HC Deb 18 July 1994 vol 247 cc151-8

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

11.42 pm
Sir Michael Neubert (Romford)

I greatly value the opportunity of raising on the Adjournment the issue of the proposed closure of the accident and emergency unit at Oldchurch hospital in my constituency at Romford. I have lost count of the times that I have had to mention threats to Oldchurch hospital on the Floor of the House before Ministers during the 20 years that I have served here, but once again I find it necessary to do so on behalf of my constituents, and many other people outside my constituency, who have expressed their outright opposition to the latest proposal.

In January, in response to a parliamentary question from me, my right hon. Friend the Member for Peterborough (Dr. Mawhinney) stated that the Secretary of State had received a petition of about 46,000 signatures and about 17,000 pre-printed letters and postcards from members of the public, as well as letters from individuals, and of course hon. Members.

The closure has been condemned by the London borough of Havering, of which Romford is a part, and by the London borough of Barking and Dagenham. It is opposed not only by myself, but my hon. Friend and neighbour the Member for Hornchurch (Mr. Squire), who, as a Minister, has to observe ministerial silence in this place on the subject. It is also opposed by the newly elected hon. Members for Barking (Ms Hodge) and for Dagenham (Ms Church), who I hope may be successful in catching your eye during the debate, Madam Deputy Speaker.

If public consultation is to mean anything, the verdict can be seen only as an emphatic thumbs down. Of course, it is not a Government proposal; its sponsor is the Barking and Havering health authority, which acts as purchaser, aided and abetted by the Havering hospitals trust as provider. My hon. Friend the Minister, whom I welcome and thank for being here tonight, is required to act as arbiter and judge between the local managers of the national health service and the public they are there to serve.

The strategy has now been approved in principle by the North Thames regional health authority and passed to the Secretary of State for decision. The region was the original author of the strategy. It is a tale not of two cities but of two hospitals—Oldchurch hospital in Romford in my constituency and Harold Wood hospital in the Upminster constituency. Throughout the 1980s repeated attempts have been made to close services at Oldchurch in favour of Harold Wood. Capital investment has been largely directed towards Harold Wood, widening the gap between the two hospitals and hastening the day when Oldchurch hospital can be closed, or virtually closed.

That is the point that we have now reached. Once the accident and emergency unit goes, other major specialties will go too and we will effectively have one district general hospital for a district of more than 400,000 people and an above average instance of ill health in parts of the district.

When the proposal for the Havering hospitals trust—note the plural, Madam Deputy Speaker—was brought forward as recently as February 1992 by the previous chairman, it was accepted that there would need to be some rationalisation of services between the two sites, as took place, for example, in the case of the ear, nose and throat service. My hon. Friend the Member for Hornchurch (Mr. Squire), who is in his place tonight, was with me in expressing concern when we discussed that prospect with the chairman at the time.

At that time it was stated that no significant change is envisaged in the disposition of accident and emergency and that trauma and orthopaedics will be retained on both sites as there is a close clinical link with accident and emergency services. Yet within weeks of the trust coming into force, A and E was targeted for rationalisation. The two hospitals are now officially described as hot and cold sites and Oldchurch at Romford is the one to get the cold shoulder.

On 9 June 1992, my right hon. Friend the Member for Peterborough (Dr. Mawhinney) wrote to me as follows: You implied that the unit could be trying to achieve a single site strategy through the back door. Havering hospitals final application for NHS Trust status describes a twin site strategy. If we approve the application, then the NHS Trust will be required to abide by that strategy. The trust was approved and Oldchurch may be retained as a site, but reduced in size. On present plans, it will be not much more than a hi-tech cottage hospital providing out-patient clinics and elective day surgery.

So much for the background. The community health council, whose resolute stand on the issue of accident and emergency services is the sole safeguard against the strategy being rubber stamped, has conceded a reduction of two A and E units to one, but believes that if there is to be one it should be centralised at Oldchurch. That is the position that I support tonight. It is not the least irony that it is proposed that all A and E services in the district should be centralised at Oldchurch while expansion proceeds at Harold Wood. That compounds the waste of public assets implied by the abandonment of past investment at Oldchurch hospital.

