HC Deb 08 February 1996 vol 271 cc544-54

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

8.12 pm
Mr. Hugh Dykes (Harrow, East)

I am grateful for the opportunity to speak on this topic. As I raised it in April last year, it may seem strange that I have raised it again tonight, but significant developments have taken place in the intervening time. I make no apology for bringing up the subject again, as there is still great public concern about the future of Edgware general hospital.

The issue must be examined again very meticulously: although it is a local issue, it impinges on all the services provided by the NHS in the neighbouring areas of north and north-west London, and, indeed—as some patients are referred from parts of greater London that are a long way away—on services north of the river generally.

I thank my hon. Friend the Under-Secretary of State for Health for his attendance. I hope that he will be able to reassure me. This has been a long campaign: it began when the last Secretary of State for Health made what we regarded locally as a tragic, unnecessary and unjustified decision to allow local agencies to proceed with the closure of the hospital's accident and emergency unit, and it continues in full force.

It is interesting to reflect on the panoply of local campaigns, which seek numerous objectives. I suppose that nothing is more important than the provision of health services—the services of hospitals, GPs and clinicians, and all the other facilities that are provided by a national health service in which we still take enormous pride. Health is one of the most crucial issues, especially for older people.

Experience suggests, however, that—logically and understandably—once a decision has been made, even local people who disagree passionately with that decision may drift away from their previous strong position. Although their arguments retain their validity, they may say, "There is nothing that we can do. The authorities are determined to go ahead, and we must accept their decision even if we still disagree with it."

In this case, however, that has not happened: if anything, feelings are stronger than they were before. That is a remarkable phenomenon, which I cannot recall observing before in many years of becoming involved in local issues. The passions aroused by this unwise decision are still extremely powerful, and the mass campaign continues—supported by most local politicians, both councillors and Members of Parliament. That must be borne in mind; but it is even more important to bear in mind the tangible underlying reasons why the proposed closure is a mistake.

It was in that spirit that, along with other hon. Members from all parties, I tabled an early-day motion on 22 January. The composition of those who signed the motion reflected approximately the percentage of referrals from constituencies in the area surrounding the hospital. The motion asked the Department of Health and the Ministers concerned to ask Barnet district health authority and the other bodies involved, including the Wellhouse trust itself, to look at the matter again.

In early November, in the House of Lords, my noble Friend Baroness Cumberlege—speaking on behalf of the Secretary of State—repeated emphatically that, in a process of extensive and thorough consultation, Barnet health authority and the Wellhouse trust had consistently sought to involve the public in their deliberations through a series of public meetings and the distribution of leaflets and articles in the local press. My noble Friend went on to say that the Secretary of State would not be reversing decisions made by his predecessor.

I can understand that. That is the normal basis on which a new Secretary of State takes over a portfolio, which will include all the adjustments that have been made in hospital policy. Conservative Members need no lectures from the Labour party, which many years ago, when it was in government, either closed or savagely cut some 60 hospital units per annum.

It is normal, and natural, for Secretaries of State to say, "I cannot go back on the decisions of my predecessor." Officials present the position in those terms when the new Secretary of State takes over. Dossiers are examined, but there is no suggestion of reconsidering closure proposals. That is understandable, but I nevertheless feel that a fundamental mistake has been made in this instance. Given the importance of the issue to local people, I hope that my hon. Friend the Minister will listen to the details sympathetically.

I was grateful for the opportunity to raise the matter in the lengthy Adjournment debate that took place on 5 April. Once again, tonight's debate has begun before the time when public business normally ends in the Chamber. Let me reassure you, Mr. Deputy Speaker: that does not mean that I shall speak at excessive length. I believe that my hon. Friend the Minister has an engagement, and I shall be speaking at a dinner if I manage to arrive on time.

