§ Mr. Simon Hughes (Southwark and Bermondsey)I am grateful for the opportunity to raise again the future of Guy's hospital on the Floor of the House. I welcome the Minister, and I am grateful to him for his attendance. I do not wish to be unfair to him, but I am conscious that he has a double interest as a Minister in the Department of Health and as a south-east London Member of Parliament, some of whose constituents use the hospital. I know that some of them have contacted him as their constituency Member of Parliament about the future of Guy's hospital. The hon. Member for Chislehurst (Sir R. Sims) asked me to give his apologies to the House today. The House will know that he, and other colleagues, have sought Adjournment debates on this subject in the past. The hon. Gentleman is normally a good ally and collaborator on these matters.
I do not wish to take an antagonistic or confrontational approach today—the Minister and his colleagues have not done so in the past year—but I have some fundamental questions to put to the Minister that follow on from the more substantive debate about the structure of health services in south-east London that we had just over a year ago.
I wish, first, to clarify the position as the public understand it and then, secondly, to express in words which have been given to me some of the continuing concerns. Thirdly, I shall ask some specific questions about specific issues.
Guy's hospital has international renown as a teaching hospital. A medical and dental school is attached to it. It is based at London Bridge. Guy's is probably the most accessible hospital in London. It is literally on top of London Bridge station and at the junction of what will be two underground lines. There is the Northern line and there will be the Jubilee line extension, which we look forward to with much excitement. It is due to open in 1998. Work is taking place as I speak. As many buses turn round at the terminal as anywhere else. The hospital is across the bridge from the City, but it serves that area as well as south-east London. Guy's hospital has traditionally been one of south-east London's two principal hospitals. Over more than 270 years, it has built up an extraordinarily high reputation.
Guy's hospital has moved with the times. Since the war, it has developed two completely new buildings. The third, newest and most controversial building is Philip Harris house, as some of us perhaps mischievously continue to call it. I understand that that name is slightly problematical for some. Philip Harris, now Lord Harris, who is a great friend of institutions in south London, came from Peckham. He donated a significant sum, which meant that the building bore his name. But he was not pleased with the Government's policy on its use. Money was withheld and the name may now be written out of the history books, as it were. I hope that we can continue to honour Lord Harris's interest.
There is frustration for all of us who live, work, have our being in or use Guy's hospital. That is because there is a state-of-the art building within the health service that has taken almost as long to complete as the British Library. I do not put it in quite the same league as the library, for the library is in the premier league of delay, 365 whereas Philip Harris house is a first division delay. There is great frustration because it was built to include intensive care beds, specialist facilities and out-patient facilities, all to be integrated with Guy's tower and New Guy's house, as the third of the post-war developments.
I gather that it is now hoped that the new building will be opened next year. The time of opening has regularly been put back. I am reminded of the worldwide call of Jews, "Next year in Jerusalem." It will be a real Jerusalem day when the Philip Harris building opens. We want to know whether it will open, whether it will be open soon, and whether it will open within the terms of the all-singing, all-dancing, all-functioning plan that was intended.
Two building sub-issues deserve to be flagged up. Given the delays and escalating costs, I understand that the National Audit Office is investigating the cost overrun. That became apparent from an answer to one of my parliamentary questions some months ago. If the Minister can help us by outlining how far that investigation has reached, that would be helpful.
The second sub-issue appears to be due significantly to a problem with copper piping. It would be helpful to know whether the problem has been resolved and will no longer delay completion.
Philip Harris house has a crucial role in the overall equation. There is general agreement that some of the wards at Guy's hospital are no longer suitable for the purpose for which they were built. Hunt's house, for example, is an old building that is due to be knocked down. The community is sentimental about it, but is ready to see it go, for it is clearly not up to scratch. It is intended in part for that building to be replaced by Philip Harris house phase 3.
