Intensive Care (London)

HC Deb 12 July 1995 vol 263 cc863-84

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

10.4 am

Mr. Roger Sims (Chislehurst)

First, I thank you, Madam Speaker, for the opportunity to have this debate, and the manner in which you responded to my application.

Just before 11 pm on 6 March, the London ambulance service was called to an incident in Orpington, where the ambulance crew found my constituent, Mr. Malcolm Murray, lying unconscious with severe head injuries. He was admitted immediately to Queen Mary's hospital, Sidcup, which lies within the constituency of my right hon. Friend the Member for Old Bexley and Sidcup (Sir E. Heath).

The senior house officer, an experienced and able clinician, concluded that the patient needed neurosurgery, and efforts were immediately initiated to find an intensive care bed where he could receive such treatment. None could be located in the London area, so the search was extended further afield, and eventually Leeds general infirmary agreed to accept the patient. Speed in transferring him was of the essence, but the London helicopter medical service does not operate at night, so the Royal Air Force was called in. It picked up Mr. Murray from Queen Mary's by helicopter at 6.30 am, and he arrived at Leeds at 8.15 am. Sadly, the patient did not survive.

Medical opinion is that it is most unlikely that any treatment, wherever it was given, could have saved Mr. Murray, but the incident attracted nationwide comment and concern. Naturally, the concern was particularly strong in the neighbourhood in which Mr. Murray lived. The incident in which he suffered the injury has led to a man being charged with murder. It is not difficult to imagine how the tragedy has affected his girl friend, Teresa Davy, and his many friends, and their distress was compounded by the difficulty in securing proper treatment for him. Ms Davy and others mounted a campaign and drew up a petition that attracted more than 4,000 signatures. She came to see me at my advice bureau expressing determination that action should be taken to prevent a repetition of those events.

Miss Davy's reactions and those of others in my constituency and further afield were fully justified. We are all entitled to expect that, should we suffer sudden illness or accident and need intensive care, we shall get it.

In the aftermath of the incident, inquiries into it and its implications were set up by both the regional health authority and Queen Mary's hospital trust. On 23 March, the hon. Member for Woolwich (Mr. Austin-Walker) initiated a brief Adjournment debate on neurosurgery, in the course of which he referred to this case. But at that stage, full details were not known, and the reports had not yet been published. A few days later, they were, and they made various recommendations and raised a number of issues, referring mainly to the availability of facilities.

Both reports speak well of the care that Mr. Murray received at Queen Mary's hospital and of the staff there, with one exception. They are unfairly critical of the consultant orthopaedic surgeon, Mr. Anthony Percy, who also happens to be my constituent. Mr. Percy's treatment is an aspect of the case about which I know my right hon. Friend the Member for Old Bexley and Sidcup feels particularly strongly. I shall confine myself to saying that statements made by the region and the trust, and comments in the media, about Mr. Percy were, in my view, grossly unfair, and have damaged his clinical reputation. I hope that the Minister will take this opportunity of putting the record straight.

One matter that obviously needs clarification is exactly how many intensive care beds there are in London—by which I mean broadly that area within the M25. Following an exchange on the radio with the hon. Member for Newcastle upon Tyne, East (Mr. Brown), in which he claimed that the number of intensive care beds in London had decreased in recent years and I said that they had increased, I tabled a parliamentary question and had an exchange of letters with my hon. Friend the Minister, whom I am glad to see in his place to respond to the debate.

This is not an issue on which we should seek to score party points with regard to statistics, but perhaps we might have clarification as to how many intensive care beds there are in London, as distinct from North Thames and South Thames regions, which cover a far wider area.

Having established that figure, I would then ask whether it shows that there is an adequate number of intensive care beds, and what formula is used for calculating how many are needed. Since March, there have been other similar cases of patients being transferred out of London, which certainly does not suggest that we have a surplus of intensive care beds.

A few weeks ago, I initiated a Wednesday morning debate on the future of Guy's hospital. I shall not rehearse that today, but I draw attention to the fact that Philip Harris house at the hospital has been planned and equipped, among other things, to accommodate 15 intensive care beds. Surely, far from now planning to use those spaces for other purposes, they should be brought into use as soon as possible.

The issues include not only the number but the type of beds. Not all intensive care beds are the same with regard to the equipment adjacent to them or the staff to service them.

Any one of us or our constituents might at any time suffer a heart attack, and the chances are that whatever hospital we were taken into in the London area would be able to treat that condition. However, if, for example, we were involved in a road accident and suffered head injuries necessitating neurosurgery, that would not necessarily be the case. Only a handful of hospitals can offer that treatment. Although, in theory, sufficient beds should be available to meet those likely needs, obviously there is a question whether there are sufficient. The Malcolm Murray case suggests that there are not.

The Department of Health is not short of advice on that matter. A report by the Society of British Neurological Surgeons published in February 1993 recommended that four neurosurgical intensive care beds should be available per million of the population. At present, in the whole of South Thames, there are nine beds for a population of 7 million—little more than one per million. The Brook general hospital, which has a catchment area of more than 3 million, had two intensive care beds.

I say "had", because the Brook unit has closed. The King's/Maudsley neuroscience centre is currently running at 40 beds short, as the new Ruskin wing has not yet been commissioned, and, although the surgeons from the Brook have been transferred to King's, they have yet to be allocated secretaries or operating space.

Commenting on his report on the Malcolm Murray incident, the chairman of the South Thames regional health authority said on television that there was no shortage of neurosurgical intensive care beds in London. Who is right—he or the surgeons? Does the Minister accept the Society of British Neurological Surgeons' report, and does he intend to take steps to implement its recommendations?

I have dwelt on neurosurgery, because it is so important, but similar considerations apply to other specialties. I ask again: is there any formula to decide how many intensive care beds we should have in London and the different types of beds there should be, and any policy as to where they should be situated?

Another general issue is how many intensive care beds should be used for routine surgery, and how many earmarked for emergency. I realise that there is a difficult balance to be struck in maintaining empty beds, and staff for them, at considerable cost for emergencies that may not arise, when the beds might be used for elective surgery such as bypass operations. Does the Department issue any guidelines on that?