In the previous debate on the Audit (Miscellaneous Provisions) Bill, the hon. Member for Brent, East (Mr. Livingstone) was, for various reasons, obsessed with the state of Brent council. With even more justification, I am obsessed with the future of Edgware general hospital, although, I hasten to add, it is on the other side of the road shared equally between myself and my hon. Friend the Member for Hendon, North (Sir J. Gorst).

I remind my hon. Friend the Minister of a number of important considerations that, once again, point powerfully to an unusual and demanding position that can irritate any Government, Ministers and officials who, once they have reached a decision, believe that they cannot go back on it. In this case, there are reasons for reconsidering the matter carefully.

I reiterate what I said on 5 April during the previous Adjournment debate. When the accident and emergency facilities at the Royal National orthopaedic hospital in Stanmore were closed about 12 years ago, it was reiterated repeatedly by the local agencies—the Minister will recall that there was a different structure then—and by Government spokesmen—and I can give chapter and verse on this any time the Minister cares to ask for it— that the local public did not need to be concerned about that, because the A and E facilities at Edgware general, which was just down the road, would take care of any substitution.

That important factor persuaded a number of local people reluctantly but gradually to accept the closure of the Royal National orthopaedic hospital's A and E unit— a successful unit, and one close to the Ml motorway. That closure was also a mistake, but it happened a long time ago, and we cannot go back on it.

In that Adjournment debate, if I may quote without taxing the House's patience, I said: I am worried about all aspects of the closure proposal. That is why others and I will be fighting hard and relentlessly to persuade the Government to change their mind. I am especially concerned about traffic congestion. It is an extremely congested area. If people are obliged to go to Barnet, Northwick Park"— the main district general hospital in the middle of my constituency, and located alongside the town centre— or the Royal Free Hospitals, their journeys will take a great deal of time."—[Official Report, 5 April 1995; Vol. 257, c. 1792.] There has been no significant reassurance by anyone that I care to recall—unless the Minister can disabuse me tonight—that that would not be so. The local public are extremely worried about that.

The hospital's A and E services are needed as much as the Barnet hospital must be expanded. Because it is in another region, I shall deliberately refrain from commenting too much in detail on Barnet hospital and its build-up, which I also welcome. No doubt there will be some referrals from my constituency to that hospital, although obviously not many. That would be welcomed by the local public, but it does not negate or reduce the primary requirement for Edgware general to remain a major multi-department medical facility in its own right, and not to be truncated drastically and tragically by closing its most important section—the accident and emergency facilities.

There is no reassurance so far on that point. It remains to be seen what the Government and others responsible for the decision will say in detail about these matters. Traffic congestion is one of the main issues that will arise again and again when these matters are considered.

There is no diminution in the force of the local campaign—I emphasise that. I am not at all reassured by any statements so far from the Wellhouse trust, London ambulance service representatives, other people involved and Department spokesmen. There has been no significant tangible reassurance about the provision of the necessary ambulance services that would take care of additional journeys to the other units instead of Edgware general. That is a glaring gap in the range of information that is needed to reassure the local public as the campaign forges ahead, trying to persuade the Government to change their mind on this important issue.

I referred to that matter last June, when there was a further development in the local campaign. There was an enormous expansion in public anger and resentment that the authorities would in no way reconsider the decision. As I mentioned in that Adjournment debate and elsewhere, the local public consultations, including those of the regional health authority, were extremely inadequate and people did not feel that their points were listened to with care and responded to in any way. They were brushed aside—that is the glaring truth of this sad saga.

After a further stage in the campaign, when a number of meetings took place, I suggested In my June statement: we have to stick together to try and persuade the Department of Health to change its mind. This is a gigantic task. We should be firmly united, not seeking narrow Party advantage. The campaign is of the whole of the people, and has nothing to do with political parties in that direct detail.

The statement continues: It needs to be a sober campaign not an historical and emotional one. In that campaign, local politicians should aim to achieve the central objective of persuading the Government to change their mind on the A and E facility, not seek to score points off each other or indulge in gesture politics, which will not save the accident and emergency facilities.