I want to ensure that Philip Harris house will be fully used and to argue, against the background of the discussions that have taken place, that it should be used for the purposes for which it was intended. One failure over the past couple of years has been not to understand that we are at risk as a nation in spending money on health service capital plant in south-east London to the extent of about £150 million, some of which has been contributed in the form of donations to Philip Harris house, and then not using such facilities to the full. We are at risk also of spending even more money on Philip Harris house through a change of use that is in the pipeline. In addition, we are at risk of spending even more money to provide facilities elsewhere, which would not be necessary if we were to use Philip Harris house for its intended purpose.
I seek assurances from the Minister that Philip Hams house will be open, at last, next year and that there are no further problems. I want an assurance also that it will be used for the purpose for which it was intended. An update on the NAO's position would be helpful.
I have set out the relevant geography and history with one exception, which was the subject of a debate in the House on 24 June. There are advanced plans for the medical and dental school, which is now called the united medical and dental school of Guy's and St Thomas's hospitals, to be merged with the King's College hospital medical and dental school and King's college, London. I apologise for that mouthful. It is proposed that the merger will take place soon. The relevant Bill has been 366 recently before the Select Committee on Unopposed Bills. It will return to the House in due course; it has been given a Second Reading. It is not entirely uncontroversial.
In outline, on the west side of a road that runs through the Guy's hospital site at London Bridge—it is called Maze Pond—there will be the medical school and its facilities. That is to be welcomed. On the east side, there will be the hospital plus the dental hospital and the dental school. That is relevant to the history of these matters, because whether the merger takes place, it is clear that there are plans to keep on the Guy's site a medical and dental presence. It is hugely important to the future of the hospital that the medical and dental school remains. There is no argument that it should not. At the same time, there are logical implications.
On Second Reading of the King's College London Bill on 24 June, the Minister who then occupied the Government Front Bench supported the Bill and, understandably, did not then go into details of health service provision on the Guy's hospital site. I hope that today the Under-Secretary of State can answer the question that is in everyone's mind, which is: why, if we are to have one of the premier British and international medical and dental schools on the Guy's hospital site, as we wish, is it not logical that there should be a large out-patient department along with in-patient provision, which goes across the specialties, or at least some, as well as including elective beds for routine waiting list operations, such as orthopaedic operations and hip replacements? Medical students would then have the opportunity on site of seeing out-patients and in-patients.
It is an obvious part of medical and dental training that there should be patients to see. I understand that the academic practice nowadays is to start clinical work at an earlier stage. Two years is not spent solely on theory, followed by practice. Obviously, it is less important that there should be beds available for dental students. At the same time, it is clearly important that there should be such provision for medical students.
All the advice that I have been given and all the feelings that have been represented to me by the student body—I heard the feelings of that body recently and spoke about a week ago to student representatives from the medical and dental school—are that there is no wish for a split site for the medical and dental school and the hospital. It is nonsense for teaching not to be carried out on the same site as the home-base hospital.
I seek an assurance that there will be sufficient beds at the Guy's site, not just for mental health patients—we welcome the 112 beds for elective patients from the local community—but for other medical and surgical work, which will make it logical for teaching to be carried out on the same site. Students should not have to shuttle around a triangle in congested south-east London—even if they use bikes—between the sites at Guy's and St. Thomas's and the King's College site at Denmark hill, Camberwell.
All those who talk about the importance of students having a good education stress the importance of students having a settled existence on one site. Of course, students go off to do six-month stints in other hospitals to learn, for example, paediatrics or maternity practice. During their training, they will probably go abroad, perhaps to Africa, Russia, or the West Indies. During their six-month stints, they will probably go to district general hospitals outside 367 London. I am not talking about that. I am talking about teaching while studying at the medical and dental school. I should like an assurance on that.
I am happy to tell the Minister that I do not dispute the fact that the Government were right that there had to be rationalisation of specialties in London. It would be nonsense to have a great, internationally renowned cancer department in Guy's hospital and to have another a mile and a half down the road at St. Thomas's and another a further mile and a half down the road from that. I have always disputed, however, that that means that all specialties—the tertiary care, as it is called—are put on one site, at St. Thomas's, and not on the Guy's site. I shall tell the Minister why that strategic plan appears to be in need of adjustment. I shall not now tackle head-on Government policy on rationalising health services in London, but I shall deal with the implications for the Guy's and St. Thomas's trust.