I also suggest that there should be some clarity on where authority lies when hospital staff seek intensive care beds. In their report, the regional health authorities say: In the Panel's view, greater senior clinical advice and direct involvement at Queen Mary's may well have been successful in securing a more flexible response from the hospitals contacted, notwithstanding the pressures they were experiencing. That, of course, implies criticism of Mr. Percy, whom I have mentioned, and were the grounds on which he was censured. Indeed, in his covering letter to the Secretary of State, the chairman of the regional authority wrote: The direct involvement of the senior clinician in obtaining a referral would have made a significant difference". In fact, in subsequent correspondence with Mr. Percy, the trust has accepted that finding beds is a management responsibility. In any case, if a clinician is considered sufficiently qualified and experienced to be in charge of a hospital accident and emergency department, surely his judgment should be accepted, regardless of his status in the hospital hierarchy. Indeed, paragraph 6 of the hospital's report says: The clinical acceptance of referred patients should not depend upon the seniority of the referring clinicians". That surely must be right, and I hope that the Minister can confirm that.

An extraordinary feature of that case was the amount of time that staff at the hospital had to spend simply trying to locate a bed. The conclusion that Mr. Murray needed a neurosurgery bed was reached just after midnight, and the hospital's report comments: Chasing beds and securing transfer arrangements continued until 05.00 hours. That should not have been necessary and is unacceptable. The lack of any central reference point under such circumstances is a case for extreme concern. To that we should all surely say, "Hear, hear," and it appears extraordinary that, when we now have so much sophisticated technology available to us, the only way that staff could find out if there was an empty bed was to telephone hospitals one by one.

The first recommendation in the region's report reads: A register of intensive care beds availability across the Thames Regions should result in easier and better communication of bed availability. Work on this has already started and the register will be introduced in mid-April. The register will be able to be sourced by telephone and will be updated twice a day. Can the Minister confirm that that system is now in place, and, if so, is it operating effectively?

Finally, can my hon. Friend confirm that the procedures to be followed in such cases as that have been clarified? Another of the region's recommendations was: Commissioners must ensure that hospitals have and follow agreed intensive care bed management procedures and their initial review should be completed within three months. That recommendation was made on 28 March, so the three months has now elapsed, and I hope that the reviews have been completed.

I hope that, in the course of the debate, the matter of the unwarranted criticism of my constituent Mr. Tony Percy will be resolved and that he will be cleared of the charges made against him.

Miss Davy and her friends were determined that whatever happened in the case of Malcolm Murray should not be allowed to happen again. I believe that they were perfectly entitled to make that demand. I hope that the Minister will give the assurances that they, and I, seek when he replies to the debate.

10.19 am

Mr. John Austin-Walker (Woolwich)

I am sure that Labour Members would endorse all that the hon. Member for Chislehurst (Mr. Sims) has said. I share his views about the medical staff at Queen Mary's hospital, Sidcup, and I wish to be associated with his remarks in that regard.

I will not dwell upon the specific circumstances of the Malcolm Murray case and the events of that tragic night, because I dealt with it in the earlier debate to which the hon. Gentleman referred. The hon. Gentleman also set out those circumstances very clearly this morning.

However, I remind the House and the Minister of the tragic death of Roberta Gerardo on new year's day. I have nothing but praise for the medical and nursing staff at the North Middlesex hospital, but there was an eight-hour delay in finding an intensive care bed for that mother of two. There were telephone calls to hospitals as far away as Cambridge in an attempt to find a bed. One was eventually located 20 miles away in Hemel Hempstead, but, sadly, the case of Roberta Gerardo had the same tragic ending as that of Malcolm Murray.

The recent report of the Health Select Committee found that, for a number of years, the former Secretary of State had ignored all the signs of a crisis in the London ambulance service. The Select Committee said that, if the political will had existed, the crisis could have been averted. I draw the Minister's attention to the existing crisis in the provision of intensive care facilities, not just in Greater London but, as the hon. Member for Chislehurst said, in the area within the boundaries of the M25.

There is sufficient evidence to show that it is not just a matter of an occasional crisis, such as the cases of Roberta Gerardo and Malcolm Murray. Night after night, hospital staff throughout the capital and beyond spend hours on the telephone trying to find appropriate facilities for patients whose lives are at risk.

The former Secretary of State accused Labour Members of being obsessed with the issue of hospital beds. But every time we asked the former Secretary of State and the Department of Health about the availability of beds and about hospital closures since 1979, she replied that the Department did not know. The Department of Health does not know how many beds have been lost, and it does not know how many hospitals have closed. The Department of Health does not collect details of the number of existing hospitals, let alone details of hospital closures.

Fortunately, the Library of the House of Commons has produced figures about the number of hospital beds available in London. I do not think that we can divorce the provision of acute services and acute beds from the crisis in the provision of intensive care facilities.

The Library data show that, between 1979 and 1993–94, the number of national health service beds in Greater London fell by 49 per cent., and the number of acute beds by 45 per cent. I know that the new Secretary of State has said that he does not intend to revisit the decisions of the former Secretary of State, but I urge him to re-examine the basis of the decisions to rationalise hospital services and to close beds in London.

We know that the Government are still pursuing the Tomlinson agenda. A recent survey showed that, in order to reach the Tomlinson targets and equalise with the rest of the country, 400 beds had to be lost in 1992–93. In fact, 1,499 beds were lost in that year.

The crisis goes across all emergency services. Hospital staff and consultants who provide acute care are spending inordinate amounts of time on the telephone trying to find beds, and we know that the same crisis exists in the mental health and psychiatric spheres. In my constituency, which has a bed occupancy rate of 120 per cent., patients must often be transported to facilities as far away as Oxford.

The calculation of the number of beds required in London is based upon the Tomlinson report and the subsequent report of the King's Fund. The Secretary of State must also examine the later report of the King's Fund entitled "London—the Key Facts", which was published in April 1994. It stated: The Capital's health care needs have been underestimated. There are now good reasons for believing that London merits a larger—not smaller—share of the NHS cake". Unless London receives an additional share of the cake, I do not believe that it can begin to address the acute needs of its communities and the problem of the shortfall in intensive care provision without damaging other areas of the health service. The King's Fund estimates that London needs an extra £200 million. If the York formula of resource allocation had not been tampered with, it is likely that London would have received those funds already. However, the Government have adapted resource allocation which distorts the formula and takes resources away from areas of social need, such as London.

