HC Deb 12 June 1995 vol 261 cc560-78

Motion made, and Question proposed, That this House do now adjourn.—[Dr. Liam Fox.]

7.38 pm
Ms Clare Short (Birmingham, Lady wood)

I rise surprisingly early this evening to ask the Minister, on behalf of people of all political persuasions in Birmingham, to tell us the truth, on the record in the House of Commons, about the plans for the future of City hospital, formerly and more widely known as Dudley Road hospital. The issue is causing enormous concern across the city and it comes after a period of enormous turbulence and change in hospital provision in the city. We in Birmingham have been lied to systematically before. There is now grave doubt, including in the local newspapers, about whether we can believe any of the things that we have been told in the past couple of weeks.

I became a Member of Parliament in 1983. The Birmingham children's hospital and the then accident hospital, which was of international renown for its burns treatment, were both due to be rebuilt; we were firmly promised that. There was then a new plan to build a healthy Birmingham and to build a series of new hospital provision on the Queen Elizabeth site. That caused enormous arguments in Birmingham, because people were worried that, if all the provision was centred in one place, people from other parts of the city would not be able to get to it. All those plans were then scrapped. The accident hospital was closed and moved into general hospital which, in turn, was closed. Children's hospital is now not getting a new building, but has been moved into the general hospital.

General hospital is a city-centre hospital. People were deeply worried—my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) was involved in the campaign to save general hospital—because it was the big hospital that served the city centre. There was terrible concern that if it closed and if there were big accidents in the city centre, there would be no way in which the people of Birmingham could be cared for. We were told repeatedly—[Interruption.] I would be grateful if the Minister would listen to this point because it is of enormous concern to the people of Birmingham. I see that he is talking and not listening.

We were told repeatedly that the people of Birmingham should not worry because Dudley Road hospital, now known as City hospital, was expanding as a district hospital, would have a large accident and emergency department and could provide for any crisis or tragedy that might take place in the city centre.

Dudley Road hospital is a much-loved, high-quality hospital that serves an enormously poor community, as well as having accident and emergency provision that serves the city centre. According to Department of Health statistics, the community is the fourth poorest in Britain. Yet the hospital is of such high quality that royal college examinations take place there. It is a teaching hospital, and the quality of many of its services is outstanding on a national scale.

The Minister should know that there is a deep ethos of public service at the hospital. Very high-quality staff come to work in the hospital and tend to stay there for a long period because they want to give a service to a needy community. It is notable that the consultants at the hospital do not make large amounts by working in private practice; they continue to work at the hospital because their sense of public service is deeper than their desire to make extra money on the side.

I have described the background of the loss of a whole succession of hospitals in Birmingham, which caused consternation across the city. We then settled down with the new reorganisation. City hospital became a trust and the 3,000 staff who worked there were determined to ensure that the hospital succeeded. In the past, there had been trouble about the hospital's budget, partly because of the Government's funding formula for hospitals. This matter was raised at meetings with the region and meetings with the Secretary of State. The formula for distributing funds, quite reasonably, provides for extra funds where there is a large elderly population because elderly people tend to be big users of the health service. However, in some of the poorest communities, the formula does not serve well because people live less long.

The hospital has had difficulties over the funding formula on a number of occasions. We have been given assurances on a number of occasions, including at meetings with the Secretary of State for Health, that adjustments would be made and that hospitals such as City hospital would not lose out under a formula that was triggered by having large numbers of elderly people because of the great poverty in the area.

Everyone worked enormously hard because there had been crises about money before and they worked with enormous success. In the past year, the throughput in the hospital has increased considerably. People were content and working hard. All the people who worked in the hospital were united and determined that the hospital would continue to succeed after the period of instability in Birmingham.

Out of the blue came an enormous shock. On 10 May in The Birmingham Post, there was a story that the maternity unit at City hospital might face the axe and that there was to be a major reorganisation of the hospital, probably with large numbers of redundancies. There was a real crisis, because North Birmingham health authority was unable to pay for the increased numbers of emergencies treated at the hospital.

It is inconceivable that the maternity unit at Dudley Road hospital should be axed. I was born there and, more significantly, many children are born there now. It is a big, successful, high-quality maternity unit in a needy community. The west midlands has a worryingly high rate of infant mortality, which is connected to poverty. The unit is an expert, high-quality one, yet we have been told out of the blue that after a year of success and increased throughput, the maternity unit faces cuts in funding and redundancies. One can imagine the worries that this has caused in the city.

On 16 May, my hon. Friend the Member for Perry Barr, having followed up the story, received a letter from the chief executive of City hospital suggesting that the hospital's future might be as a sort of cottage hospital in the town. This terrified us all, and the sense of consternation across the city grew; I do not exaggerate. The Birmingham Evening Mail, the evening paper that is read throughout the city, started a campaign, for which we are all enormously grateful. We are united in our admiration for the newspaper at present. That is not always the case among politicians in the city, especially as the right hon. Member for Sutton Coldfield (Sir N. Fowler) chairs its board. Some Labour Members think that that is a little odd. None the less, on this issue there is no question.

The paper started a campaign called, "We are watching you every step you take", "you" meaning the Government and the regional health executive. It is determined to find out what is going on and it has said clearly—this is the spirit of the city—that it is not prepared to see another hospital go. With the closure of the general hospital, this hospital is crucial to cover the accident and emergency needs of the city centre. There was consternation all round at the suggestion that we would lose the hospital and have a tiny replacement hospital. I tell the Minister that the present hospital is on an enormously large site. There has always been a suspicion that there might be the ulterior motive of selling a lot of the land. That is part of the fear.