For two reasons, it is better that some of the specialties remain on the Guy's site: first, it will be less expensive to the taxpayer to use to the full the buildings on which we have spent the money, and not to have to spend more public money on other buildings elsewhere. I am happy to go through the details of that with Ministers. Secondly, all the advice from health services in America and Scandinavia, and from independent management in this country, is that hospitals with 1,500 beds are not the best places to teach, to work as a nurse or doctor, or to be treated as a patient; that it is a much better hospital if it has 700 or 800 beds; and that economies of scale and the opportunity for best practice, both clinically and managerially, are achieved by a smaller number of beds than the theory of the 1980s suggested.
Therefore, the implication is that there should not be more than 1,000 beds at the St. Thomas's site or the Guy's site. It also means that, to make the Guy's hospital site viable in its mix of uses—not across all the specialties, but to make out-patient provision hang together with teaching, elective beds, mental health, and the other services that are necessary, particularly intensive care and accident and emergency—some of the specialties should remain at Guy's. I am happy to debate what they should be, but there are strong arguments that cardiac or cardiological services should stay. I ask the Minister to consider objectively—taking into account the views of the community and its advice—whether that is the right course.
Concerns have been expressed since we last debated the issue. There has been a real set-to in the past couple of months about gynaecological beds. In a letter dated 7 May, the chief executive said that there were no plans to withdraw the ability to admit gynaecological emergency patients at Guy's. By the end of the month, it was clear that emergency beds for gynaecology would be closed by 1 June. There were all sorts of semantics about what was going on. The confidence of the community is not enhanced by such to-ing and fro-ing, and it will be a real exercise to build up its confidence.
Just the other day, I received a letter from the chief executive of my local health authority—Lambeth, Southwark and Lewisham health authority. He has always been extremely helpful and constructive, and I have always valued his help. He tells me that his authority has a tough job ahead to ensure that it can set a balanced budget for next year, because it does not have enough resources. Some £19 million or £20 million will have to 368 be cut. If the health authority is to have less money to spend, it will not be able to afford to spend as much money on services at local hospitals such as Guy's. We should not be spending that extra money anyway, if savings can be made on the Guy's site.
That is all the more reason for listening to the voices in the community that are saying to the Government, "Please let's talk about and get right the balance of beds. Please let's talk about and get right the best use of the buildings. Please let's talk about and get right the outturn of the strategic change in health services in London," in an area where the population is increasing and where demand is increasing. The Government know that the community needs hospitals such as Guy's to be functioning fully.
I end with a quotation from a letter that was sent to me. It is from somebody who wrote to the secretary of the nurses league and attended a commemorative event when the last Guy's nurses graduated just over a month ago:
May 11th must have been one of the most thought provoking days for all of us who experienced the overwhelming standing-room-only response in Southwark Cathedral and attended the AGM of the nurses league that afternoon. In fact, my thoughts have been so provoked that I am absolutely livid that Guy's was set up from the beginning, first as the flagship trust, and then as the fall guy in the NHS restructuring programme. Addresses to the AGM set out in detail events which affect the status of Guy's since 1991.The letter goes on to express the concern of a former nurse from Guy's who is not sure that the Government and the other parts of the health service will ensure that we have a fully functioning, viable hospital. For the reputation of the health service, for the sake of the best treatment available in Britain in some areas of medicine and for the local community, it is vital that Guy's hospital survives as a flourishing hospital.I hope that the Minister will give me reassurance. I hope that the Government are open to adjusting their current plan where evidence shows that it can be adjusted to the advantage of everybody.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)I congratulate the hon. Member for Southwark and Bermondsey (Mr. Hughes) on his success in securing the debate. I am delighted to have the opportunity to respond. As always, he spoke knowledgeably and eloquently about health services for his constituents. I can assure him that the Government are equally concerned that the best possible health services are available to the people of south-east London.