In that spirit, there were various questions from me and hon. Members in the summer months, seeking to get the Government to persuade Barnet health authority to change its recommendation and to reconsider these matters, as it could within its own powers, but we did not succeed, as is well known.

Autumn came. After continued campaigning, there was still no significant response from the Department to, for example, my question in a letter to the Secretary of State for Health on 21 July about traffic congestion and the excessive time needed for ambulance journeys Northwick Park hospital even with the blue light operating. Some informal tests have been done of those journey times, which were disturbingly long.

I again show to the Minister the local map produced by the Canons Park residents association campaign in its newsletter, an effective document. It produced a series of articles about the issue, continuously, up to the latest editions, showing again how congested the area around the Edgware general hospital is, how relatively uncongested the area around Barnet general hospital is, and the difficulty of those various journey times.

In July last year, the Prime Minister was kind enough to reply to my letter to him. I thought it was right to make some of these points to No. 10 Downing street. At the end of his letter, he confirmed that it was necessary to retain "significant" hospital services at Edgware. He did not go into detail—rightly, he left that to the Department and to his colleagues—but it is what "significant" means that is of major concern.

All the medical experts that I have talked to say in some detail say that, if we excise anything other than just the marginal A and E services in a modern A and E unit such as that at Edgware hospital, we inevitably undermine the provision of services in that hospital and its ultimate rationale. We could turn it into a sort of bucket hospital— if that is the right phrase, without alarming people excessively—that just starts running down.

I am sad to say that there are a few examples of the running down of facilities already as people psychologically start preparing for the ominous moment in May 1997, the scheduled date for the closure of this significant facility. They are starting to think of it as a much truncated unit offering a limited range of services.

There is still time, however, for all this to be reconsidered, without anyone being humiliated into a drastic climbdown or a change that is beyond all reasonable expectations. It would be absurd for anyone to expect the Government to say that they are completely reversing a decision that was taken after, I presume they would suggest, considerable thought, but it is the way in which the issue is reconsidered to try and achieve the right solution for the modern A and E facility that we still want at Edgware hospital in 1997 and beyond that is important.

That is the key to what the Government can suggest to Barnet health authority and the Wellhouse Trust on how they should handle the matter and reconsider. None the less, I am aware of the absolute need to support the new managers of Wellhouse trust and not to humiliate or embarrass them, or to make them think that their role is being betrayed by a change that goes beyond their expectations for the detailed range of services that the modern hospital will offer.

I acknowledge that Barnet, with its expanded, modern, high-technology facilities, is vital, especially for people in the northern part of that borough. Again, I shall deliberately refrain from annoying my colleagues, if they read my words in Hansard, by commenting too much on what is happening outside my borough of Harrow.

Of course, Northwick Park hospital is central to our requirements in Harrow town centre. It also serves Brent, and takes patient referrals from as far as away as Ealing and beyond. However, Edgware general is in the middle of all those areas, and it should still be a significant major hospital for them, rather than being reduced, as it might be, to a low-facility unit.

The campaign continues. I pay tribute to the enormous power and effect of the Hands Off Our Hospitals campaign, and to all the people who have organised it. They have not given up; they have not reduced their activity and efforts. I shall bring to the Minister's attention information that we received recently through the campaign supporters' newsletter. There will be a campaign consultative meeting on 22 February, and another major rally, to engage the attention of all of the public in that area again, on 19 March, right in the heart of the Edgware general hospital area.

I understand the temptations for Ministers, bureaucrats and officials. If I were in their position, I should probably feel the same, and hope that attrition would account for the campaign, and that there would be a diminution in the intensity of feeling. But that is not happening. I must emphasise that to the Minister as strongly as I can. People want those significant facilities to remain. They want much more than the suggested replacement—that is, the minor accident treatment service now officially proposed by Wellhouse.