The nub of the argument was set out in my question in April this year: Should not ease of access by road and proximity to the main centres of population be the overriding factors in determining the location of casualty departments? Does not that consideration point to the continuing need for Oldchurch hospital in that all important life-and-death role?"—[Official Report, 26 April 1994; Vol. 242, c. 93.] There is also the question of capacity. Other hon. Members may speak of that, particularly my hon. Friend the Member for Ilford, North (Mr. Bendall), who has concerns relating to his local hospital.

Mr. Vivian Bendall (Ilford, North)

I do, indeed, have concerns. We have a new hospital, the old one having closed approximately a year ago. Our A and E cases increased by 13 cases in the first year. If the A and E unit goes from Oldchurch, it is expected that that figure will increase by a further 25,000 cases in a year, which would mean a further 100 beds to our hospital. That would certainly mean a very large expansion programme on a new hospital that has just been built.

Sir Michael Neubert

I am indebted to my hon. Friend for those figures and for painting a rather wider picture than I can from the vantage point of Barking and Havering health district. We know that the ricochet effect of the closure of A and E services, say, from Bart's eastward out as well as from Oldchurch westward in, could have on other hospitals in the wider area of north-east London.

I return now to the two main considerations that I have highlighted. Romford is at the centre of a strategic road network, and Oldchurch hospital is on a dualled ring road close to the centre of the town. Access is easy from east London and Essex—it has to be, for Romford to have acquired the reputation of a thriving commercial and retail centre. Harold Wood, by contrast, is some miles to the east and reached only by roads which were once and are now not much more than country lanes. Romford is much closer to the densest population, where, on average, accidents are more likely to happen, and to those areas of above-average illness and deprivation, which are a major feature of the district.

As distance and travelling time are of the essence in an emergency, Romford is much the more suitable place to have the only A and E department if there is to be only one. Let me illustrate the point by specific reference to the annual report of the director of public health, 1993, entitled "Bringing Health to Life in Barking and Havering". It states, on page 31: In Barking and Havering, there are major contrasts between the localities. It takes as a yardstick mortality from coronary heart disease at ages under 65. The current national average is 58 per 100,000. The district average is 57, but that represents a twofold spread from 39 per 100,000 in one part of the district to 71 per 100,000 in another. The report goes on to point out: at ward level variations are even sharper, and cites 97 per 100,000 in Goresbrook compared with 25 per 100,000 at Upminster, which is very comparable with what it calls more affluent Harold Wood". The conclusion is clear. If I am under 65, live in the west of the district and suffer a heart attack—I am three or four times more likely to have a heart attack in the west than if I lived in the east of the district—I would want the A and E department to be at Romford rather than Harold 'Wood. The extra travelling time might well prove fatal.

The health authority defends its strategy by all kinds of arguments: from paramedics attending every emergency, to green field helicopter sites, to minor injury units around every other corner. But my constituents are not convinced that that represents the real world, and, unlike the authority, they do not believe in the priority of "timescale financial and logistical reasons" to use the phrase used by the authority in defending its proposal.

My constituents believe that the patient should come first. It would be irresponsible not to put health needs higher, when two recent press reports record Havering hospital trust as bottom of more than 30 authorities for assessing people quickly in the A and E units—now, before two units are reduced to one.

The London ambulance service is the slowest in the country in responding to 999 emergencies. The North Thames regional health authority, in a debate which, it is reported, raised many doubts, approved the strategy in principle, but hedged it about with such an extraordinary number of caveats—I could list them if there were time, as set out in its letter of 21 June to the chief executive of Barking and Havering health authority—that one wonders how approval could be given on such a conditional basis. I hope that my hon. Friend the Minister, for his part, will not be prepared to accept such a flawed strategy. Meantime, he may be interested to know that the region has apparently given permission for preliminary building work to start at Harold Wood. So much for the process of consultation.

