§ Mr. William Ross (East Londonderry)I am sorry that I have had to raise this matter on the Floor of the House. I had hoped that tender documents for the hospital would already have been out, but they are not. I must therefore ask the Minister the reasons for the delay.
The debate on how best to provide good-quality medical and hospital treatment for Coleraine and the surrounding area has been going on for many years. I was told today that at least one person was brought over from England in 1952 to help to design the Coleraine hospital. For much of the time since then, there has been a deep division as to whether there should be one hospital or two—one at Coleraine and another at Ballymoney.
The matter was finally settled in favour of a single hospital at Coleraine, and the debate then began as to whether the existing site should be used, or whether it would be better to create the badly needed acute hospital in a brand new green-field location. The latter option was finally accepted, and a site was identified and purchased on the outskirts of Coleraine.
There is no question about the need for the provision of comprehensive hospital services in the Coleraine and North Antrim areas. In the catchment area, there is a population of about 110,000; that number doubles during the summer months, owing to the movement of many people to the north coast, which, as the House will know, is a major tourist attraction.
The present hospital is, to put it mildly, in a poor and deteriorating condition. For example, the out-patients department is still housed in wartime nissen huts. Such accommodation was never suitable for that purpose. The buildings, which were a second world war temporary construction, were originally designed to have a 10-year life. After the war, many such buildings were purchased by farmers and used to house farm animals, potatoes, turnips, chickens and everything else. All the animals, the farm produce have long since disappeared, but people are still using the huts. That is unacceptable.
The medical wards are prefabricated buildings, which are also long past their expected life span. In addition, many non-clinical services are long overdue for upgrading. The kitchens, the boiler plant and the mechanical and electrical services all need urgent work. When there is heavy rain, buckets are needed to catch the leaks. I understand that the mortuary is the most recent part of the hospital to come under assault.
Given the situation in the hospital, the board and the trust have been unwilling to spend money on major repairs in recent years, as they were aware that the new Causeway hospital was due to come into use—originally by 1999, but, according to a more recent estimate, by the end of 2000 at the latest.
The result is that, if the new hospital does not go ahead now, the necessary upgrading to meet the immediate requirements of the statutory authorities, which in the circumstances have been very fair to the hospital, are currently estimated to cost £5.3 million. To bring the facilities up to modern standards would cost £26 million, and we would still be left with an old hospital and worn-out buildings.
952 The site of the present hospital is a valuable one, right in the centre of Coleraine. No doubt it will bring a considerable sum to the coffers of the trust when it can be sold, as soon as the new hospital is built.
I am deeply concerned about the seemingly endless delays in starting building work, and my concern is shared by the entire community that is to be served by the new hospital.
The need for the hospital, its clinical profile and the estimated costs have been examined in detail no fewer than four times, and every time the need for the hospital was proven. The original option appraisal exercise took place in 1990. It was detailed and thorough, and concluded that the hospital must be built. There was a review in 1993 and early 1994 on new targets and throughput, and another review later in 1994 regarding a reduction of 4,000 sq m relating to capital charging. A further review was conducted later in 1994 and early 1995. To everyone's astonishment, a fourth review was called for during the current year, which ended with the same result. Such a detailed examination of a proposed new hospital is unprecedented.
It is clear from various letters that the questions raised by the Department were simply nit-picking, for the issues could and should all have been dealt with far more expeditiously. Two or three meetings at senior level with the board and the trust should have sorted out all the problems, without the endless inquiries that have been made.
The attitude of the Ministers involved in the saga has been plain. The right hon. Member for Richmond and Barnes (Mr. Hanley), who originally gave approval in 1992, was forthright. He stated on 28 January 1992 that he had identified the funds and set out the time scale—he said that it was the only realistic time scale—and he expected the new hospital to open in 1999. He said that he hoped that his announcement would facilitate the process—he was referring to a process of rationalisation between the existing hospitals—by reassuring those who may have harboured doubts about the depth of the Government's commitment to the construction of the new Causeway hospital.