The consultations that the trust management said would be undertaken do not seem to have added up to much yet, although my colleagues and I have been offered several meetings. I do not decry that in any way, but I am not sure the trust is doing what it should for the local public.

There was an arresting headline in the local press recently. I hope that I am not showing too many exhibits tonight, Mr. Deputy Speaker, as if we were in a court of law, but we are dealing with a vital issue for the local population, and I am grateful for your indulgence. I should be happy to let the Minister have a copy of the 1 February edition of the Edgware and Mill Hill Times, whose headline is "Closure plans may be illegal".

I have been dealing with many other matters this week, so I have not had the chance to find out whether that charge has been refuted, from whatever quarter, so I quote it subject to those inevitable reservations. Underneath that startling headline is another: "CHC threatens legal action over lack of consultation on Edgware General". The article says: Barnet's patient watchdog has accused health chiefs of acting illegally over plans to close Casualty"— that is, the accident and emergency facility— and has warned it could take the matter to the courts. Barnet Community Health Council… believes that Barnet Health Authority … is breaking the law by obstructing it in its duty to be consulted over health care changes. Much more follows, and what the newspaper says must be of significant concern to the Department of Health when it considers what would be the only drastic reduction or elimination of a major facility in a significant NHS hospital on the outer London fringes. That, among other reasons, is why we feel so steamed up about it.

One reason why I have deliberately raised the subject now is that there are now rumours of possible second thoughts from the Department of Health, and of a possible reconsideration of some aspects. The Wellhouse trust management may be trying to engage the attention and sympathy of local GPs, by holding various consultations to try to find possible ways through the problems.

Provided that the present A and E facilities are to be retained in their basic and major form, any suggestion would be considered fairly and fully by the patient representatives, by the representatives and spokesmen of the Hands Off Our Hospitals campaign, by the local parliamentary representatives, by local councillors and by the many thousands of other local people involved.

It is now for the Government to take on board the serious fact that the campaign will not go away. The campaign has no narrow political axe to grind; it represents literal common-sense reality, and what the local public feel, aided by their medical advisors and by a range of powerful voices from GPs, surgeons and consultants, all of which say that the decision must be reconsidered.

A basic mistake was made. The profound consultation necessary was lacking. There was an unwillingness— possibly inadvertent but, unfortunately, probably deliberate—on the part of the regional health authority and the district health authority to consider the many and voluminous representations of local protestors.

Those people were not simply indulging in the normal knee-jerk reaction, without any consideration of the details, when medical facilities are threatened. The very location of the hospital provides the main reason for the continuing concern. There is an overriding need for the Government to think again and to work out how they can accommodate the demands from Members of Parliament and from the local public.

The campaign will not go away. It will continue. If the Secretary of State and his ministerial colleagues can give us comfort and say that the services will be maintained, the public will be reassured, even if there are to be some changes. I am speaking theoretically, because I do not want to raise the subject of change deliberately.

For obvious reasons, I refrain from making any specific suggestions tonight. But even if the main high-technology equipment is to be located at Barnet—one can understand the investment priorities of its new programme—none the less, despite that small reduction at the margin, the whole range of existing A and E facilities could be maintained.

There must be a way forward, a way in which the Government can meet the demands of the local public. If not, the campaign, the agitation—I use that word in a respectful sense—and the massive force of the combined voice of the people will continue, and I shall give it my full support all the way, as is my duty as a Member of Parliament.

I hope that my hon. Friend the Minister can say something that will help, because the local press will be waiting for the Hansard report of the debate. I did not suggest that, but that is what I was told. This is a most important occasion. There is still more than a year before the fateful decision is to be made, and before there will be any further damaging rundown of the hospital. Alarming stories are already coming out. I hear messages about them every week, with examples of services that are just beginning to be reduced at the margins, because of the low morale of everybody involved and the plight of the staff, for whom I have much sympathy.