11.54 pm
Ms Judith Church (Dagenham)

I thank the hon. Member for Romford (Sir M. Neubert) for giving me a moment to speak tonight and for raising this important matter. Although Oldchurch hospital is in his constituency, it is only a few hundred metres from my constituency.

The proposed closure of the accident and emergency unit at Oldchurch hospital is yet another ill-judged decision which has been thrown up by the national health service market that the Government have created. Why is it closing? It is closing to save money. The people of Dagenham need the accident and emergency unit. To get to Harold Wood, which will be the nearest alternative, will take an extra 15 minutes. That is an extra 15 minutes on a Sunday morning when there is little traffic. In peak periods, it will take considerably longer.

Last week, in a two-hour period, 59 people attended the accident and emergency unit at Oldchurch suffering from asthma and other breathing difficulties as a result of the dreadful air pollution over the city. If the accident and emergency unit at Oldchurch hospital closes, people will lose their lives as the ambulances do not get through to Harold Wood.

I hope that the Secretary of State and the Minister will reconsider the proposals when they come through and that this hopelessly ill-judged decision will not be taken. It is a decision against which the people of Dagenham voted significantly in the recent by-election.

11.56 pm
Ms Margaret Hodge (Barking)

I thank the hon. Member for Romford (Sir M. Neubert) for allowing us to participate in the debate. Although Oldchurch hospital is in his constituency, it serves the needs of people from my constituency. I ask the Minister to consider rejecting the proposals that have been put to the Secretary of State for the closure of the accident and emergency departments at Oldchurch hospital.

The Government's reforms have the stated objectives of putting the patients first. I suggest that the basic principle behind the proposals is that we push the patients to the bottom of the pile.

I should like to raise two issues briefly with the Minister. First, the proposals reflect broken trust. When the Havering hospital trust was first established, those responsible for so doing gave an undertaking that they would not proceed with the closure of the A and E department at Oldchurch. Within weeks of attaining trust status, the trust started consulting on the proposals.

Secondly, the trust has stated that the closure of the A and E department will not lead to the closure of the Oldchurch hospital. I do not believe that. If the A and E department of any hospital is closed, that hospital is condemned to a slow and painful death. I should like an assurance from the Minister that, if he accepts the proposals, we shall still have Oldchurch hospital as a district general hospital to serve the needs of the locality.

The closure is predicated on false assumptions. It is predicated on the assumption that GP facilities have improved. They have not. They are among the worst in the country, and none achieve high status. It is predicated on the assumption that we have a better ambulance service with more paramedics. We all know that the ambulance service is deteriorating. It is predicated on the assumption that we have minor injuries units. None is in place yet.

It is predicated on the assumption that there is a better transport infrastructure for access to Harold Wood. There has not been even an application for planning permission. It is predicated on the assumption that there are sufficient beds in the remaining hospitals to take up the closure of Oldchurch A and E. We know that Harold Wood does not even have enough beds simply to cope with the demands from the A and E department.

No other health authority is attempting to serve the needs of a community of 400,000 people from one site only. That is what North Thames regional health authority proposes to do. It is our view that if the proposals were accepted by the Secretary of State, up to 40,000 accident and emergency patients would have nowhere to go and that those patients would be at the bottom of the pile.

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

I congratulate my hon. Friend the Member for Romford (Sir M. Neubert) on raising this matter, which is clearly of great interest to his constituents and is clearly causing them a great deal of concern. He and the hon. Members for Barking (Ms Hodge) and for Dagenham (Ms Church) have pointed out that these are proposals and that they have been made by the local trust.

I am able to say only a limited amount at this stage. I have listened carefully to what has been said. I am aware that reviews have been undertaken into services in the two hospitals and that the trust has undertaken an evaluation. The conclusion of the trust's review was that both Harold Wood and Oldchurch hospitals would be required for the foreseeable future, but that action and emergency services should be located at Harold Wood. The health authority has arrived at a broadly similar conclusion.