The hon. Member for Chislehurst referred to the closure of the Brook hospital—the hospital that should have taken Malcolm Murray but which did not have a bed available on that evening. As the hon. Gentleman said, the hospital is now closed. Service planners in the South Thames region say that a neuroscience unit requires five or six intensive care beds. At the time of Malcolm Murray's death, the King's site had two intensive care beds and the Brook had three.

It has now been decided to relocate the Brook unit to King's hospital. The services which are provided for the people of south-east London and north Kent—the area represented by the hon. Member for Chislehurst and the right hon. Member for Old Bexley and Sidcup (Sir E. Heath)—have been relocated in inner London. That area is close to the M2, the M20 and the M25, and the high incidence of road traffic accidents may result in the need for intensive care and neurosurgery services. It makes no sense to relocate those very important services further away from the area they are intended to serve and closer to central London.

The situation is the same north of the river in east London. The neuroscience facilities at Oldchurch hospital may be transferred to the Royal in inner London. For years, a threat has been hanging over St. George's trust and the world-renowned Atkinson-Morley hospital in south-west London. Moving specialist units and the intensive care facilities that go with them further into central London seems to fly in the face of the Government's original aim to move services out of the centre of London.

Although, in some ways, inner London may be over-supplied with acute services, the same is not true of Greater London as a whole and those constituencies on the periphery of London. It seems strange that the current practice should fly in the face of the Government's professed policy of allowing services to follow the patients. We now find patients chasing scarce resources and scarce beds.

No one has adequately explained to me or to my local community health council why the former Secretary of State took the decision to shoehorn the services at the Brook hospital into the King's Maudsley. The former Secretary of State ignored the fears, concerns and dissatisfaction expressed not only by my constituents but also by consultants involved in service provision.

The hon. Member for Chislehurst referred to the way in which the services have been shoehorned into the unit at King's with 44 Maudsley neurology beds, without easy access to medicine, surgery or intensive care.

The Secretary of State says that proximity to psychiatric services will be advantageous to the neurosciences. It would not have been advantageous in the case of Mr. Murray or most people requiring acute neurosurgery. There is no logical argument for locating neurosurgery services with psychiatry. They need to be located in a major trauma centre with intensive care facilities.

It would have been possible to transfer the services from the Brook, either to the new Queen Elizabeth hospital when the trust takes it over from the Ministry of Defence, or alternatively, to Queen Mary's hospital in Sidcup, where it would have been perfectly placed to serve the sub-region for which it was designed.

There is chaos in the neurosciences following the closure of the Brook hospital, and I am particularly concerned about paediatrics. At the moment, the neurosciences are split; neurology is at the Maudsley, neurosurgery is at King's, and paediatric neurology is split between Guy's, St. Thomas's and King's. Paediatricians at Greenwich are now saying that they would prefer to send their patients to Great Ormond street, where all those services, including intensive care, are provided under one roof.

A worrying aspect of the report into the incident involving Malcolm Murray is the suggestion that perhaps the region should be looking at private facilities. Is that the route that the Government are taking? If there is sufficient supply of intensive care specialist facilities, why should the region and the trust have to look to the private sector?

The Minister talks about more effective bed management, saying that it is not a matter of the number of beds but how they are used. The hon. Member for Chislehurst said that there has to be a balance between keeping emergency beds open and using them for necessary, urgent and acute work. To my mind, that demonstrates the pressure on the acute beds and the inadequacy of provision to meet the demand for acute services. I also fear that what the Minister is saying may inevitably lead to the earlier discharge of critically ill patients than is clinically justifiable.

In the debate on 23 March on neurosurgery services in the south-east, the Minister referred to a meeting two days earlier between the Secretary of State and the royal colleges, the Intensive Care Society and the British Association of Critical Care Nurses to discuss the MacPherson report. He said that the meeting had been brought forward. I do not know whether that was because of my Adjournment debate or because of the tragic circumstances of Malcolm Murray, but it is worrying that it requires such a tragedy to spur the Secretary of State into action.

What was the result of that meeting, apart from the establishment of the steering group? What are the recommendations of that working group, and when is it likely to report to the House? I hope that the Minister will provide some answers to the questions that are being asked today, and that it will not require a further tragedy such as that of Malcolm Murray or Roberta Gerardo before the Government act to address the number of intensive care beds required to serve the capital city.

10.34 am

Sir Edward Heath (Old Bexley and Sidcup)

I am delighted that my hon. Friend the Member for Chislehurst (Mr. Sims) has had the opportunity of raising this subject today. I owe him and the House an apology for not being here for the first part of his speech, owing to traffic conditions entirely beyond my control. Since then, he has given me the opportunity of reading his speech, which I have done, and I thoroughly support everything he said.

As my hon. Friend knows, I should like to add one or two points. There are two major aspects of the problem that has been raised today. The first is the national one, which concerns the facilities available for dealing with such cases. The second is the personal one concerning Mr. Percy, who is a constituent of my hon. Friend. He came to see me directly after the events, because Queen Mary's hospital is in my constituency, and that was where he became involved.

I shall first add a word to what my hon. Friend and Opposition Members have said about the provision of intensive care facilities in Britain under the health service. It is quite obvious that they are not sufficient. Today we are discussing two cases. One involved a patient in Maidstone who had to be driven to Southampton before a bed could be provided where he could have proper treatment. That cannot be a satisfactory state of affairs. In respect of Queen Mary's, as is well known, a patient had to be flown from Sidcup to Leeds by a helicopter that was specially commissioned from the Royal Air Force, and paid for by the Royal Air Force, before he could receive proper treatment.

There is general agreement among the medical profession at Queen Mary's and at Leeds that everything possible was done by the doctors involved. There is no question about that, so it is not the problem. The problem concerns the facilities where treatment can be provided.

We have just heard that the Brook hospital was immensely important for many decades. For as long as I have represented Old Bexley and Sidcup, there have been attempts to close down the Brook hospital, all of which were successfully resisted until the present one. We now have a case where the lack of facilities at the Brook hospital meant a flight from Sidcup to Leeds. The Brook hospital was telephoned, but as it was closing down, no facilities were available.

