§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]
§ 10 pm
§ Mr. John Austin-Walker (Woolwich)
Tonight's debate takes place against a background of chaos—the chaos of cuts, closures and confusion in the national health service in London and the Thames region—and in the wake of the tragic death of a patient for whom a bed could not be found in greater London.
On the radio today, the hon. Member for Hendon, North (Sir J. Gorst) described the consultation about cuts and closures in his area as a sham. A fortnight ago, the Minister responsible for the citizens charter—who has just left the Chamber—said he was astonished that there was nowhere in London where one of his constituents could be treated. The Secretary of State for Health, however, seems to suggest that there is no problem in London and the south-east.
Let me remind hon. Members of the tragic events that led to my request for this debate. On Monday 6 March, at about 10.55 pm, Malcolm Murray was involved in a road accident. An ambulance was called at 10.57 pm, and arrived about 10 minutes later to take the patient to Queen Mary's hospital in Sidcup, arriving at about midnight. While doctors, nurses and ancillary staff fought to stabilise the patient and save his life, the senior house officer—the junior doctor—spent hours on the telephone trying to find a specialist neuro-surgery bed.
The nearest neuro-surgery unit—at Brook general hospital, with which the hon. Member for Eltham (Mr. Bottomley) is familiar—was closed that evening: it was not accepting referrals, because of an outbreak of gastric flu. I understand that the junior doctor contacted some nine units in the Thames region, and eventually a place was found; as we now know, the nearest that could be found was in Leeds. I am aware that an inquiry is currently taking place.
At about 5 am, an RAF Sea King helicopter travelled from Wattisham to Sidcup to airlift the patient to Leeds, where he arrived at about 8 am. He went into theatre at about 9 am, and was there for several hours. After surgery, his condition was critical and, tragically, he subsequently died.
In advance of the inquiry, I wish to pay tribute to the staff at Queen Mary's, Sidcup, who did all in their power to save the patient's life. I also pay tribute to the RAF for its rapid response, and to staff at Leeds general infirmary, who also did all in their power to save the patient.
During that week, in a damage limitation exercise, the Prime Minister said: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.]Leeds infirmary is indeed a specialist unit, which had the skill and expertise to treat the patient, but that skill and expertise is not unique to Leeds; it was available in the nine or 10 specialist neuro-surgery units in Greater London and the south-east, where no bed could be found for a patient from south-east London.
592 In a letter to me, the Under-Secretary of State for Health wrote that it was oftenvery difficult to strike a balance between wasteful over-provision of services and effective use of the resources available.In a parliamentary question, I asked what was the capacity and occupancy of those units on the night concerned; that information, surely, would show whether there was wasteful over-provision and over-capacity. The Minister said:Information on units' capacity and occupancy rates on the night of 6 March is not available centrally."—[Official Report, 13 March 1995; Vol. 256, c. 409.]If that information is not available to the Minister, I do not see how he could make the statement that he did in his letter to me.
The Minister also suggested in his letter that one in six existing beds is inappropriately used, and therefore not always available for the life-threatening emergencies for which they were primarily intended. Is he suggesting that, perhaps, some consultant surgeons in London were refusing to take admissions, waiting for a more interesting case? Again, I should like to know the substance of what he said.
What is beyond dispute is that the south-east quadrant has been poorly served in neuro-sciences because of uncertainty about the future. For example, the Brook hospital has had great difficulty in recruiting a neuro-anaesthetist.
I accept the argument that any specialist centre needs a high volume to gain expertise, not just for the surgeons but for the whole team. One health service planner in my region has suggested that a critical mass would be a unit with five or six intensive care beds. I understand that the Maudsley has two, and the Brook three. Both size and uncertainty may have contributed to recruitment problems.
The Government's favoured option appears to be to move the Brook further into central London and so further away from south-east London and Kent, the area that it is supposed to serve. Despite the Secretary of State's recent statement to the House—in which she said:A generation ago, people travelled from the home counties to the London hospitals"—now:Patients and GPs rightly say that they would rather have treatment close to home than travel to London.—[Official Report, 20 February 1995; Vol. 255, c. 33.]I do not dispute the need for centres of excellence, but why not one in south-east London? If the Brook is to close, why could not neurology and neuro-surgery facilities be located at the Queen Elizabeth hospital in Woolwich or Queen Mary's hospital in Sidcup? They are extremely convenient for the M2, the M20 and the M25. Indeed, the Queen Elizabeth has its own helipad.
In a recent debate, the Secretary of State asked how we could deal with the issue of hon. Members having great affection for their local hospitals, which cannot provide the critical mass for sub-specialties and the costly equipment needed for state-of-the-art services. In Greenwich, the Queen Elizabeth or Queen Mary's could house the Brook units. North of the river, Oldchurch, with its accident and emergency and maternity and gynaecology intact, could also continue to provide neuro-surgery services. We do not need to move the units into central London to provide critical mass.