Baroness Denton, who was formerly in charge of this aspect of Northern Ireland's government and provision, gave a verbal assurance to Mr. Bill Tweed, the chief executive of the Causeway trust, on 15 July 1994. Her predecessor, Lord Arran, gave the same assurance on 22 December 1993—a lovely Christmas box, which has not yet been delivered. The present Under-Secretary of State for Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), who I am glad to see on the Front Bench, renewed the assurance twice, on 18 January 1995 and again to me personally on 22 March 1995.
To date, £7 million has been spent on site purchase, the new laboratory, professional fees and considerable siteworks. I have a colour photograph showing the entire area—wonderful roads and entrance, but unfortunately no hospital. The difficult rationalisation process, which the right hon. Member for Richmond and Barnes considered a vital prerequisite in 1992, has been put into effect, not without some difficulty and resistance. It was driven through by the board and the trust on the basis that the new hospital was coming. I am told that the result of the final examination requested by the Health and Social 953 Services Executive has recently been delivered, and it shows that any redesign at this stage would be quite uneconomical.
The result of all this is that the trust is ready to go ahead once the Minister gives clearance for the project, and there is no reason why he should not do so, for, in the expenditure plans and priorities for Northern Ireland published in March this year, the sums required were set out on page 260, in table 9.29.
There is one error, in that the original year of completion was to be 1999, not 2000, as shown in the publication, and the sums already expended are slightly higher than those shown, but that is not unexpected. The provision for 1996–97 is just over £8 million, so in March this year the Government were still on course, and clearly expected the project to go to tender before the end of 1996. The documentation should have been finalised, and they should already be in the process of seeking tenders.
The estimates included sums for the redevelopment of the Royal Victoria and Altnagelvin hospitals. Altnagelvin was in the 1995 expenditure plans. The Royal Victoria was not, but the 1996 estimate shows that some £5 million will be spent in the relatively near future.
Given the history, it is perfectly clear why my constituents and I were sure that we could rely on the assurances that I have mentioned, plus private chats with Ministers down the years, all of which were given on behalf of the Government by so many Ministers on so many occasions. We were certain that the hospital would be built. But all the time, nagging concerns were expressed to me at various times by the professionals involved, by the medical establishment in the catchment area, by the local council and by members of the general public, who, naturally, were taking a keen interest in these matters.
I was concerned enough to write to the Minister on 20 September last. To be frank, his reply of 22 October thoroughly alarmed me, for there seemed a definite retreat from the assurances that were given. I did not like the resiling that I saw in the letter.
My alarm is rapidly turning to anger, for I am also aware that, despite the fact that approval for the Causeway hospital was given so long ago—at the beginning of 1992—the Royal Victoria, which received approval in May 1993 for its refurbishment, redevelopment or whatever, and Altnagelvin, which received approval for its major works in 1994. are at precisely the same stage as the Causeway hospital project. It is quite remarkable that they have managed to catch up, but it is not without significance that neither of those two projects ever had a comprehensive review at the beginning. They had in comparison a very casual examination of what was required and proposed. It is remarkable, and we need a fuller explanation.
The entire community wants to know why the Coleraine project has been subjected to these long delays, all of which lay within the Department. Much money has been spent. The site is ready. The design and commission teams are in place and are already paying for their rented accommodation. Frankly, they will run out of work if the project does not go ahead. They will soon have to be disbanded, and it will be difficult to get them back together again. The list of contractors has been selected.
The trust is ready to go, despite the obstacles put in its path. Many hoops were put up, and the trust and the board hopped neatly through them one after the other. 954 The contractors met all the deadlines as soon as humanly possible, and much sooner than some persons would have liked. They are ready to roll.
The perception of the community that would be served by the hospital, particularly in Coleraine, is that the Causeway is the victim of a sustained campaign of discrimination. Only a clear commitment to go ahead now would remove that perception from the minds of my constituents.
§ Rev. Ian Paisley (North Antrim)This is a very serious matter for the hon. Member for East Londonderry (Mr. Ross) and for myself. I remind the Minister that large sums were spent through the Province on a promise that the Waveney hospital in Ballymena would be the main acute hospital in the area. The tragedy is that, with the closing of the hospital in Ballycastle and the rundown of the hospital in Ballymena, there is currently no acute service hospital nearer than Antrim for my constituents. If the Causeway hospital does not go ahead, all the people, from as far north as Ballycastle, will have to travel to Antrim.