On 18 May, an exclusive report in The Birmingham Post, the morning paper, said out of the blue—no one, including consultants, trade unions, Members of Parliament and people in the city had heard of this—that we were to get a £100 million new hospital on the City hospital site. We were all deeply sceptical and suspicious. We thought that this was all about a hidden agenda to close Dudley Road hospital. How one minute could people be talking about cuts and getting rid of the maternity unit and the next minute saying that £100 million, which no one had heard of, was available? We had heard the rumours about there being a tiny cottage hospital on the site of the massive district hospital. We were all deeply suspicious, and those suspicions were voiced by everyone, including our local evening paper.

The chief executive of the West Midlands health authority was extremely angry. He suggested that people should not mistrust his word, and that we should be grateful for the suggestion that we should have a new hospital. What happened then? There was a further leak of minutes of dinners—not meetings, but dinners—of the West Midlands health authority executive and of dinners of the trust that controls the City hospital suggesting that there would be an extremely small hospital with some beds. There would be an accident and emergency function, but the rest of the provision would be for walking patients who would be treated and go home that evening. The local evening paper felt vindicated. Of course we were right to be suspicious. The announcement of the unheard-of f100 million hospital seemed to be a smokescreen and an excuse for closing City hospital.

I want some firm and clear answers from the Minister. He has had plenty of notice of this debate and I am sure that he has been fully briefed about the depth and extent of suspicion and fear in Birmingham. Everyone will read his words with enormous attention, and I hope that he will give us some clear answers.

Was there or is there a plan for a new hospital on the site? If so, when was the plan drawn up, and is there a budget? Will the primary role of the planned hospital be ambulatory care and a day treatment centre? There may be some beds because of the accident and emergency function, but there is an assumption that there will be a substantial reduction in emergency medical admissions. Rather than the current practice of admitting patients for 24-hour stays, they would be assessed, have their treatment prescribed and be discharged to the care of their GP. Is that the sort of hospital that is planned? Is the plan for a hospital of the same size as the existing City hospital, or will there be a greatly reduced hospital?

Are other hospitals in Birmingham facing similar plans? Is only City hospital to be downsized? Has City hospital been picked for a national experiment? That was the suggestion in a letter received by my hon. Friend the Member for Perry Barr, which seemed to describe a new kind of hospital with no beds and in which people are treated overnight and sent home. If so, will the Minister explain why one of the poorest communities in this country has been chosen for that experiment?

Surely it would be better to choose an area in which people have good housing, warm homes, high-quality food and support and relatives to care for them for that experiment. It is inconceivable that anyone serious about health planning would carry out such an experiment—if it is desirable at all—in such a poor community. I should like to hear the Minister's comments on that proposition.

Why has City hospital been singled out for the experiment? I suggest to the Minister that the reason might be the inability to pay for services provided at City hospital. That goes back to the funding formula, which gives too little money for our part of the city. It is a poor and needy community in which people do not live as long. Therefore, the entitlement which comes from an area having a large number of elderly people is not triggered.

I think that the scheme is market-driven. The money is running out, and that is why the plans are changing weekly and monthly. A mad new idea has come up for a cottage hospital service for a very needy area. The Rowntree reports have clearly demonstrated the growing inequality in this country, and with increasing poverty goes increasing ill-health. In poorer areas, there is more sickness and ill-health, and there is an enhanced need for money for medical treatment.

Primary care is not well developed in west Birmingham. If there is to be an experiment, surely an area should be chosen that has high-quality primary care. If people are to be sent home immediately, high-quality GPs and community nurses must be available to care for them.

Is it true that fundholders in the west midlands have a £40 million surplus this year? If so, and I believe that it is, that is an outrage. The crisis has been triggered by a shortfall of £4 million, which was caused by the hospital being so successful in increasing its throughput. The mad market experiment in which the Government are engaged means that fundholders have £40 million that they do not need. A crisis is being faced by the people of Birmingham as a consequence of the mad experiment in commercial forces in which the Government are engaged.

I understand that the west midlands was the only region in the country that chose a nine-month waiting list initiative instead of a 12-month one. Where did that money come from, and where did it go? Is it not more important to pay the bills for City hospital and to keep it going? Is it not true that the money is increasingly in the wrong places, and that the most needy are experiencing worse health care?

I suggest to the Minister that City hospital is an inappropriate setting for the experiment of a cottage hospital in the middle of a city. I understand from our local newspaper that the £4 million missing for this year has been settled, but I want an undertaking that it will be settled for longer than this year. We met the Secretary of State for Health, who promised us that she would attend to the funding formula problem. But it is not good enough to provide £4 million for this year and then say that there will be a crisis next year.

That hospital needs stability, and all concerned want to know where things stand. A group of GPs and hospital doctors are currently going through every service that the hospital provides, looking at all modern developments and making sure that we plan for the future. We must make sure that we have proper provision for the people of west Birmingham. We are not against change, but we want decent services for the people whom we represent.

We do not need this new hospital. We are being conned. I was born in Dudley Road hospital, and my family has been cared for there throughout our lives. I have been in and out of the hospital throughout my life. It is a big old Victorian hospital in large grounds. Of course it needs some attention here and some further work there, but all sorts of building developments are taking place on the site. It is not falling apart, but out of the blue we were told that the hospital was to be pulled down and some tiny cottage hospital built.