The Government now have a marvellous opportunity to seek to reassure us and to put a new dynamic into the future of the Edgware general hospital, by saying that the important A and E facilities will be kept—because, as I have explained, they make sense. So I look forward with great anticipation to my hon. Friend's words.

8.38 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam)

I congratulate my hon. Friend the Member for Harrow, East (Mr. Dykes) on his success in the ballot, and I am pleased to have the opportunity to debate what is undoubtedly an important matter. As always, my hon. Friend spoke forcefully and with eloquence in advocating the best possible health care for his constituents. He has, if I may say so, conducted a long and skilful campaign on the matter.

I should mention in passing that my hon. Friend the Member for Hendon, South (Mr. Marshall), who has also been assiduous in this matter, unfortunately cannot be here this evening. I know that he has also played a part in the long-running campaign.

I acknowledge the point that my hon. Friend the Member for Harrow, East made forcibly about the strength of local feeling on the matter, which is probably running as high as it has been at any stage during the whole lengthy business. I can assure him that the Government are concerned about the matter. Ministerial colleagues and I have devoted a great deal of time and attention to the subject in recent months, and we want to ensure the best possible balance for the future provision in the area. I hope that my hon. Friend will take those commitments and assurances in the spirit in which they are given.

My right hon. Friend the Secretary of State has recently met deputations about the future of Edgware hospital— including one led by my hon. Friend—and the matter has been the subject of debate in this House and in another place on a number of occasions. I also assure my hon. Friend that the Government's first priority, and that of the Secretary of State, is to put the interests of the patient first. As decisions are implemented and new decisions are taken, our guiding principle will be that the quality of service should be at the very least maintained, and wherever possible improved.

The changes already agreed at Edgware are designed to provide the people of Barnet and Edgware with a high-quality, improved clinical service for patients. The present split-site arrangements at the Wellhouse NHS trust, with the inevitable duplication of facilities between the Barnet and Edgware sites, are not only inefficient, but significantly detrimental to good patient care. That is despite the dedication and hard work of the excellent medical and nursing staff at the Wellhouse trust. To ensure that the best health services possible are provided, patients need modern facilities in hospitals large enough to ensure appropriate levels of staffing and expertise. That is precisely what the development at Barnet general hospital is about.

The changes due to take place at Edgware and Barnet hospitals are part of a long-term programme of improvements to health services provided at the Wellhouse trust. They have been finalised only after an extensive and thorough process of consultation. Barnet health authority has been exemplary in involving the public in its deliberations through a series of public meetings, the distribution of leaflets and articles in the local press. It has gone to great lengths to explain how patients will benefit from the planned changes, and why change is necessary.

Inevitably, when change comes to much-loved local hospitals such as Edgware, there is great public concern. It is also unavoidable that, when changes to any local health services are determined, there will be some who find the new arrangements less convenient. I fully understand that. I say again, however, that we believe that the changes at Edgware and Barnet will lead to an improvement in patient care.

I now wish to refer to the implications for Edgware hospital, which are of such concern to my hon. Friend. Despite any change to its status that may ensue, Edgware hospital will continue to be a significant provider of health care in the area. I note the point that my hon. Friend made about a letter from my right hon. Friend the Prime Minister, which stated that the hospital would be a significant provider of health care. He rightly asked what exactly was meant by the word "significant" in that context.

The Government mean that there will be an extensive provision of out-patient clinics, day-care services, a breast-screening centre and mental health services. These will ensure that the hospital continues to provide an extremely wide range of services. In addition, an accident service will continue at Edgware. My hon. Friend knows that the MATS centre—to use the jargon—was opened by the chief nursing officer in November 1995, and the majority of patients who currently look to Edgware for their health care needs will continue to find them there.

Decisions remain to be taken on the final pattern of services at Edgware. Consultation is under way on various proposals, including the treatment of the elderly and children on the Edgware site. The decisions that have already been taken—never mind those that may be taken following consultation—mean that around four out of every five patients currently attending Edgware will continue to be treated there.