The reorganisation of services at Guy's and St. Thomas's trust has generated strong feelings locally, and fears for the future of Guy's hospital. I recognised those concerns in the hon. Gentleman's speech. The debate provides me with the opportunity to explain to hon. Members the reasons why the changes are necessary, and the significant benefits to health care provision that they will bring. I hope that I shall be able to assure the hon. Gentleman that Guy's has an important and exciting future in the provision of local health care, medical education and research.
I should also refer to the King's College London Bill, as the hon. Gentleman did, which my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) brought to the House for its Second Reading 369 on 24 June. The Bill is designed to bring about the merger of King's College hospital and the united medical and dental school. Although independent of the health service changes at Guy's hospital, the merger and the health service changes reinforce each other. There are close working partnerships between the NHS and London university, to ensure that plans are co-ordinated and achieve a coherent, consistent and properly managed change.
During the earlier debate, the hon. Member for Southwark and Bermondsey and others made various points, some of which the hon. Gentleman repeated today. I particularly noted what he said about the need for a sufficient number of in-patient beds to provide appropriate work experience for students, and about the undesirability of unnecessary travelling around south-east London. As I have said, there will be at least 112 beds in the new Guy's hospital, and a certain amount of travelling will be inevitable regardless of the configuration, because Cornwall house—which will be part of the development—and King's College, St Thomas's and Guy's are all at different sites. I noted the hon. Gentleman's general points, however, and I shall do my best to ensure that Ministers respond to what he and others said.
The changes agreed for Guy's and St Thomas's were decided on against a background of changing patient needs. The aim is to develop the service to enable it to respond to those needs, and to rising expectations and medical advances. Guy's and St Thomas's between them are larger than is necessary to provide the services required by residents, and the specialist service for which some patients travel further. The split-site arrangement is both inefficient and detrimental to good patient care, notwithstanding the dedication and hard work of the trust's medical and nursing staff, to which, like the hon. Member for Southwark and Bermondsey, I pay tribute. The two hospitals are little more than a mile apart, and both are accessible from the surrounding area.
The trust considered a range of options for amalgamating services to create stronger single departments, avoiding unnecessary duplication and freeing space for medical education and research. The agreed changes build on the best features of the two hospitals. The division of services between the hospitals has been chosen because it concentrates medical staff and facilities related to accident and emergency services in one hospital, which is the arrangement preferred by doctors. In-patient and specialist services are to be consolidated on the St Thomas's site, and Guy's hospital is to be developed at the leading edge of future medical technology and service delivery as a major centre for planned patient care, offering a comprehensive range of high-quality diagnostic and treatment services for patients who generally do not require an overnight stay.
Essentially, Guy's will remain a major hospital site, focusing on planned care services. Those will include a range of out-patient, day-care and elective in-patient surgical services, centred in the new Guy's phase 3 development. The decision to use St Thomas's rather than Guy's as the site for the accident and emergency hospital was made for a number of reasons; the hon. Gentleman will be familiar with the arguments. The local population served by the A and E department at St Thomas's is half 370 as large again as that served by Guy's, and twice as large during the working day. It is also easier for ambulances to get to, and there has recently been a major extension to it.
Incidentally, as the hon. Gentleman may know, St. Thomas's started off on the site of London Bridge station, and Guy's developed next to it. Originally, the two hospitals were close together.
Overall, we believe that the changes yield the most efficient and clinically coherent balance of services between the Guy's and St Thomas's sites. They give Guy's an exciting future as both a community-style hospital and a world-class centre at the forefront of new developments in medical education and research. Guy's will continue to be a substantial provider of health care. The ambulatory care centre will include a day-case surgery and other single-day treatments, a development centre for minimally invasive therapy including endoscopy, a wide range of out-patient clinics, a new diagnostic centre and a minor injuries unit. As I said earlier, the centre for planned surgery will contain some 112 beds, operating theatres and other facilities.