I am told that there are strange capital charges in the funding formula. Is there some distortion in the formula that means that a large old hospital—no matter how adequate, warm and well maintained—is somehow more costly, and therefore must be got rid of?

I very much hope that the Minister will give some adequate answers tonight. Everyone in Birmingham will be watching the Minister, with the help of our newspapers. If he, his Administration and the regional executive carry on their threats, we will cause so much fuss, agitation and protest in the city that he and they will regret that they ever dared to try to close or replace City hospital.

7.56 pm
Mr. Jeff Rooker (Birmingham, Perry Barr)

rose—

Madam Deputy Speaker (Dame Janet Fookes)

Order. Before I call the hon. Gentleman, I must be clear that he has the sanction of both the hon. Member for Birmingham, Ladywood (Ms Short) and the Minister.

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

indicated assent.

Ms Short

indicated assent.

Mr. Rooker

I am grateful to my hon. Friend the Member for Birmingham, Ladywood (Ms Short) for allowing me to participate in this Adjournment debate, and I hope that my hon. Friends the Members for Birmingham, Yardley (Ms Morris) and for Birmingham, Northfield (Mr. Burden) may also be allowed to take part. We have been lucky—it is the first bit of luck that City hospital has had—to have extended time for this debate, and we should make good use of it.

I do not want to be repetitious. The Minister will be the most famous man in Birmingham tomorrow, because all his words will be read. The people in the city are aware of my views and of those of my hon. Friends, but they will want to know the Minister's views.

City hospital served the old West Birmingham health authority which—before the amalgamation last year—consisted of the four wards in my constituency, all the constituency of my hon. Friend the Member for Ladywood and one ward in the constituency of Small Heath. West Birmingham health authority's calculations and reports from the former director of public health—all of which have been published—show that it is the most unhealthy part of England in which to live. A whole series of indicators—early death rates among adults, suicides, accidents in the home, perinatal mortality rates and low birth weight babies—confirm that.

We need a good hospital and better primary health care. We are debating a part of Birmingham that is not wealthy and is unhealthy: that point must be taken on board. Since the trusts were formed and the current spate of reorganisation, there has not been as much contact between those who run the health authorities and Members of Parliament as there was previously. We have had crisis meetings in the past, and we have certainly had such meetings in the past few weeks. There has been no full and frank exchange of views and thoughts.

That may be because those currently involved in health planning in Birmingham know what happened in the days of Sir James Acker's reign at the West Midlands regional health authority, when there was one plan after another for Birmingham and we went to one Secretary of State after another. The consensus among my hon. Friends was that, by and large, we had been conned regarding the proposed hospital closures and other changes in health care. The good times that we were promised have not arrived. Therefore, we are bound to be a little sceptical and, for that reason, the current health planners have decided not to talk to Members of Parliament.

However, rumours were rife around the city. They could not be pinned down. The regional chief executive said that he did not know the origins of the idea that there were one too many hospitals in Birmingham. At meetings that I attended in the last decade to discuss health planning issues in Birmingham—right back to when we devised the "Plan for a Healthy Birmingham"—we were told that, according to population changes and new modern medical techniques, Birmingham had one hospital too many.

We were never told which hospital it was, and general hospital was framed for closure. It was not a fully fledged district general hospital. It was located in the city centre, but it was not a large hospital—I do not think that it ever had more than 400 beds and three operating theatres. Unlike my hon. Friend the Member for Ladywood, I was born at the former maternity hospital in Loveday street, which is attached to general hospital.

When the city centre hospital ceased functioning as a mini district general hospital—it serves various other purposes today—we were told that modern health techniques in hospitals required the construction of large district general hospitals in order to deal with all complications that might arise as a consequence of patient treatment. We said at the time that the hospital was useful for dealing with accidents and emergencies because of its proximity to the city centre and that it was very easy to reach.

We were then told that Dudley Road hospital was a city centre hospital. The authorities were very clever to change its name to City hospital, because that gives people outside Birmingham the impression that it is located in the city centre. As a Brummie, I would not describe Dudley Road hospital as a city centre hospital. Many of my constituents have difficulty reaching it, and it is their district general hospital. It is sometimes easier for them to travel to Sandwell hospital or to Good Hope hospital in Sutton Coldfield.

Over the years, we got the impression that the planners wanted to close one hospital in Birmingham, but we could not tell which one it would be, as building work was under way almost constantly at Dudley Road hospital, Good Hope hospital, East Birmingham hospital—which was renamed Heartlands—as well as at the Selly Oak and Queen Elizabeth hospitals. It was extremely difficult to forecast what would happen.

After a period of quiet and lack of discussion, it appears that Dudley Road hospital is to close—notwithstanding the fact that the maternity hospital is located there and that the new eye hospital is being built on that site. I have no complaints about the fact that there is to be a bedless hospital. I think that some of the headlines about that have been unfair, bearing in mind that it will be situated next to an 850-bed district general hospital. However, if an 850-bed district general hospital is not located next to the new eye hospital, we will have a problem. The Minister must be made aware of that.

The current eye hospital in the city centre has been closed many times for health reasons and its current lease is about to expire. Hence, a new eye hospital is to be built on the Dudley Road site. I do not know whether the Minister has visited the Dudley Road hospital.

Mr. Sackville

indicated dissent.

Mr. Rooker

I hope that he will visit it soon. When he does, he will see that a large part of the site has been cleared recently. Many of the oldest parts of the Dudley Road site—which are more than 100 years old—have been demolished. Part of the site was the old workhouse. However, the entrance to that former workhouse has been retained as it is a listed building and therefore cannot be demolished. A great monolith representing part of Birmingham's history remains while the rest of the area has been demolished.