This is a very serious matter, and all of us are seriously concerned about it. We thought that we had it resolved by the promise of a new hospital in the hon. Gentleman's constituency but on the periphery of my own. It was called the Causeway because it was to serve both communities. As the hon. Gentleman said, Minister after Minister—the right hon. Member for Richmond and Barnes (Mr. Hanley), the Earl of Arran, Baroness Denton and the hon. Member for North-East Cambridgeshire (Mr. Moss), who will reply today—gave us assurances on two occasions.
There are serious questions that the Minister must answer today. First, why all the reviews? It seems strange that one review is carried out in September 1994 and another in October 1994. Why? No other new hospital in our country has had such treatment. The hon. Gentleman is right: people are saying that there is discrimination in this case. This has not happened in the other new hospitals built. An appraisal was carried out in 1995. In June 1996, there was yet another. Why all these appraisals, when it was decided that the hospital was needed and that it would be built?
Then, of course, we have the fact that the Causeway hospital development group met monthly for four years. It has had 49 meetings. Now there is a question mark over the whole affair. What about the promises made to the medical staff, and the rationalisation that was necessary for the configuration of the new hospital?
§ Rev. Martin Smyth (Belfast, South)The hon. Gentleman speaks of rationalisation. Does he recall that, between 1982 and 1986, the Northern Ireland Assembly agreed that rationalisation should proceed? At that time, as Chairman of the Finance Committee, I asked whether slippage money could be used for rationalisation, and millions were returned to the Treasury.
§ Rev. Ian PaisleyI recall that very well, because it was a matter about which people were urgently concerned. Promises were made to staff, particularly consultant medical staff, on the radical changes that were to take place because of the new hospital. 955 Will the Minister confirm that the Causeway hospital site cost £0.85 million, the Causeway laboratory £1.89 million, the advanced siteworks £1.18 million and the main project £2.4 million? What is the estimated cost of the total upgrading of the present facilities if the delay is lengthened? Has the commissioning team been stood down? Have officers' leases ended? If the design team is stood down, will its members seek compensation? What is the position on putting out tenders? When will tenders be issued?
I know that the Minister is concerned about the matter—he is not unsympathetic. However, we must answer to our constituents, and we need answers today at the Dispatch Box.
§ The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Malcolm Moss)I am grateful to the hon. Member for East Londonderry (Mr. Ross) for the opportunity to outline the Government's record and position in relation to the Causeway hospital. I recognise that the matter is close to his heart. Similarly, I know that the hon. Member for North Antrim (Rev. Ian Paisley) is committed to the project. Perhaps more importantly, I am aware of the concerns of the local population from the range of correspondence which has come to me recently.
As the hon. Members helpfully explained, the campaign for a new hospital serving the Causeway area has been active for many years. In 1976, the Northern health and social services board set out its strategy for the development of acute hospital services. It was based on the provision of two modern hospitals to rationalise and concentrate services from a range of small dispersed units which were in poor condition and hopelessly ill equipped to meet the needs of modern clinical practice and standards of care.
A new area hospital at Antrim is to serve primarily the southern part of the board area, and the northern end of the board area is to be served by a new hospital in the Coleraine area, which would enable rationalisation of the Coleraine, Route, Robinson and Dalriada hospitals.
As hon. Members are aware, the first element of the strategy was finally achieved—after a slight delay—with the opening of the Antrim area hospital by the Secretary of State in 1993. The development of services in Causeway was planned to follow upon completion of the new Antrim hospital. From 1988 on, the Northern board appointed management consultants to look at the options. The then unit management and Coopers and Lybrand were involved, and, after considerable analysis, in December 1991 the Government approved and accepted the option to build a new hospital on a green-field site at Lodge road, Coleraine.
Shortly after that, in January 1992, my predecessor, my right hon. Friend the Member for Richmond and Barnes (Mr. Hanley), announced the timetable for the project. It was envisaged that detailed planning and design would commence in 1994, with the major construction phase beginning in 1997 and the project to be completed by 2000. The speed with which the result of the option appraisal was translated into a programme of action with supporting funding reflected the Government's priority for, and commitment to, the project.