593 I have mentioned Oldchurch, which is across the river from my area. I understand that there has been consultation, but no commitment to the number of neuro beds or facilities. My information might be wrong and my fears unfounded, but I can tell the Minister that they are shared by people in that locality. Perhaps tonight he could go some way towards giving them some assurances.
My experience and that of my colleagues representing south-east London appears to be replicated by that of hon. Members representing north-east London. The hon. Member for Romford (Sir M. Neubert) has been a consistent campaigner for Oldchurch hospital. In the past, he has been supported in his campaigns by other Conservative Members, including the hon. Members for Upminster (Sir N. Bonsor) and for Hornchurch (Mr. Squire). Indeed, in a debate some years ago, the hon. Member for Hornchurch, in opposing the closure of Oldchurch, called on the Secretary of State to
desist from this unnecessary, irrelevant and expensive exercise".—[Official Report, 27 February 1991; Vol. 186, c. 1094.]The reorganisation plans were also vigorously opposed by my former colleagues, Jo Richardson and Bryan Gould. Recently, my hon. Friends the Members for Dagenham (Ms Church) and for Barking (Ms Hodge) have told the House of their concerns about more recent plans for the Oldchurch hospital. As the hon. Member for Romford previously told the House about closure plans:
the community health council, the London boroughs of Havering and of Barking and Dagenham, trades unions, doctors, patients, other organisations and members of the public have been loud in their disapproval."—[Official Report, 27 February 1991; Vol. 186, c. 1091.]While the proposals for total closure may have been shelved, the rundown of the hospital has continued, despite vociferous local opposition. The Government appear to have ignored the views and wishes of the community in one of the largest health districts in London by agreeing to transfer accident and emergency services miles away to Harold Wood, with an insufficient number of additional beds to satisfy the in-patient demand that will be generated.
A series of inevitable consequences has been set in train, and the consultation exercise becomes a sham. Many of the regions where accident and emergency services are threatened score high on any social deprivation index. The Black report in 1980 showed conclusively that accidents are class-related and that,when people work in hazardous conditions, or children in unsafe housing experience higher accident rates, it is the speed and the quality of response of the health service that can make all the difference to whether injury is fatal, or whether it results in permanent or temporary disability.Early response was crucial in the situation at Orpington hospital and at Queen Mary's hospital, Sidcup.
Oldchurch hospital has a high neuro-surgical case load compared with other units in the Thames region. It could be expanded on site. The beds currently closed could be reopened with increased contract income. In those circumstances, the move of the unit either to Royal London hospital or Harold Wood hospital makes no sense, but that is the likely outcome.
Neuro-surgery services serving east London, north and south of the Thames, could end up moving further into central London. In the south-west of London, what is the 594 future for the world-renowned centre of excellence at Atkinson Morley hospital, over which a threat has been hanging for many years?
Over a long period, together with Greenwich council and the community health council, I have expressed the view that the regional cardio-thoracic and neuro-science departments should continue to be located at Brook hospital. When it was clear that the Ministry of Defence intended to vacate the more modern facilities at Queen Elizabeth military hospital, local Members of Parliament of both parties supported a planned transfer of services from the Brook to Queen Elizabeth hospital.
The regional speciality services based at the Brook have established an enviable reputation, pioneered much innovative work, and been responsible for many medical advances. That has been achieved despite the fact that staff have been working in a less than adequate physical environment, in a hospital that has had the threat of closure hanging over it for some 15 to 20 years, and where staff have been demoralised by the progressive rundown of their departments. But as the community health council has said in its response to the consultation document:
The letters we receive from neuro and cardiac patients from a wide area and the enthusiastic fund-raising and support work carried out locally both testify to the excellent service carried out by these departments".I share the community health council's concern that the option of moving the regional specialties to the Queen Elizabeth was not even considered in the post-Tomlinson speciality review. The reason given was that the Queen Elizabeth was not a national health service hospital. It was not at the time, but discussions were well under way between the Department of Health and the MOD, and between the MOD and the local health authority. It will be an NHS hospital in the near future. That proposal should be considered seriously now.
The most recent consultation document says that other health authorities are already planning to send patients to the proposed central London centres, but, as the Queen Elizabeth option was not included as a possibility, other commissioners have not been in a position to consider all the options.
The Minister must be aware of the growing fears and concerns, and of the dissatisfaction expressed by consultants about the plans for the Maudsley-King's unit, both in the transitional period and in the long term. Services from the Brook will be shoehorned into King's, which is already unable to cope with demand, as evidenced by the deferral of the proposed closure of Dulwich hospital. Services are to be shoehorned into that unit, together with 44 Maudsley neurology beds, without easy access to medicine, surgery or intensive care. Doubts still remain about the ability to provide the capital investment needed for a long-term solution.