A district general hospital containing 850 beds is not a large district general hospital; it is a modest hospital. We are now very short of emergency beds in Birmingham. No one in his right mind wants disasters to occur, but it is the responsibility of all those involved in political life to plan for the future. If people turn on a power switch and the lights do not come on, they will not thank us when we say, "Sorry, we did not build enough power stations." Similarly, if there is a rail or aircraft disaster, we cannot say, "Sorry, we got rid of the spare hospital beds on the orders of the accountants." Last week I asked what would happen if a 747 crashed in Birmingham. Many senior people replied that not many people would be injured. That is not the right way to approach the issue. It is no use saying that the health service will stop and that we will get on the telephone and locate empty beds. If we reduce the number of beds available at Dudley Road—whether or not the hospital is rebuilt—we are courting full-scale disaster in Birmingham.

My noble Friend Lord Howell of Aston Manor, a former Member of this place, recently waited 12 hours for a bed on the day before his operation was to take place. He asked for nothing more than his rights as a patient of the national health service. He had gone to that hospital all his life, yet he had to wait 12 hours for a bed in order to undergo an operation the next day. He experienced the problems at that hospital at first hand.

My hon. Friend the Member for Ladywood mentioned the current spate of rumours surrounding the fate of the hospital. There was a press report about the possible closure of the Dudley Road maternity hospital, and before the most serious rumours took off, I was contacted by doctors from the Laurie Pike health centre—formerly the Birchfield medical centre—in my constituency. It is a world-class local primary health care general practitioner practice. Doctors who want to learn how to run a good practice with their own researchers and who wish to get out into the community practise in that centre. I once sent the former Home Secretary, the present Foreign Secretary, to that centre to learn what was happening in inner-city health care. I told him to talk to the doctors rather than to the self-appointed community leaders.

The doctors in that centre wrote to me saying: We are GPs in the Laurie Pike Health Centre caring for patients in Perry Barr, Aston, Handsworth and surrounding areas for which the City Hospital, Dudley Road is the main provider of secondary and maternity care. We are deeply concerned about the implications of the proposed closure of the maternity and possibly other departments at the City Hospital. This would seriously affect the care of our patients and indeed all those in the catchment area. It would not only be difficult, particularly for pregnant patients to travel to the Maternity Hospital or Good Hope but we do not consider that they would receive comparable care". The press reports about that proposed closure were worrying enough, but on VE day, as I sat in the cathedral an hour before the start of the commemorative service, two people approached me within half an hour of each other to ask whether I had heard rumours about the possible bulldozing of Dudley Road hospital. I had not heard those rumours before that day.

I then wrote a letter of no more than 50 words to the chief executive asking him to comment on the press reports about the closure of the maternity hospital and about the rumour that I had heard. The rest is history. The chief executive, Mr. Tarver, replied to me by letter. I understand that he has been ill recently and I wish him a speedy return to health. He has served West Birmingham health authority and the City hospital trust with distinction. He wrote me a frank letter in which he answered my questions and commented upon the rumours. I was horrified: it was the first I had heard of town hospitals. The new concept involved bulldozing district general hospitals and replacing them with small town hospitals located in the suburbs.

I am in favour of small town hospitals as a complement to district general hospitals, but not as an alternative to them. My constituency suffers from the lack of good-quality health centres where minor operations may be performed and where localised aftercare could be provided in the community prior to patients returning home. Small town hospitals should not be an alternative to the City hospital and the work that it does.

I was concerned about that proposal, and I made Mr. Tarver's letter public. I asked the medical journalist at the Birmingham Evening Mail, Mr. Derek Weekes, to investigate the matter. I am 100 miles away for four days every week and he was able to speak to many people. My hon. Friend has quite rightly paid tribute to the Birmingham Evening Mail for its excellence in reporting general health-care issues and the NHS in Birmingham. Its reporting of those issues was of a high quality before the right hon. Member for Sutton Coldfield (Sir N. Fowler) took control of the company, and the newspaper has maintained that standard ever since. It is to the credit of the editor and journalists concerned.

The staff at the hospital asked the management whether they could have a copy of the letter that Mr. Tarver had sent me. They were refused, because of all the complicated questions that I had asked. I had written a 50-word letter enclosing a newspaper cutting about the possible closure of the maternity unit and asking for comments on what I had heard in the cathedral on VE Day. I did not ask a series of detailed questions. I have done so since, but it is obvious that there was less than openness with the staff. That is the root cause of the problem.

If the Minister wants to get a grip on the matter and stop what has become a public relations disaster for health service management in the west midlands, and consequently the Government, the one sure way to do it is by total openness. It is only a few weeks since the new code of open practice in the health service was launched by the Secretary of State.

I take no joy in the matter. What has happened in Birmingham is tragic. It is causing consternation among our constituents as GPs, patients and families of patients. It is totally unnecessary and it can be cured only by openness in thinking and sharing thoughts about health service planning with consultants, GPs and hospital staff. It is not happening because of money, accountants and budgets. One hospital has been set against another because of the market. That is the difficulty, and the Minister is the only person who can do anything about it.