I have said previously that the reports that were produced in recent years on the hospital service, and the distinguished people who wrote those reports, dealt with everything except the patients. They have centralised everything for the benefit of the medicos and the administrators, but the fact that a patient, instead of being able to go to the Brook hospital, had to be flown to Leeds never crossed their minds. That is the essence of the matter as to the proper provision of such facilities.

The chairman of the region stated that there were ample facilities in the London area, but he is quite wrong. His comment must raise doubts whether he is suitable as a regional chairman. He said that beds were available at the Royal Free hospital that night. That is also untrue. The Royal Free was telephoned, and replied that there were no beds available. It has now said that, had a more senior person telephoned the hospital, a bed might have been available.

What philosophy or approach is it to say that a bed is available only to a top person who is said to be influential, but not if those on duty at the hospital and carrying out the work there apply for a bed? That cannot possibly be tolerated as an approach to service in our hospital system.

I am sure that the Secretary of State and the Minister would not for a moment suggest that such an approach can continue. The report produced by Queen Mary's, Sidcup, was very full, and made a number of suggestions that have been touched on by my hon. Friend the Member for Chislehurst. Like him, I hope that they will receive full consideration in the Department. The Minister may not be able to say at the moment whether they are all acceptable, and I quite understand that.

We now have a new Secretary of State for Health, who may have a different approach from his predecessor. He and the Minister might want to look at those suggestions. As far as I am concerned, the fuller the consideration they get the better, because a great deal of thought has gone into them and into what should be said and done about them. There are practical propositions, but the fact remains that beds with the equipment to deal with neurological cases are not available in London, and they are the basic necessity.

I now come to the personal position of the doctor involved at Queen Mary's. The matter has been handled deplorably. The first investigation, which was hastily rushed, was carried out by the chairman of the region, and three lay people. Not one was a medical person. It was said that they consulted a doctor, but what his qualifications are we do not know. Was he familiar with all the problems of this particular field of medicine?

The committee produced its report, and the chairman went on television and said that Dr. Percy had not only been criticised but condemned for his mistreatment of this case. The chairman was followed by the Secretary of State herself, who also said on television that the doctor had been condemned.

What sort of justice is that? They were three lay people, not in any way experts or experienced in these matters. What is more, the doctor himself was not invited to appear before them to give his account of what happened or to attempt to justify his actions. I cannot consider that that is possibly justifiable in any organisation, be it private or public, but least of all public.

To behave in that way is totally unacceptable, and I hope that it will be made clear to them and to all the other regions that, if doctors are going to be criticised in this acute way, the investigations have to be properly handled. The committee should include people who are experienced, and the people being considered should be invited to give evidence, as fully as they like, about their own position. Nothing else is possibly justifiable.

There was a leak of the report of the region. How it happened or where it came from we do not know. It has been denied by the region, but it led to a press attack on the doctor, of the most extreme kind. As the case is coming before the courts, I do not propose to say any more about it. It would be improper on my part, even though the House of Commons has special arrangements.

As a result of the leak, Dr. Percy has, in the minds of millions of people in this country and throughout the English-speaking world, been condemned for his conduct in this case. We all know when that happens how difficult it is for any person to wipe out what has appeared in the press in the most extreme form. That was the consequence of the leak.

The inquiry that was made by Queen Mary's took longer and was thorough, and all those involved, in addition to Dr. Percy, were invited to give evidence to it. They did so. In addition to making recommendations about the general situation, it also commented fairly fully about the doctors involved.

What is very important is that the people who were working that night in Queen Mary's were also described fully. In paragraph 12, the report says: The Panel felt very confident that the team in place on the night in question were of a high calibre and sound experience. Indeed, ironically, if they had not been so experienced help may have been sought at an earlier stage. There was no question about those who were in charge in the hospital. The senior doctor in charge had been at Queen Mary's for a comparatively short time, but was very experienced in the problems that arose that night. There was no criticism of him or of any of those who were working with him.

I am told that, altogether, a group of 15 hospital specialists worked on this case, all through the night, until they could get the RAF helicopter. My hon. Friend the Member for Chislehurst mentioned the administrative arrangements, which need to be improved, to get facilities for handling such cases. They did extraordinarily well to find out that, although other helicopters were not available, the RAF had one, and to get around the problems of paying the RAF, which, with limitations on Government expenditure in mind, wanted an assurance that it would get the cash quickly once the helicopter was used. There is room for improvement in the administrative arrangements as well.

We then come to the question of Dr. Percy and what he did. Let me quote again from the report: It was the view of the Enquiry Panel that there were no grounds for criticism of the clinical supervision of the patient"— no grounds. However, once the call had been received by the consultant Orthopaedic Surgeon"— Dr. Percy— at 0217hrs he could have taken greater responsibility in helping the junior staff on site possibly by attending the hospital or by telephoning neurosurgical colleagues in specialist centres when it became clear that Leeds was the only option available. There are two things about that. First, the panel says that Dr. Percy could have taken greater responsibility in helping junior staff, possibly by attending the hospital. In fact, he did what the junior staff asked. He was absolutely certain that the staff were doing their job properly after they reported to him, and advised them about getting in touch with hospitals where beds would be available. He later advised them on how to solve the transport problem. In that respect, he had done what was required, and had done it properly.

The report continues: Nonetheless, at 0217hrs with a patient who clearly required specialist attention it is probably the case that the involvement of the consultant would not have made any difference to the clinical outcome. Those are two statements. What grounds are there for censuring that doctor? Justice has gone badly astray, to the permanent damage of the doctor, who is highly skilled and respected, unless this is corrected—and it must be corrected, because it is entirely unjustifiable.

The report continues: With the benefit of hindsight the consultant has recognised that he could have telephoned the Brook consultant neurosurgeon at home to try to ease the administrative situation". It is very doubtful whether he could have telephoned, but how he could have eased the administrative situation when the Government are determined to close down the whole show, I do not know.

"This reflection was positively welcomed by the panel." That endorses the fact that there were no grounds for censuring Dr. Percy.

