carefully their future work load and expenditure of income. Within that context, we shall see changes. We want to ensure that they are made in an organised manner.

The Tomlinson report, as my right hon. and learned Friend knows, like many previous reports, has suggested that London is likely to be over-bedded in future in terms of acute services. We shall see a transfer which we shall have to push hard. We shall have to make some positive changes towards primary care which will affect many hospitals in London.

My right hon. and learned Friend also knows that the Tomlinson report and the Government's response to it set in hand six independent specialty reviews. One was to do with burns and plastic surgery, and one of the hospitals that was involved in the review as a provider of those services was Queen Mary's. The London implementation group, which is the body set up by the Secretary of State to specialise, to go into great depth on the whole question and to give her advice about the decisions that she should take—later this year, we hope—was charged with reporting on acute hospital provision in south-west London.

The regional health authority has, therefore, set up a south-west London hospitals review. That is all quite clear. I do not think that it quite merits the description that my right hon. and learned Friend gave it. He did me the courtesy of giving me some idea of what he would say through the medium of the early editions of the Evening Standard.

Mr. Mellor

My hon. Friend's office was advised by those at Queen Mary's of the point that I was going to make, and I invited my hon. Friend to telephone me before 10 am, which he failed to do. My hon. Friend would do well to deal with the substance of the matter rather than making silly points.

Mr. Sackville

My right hon. and learned Friend should not take it too personally. He has made some fairly critical remarks about the review group, both in his speech and in the local newspaper. I remind him that three eminent consultants—for example, Mr. Philip Sykes, the consultant plastic surgeon at St. Lawrence's hospital in Chepstow—a senior nurse, Mrs. Driver from Leicester, and others have given their time to advise impartially on how they see the future for plastics and burns in south-west London.

I must tell my right hon. and learned Friend that there is no sub-agenda. The group is merely saying what it believes will be the demand in the future and how that demand can best be met. The members of the group have decided that, in their opinion, there should be a split, because quite a large number of the patients come to Queen Mary's from beyond the M25. That is their opinion; it is advice which they are offering the Secretary of State. I cannot debate with my right hon. and learned Friend the details of that—indeed, I am glad to say that he has not invited me to do so. That is just one factor in the decisions that will have to be made later.

My right hon. and learned Friend talked about public confidence. The changes that have to be made iire extremely worrying for staff, patients and others. We must make any changes that we have to make in as calm and organised a way as possible. Clearly, Queen Mary's has great qualities, and they will all be taken into account. My right hon. and learned Friend must remember, however, that in all these matters, the patient and patient services are what matter.

Loyalty tends to be to buildings and institutions—that is the same everwhere—rather than to the services that are provided in them. Sometimes, painful decisions have to be made. I remind the House that that is true all over the country. In all the great conurbations, we find that we probably have too many buildings, too many acute beds and a very expensive health service that will probably have to be changed so that we can deliver it more efficiently. We know that demand will grow and we will have to make sure that we achieve the greatest efficiency. People in London must remember that there is life outside the M25. There are enormous problems—

Mr. Mellor

My hon. Friend is in danger of persuading me that, coming from Stockport, he is unaware that there is life within the M25. He had better not be too insouciant about this issue.

Mr. Sackville

It is Bolton, not Stockport. The problems that afflict Newcastle, Birmingham, Manchester and all the great conurbations are the same, even if in London they are perhaps more intense. Difficult decisions have to be made everywhere. If we do not face up to the sort of decisions that have to be taken in London, because it is the capital or because of the influence of particular consultants or the national media or whatever, we are letting down the NHS employees around the country and patients who may feel—there is evidence to back this up —that, until now, they have been subsidising services in London.

Those are the arguments that lead up to the Tomlinson report and those are the kinds of decisions that we have to make. I hope that my right hon. and learned Friend will remember that.

There are always powerful arguments to be made against the closure of any well-loved hospital or of any health services. They can be made in more or less emotional ways. They can be made by pointing to quality of services, to the venerability of services or whatever. But we must face the fact that changes will have to be made.

I will not try to prejudge this issue. I will only say to my right hon. and learned Friend that what he has said this afternoon will have been heard. Everything that he has said will be taken into account in any decisions that will be made later this year—as will a petition which I understand is being organised from Queen Mary's, and all the other factors, including the specialty review.

There is no hidden sub-agenda in any recommendations that have been made to my right hon. Friend the Secretary of State about Queen Mary's. Decisions have to be made based on what will, over the next half century, be the best way to deliver services for everyone in south-west London taking into account the effects that those decisions have on services for people who live further out and who now have to come into London and may not feel that that is the future for them.

I congratulate my right hon. and learned Friend once more on raising this subject today and I have no doubt that what he has said will be heard and will influence the debate very strongly.

Question put and agreed to.

Adjourned accordingly at six minutes to Five o'clock.