I look forward to hearing his answer to my hon. Friend the Member for Ladywood about the proposed £100 million hospital. Mr. Edwards, the regional director of the NHS, wrote to me on 23 May. His letter consisted of three sentences, each a paragraph. The middle one was: Do you want a new hospital or not?". Frankly, no one had ever offered a new hospital. My answer is that I am not sure, for the following reason. There is no question about the site being large. It is bordered by main roads and the canal. It is not far from the prison. Where would the new hospital go? Would the present one be knocked down to clear the site for a new one? Would the new one be built somewhere else while the present hospital is operating 850 beds?

Someone has to answer some practical questions about putting another hospital on the site. Even with modern building techniques, there is no room to put another hospital of the same size on the site while maintaining the existing provision. The idea that the hospital at Dudley Road could be knocked down and everyone squeezed into all the other hospitals in Birmingham, if accepted, would be the final nail in the coffin. It would get rid of the spare hospital in Birmingham because, on the evidence of the past 10 years, I do not believe that a new one would ever be built once the site was cleared. That is a real problem.

Openness has to be the way forward. That openness has to include the meetings of the health authority and the trust. The Birmingham Post did some work on that issue. There were five meetings concerning Birmingham health service trusts and authorities, all behind closed doors. The journalists went to an open session and found that members of the authorities were not asking questions. It has been left to Members of Parliament and The Birmingham Post to ask some key questions of those in charge of the health service.

It is not always easy to find out who is in charge of the health service. The way in which it has been reorganised means that accountability has been diffused, spread and blurred. That in itself causes difficulty; therefore, sometimes we have to reach for our press pack or press six-gun. We cannot get the answers because we cannot find out who is accountable. It is all part of the consequences of constant reorganisation and lack of accountability.

There is also considerable lack of accountability in the House, as the Minister will make it clear that it has nothing to do with him—it is the trust for this, the trust for that, with this authority or that authority making the decisions. That is not good enough. We want some accountability in the House of Commons for a public service that is supported and loved by the vast majority of people in Britain.

I will not repeat what my hon. Friend the Member for Ladywood has said. I hope that the Minister will answer the questions and make the position absolutely clear so that it cannot be misunderstood by anyone, even by the most malicious of the Government's political opponents.

I am not seeking to make party political capital out of the issue. I want the truth for my constituents and the citizens of Birmingham, but I cannot secure that if the Minister and the health service are not open with me. If I feel that they are not being open and that I am being misled, I shall use arguments that border on a political attack as they are my only weapons as a Member of Parliament.

I should rather satisfy my constituents and the doctors that we shall maintain quality health care at City hospital, with progress and advancement. Nobody wants to ossify what we have; we want to advance on a range of issues.

It has been an unfortunate three or four weeks for the health service in west Birmingham, the knock-on effects of which have affected the rest of the city. That has done the health service no good, the Government much damage and, above all, has given my constituents some unnecessary sleepless nights.

I shall not recite individual cases, but I have been deluged with letters from constituents complaining to me about occurrences in the past few months that they thought they could put up with, but they now realise how much pressure the staff have been under at Dudley Road. The hospital has treated 13 per cent. more patients in the past year. That is part of the reason for the present financial difficulty. I consider 13 per cent. more patients to be a success. The hospital should not be penalised because of the way in which the Government organise health service finances.

I look forward to hearing what my hon. Friends have to say and the Minister's detailed response to the debate.

8.16 pm
Mr. Richard Burden (Birmingham, Northfield)

With the permission of the House, I shall make a short contribution to the debate. A few weeks, ago I left the House early. I went back to my constituency on a Thursday to find an article in the newspaper that day talking about a £100 million investment in City hospital. I was not aware of the correspondence that my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) had with City hospital. I was suddenly confronted with the news of a£100 million investment and I was asked for my reaction. My initial reaction was that I wanted to look at the fine print and I was rather sceptical.

In Birmingham we have heard quite a lot about mega-investment in hospitals over the past few years. Not many years ago, we had the so-called "Building a Healthy Birmingham" plan. At that stage we were promised an investment of £500 million in new and refurbished hospitals in the city. We were told—and we knew—that the hospital stock in Birmingham had not had sufficient investment for many years. Part of that investment included a new children's hospital.

The "Building a Healthy Birmingham" plan was unpopular because the regional health authority in one of its guises had not talked to many people about it and when it did, it did not listen to them. When that plan was dropped, nobody shed many tears, but a couple of years later—about two years ago—a new document called "Looking Forward" told us that we would have investment of more than £100 million in hospital services in Birmingham.

Mr. Deputy Speaker (Mr. Michael Morris)

Order. This is not a general debate about hospital services in Birmingham. It is a very specific debate about Dudley Road hospital.

Mr. Burden

The relevance to Dudley Road will become clear. It relates directly to a letter about Dudley Road and the dinner to which my hon. Friend the Member for Perry Barr referred concerning Dudley Road, which puts the issue in the context of hospital developments in Birmingham.

"Looking Forward" talked about around £100 million investment. I took that up with the Minister responsible for health in another place who explained that it was not really a cut in hospital investment. I could not see that. The new programme promised no new children's hospital, just a rejigged children's hospital on another site, but we were promised a new emphasis on primary care.

Mr. Deputy Speaker

Order. It is no use the hon. Gentleman acknowledging a ruling from the Chair and then starting to talk about primary care, which has little to do with Dudley Road.

Mr. Burden

I do not want to try your patience, Mr. Deputy Speaker, but my hon. Friend made the point that, if Dudley Road is to close as a district general hospital and there is not sufficient primary care in Birmingham, the idea being mooted of a network of cottage hospitals could not be effective.