In response to the consultation document, the community health council states:
In addition, it is claimed in justification for the proposed move of Neurosciences to Kings, that proximity to the psychiatric services at the Maudsley will be advantageous. The CHC has not heard any arguments supporting this theory. While cross referrals may take place, they are unlikely to be greater between Neurosciences and Psychiatry than between many other speciality areas.It is also difficult to understand why the Tomlinson and post-Tomlinson reviews concluded by recommending that specialist services be moved into London (though the reviews differed in the 595 preferred destination) when these recommendations go against the two main aims of the exercise: to move services out of London and to ensure that services followed patients.Greenwich residents have a higher level of cardiac problems than most of their neighbours and accidents necessitating neuro-surgery occur more in this area near to major road systems. The proposal however is to move services into London and away from patients.There appears to be complete confusion and little agreement about future plans. Why are some cardiac beds to be transferred to Guy's/St. Thomas' and some to King's? The Lambeth, Southwark and Lewisham consultation document shed no light on this. Neurosciences will be split, as the King's development will not be ready to receive them for at least two years after the Brook closes. Patients will need to go to the Maudsley for neurology and to King's for surgery. I wonder whether that will that count as two patient episodes. In any event, it is neither cost-effective nor in the interests of patients or staff.
There are already problems for my constituents, with paediatric neurology services being split between Guy's/St. Thomas' and King's—so much so that paediatric consultants in Greenwich are recommending that future contracts for acute neurology and neurosurgery be placed at Great Ormond Street, where services can be provided under one roof.
I ask the Minister, even at this late stage, to recalculate the cost of the proposed move of the regional specialty services and contrast it with the cost of transferring those services from the Brook to the new Queen Elizabeth NHS hospital. While doing so, will he perhaps tell us why, in the transfer, it is proposed that 10 beds will disappear?
§ The Minister for Health (Mr. Gerald Malone)
I am grateful to the hon. Member for Woolwich (Mr. Austin-Walker) for the opportunity to inform the House about the important matter that he has chosen for this Adjournment debate. I begin by offering the family of Mr. Malcolm Murray my sincere condolences following his recent tragic death.
I am delighted to see my hon. Friend the Member for Eltham (Mr. Bottomley) in his place. Indeed, he ministered to the hon. Member for Woolwich, who, although he did not refer to the need for ear, nose and throat facilities in his constituency, seemed to require them this evening. I congratulate him on getting through his speech despite his evident difficulties.
I deal first with the Murray case. It leads to a number of concerns, and I should like to take this opportunity to deal with them. The transfer of Mr. Murray from Queen Mary's hospital in Sidcup to Leeds during his NHS treatment for serious head injuries on 7 March has rightly led not only—partially—to this Adjournment debate but to other expressions of serious concern about the availability of appropriate facilities for his treatment and care.
The House will by now be well aware that, on 8 March, South Thames regional health authority initiated an investigation into the case and the key issues arising from it. South Thames RHA has already given a commitment to publish its report to my right hon. Friend the Secretary of State for Health as quickly as possible. I understand that the report will not be long delayed.
596 I am sure that the House and the hon. Member for Woolwich will appreciate that I cannot pre-empt the findings of the panel that has been appointed to report, but I should like to take this opportunity to make three points about the case and the circumstances that pertained on the night of 6/7 March.
The patient, Mr. Murray, required neurosurgery and intensive facilities. The intensive care facilities at or adjacent to the 10 hospitals in the Thames regions with neurosurgery facilities were certainly all very busy on the night in question. That does not, however, rule out the possibility that, with better bed management, a neurosurgical bed with intensive care support might have been made available.
On the general question of overall provision of neurosurgery facilities, which is of course important and sets the context of the debate, a review of regional records shows that, in 1994, all South Thames residents requiring neurosurgery were treated in hospitals in the Thames regions or in Southampton, which is more convenient for some residents in the south-west part of the South Thames region. More specifically, I understand that the consultant who received Mr. Murray in Leeds praised the way in which he had been treated before and during his journey. It is important to set that matter on the record.
As I have said, however, more detailed public consideration of this case will have to await the publication of the panel's report, but Ministers are being kept abreast of the key findings and issues raised, which will inform other decisions meanwhile. I am sure that the hon. Gentleman understands that, on that particular matter, I am not in a position to go further this evening.
I turn now to the broader question raised by the hon. Gentleman about reviews of neuroscience. The House will be aware of the independent review of neuroscience in London, which was published in June 1993, to which the hon. Gentleman referred. The work of that review group has been carried forward in South Thames since October 1994 by another neuroscience review group, with the full involvement of clinicians. The analysis undertaken by that review group was reported to chief executives of health authorities in South Thames on Wednesday 22 March.