956 Over the past four years, the local population has seen that commitment demonstrated by physical investment. The proposed site was purchased at a cost of £0.85 million, and the first and essential stage of the development, the new area laboratory, was built on the site at a cost of £2.7 million. It became operational in 1994. Those investments, plus expenditure on landscaping and initial design fees, bring the total spend to date to £8.35 million. I hope that hon. Members will agree that that represents a considerable investment already in the light of pressures on public expenditure and the competing investment priorities.
At the same time, it is important to ensure that the original case for such major investment remains valid over the necessarily lengthy planning period. The acute sector has seen many changes in the past decade: productivity has increased significantly, and clinical practice has seen the expansion of day surgery. Hon. Members may recall that, in 1993, the Public Accounts Committee examined acute hospital provision in Northern Ireland. In the memorandum of reply to the Committee, my Department gave a commitment that all proposals for major investment would be kept under constant review and the underlying assumptions would be tested before any final decisions were taken.
As the Minister responsible for health and personal social services in Northern Ireland, I am keen to endorse that commitment to ensure that what is built at Causeway and elsewhere is demonstrably what is needed, and no more than that. Therefore, at my request, earlier this year the health and social services executive asked the Causeway trust to review the case supporting the investment. In the light of the new regional strategy that I issued in July, I was particularly anxious to ensure that investment in a new hospital in Coleraine was consistent with the vision for acute hospital services set out in that strategy. The trust was therefore asked to ensure that the investment was acceptable and affordable to the principal purchaser, the Northern board.
I am pleased to record that the trust tackled that exercise in a rigorous and comprehensive manner, submitting a detailed review carried out by Coopers and Lybrand. The Causeway trust board has acted with commendable professionalism, urgency and diligence, and I take this opportunity to thank the chairman, the chief executive and board members for their co-operation throughout.
As a result, the executive identified a number of issues as requiring clarification by the trust and the board. The trust again dealt with them expeditiously and, as a result, the executive wrote to the trust on 5 November to inform it that the case for the investment had been revalidated. The executive advised the trust that, because of the additional costs involved with a redesign, it would not be economic—I confirm the hon. Gentleman's earlier comments—to seek a reduction in the project design.
As hon. Members are probably aware, the Government have reaffirmed the need for the new Causeway hospital to provide a locus for the acute services to the local population in the next century. The matter now rests with me in terms of a decision on the next stage of the project. Hon. Members will be aware of the pressures on public expenditure in general. My right hon. and learned Friend the Secretary of State will soon announce decisions on public expenditure in Northern Ireland following the Chancellor's Budget statement. Hon. Members will 957 recognise the added pressures on public funds in Northern Ireland caused by the ending of the IRA ceasefire and the consequences of the summer's unrest.
The projected investment at Causeway—about £40 million—is significant. As Minister responsible for health and personal social services, I have a responsibility to ensure that such investment decisions are affordable and deserve the top priority with other pressures on my programme. I shall look at those issues once the Secretary of State has taken his decision, and I hope to make a statement before long.
To sum up, I believe that the Government have an impressive record of achievement already with the Causeway hospital project. The investment appraisal was approved quickly and a firm timetable was set out. Significant public funds have been made available and allowed preliminary investment on the site. We have ensured that the project remains tight, affordable and thus value for money for the taxpayer. The timetable set out by my right hon. Friend the Member for Richmond and Barnes has largely been adhered to.
I recognise the local population's wish that we move on to the last major phase, but I ask hon. Members in the Chamber today for some forbearance over the present delay. I am likely to face difficult decisions over health spending next year, and decisions on Causeway must be part of that process, not taken outside it or ahead of it.
§ Rev. Ian PaisleyWill the Minister assure the House that he will meet Causeway trust members and converse with them?
§ Mr. MossI have already given that assurance to the hon. Gentleman and to the hon. Member for East Londonderry. I am more than happy to meet Causeway trust members. They have not asked for a meeting at this stage, but my door is always open to any trust board members who wish to talk to me.
In determining the way forward, I assure hon. Members that I hear and understand their concerns and those of their constituents. They can be sure that I shall give them due weight in the weeks ahead.
§ It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.