Mr. Deputy Speaker

Order. I am not prepared to debate the matter with the hon. Gentleman. This is the first time in three minutes that he has even mentioned Dudley Road. I will be most grateful if the hon. Gentleman will remark specifically about Dudley Road, and make such other allusions as may be relevant. So far, the hon. Gentleman has not referred to Dudley Road.

Mr. Burden

Because of public concern about Dudley Road, the chair of NHS Executive West Midlands, Brian Edwards, wrote to all Birmingham Members of Parliament on 6 June. He explained: I thought it might be helpful if I put events into the sequence in which they occurred. Item 3 states: On 26 April Brian Edwards met the Chief Executives of all hospitals in Birmingham to discuss how hospitals might work together to improve services and reduce unnecessary costs. Roger Tarver, of City Hospital, copied his personal notes of the meeting to his fellow Directors. I have a copy of those notes. The third paragraph states: Regional officers had decided that a new, but much smaller, hospital should be built at Dudley Road. However, Mr. Baker's letter continued: We have absolutely no plans to close City Hospital. It not only services a very needy local population but also plays an essential part in the fabric of the Health Service in Birmingham. Personal notes or not, it is clear that City hospital's chief executive believed from a meeting attended by representatives of all the hospitals in the area and of the regional health authority, to plan future hospital services in Birmingham, that City hospital as we know it was to be replaced by a new, smaller hospital—and that some of the services that it and other hospitals provide would be rejigged elsewhere.

Roger Tarver's notes state: The Birmingham Women's Health Care Trust—not wishing to become a baby factory—could provide services for complicated births and neonatals currently dealt with at City Hospital. So we need to ask what plans there are for maternity services at City hospital. Another note observes: An option appraisal is to be developed for the relocation of orthopaedic services from the Woodlands site. It will compare a new build at the City Hospital with use of the new Solihull Hospital, given that there appear to be limited uses for the latter, the preferred solution is predictable. That concerns me because, on the face of it, that note states that Dudley Road will have a new range of services, including extra orthopaedic services—but that they might go to Solihull hospital instead. The point is, though, that those services would come from Woodlands hospital on the borders of my constituency, which has been the subject of a long and well supported campaign over the past two years to remain open. We thought that it had finally been reprieved just a few months ago, and it has been given trust status. It could now lose its lifeblood of orthopaedic services to City hospital. We must have answers.

When the new regime arrived in West Midlands regional health authority, it was at pains to emphasise that it wanted to be open and have a dialogue with Members of Parliament and the people of Birmingham. We were told that the lessons of the "Building a Healthy Birmingham" plan had been learnt and that henceforth, everything would be above aboard, and everybody would be involved and told what was happening. The events of the past few weeks leave me most worried. The Birmingham Evening Mail is right to print the words "We are watching you" whenever it mentions the issue. We do not currently have enough confidence in the system to know what is happening.

At an apparently private dinner on 26 April, the City hospital chief executive took personal notes that imply comprehensive reorganisation of Birmingham health services, involving the possible transfer of orthopaedics from my constituency to Solihull hospital, which is under threat, or to Dudley Road. There is mention of maternity services now at Dudley Road being transferred to the women's hospital, and of changes at the children's hospital.

Those matters are of major public concern. Every time I ask the regional health authority what is going on, we are told that planning is a matter for individual trusts. Now we are told that all the trusts and hospitals have got together with the regional health authority over dinner to devise a new blueprint for Birmingham hospital services.

We must know what is happening. I am pleased that we are meeting the regional health authority chief executive in a day or so, and I hope that he will give answers. I hope that Ministers can give answers as well. All the problems that London—which has received a good deal of publicity over health care—is experiencing are equally important in Birmingham. The future of local hospitals are important to local people. They made their views crystal clear in the "Building a Healthy Birmingham" debate. They want to be listened to and to have say. They do not want to be bounced into things, and they want people to be straight with them.

What is the future of City hospital? How big will it be? How many beds will it have? If there are plans to build a new hospital, we have a right to know how it will be financed. As my hon. Friend said, the capital charges debate has bedevilled a number of Birmingham hospital projects, including the children's hospital rebuild.

Added to that is the private finance initiative. My experience of it in Birmingham relates to a new primary health care centre, when it led to further delays in the building programme. If City hospital is to be rebuilt, will private finance be sought? If so, from where? Will it be just an injection of private capital into something that will remain a national health service development in all its aspects—I mean, one owned and run by the NHS, and whose ancillaries services will be run by the NHS? If we do not receive a clear answer, I will be profoundly worried.

I hope that the Minister will answer our questions today and will also tell the people who run the NHS Executive West Midlands that, before they embark on mega-reorganisations in future, they must talk to Members of Parliament and to the people of Birmingham.

8.18 pm
Ms Estelle Morris (Birmingham, Yardley)

With the leave of the House, I shall make a short contribution to this Adjournment debate. My constituency is not in west Birmingham but lies to the east, and Heartlands is my district hospital. I want to emphasise the importance of the matter to the whole of the city.

At risk is the confidence that Birmingham people were just about beginning to have in health provision management in the west midlands. The Minister will not need reminding that West Midlands regional health authority and Birmingham hospitals have been through a difficult time in recent years. There is a history of mismanagement and poor service. One of the worst effects of that was that it damaged public morale and the public's confidence in their hospitals.

There has been a period of quiet over the past year or 18 months since the new administrators took office, and some good things have happened. The fact that waiting times in all our hospitals, including Dudley Road, have fallen is much to be welcomed. There has been a healing process; the period of quiet has been a time when people's experience of hospitals—although by no means satisfactory, and no excuse for resting on laurels—has not been as bad as it was two or three years ago.