The panel did not censure Dr. Percy. The fact that the chairman of the region went on television and announced that the doctor had been censured was entirely unjustifiable. The fact that the previous Secretary of State for Health also went on television and gave her view that the doctor had been justifiably censured was also completely unfounded.

I cannot over-emphasise the damage that it does to a person in a professional career to allow such things to be said. There is still confusion. I, among others, was assured by the hospital that the doctor had not been censured. I do not think that one can take the sentences that I have read from the report as censure. On the other hand, he has been told by the administrator that he has been censured. That, again, is entirely unsatisfactory. I ask the Minister and his advisers to get to the root of this and sort it out. We are relying on him to do so.

I want to say one word in general to the Minister, which perhaps he could pass on to the new Secretary of State, and it is this. The health service is doing a good job—there is no doubt about that—but it has one great drawback, which is that, publicly, it is always announced that more and more money is going to the health service. Yet the health service knows that, because of the rapid advance of medicine in so many different spheres, its need for finance is increasing faster than the amount that it receives. It is that which Ministers must take account of if there are to be proper arrangements for looking after the health of the British people.

Medicine has not stood still. It has probably advanced almost faster than any other scientific area, except nuclear and space. The fact that that is not acknowledged by Ministers is why people do not have confidence that Ministers know how to deal with the situation. That goes to the root of the question.

The same is also true of hospitals. Queen Mary's hospital has a tremendous reputation, and the result is that it can often deal with patients more quickly than neighbouring hospitals. We are then told that, if hospitals can deal with patients more quickly, they do not require so much money. The fact is that they require more money because they are dealing with more patients because they are dealing with them more quickly.

Could we please have a Secretary of State who recognises that, and perhaps mentions it occasionally, so that we know that he recognises it? That is essential to an understanding of the position of the health service.

The other aspect that I want to mention is that there are matters which are not satisfactory, such as the one that we have been discussing this morning. Will the Secretary of State please agree that these things are not satisfactory, and tell us how he will deal with such unsatisfactory aspects? Instead of merely emphasising again how much money is going into the health service and how much the Government want to maintain it, let us have a little quiet appreciation of the problems where they do exist, and an indication of how they will be dealt with for the benefit of the patients and of our constituents.

If the Secretary of State adopts that attitude, he will be far more successful in commending to the population—the voting population is getting closer and closer—the good things that the health service is doing, because our constituents will see that those things that are at the moment lacking are being satisfactorily looked at and dealt with.

10.52 am

Mr. Nicholas Brown (Newcastle upon Tyne, East)

I count it a privilege to follow the right hon. Member for Old Bexley and Sidcup (Sir E. Heath), and, like the right hon. Gentleman, I congratulate the hon. Member for Chislehurst (Mr. Sims) on having secured it. It is an important debate. It is important to Mr. Murray's family and friends, to the clinicians who cared for Mr. Murray, and to other health service workers who tried to do their best for him. It is also important because it raises wider questions about the provision of intensive care beds in the capital and the capital's catchment area.

When the incident occurred, the Under-Secretary of State for Health, who is to reply to the debate, wrote to the hon. Member for Orpington (Mr. Horam) about the case. In his letter, he did something which was, frankly, deplorable. He said: The junior doctor in charge of his case at St. Mary's failed to persuade any of the other local neuroscience centres he contacted to admit him. In other words, the letter sent by the Minister pins the blame firmly on the junior doctor.

Like the right hon. Member for Old Bexley and Sidcup, I deplore that scapegoating of health-care professionals. It is not justified. In any event, it is the job of the bed managers of hospitals to find beds. I cannot see how a senior doctor could find a bed that a junior doctor could not. A bed was either available or it was not.

That is the issue to which those who have responsibility for the health service should address themselves, rather than seeking to scapegoat health-care professionals. Like the right hon. Gentleman, I also deplore the appearance of the previous Secretary of State on television pontificating on who was guilty and who was not before the matter had been properly inquired into.

The Under-Secretary of State went on to say that he had already commissioned a study of intensive care provision. That will be an important study, and we look forward with interest to seeing the fruits of it. This is not the first time that the House has debated the provision and availability of intensive care beds in the NHS and, in particular, in the capital. There has been a spate of highly publicised incidents in which seriously ill or injured patients have been transported from one hospital to another in a desperate search for a bed in an intensive care unit. Mr. Murray's tragic case is one of the most dramatic, but it is not an isolated incident.

I well remember the Prime Minister being asked about this at Question Time. He defended the 200-mile journey by saying: I understand that Mr. Murray required a highly specialised form of treatment with which Leeds was particularly able to help".— [Official Report, 9 March 1995; Vol. 256, c. 454.] It is incumbent on the Minister when he responds to say what the highly specialised form of treatment was—a form of treatment which apparently was not available in the capital. It is also incumbent on him to say how it was that Leeds was "particularly"—the Prime Minister's word—able to help. I look forward to the Minister's explanation, and I hope that it is as plausible as he can manage.

As my hon. Friend the Member for Woolwich (Mr. Austin-Walker) pointed out, incidents such as this have sparked a series of inquiries into the availability of intensive care in the NHS. It is right in a debate such as this that we should ask what is the size of the problem. The Department of Health has already conducted a study entitled "Study of Provision of Intensive Care in England", dated 1993. It provides us with some useful facts and findings to guide our debate.

The Department of Health tells us, for example, that, in the United States in 1992, the proportion of moneys spent on intensive care was 10 per cent. of total health costs. In the United States, total health costs consume some 12.4 per cent. of GDP. In the United Kingdom, for the same year, we spent on intensive care 1 per cent. of health-care costs, and in this country health-care costs consume only 6 per cent. of GDP. That represents a twentyfold difference.

The report goes on to state: We found that considerable numbers of patients were denied the possibility of intensive care because the intensive care units were full. It does not go on to say that perhaps, if a junior doctor had tried harder, or if a more senior doctor had asked for a bed, one would have been found. The Department's own study says that the intensive care units were full.

It goes on: In our study we have shown that intensive care provision in England based on numbers of staffed beds is unequal between regional health authorities. Our debates on provision in London have highlighted that.