I should like to make some general observations about the provision of accident and emergency services. Obviously, it is vital that all people living in the area should have access to the best A and E services available. We should be looking for first-class services, supported by the necessary back-up. They should deal with the full range of injuries and illnesses at any time, day or night, and should be flexible enough to deal with the characteristic peaks and troughs.

To perform to that high standard, major accident and emergency departments need direct access to a wide range of acute specialty and support services on the same hospital site. Many health service districts have concentrated their A and E services on one site to achieve that. That is in line with the National Audit Office report on A and E which was highly critical of "split site" arrangements and said that they jeopardised the treatment of patients. The 1992 report of the national confidential inquiry into perioperative deaths concluded: The problems caused by the requirement for consultants (and their teams) to work and be on call regularly on more than one NHS site are well known. The use of split sites should be historical. The message, therefore, is that the best accident and emergency services come from larger departments. Research shows that the incidence of preventable deaths is reduced by concentrating highly experienced medical and nursing staff on one location.

As my hon. Friend the Member for Romford said, the community health council has apparently accepted the argument for one site and there seems to be—I hesitate to say this, but I think that it is right—a measure of agreement that accident and emergency facilities in the area should be rationalised at one site. Evidently, considerable disagreement exists about which site that should be.

A number of arguments exist for rationalising at the Oldchurch site and a number for rationalising at the Harold Wood site. Among the arguments for Oldchurch would be better access for Dagenham and Barking residents, who are the major users of emergency services. It might be said that the accident and emergency service should be located nearer those residents because of the relative deprivation and the problems of the somewhat underdeveloped primary care services in the area.

Reference has been made to ambulance journey times. I agree that the performance of the London ambulance service has been disappointing compared with other parts of the country, but we have considerable confidence that it will improve. In an age of paramedics—we are aiming soon to have a paramedic on every front-line vehicle—the location of accident and emergency departments, in terms of trauma, is perhaps becoming subsidiary to the location of ambulances and the ability to get an ambulance to the scene.

Again, it has been said that closing Oldchurch A and E would put too much pressure on neighbouring hospitals, including King George and the Newham general. Likewise, the population of Dagenham and Barking seems likely to increase as housing developments in the east Thames corridor get off the ground, not forgetting that cancer and neuroscience specialties are already located at Oldchurch.

The arguments for Harold Wood include, importantly, the fact that changes could be achieved much more quickly on the Harold Wood site because there are far fewer constraints and because the layout of existing buildings at Oldchurch mitigates against development.

There is undoubtedly, for the same reason, the question of difference of cost. There is no doubt that existing facilities at Harold Wood are of a higher standard, and the backlog of maintenance costs is high at Oldchurch.

The specialty reviews considered Oldchurch to be unsuitable for retention of cancer and neuroscience work, and clearly the local health authorities support development of these specialties at Harold Wood. It has been suggested to me that the London ambulance service favours Harold Wood if there is to be a single-site option.

As my hon. Friend the Member for Romford knows, the health authority met formally on 7 April to consider the outcome of its consultation. I understand that the local community health council has asked for further appraisal of the proposed location. At its meeting on 5 May, the health authority decided to stick with the proposals and, as the CHC maintained its opposition, the matter was referred to the regional health authority.

I am told that there was considerable debate at the regional health authority meeting on 13 June, when a decision was taken to support the strategy of centralising services at Harold Wood, but with three qualifications: that appropriate alternative arrangements should be in place before any closure of A and E facilities; that adequate arrangements should be made and implemented for road access to Harold Wood; and that adequate and appropriate interim arrangements should be in place for the redevelopment phase.

I understand the strength of feeling about this matter and I confirm that if the matter comes to Ministers, what has been said this evening will be taken into account. I have no doubt that I can include my hon. Friends the Members for Hornchurch (Mr. Squire) and for Ilford, North (Mr. Bendall) in the concern that has been expressed about the matter.

I cannot say more than that at present, as all hon. Members who have spoken will understand, but I recognise that this is a matter of deep concern.

Question put and agreed to.

Adjourned accordingly at eight minutes past Twelve midnight.