Now there is a perception among people throughout Birmingham that the period of quiet has been used as an opportunity to plan the closure of another hospital. That is tragic. Not only would it be a tragedy if Dudley Road were closed, but the recovery of morale among the people of the city would be hindered. The Minister must begin quickly to explain the intentions of his administrators as regards the city of Birmingham.

This problem is a festering sore. If it is left to fester, the people who live in the west of the city—the constituents of my hon. Friends the Members for Birmingham, Ladywood (Ms Short) and for Birmingham, Perry Barr (Mr. Rooker)—will not know the future of their health care in hospital, and they will be pitched into a period of uncertainty that we could well do without. It is the very last thing we want.

Furthermore, we do not want the public's lack of confidence in the hospital administrators to be allowed to grow. We do not want to have to come to the Minister and tell him that, if he is going to save Birmingham's hospitals, he will have to change the chief executive and the hierarchy again.

Let us nip the problem in the bud. Let us have some openness and some clear answers, so that we and the people of Birmingham can take part in the debate, if one is to take place. People in the west of Birmingham must not be left uncertain as to whether they will have a hospital. They need to know that the people running our hospital service are prepared to consult them about what has been going on behind their backs, and that they will not act without taking their views into account.

We ask, first, for an assurance that Dudley Road will continue; secondly, for an assurance that the administration of our hospitals is in good hands and will be opened up. Thirdly, we ask, even today, for an end to the rumours, scaremongering and uncertainty that are plaguing everyone who works in our hospital service—and all the families who look to it for their health care.

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

I welcome the fact that the hon. Member for Birmingham, Ladywood (Ms Short) has sought this debate. Indeed, I am not surprised that she has. I have seen some of the headlines in the various Birmingham newspapers; clearly things have been said, which have caused alarm. I should like to do what I can to calm those fears, although in doing so I also recommend that hon. Members present for the debate meet the regional health authority—I believe that they intend to do so. Mr. Brian Edwards will be in a position to reinforce what I am about to say.

There are no plans to close the City hospital, otherwise known as the Dudley Road hospital. There have been suggestions and discussions—this is all now in the open—between many of the chief executives and other local employees of the health service about the possible advantages of redeveloping City hospital, for a number of reasons.

Clearly, the hospital is a large and rambling site. It is also of a certain age and, as Mr. Bryan Baker, chairman of the RHA, put it—much better than I could: Although the staff at City Hospital provide an excellent service, the buildings are now as much a hindrance as a help, particularly the cramped Accident and Emergency and Out-patient building at the front of the hospital, and the long corridor of wards in the main block. So there is apparently general agreement among those working for the health authorities and trusts concerned that patients and staff could probably benefit from a new development of the hospital.

That is not to say that the hospital will close, or that the services there will be withdrawn. But all over the country, older hospitals, particularly those that are rambling and difficult for staff and patients, are being redeveloped. Hundreds of millions of pounds are being spent on building new hospitals or building new wings on current hospitals, and that is good. Thus, I was a little concerned to hear the hon. Lady apparently rejecting out of hand the idea of a redevelopment. She should not do that.

Ms Short

No one would reject a redevelopment of the local hospital, although it is not such a shambles as to amount to a crisis. It does not need to be pulled down; it works quite well. People like the space in older hospitals. What we reject is a cottage hospital. If we are being conned with one, we do not want any part of it. We would rather keep what we have.

Mr. Sackville

I can reassure the hon. Lady that it will not be a cottage hospital or a tiny hospital. I acknowledge that the notes circulated by Mr. Tarver, and his letter, were open to alarmist interpretations. The view that he expressed was not, as far as I know, shared by his board or the other authorities involved. It should be seen merely as a contribution to the preliminary part of an important debate that will take place on the buildings at the City hospital.

If there is to be a new development and it is thought that there are good reasons for one, it will be the subject of a great deal of open consultation. As a Health Minister, I would expect no less. The resulting hospital is likely to be physically smaller than hospitals that would have been built some time ago. There are a number of reasons for that: hospital design, and the fact that there is much more day surgery these days. Stays in hospital are shorter; much more work is done in the form of out-patient work. Some conditions that used to require stays of a week or more are treated in one day now, or even require no in-patient admission at all. There is no argument between us on that point—hence the emergence of smaller hospitals.

As that process continues around the country, we find that more patients are being treated. To quote a well-worn statistic: we now treat more than 120 patients for every 100 treated four or five years ago—after making allowance for the small change in the method of counting, from deaths and discharges to finished consultant episodes.

Mr. Rooker

I am elected to represent the citizens of Birmingham, and we are also here in Parliament to take a national overview. My experience tells me that we cannot use what is happening in the rest of the country to organise Birmingham. The fact is that we have been short-changed on our hospital care for a decade or more. Primary health care infrastructure has not been built up to cope with the changes in the hospitals. The pressures on the community care services exerted by speeding patients through hospitals, and bringing them back to hospital time and again, have brought those services to breaking point. That is why I am worried by talk of a smaller hospital without guarantees that primary health care and the necessary mini-health centres around Birmingham will be in place before we start.

Mr. Sackville

A reduction in the number of beds—we have heard all the arguments about that, especially in London recently—must be accompanied by a discussion with everyone concerned and by every attempt to reassure the public, along with the provision of suitable primary care and other community care facilities. We cannot rely on a change to day surgery alone. If we are to reduce the number of acute beds, we must ensure that there are facilities to treat people elsewhere. It is often an improvement from a health point of view to treat people in their homes or near their homes instead of admitting them to hospital. In terms of outcome, that is often an improvement. I agree with the hon. Member for Birmingham, Perry Barr (Mr. Rooker) that we must not proceed with bed reductions without being sure that the facilities that are needed are put in place.