The hon. Member for Chislehurst referred to an exchange about whether there had been increased or decreased provision for the capital in recent times. I wrote to him after the exchange telling him where I obtained my figures. I obtained them from the Minister in answer to a parliamentary question. They relate to the two London regional health authorities, and show that, between 1992 and 1993, the number of beds fell by 12 to 724. In other words, the two London regional health authorities covering London and its immediate catchment area have lost provision.

A survey was carried out in January this year by consultants at St. George's hospital, which showed that, out of 35 hospitals within the M25, only eight to 10 intensive care unit beds were available. Between 30 and 40 of those beds were closed because of funding or staff shortages. That is a slice of life revealed by a survey conducted by consultants at St. George's.

A second survey was conducted in February 1995 of five cities—London, Birmingham, Manchester, Cardiff and Glasgow—which found that, of a theoretical total of 452 intensive care beds, only 376 were open. The figures that the Government like to use do not reveal the whole story.

The Government responded to the survey by admitting the existence of pressing problems in the provision of intensive care beds, especially in London; and, as the Minister's letter reveals, they have ordered an urgent review. Given all that Ministers have said about the Labour party's call for a review and a moratorium on closures, it is a bit rich for them to say now that they will conduct an urgent review of intensive care provision.

Despite the Government's commitment, only two months passed before the previous Secretary of State signed the warrant for the closure of Guy's hospital, and approved the ripping out of brand new and as yet unused intensive care equipment from a ward in Philip Harris house. The hon. Member for Chislehurst knows what an obscenity I consider that to be; we have debated these matters in the House before, and I do not suppose that his views differ much from mine.

It is fair to say that the provision of intensive care is very expensive. One bed costs about £1,500 for 24 hours, and health authorities and trusts think carefully before purchasing and providing more than is absolutely necessary. That apparent drive for efficiency, however, can have terrible, tragic results, especially in the event of an unexpected increase in demand.

The case that we are discussing suggests that one accident occasioned an unforeseen increase in demand in the capital on the day in question. What if four people had been injured in a traffic accident, rather than one? The tragedy would have been multiplied by four. If one bed was not available, four certainly were not.

It is clear to me—as it is to every observer, whether politically neutral or not—that there is a crisis in provision in the capital, and, indeed, in other urban areas. That crisis is money-driven, and driven by the Government's peculiar approach to the management of the national health service: savings are everything, and the provision of a front-line service must take second place.

The demand for intensive and emergency care cannot be entirely predictable, by its very nature. No one can predict when a serious traffic accident, for example, will occur—or, indeed, when a hospital operation will go wrong or something unexpected will be discovered. It is therefore essential to proper patient care to allow a reasonable margin of safety in the number of intensive care places that are funded and staffed.

As my hon. Friend the Member for Woolwich (Mr. Austin-Walker) pointed out, that margin of safety has not been in evidence in several instances. It is not good enough for Ministers to pass the responsibility on to local management, or, even more shamefully, to try to scapegoat individual clinicians.

As the right hon. Member for Wokingham (Mr. Redwood) has observed, it is the duty of Government to ensure that there are enough intensive care beds. If today's debate has highlighted that need as well as the tragic case of Mr. Murray, I hope that it will have done some good.

11.3 am

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

I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on raising a matter that has caused considerable concern not only in his constituency but nationally as a result of the dramatic events on the night of 6–7 March. I welcome the presence of my right hon. Friend the Member for Old Bexley and Sidcup (Sir E. Heath), who has been involved through his discussions with the doctor concerned.

The Opposition Members who spoke have used the words "crisis" and "chaos" liberally, no doubt in an attempt to draw attention to what they were saying. There is no crisis, but an intelligent discussion is needed about the number of intensive care beds. For reasons that have already been given, a difficult balance must be struck between wasteful over-provision—the provision of resources that are then not used for much of the time—and the need to minimise the risk of incidents of the kind that we are discussing.

Both Opposition speakers refrained from specific discussion of the number of intensive care beds, and attempted to widen the argument to tie question of the number of acute beds generally in the London area. The two issues may be conncected to some degree, but it is inappropriate to suggest that "a bed is a bed is a bed". As we all know, there is a world of difference between the question of how many acute beds there should be in London hospitals, and the specific issue of how many intensive care units there should be and how many staffed beds should be available in them.

Today's debate principally concerns the incidents that took place in March, and the lessons to be learned about the provision of neurosurgery and intensive care. Hon. Members discussed, in general terms, the sorry circumstances of the transfer from Sidcup to Leeds on the night of 6–7 March in a debate on 23 March. At that time, we were awaiting the report of an investigation of the case; I am now able to reveal the findings of that investigation, and the action that has been taken since. Before I do so, let me add my condolences to those that have already been extended to the Murray family in their bereavement.

Much has been made today of the treatment of Mr. Anthony Percy, the orthapaedic consultant at Queen Mary's hospital in Sidcup. I appreciate the reasons for which my right hon. Friend the Member for Old Bexley and Sidcup expressed concern, but the investigating panel felt that Mr. Percy—who was contacted at home at various times by the senior house officer in his attempts to find a bed for Mr. Murray—might have done more to help in what was a highly unusual and difficult situation for hospital staff.

It is a matter of record that the trust's chief executive wrote a private letter of censure to Mr. Percy, commenting on his contribution—although stressing that he had been responsible for no failure of clinical care, and that the question of disciplinary action did not arise.

My right hon. Friend the Member for Old Bexley and Sidcup suggested that that was inconsistent with another statement that the clinical outcome of the case would not have been affected, but it is not. No one has suggested that the clinical outcome was necessarily affected, however unsatisfactory it was that the patient had to be transported to Leeds. No one has suggested that that had a significant adverse effect on the patient—although I should be the last to say that what happened should have happened in that way: it is unacceptable that the patient had to be taken to Leeds.

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

No.

I well understand Mr. Percy's wish now to do all he can to put right the damage that he feels has been done to his reputation, and I very much regret the way in which the whole matter was reported.

Mr. Brown

Will the Minister give way?

Mr. Sackville

No. The hon. Gentleman had his chance to give his views; I have quite a long speech to make.

Given the possibility of legal proceedings, hon. Members will appreciate, as my right hon. Friend has said, that I cannot comment further on this matter. What I can categorically state is that there is no question of Mr. Percy being used as a scapegoat to deflect criticism of bed shortages in London.