That analysis is, of course, connected with the proposals for the future of acute services in north and south-east London, which are now with Ministers for a decision. I am confident that our forthcoming decision on acute services in north and south-east London will provide the context for the rapid resolution of the issue of how best to provide the balance of tertiary neuroscience services required in the Thames regions.
I take this opportunity totally to refute the hon. Gentleman's suggestion that consultation is a sham. It is far from that. It is a proper consultation process in the fullest sense. The findings of the consultation process will be seriously regarded by Ministers, and properly considered, and decisions will be brought forward in due course in a proper way.
I am, of course, very much aware of the specific concerns about the robustness of neuro-anaesthetic cover at the Brook hospital, pending the taking of those decisions. Indeed, not too long ago, I had the benefit of a meeting with the hon. Gentleman and my hon. Friend the Member for Eltham in my office to discuss this very matter, and I listened to the points that they made 597 extremely carefully. I made further inquiries, and I am pleased to be able to say to both of them tonight that those inquiries proved fruitful.
As the result of all that, steps have now been taken to strengthen cover, with two appropriately trained senior registrars who are now available for the Brook. That means that the Brook neuro-surgery unit will be able to remain operational until new, improved facilities in the long-term are available elsewhere.
I hope that the hon. Gentleman accepts that my colleagues and I listened to the important points that he made. I hope that he will welcome my response as suitable, and that it allays a number of his concerns.
§ Mr. Peter Bottomley (Eltham)
May I say how much agreement there is on this side of the House with what the hon. Member for Woolwich said about the Brook, and how great a welcome there will be in and around the Brook for the announcement that my hon. Friend the Minister has made. The work load carried by the consultant anaesthetist has been extremely heavy, and everyone owes her a debt of gratitude for what she has managed to achieve.
§ Mr. Austin-Walker
I simply want to associate myself with what the hon. Member for Eltham (Mr. Bottomley) said, and to express my gratitude for the response.
§ Mr. Malone
I am grateful to the hon. Gentleman; the matter was indeed important. I must tell him that there are occasions on which Ministers are actually keen to reach the right conclusion, and I hope that this has been one of them.
At the beginning of my speech, I said that Mr. Murray required intensive care in addition to neuro-surgical services. The availability of intensive care unit services was just as much an issue in that case was the availability of neuro-surgery beds.
In 1992, the Department 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 was published on 7 February.
On 21 March, the Secretary of State met the presidents of the Royal College of Surgeons, the Royal College of Anaesthetists, the Royal College of Physicians and the Royal College of Nursing, as well as representatives of the Intensive Care Society and the British Association of Critical Care Nurses to discuss the findings of Professor 598 MacPherson's report and the way forward. My right hon. Friend brought that meeting forward, because she too was concerned about the implications of the events that had unfolded.
As a result, it has been decided to establish a professional working group to seek professional consensus on the criteria for admission to and discharge from intensive care. In addition, the Department is funding the intensive care national audit and research centre, to set up an audit facility and to maintain a United Kingdom database of patients in intensive care. The outcome of all that work will provide better information about the way in which intensive care units should be used to help inform practice in that important area.
The hon. Member for Woolwich asked what had been discovered about the occupancy of intensive care beds, especially those connected with neuro-surgery units, on the night in question. He will understand that I cannot answer that question specifically tonight, but I can assure him that such matters will be part of the subject of the review that is under way. When the report is published, in what I hope will be a short time, the matter will be dealt with, and the hon. Gentleman will have the answer that he seeks.
The tragic events of 6 and 7 March serve to underline the urgency and importance of the work already in hand to define and facilitate the best future pattern of neuro-science and intensive care facilities in the Thames regions. I believe that everybody acknowledges that, although people may have their individual views about how that destination should eventually be reached. It is true that existing patterns of services have served the community well, but both disciplines are at a watershed in their development.
In the context of what I have said this evening, I hope that the hon. Member for Woolwich will concede that the professional views widely expressed across London agree that a reconfiguration of specialties is extremely important if the excellence of medical care that London deserves, which should be the norm in this city, is to be preserved.
That aim was what informed the debate that resulted in the Tomlinson report and the inquiry undertaken by the specialty neuro-surgical review in 1993. I emphasise to the hon. Gentleman the importance of taking those matters forward, and the fact that the consultation process that is under way, which I shall consider soon, is an important step in the process.
I hope that what I have said tonight will reassure the hon. Gentleman that, in the round, we are looking at such matters in the most serious way. As for the particular points that he and my hon. Friend the Member for Eltham raised, of course we consider the specifics when they are raised before us. I hope that he thinks that my response this evening has been constructive.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.