I must also emphasise—quite apart from what I have said about existing and potential services—that the changes at Edgware hospital will not happen immediately. They will only take place once any redevelopment of Barnet general hospital and the expansion of services at Northwick Park and the Royal Free hospital have been completed, and improvements in the ambulance service have started to be delivered. All this is part of a coherent plan, and we must ensure that nothing happens until we are perfectly certain that all the other elements are in place.

The House will be aware that the redeveloped Barnet general hospital will provide the full range of acute services. I can assure the House that the facilities being developed there will be of the highest quality. The £29 million first phase of redevelopment work started in November last year. The second and final phase, costing £33 million, can now go ahead. Once this work has been completed, we will in effect have built an entirely new hospital, which will allow local people access to the highest quality specialist acute facilities. The new accident and emergency department at Barnet will be one of the most up-to-date in the country, capable of treating 70,000 patients a year to the highest clinical standards.

As Edgware hospital changes its role and becomes more of a local hospital, so local primary services will need to adapt to the different circumstances. It is an essential element of the plans that primary care services will be developed. Local GPs will need time to develop human and financial resources to manage the shift from secondary to primary care, and will need to be closely involved in the development of services on the Edgware site.

My hon. Friend did not mention the fact that, in order to facilitate these changes, the local primary health care development fund plans to invest £17 million over a five-year period to improve local primary care services. My hon. Friend knows that the Government believe that the health service should be primary care-led, so we attach great importance to bringing together hospital and primary care.

Projects at present under way include the extension of nursing in the home for the terminally ill, improvements in GP surgeries and an outreach ophthalmology clinic. Projects planned for the future include increases in community nursing staff, further training of GPs to carry out minor surgery, and the introduction of community physiotherapy to improve the care of diabetics. I believe that these developments provide an excellent framework in which to ensure the success of the new Edgware hospital.

My hon. Friend also referred to the problems of transport in the area. I am aware that specific concerns have been expressed about the problem. I do, of course, acknowledge that some patients from the Edgware area will have great difficulty in travelling to Barnet. For this reason, a free NHS bus service will operate between the sites for those patients who require services that are being concentrated at the Barnet site. Special arrangements will be made for elderly and infirm patients who are less mobile. It must be recognised, however, that the majority of the services currently provided at Edgware will remain.

Particular concern has been expressed about the problems of transport in relation to accident and emergency provision. To address these concerns, the health authority intends to provide additional investment over and above the significant increase already agreed this year. Two additional ambulances and crews will be funded at an extra cost of £320,000.

As a former Transport Minister, I have considerable sympathy for my hon. Friend's point about traffic congestion in the area. He said that that was a serious matter that had not been fully addressed. We take that point seriously, and understand local concern that problems could be caused at the congested bottom end of the Ml. I will look at that point.

Mr. Dykes

We are concerned about the specific length of the journey from Edgware general to Northwick Park. The actual time would be a minimum of 45 to 50 minutes in normal traffic conditions, and that is far too long.

Mr. Horam

I hear what my hon. Friend says, and that adds to my concerns about traffic congestion. I will look at that point.

We believe that the proposals approved for the development of hospital services for Edgware and Barnet will lead to improved health care for the local community.

They are being brought forward after lengthy consideration and consultation—which has not yet been completed—and will allow Barnet health authority to meet its statutory duty to ensure that residents of the area are provided with a comprehensive health service meeting the full range of their needs.

Some of the current facilities are below the standards that we believe patients should be able to expect. We are engaged in an effort to improve conditions for the people of the Harrow and Barnet area. We believe, therefore, that, if the plans are properly and fully implemented, taking into account the additional consultation, which is in train, that part of London will have facilities that will match the very best in the national health service.

Question put and agreed to.

Adjourned accordingly at eleven minutes to Nine o'clock.