Indeed, the investigation panel concluded that there was not a shortage of beds. Although the intensive care beds in neurosciences centres were certainly all very busy, the panel believed, on the evidence it had before it, that Mr. Murray could have been treated that night in London following his head injury. The key point is the management and use of beds and the co-ordination and communication between units, rather than the absolute number. That is the real issue, and I shall return to it.

Mr. Sims

My hon. Friend says that there is no question of there being any scapegoats in this matter, but has he read all the correspondence, in the course of which the chief executive says that he fears that scapegoats were required, the implication being that Mr. Percy is the scapegoat? Can my hon. Friend say whether Mr. Percy was censured or not? If so, why was he censured, and if there were no grounds for him being censured, why cannot that censure be withdrawn?

Mr. Sackville

I have stated the facts as I know them: a letter of censure was written to Mr. Percy by the hospital, critical of his performance. That is a matter of record.

Mr. Nicholas Brown

The Minister told the House that it was a private letter. If so, why did Ministers go on television and talk about it?

Mr. Sackville

We did so because it was very germane to the whole account of what happened on that night that the hospital was critical of Mr. Percy. There was enormous press interest in the matter. As I said, however, I regret the way in which some newspapers and media carried the story. I can understand why Mr. Percy feels that he has been unfairly treated.

Sir Edward Heath

That letter was sent some time after all this began, and I have quoted from the report of the hospital panel and its chairman of chancellors. Their conclusion was obviously different. The letter was sent by the administrator of the hospital. By what authority did he send that letter, when it was not justified by the whole panel of the hospital, with the chairman presiding?

Mr. Sackville

I understand that the letter was sent with the full knowledge of the chairman of the hospital, and that clearly the hospital was critical. The fact that that was perhaps blown up to a considerable extent by the media is regrettable, but it remains a matter of fact that, with the full knowledge and permission of the chairman, the hospital was critical of Mr. Percy.

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

No. I will carry on, because I have a lot to say about the action that has been taken since on intensive care beds.

On the situation during that night, the panel also concluded that the Royal Free hospital did have two intensive care beds available and could have taken the patient. I appreciate that that raises all sorts of queries, and I would like to make it clear that a call was made by Queen Mary's hospital, and the information was given to the doctor concerned that the Royal Free considered it clinically inappropriate to transport the patient across London. That was its opinion, and it was therefore asked to see whether some nearer facilities could be found.

As far as can be ascertained, there was no further contact after that. The Royal Free was not contacted again. That is why I say that there was a failure of communication and co-ordination, but it remains clear that two intensive care beds were available at the Royal Free. That much we know, and it is a matter of great regret that that was not followed up. I am not blaming anyone. The situation was confused and difficult. Later, a decision was therefore taken to transport the patient to Leeds.

The report makes it clear that, with the proper use of existing intensive care facilities and better co-ordination between hospitals, it should be possible to minimise the risk of inappropriate transfers of this sort occurring in the future.

Sir Edward Heath

Does it not seem to my hon. Friend to be quite extraordinary that, if those beds were available at the Royal Free, which it has since denied, and a doctor is on the other end of the telephone, the hospital should not say to him, "Yes, it would be much easier and more suitable for the patient if you could get him into the Brook, but if you can't get him into the Brook, then come back to us." It said nothing of the sort. It said to the doctors in Queen Mary's hospital, "Aren't the beds available? Try the Brook."

Mr. Sackville

That is not the information that I have, which is that the hospital said that beds were available, but advised that nearer facilities be sought. Unfortunately, that was not followed up. That is one of the factors that led to the inappropriate transfer of this patient to Leeds.

As the House already knows, the report calls—

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

No. I shall continue, and I have said what I understand to be the facts about what happened in relation to that telephone call.

The report calls for the establishment of stronger systems for the referral of patients to specialist neuroscience centres, better co-ordination of bed usage between neuroscience centres, and improved communication between specialist centres and their referring hospital. Those are important recommendations. All of them are being implemented, with some already in place and others being refined.

A key recommendation was that the London emergency bed service, about which my hon. Friend the Member for Chislehurst asked me earlier, should extend its service to cover intensive care beds. The new service began on 17 April, and is already proving to be of considerable assistance to units in helping to match supply and demand for intensive care services.

Trusts in the region were asked immediately to review their on-call protocols to make much clearer the involvement expected of staff out of hours.

All acute hospitals are required to make formal relationships with one of the specialist neuroscience centres. That is the centre that they will contact initially if they need to refer a patient for neurosurgery. Many hospitals in South Thames have already confirmed that they have such procedures in place.

For their part, the specialist neuroscience centres have introduced procedures to inform hospitals that normally refer patients to them of any severe pressure on beds and the alternative arrangements available. The burden of finding a bed is thus co-ordinated by the specialist centres. If the specialist centre cannot identify a place, a referral is made to the emergency bed service, which maintains a comprehensive information service on bed availability for all London hospitals.

The procedures that have been established should ensure that, when a patient needs access to a specialist centre, the referral can be organised efficiently and with optimal clinical effectiveness. I have gone into the matter at some length, and I want to make it clear to the House that, with good organisation, the things that occurred on that night should be avoided in future. I hope that some of those actions that have been taken will minimise the risk of such events recurring.

Health authorities are actively considering intensive care provision, and are working with their local hospitals to ensure that the referral procedures are in place. The two Thames regions are also holding detailed discussions to ensure a fully co-ordinated approach to forward planning and bed usage between their specialist neuroscience centres.

Mr. Murray's injuries were severe, and he required both neurosurgery and intensive care. An intensive care unit is a specialised hospital ward where critically ill patients with organ failure can receive treatment and monitoring, using invasive techniques and high-technology equipment, and benefit from the high staffing ratio—at least one to one—necessary to maintain adequate care. The number of available intensive care beds in England has risen by over 100 since 1989 to more than 2,600, and the number of qualified intensive care nurses has risen by 1,000 to 7,650. The working group that has been set up will produce guidelines on admittance and the better use of those beds.

Despite those increases in facilities, there were allegations of shortages long before the Murray case. To clarify the matter, we commissioned a report from Professor Klim MacPherson of the health promotion sciences unit at the London School of Hygiene and Tropical Medicine on the provision of intensive care services in England.