I was asked specific questions by the hon. Member for Ladywood. She asked whether there were plans for a new hospital. No, there are not. There have been some preliminary discussions, the general outcome of which is that it is likely to be advantageous to redevelop City hospital. The hon. Lady asked me when that would happen. That I cannot answer, because there are no firm plans at present. She asked me what the budget would be. I do not know, because in advance of detailed proposals for major hospital schemes, it is impossible to make any estimate. I can only tell the hon. Lady that there are many schemes throughout the country where £50 million or more in capital is being spent, in either building a new hospital or redeveloping parts of major hospitals.

Mr. Burden

The chief executive of the NHS Executive West Midlands has specifically mentioned £100 million in talking about the City hospital site. May we be clear that there is no plan for an investment of £100 million? May we take it that it could be more or less, and that mention of £100 million should not be taken as a guarantee?

Mr. Sackville

That is correct. It would be impossible to calculate at this stage the capital cost of a major new future development. Such a figure would be an informed guess of the cost of development and would make it a major hospital development. We are tending to see smaller hospitals rather than larger ones.

There is no question of an experiment. The words used by Mr. Tarver described his own view. The most likely outcome of any discussion on redevelopment is a more traditional hospital model, even if that is accompanied by a certain amount of provision for community facilities.

The hon. Member for Ladywood also asked me about extra funding for the deficit that is still being experienced in the finances of City hospital. As she knows, that money has been made available. It will be made available, however, on the condition that plans are laid to bring the finances of the trust into balance, as with every other trust throughout the country. She should not suppose from what I have just said that there will be massive redundancies or cuts in services.

Ms Short

I hope that the Minister listened to what I said about the problem arising from the formula for funding west Birmingham. We are faced with a problem of success. The hospital has treated more patients. We cannot make up the deficit without a reorganisation of the funding. Everyone who works in the hospital has worked harder. The problem with funding is not the fault of the staff. I hope that the Minister will give an undertaking that funding will be examined specifically.

Mr. Sackville

I would expect the regional health authority and the districts concerned to arrive at a fair method of allocating funds to match the problems—social, medical and others—of the local population. The hon. Lady makes an important point.

I have been assured that, if redundancies are necessary, the trust would hope to confine them to support services and administration. It would not be looking for redundancies. It would be more likely to seek a freezing of vacancies to ensure that savings could be made without painful, large-scale redundancies or damage to patient services. It is an exercise that has had to be undertaken at several hospitals throughout the country. The hon. Lady will rarely, if ever, have heard of large-scale redundancies in our acute hospitals.

The hon. Members for Ladywood and for Perry Barr asked about openness. I give an undertaking that no plans will be brought forward in secret. If there are to be developments at City hospital, they will be discussed widely.

I reiterate that it is unfortunate that various rumours have circulated and that Mr. Tarver's remarks have been misinterpreted, giving rise to the idea that the hospital will close. There are no plans to close City hospital.

Mr. Rooker

I have not had any discussions with Mr. Tarver for about two and a half years. Given what has been said, and in the light of the letter last week from the regional executive disowning Mr. Tarver's letter to me, I seek an assurance that Mr. Tarver, who has been a loyal servant to the health authority, will not be made a scapegoat because of the bad publicity that has been received by the RHA. It is bad enough that consultants have been threatened with the sack for talking to Members here and in the other place. We shall not accept the scapegoating of any servant of the health service in Birmingham for doing his duty and telling the truth. I seek the Minister's assurance that Mr. Tarver will not be scapegoated.

Mr. Sackville

I wish to make it absolutely clear that the remarks to which the hon. Gentleman has referred should not be seen as anything more than a contribution to the debate.

Ms Short

Mr. Tarver is deeply respected by everyone who lives in the area of which I represent a part. Perhaps he was more honest than some when discussions took place at dinners. Rumours have been confirmed by several different sources. We are not dealing only with Mr. Tarver's minute.

It would be intolerable if it were suggested that he should be penalised in any way. We consider him to be a good man and we want him to continue to work for the trust.

Mr. Sackville

I note the defence that has been mounted on behalf of Mr. Tarver. I am not attacking him. I am trying to put in context the views that have been expressed, which have clearly led to considerable alarm.

It was said by the hon. Members for Birmingham, Northfield (Mr. Burden) and for Birmingham, Yardley (Ms Morris) that in the west midlands, especially in Birmingham, there has been a period of relative calm about health matters in recent months, and perhaps over the past year or more. That is to be welcomed, and I hope that it will continue.

Much has happened over the past few months. More patients are being treated. About £26 million is being spent on improving primary care facilities. There has been a remarkable achievement in waiting times, as the hon. Member for Ladywood mentioned. The redevelopment of City hospital has been mooted and it should be good news for health in Birmingham if it goes ahead.

Birmingham is acknowledged as a centre of excellence. It is home to Europe's first quick and early diagnosis unit for cancer treatment. It is one of the country's designated heart transplant centres. New and high-quality accident and emergency facilities are being developed in a number of places. There is good news. It is unfortunate that certain reports have given rise to alarm. I hope that I have been able to put the matter in context.

Question put and agreed to.

Adjourned accordingly at twelve minutes to Nine o'clock.