I noted what the hon. Gentleman said about the distribution of specialties between the two sites, but obviously the intention is to achieve what the Government and, I hope, clinicians regard as the most sensible arrangement for specialties. Moreover, by giving Guy's that framework of care, we are putting it at the leading edge not only of medical research and technology—I hope that the combination will achieve that—but of the developing area of day-case surgery, which is expanding far more rapidly than the traditional services. I think that that opportunity is very important.
The dental hospital and school at Guy's will continue to provide services for the local population, and also specialist services for patients from further afield. The unification of the medical schools, and the co-location of teaching and research facilities with clinical services on the Guy's site, will bring benefits to both patients and education and research. Obviously, the changes cannot happen overnight; accident and emergency services will remain at Guy's until building developments at St. Thomas's are completed, as will cancer and kidney treatment.
In all, the developments at Guy's will mean no change for about 80 per cent. of visits by patients who currently look to Guy's. Clearly the hospital has a future, and we believe that it is a very exciting future.
The hon. Gentleman asked a number of questions about the Guy's phase 3 development. There were two aspects to his concern—the future use of phase 3 in the light of service reconfigurations, and the management of phase 3 as a construction project. The phase 3 development was designed with out-patient services and research very much in mind, and under the plans it will be used substantially in line with its design. It will be seen as particularly well suited to the future role of Guy's hospital in providing a one-stop patient service, focused on out-patients and day-case patients, enabling diagnosis and decisions about treatment to be accomplished in a single visit.
The trust estimates that 75 per cent. of the space involved in phase 3 will be used as originally intended. That includes the united medical and dental school. The use of the remainder, and any other space on the Guy's site not taken by the university, is a matter for the trust: 371 it must decide how the space that it retains can best be used. Trusts own and are fully responsible for the capital assets transferred to them, and bearing the cost and responsibility of ownership is a powerful incentive for them to make the best use of those assets.
§ Mr. Simon HughesCan the Minister assure me that, as far as he is aware, it is 100 per cent. certain that the space that he described as not designated for a specific use will continue to be used for health service provision?
§ Mr. HoramI repeat that 75 per cent. of the phase 3 space will be used as originally intended.
Let me bring the hon. Gentleman up to date on the construction of phase 3, as far as I am able. As he said, there have been a number of problems, but they are being dealt with as expeditiously as possible. The trust is negotiating an alternative commercial settlement, which will require the approval of the NHS chief executive and the agreement of the Treasury. That settlement is linked with proposed amendments to the fabric of Guy's phase 3 to reflect the change in the use of the building since its original design, and will also deal with other problems along the way. The contract will be separate from, but linked to, the commercial settlement.
Detailed heads of terms have now been signed, and a programme of work has been agreed that should enable the building to be completed in a modified form by the summer of 1997. I understand the hon. Gentleman's scepticism about the dates that have been mentioned in the past, but I hope that this will be a red-letter day, if not a Jerusalem day, for Guy's. The target date for the move out of Hunt's house is also the summer of next year. As the hon. Gentleman knows, those developments will be examined by the Public Accounts Committee after the examination currently being conducted by the National Audit Office. I cannot help him in that regard, however, because the timing is a matter for the NAO rather than the Government. I do not know what the present situation is, but there will be an NAO report, followed, I have no doubt, by a PAC hearing.
I understand the hon. Gentleman's concern that, while a good deal of public money is being spent, it should be spent wisely, and we should not revise the plan in such a way that it is wasted. A good deal of money certainly is being spent—"not only the £150 million that includes Guy's phase 3, but a further £140 million. Most of it is being spent at Guy's on the private finance initiative project involving the united medical and dental school—we hope that that will be forthcoming in due course—and a further £117 million is being spent on the other PH project, admittedly involving St Thomas's more than Guy's. All that, plus the refurbishment and improvement along the way, shows the extent to which the Government believe that it is worth spending a lot of money on Guy's to give it the exciting future that we believe it has.