That thorough report showed that, overall, there was sufficient provision. However, it identified a number of problems and important issues. In particular, it showed that about one in six admissions to intensive care are considered by clinicians to be inappropriate, on the grounds that the patients are either too ill to have any reasonable chance of recovery, or not ill enough to require the level of specialist care that is provided in an intensive care unit.

On 7 February, the report was formally sent to all health authorities and trusts asking them to examine local provision carefully in the light of the findings and recommendations. Following the publication of the report, Ministers met leaders of the relevant professional bodies and, in the light of those discussions, a working group of professionals, to which I have just referred, is considering guidelines for admission and discharge. It is also looking at the relationship between intensive care units and other less intensive forms of care, such as high dependency units.

Given the resources that are required for an intensive care bed, it is vital that we get the balance right between meeting the need for both emergency and planned treatment requiring intensive care, and avoiding those facilities being under-used. As we have heard in the debate, that is a difficult balance. Getting it right remains a challenging priority for all those involved, given the fluctuations in demand for this highly specialised and intensive treatment.

The Government's policy, whether for London or for the rest of the country, is that it is for individual health authorities to plan the level of provision that is appropriate for their, areas, taking into account all factors of need, demand and the availability and desirability of other services.

Of particular interest to the debate is information on London. Professor MacPherson's report found that each of the Thames regions had more general intensive care beds per head of population than the national average. The former South East Thames region had the highest ratio in the country, with three beds per 100,000 of the population. The Department's information returns show that, in inner and outer London, the average number of available intensive care beds rose from 480 to 501 in the year to 1994.

The Government do not hold central information on the number of intensive care beds within different specialties. According to the London emergency beds service, there are currently 247 general adult intensive care beds in 35 hospitals within the 16 London health authorities. There are also 29 neuroscience intensive care beds, 50 paediatric intensive care beds and 186 beds in cardiothoracic units. In addition to these 512 beds are intensive care beds in renal, liver and other specialist units that are not presently covered by the emergency beds service.

To help to ensure the best use of available resources and to improve communication and co-ordination, the emergency beds service has extended its coverage to intensive care services, including neurosurgical intensive care in the Thames regions and surrounding area. It is operational 24 hours a day, and it contacts every intensive care unit in the Thames regions twice a day—or three times a day for those with specialist neurosurgery or paediatric beds—so as to update its information on bed availability. It is thus able to respond immediately to units that are seeking to transfer a patient because they have no spare capacity.

Initial experience of the emergency beds service is that it is proving very helpful. In the first 45 days of the service, there were 173 inquiries from 53 hospitals. On average, that is four a day, and there were as many as 13 on one day in April. The work of the service led to 112 patients being transferred to 54 destinations. Some 78 per cent. of the inquiries were for general intensive care and 14 per cent. were for neurosurgical intensive care.

The service is of considerable assistance to units in helping to match supply and demand for intensive care services. Similar services are being established in other parts of the country, with considerable benefit.

In the light of Professor MacPherson's finding that many intensive care beds are inappropriately used, no discussion of intensive care would be complete without considering acute bed provision. That the NHS generally will have fewer acute beds in 10 or 20 years' time is common ground. However, neither the Tomlinson report nor "Making London Better" includes a planned or target reduction in beds, and it is not Government policy to set such targets.

We have said that, in London, as in the rest of the country and in the world, more patients will be treated with fewer beds. Developments in modern health care, such as non-invasive diagnosis and treatment, and new and improved drug therapies, mean that, overall, the demand for beds is steadily falling. That trend is clear in Britain and overseas.

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

No. I should like to continue.

The common theme from many studies is the need for better management. That was the key message of a report on beds from the chief executives of the inner London health authorities. Considerable work is being done to develop neurosciences in the Thames regions and London. That is well in hand, and the transfer of neurosurgery from the Brook hospital is being phased to ensure the continuation of safe and effective services. My hon. Friend the Member for Chislehurst spoke about that transfer.

The new neurosurgery service, which was established at a cost of £7 million including magnetic resonance imaging facilities at the Ruskin wing of King's, will begin to take patients next month. It will be complemented in 1999 by the move of the neurology service from the Maudsley to King's, so that a comprehensive service will be available in one building. The Higher Education Funding Council is also investing in specialist research and teaching facilities. That will bring an academic dimension, and further complement the service at King's.

A clinically led review of neuroscience services in South Thames recently proposed that a new specialist neurosurgery unit should be located at St. George's hospital, Tooting. If health authorities agree to those proposals, the new centre will replace the outdated facilities at Atkinson Morley hospital and Hurstwood Park. Actions already taken and current considerations demonstrate the commitment to ensuring that London and South Thames in particular have the best possible pattern of neuroscience services.

The events of 6 and 7 March underline the urgency and the importance of the work that is already in hand to define and facilitate the best possible future pattern of neuroscience and intensive care facilities in the Thames regions. I hope that I have been able to demonstrate the Department's commitment to ensuring that everything possible is done to avoid any repetition of the unacceptable events of that night. I understand the concerns of my hon. Friend the Member for Chislehurst about what happened.

I am grateful to my right hon. Friend the Member for Old Bexley and Sidcup (Sir E. Heath) for his comments about the good work of the NHS. I agree that the many new technologies, new medicines and new ways of treating patients mean that there will be a demand for ever greater resources for the NHS. I hope that my right hon. Friend was not entirely correct when he said that Ministers have failed to acknowledge that.

I take it as read, just looking at the history of resources in the NHS, that the same pattern will continue; that we will need to find more and more resources to provide for ever greater demand for health as new ways of treating patients emerge. I think that many problems will exist. The problem of balancing the need for intensive care beds with supply will always exist. I hope that, as my right hon. Friend the Member for Old Bexley and Sidcup suggested, we will take a quiet and sensible approach to the matter, and that some of what I have said will convince him that we are doing just that.

Sir Edward Heath

Does my hon. Friend accept that, while we welcome the improvements that he has outlined and hope that they will be more effective than the present arrangements, I for one cannot accept the information that he has been given on Mr. Percy? As the matter is likely to come before the courts, he has heard far from the last of it.