HC Deb 27 November 1996 vol 286 cc301-8

1.2 pm

Ms Margaret Hodge (Barking)

I have been a Member of Parliament for barely more than two years, yet this is the third Adjournment debate in which I have spoken on the health service in Barking. That fact reflects the importance and, tragically, the failure of the national health service as it is delivered locally. People in Barking are getting a raw deal from the NHS, and I shall continue to argue their cause, publicise the facts and act as their voice until someone, somewhere does something. Access to high-quality health care should be based on what one needs and not on where one lives, but the experience of my constituents suggests otherwise.

I know of many dedicated doctors and nurses who work in King George's hospital and provide the first-class service to which we are all entitled, and for which my constituents are immensely grateful. But the story that I have to tell is one in which too many people wait for too long, too many people experience poor-quality care and too many mistakes are made—all of which leads me to think that something deeper and more serious is going wrong. When a school is thought to be in trouble, it is inspected by the Office for Standards in Education; when a children's home or an old people's home is failing, the social services inspectorate intervenes; but when a hospital appears to be failing, no inspector intervenes on our behalf. The purchaser has little muscle and, with all the closures, nowhere else to buy. My constituents have nowhere else to go.

The hospital advisory service appears to have experienced a stillbirth. Inspection is not the job of the Audit Commission, and my constituents are not helped by complaining after the event to either the trust or the ombudsman. Today I ask the Minister immediately to carry out a detailed inspection of King George's hospital and to consider setting up a national inspectorate for all hospitals, whose job it would be to monitor quality standards in every hospital in the country. I am not in the business of pursuing a narrow party political campaign on that issue in the run-up to the general election, because my constituents' well-being is too important to me. I am representing the genuine concerns and interests of local people, whose voices are not being heard.

The Minister will be well aware of the context in which King George's hospital is operating. Barking residents have been starved of hospital beds. In 1988, Dagenham hospital was closed. Between 1990 and 1994, we lost more beds than any other health authority area, and more than one in 10 of our hospital beds went. In 1993, Barking hospital—which was originally built not through taxpayers' money but through the voluntary efforts of my constituents—was mothballed, despite having a brand-new maternity wing added a few years earlier, at a cost of £6 million to the taxpayer. Those buildings and that site are now owned by the Redbridge trust, which runs King George's hospital. Those facilities lie idle, while King George's hospital cannot cope.

In 1995, Rush Green hospital was condemned to oblivion, and then, most recently, the undoubtedly wrong decision was taken to close the accident and emergency unit of Oldchurch hospital. Inevitably, that placed new and additional burdens on King George's. I well remember a meeting with other local Members of Parliament, one of whom is in the Chamber today, when we urged Ministers not to close yet another accident and emergency department in our area. We predicted that the closure would place an intolerable burden on the remaining hospitals, including King George's. However, those with whom the buck must stop at King George's—the chief executive and the chairman—colluded in that last, disastrous closure decision. They reassured me, as they must have reassured Ministers, that King George's could cope with the additional work load created by the closure of yet another accident and emergency department.

In the market, the pressure is on individual hospitals to compete. No doubt the bosses at King George's saw the proposed closure of Oldchurch accident and emergency as an opportunity to grow bigger and, like any business, as an opportunity to grab a larger slice of the market. Barely a year later, however, they cannot cope. The victim of their desire for aggrandisement and power is not the hospital business or the personal income or status of those who run it; the victims are the helpless people in my constituency, who are at their most vulnerable moment when they put their lives and well-being in the hands of hospitals. All too often, they are being let down.

I am not expressing the view of only one Member of Parliament. There is now a substantial body of evidence that should give Ministers—who hold ultimate responsibility for our hospitals—great cause for concern. The record of King George's on the patients charter is poor. It is the worst in its group in operations cancelled, it is the second worst in percentage of patients who are assessed within five minutes of arrival at the A and E, and it is seventh worst in its group in percentage of patients who are seen within 30 minutes of their appointment time. As if that were not enough, more cases have been referred to the ombudsman from patients at King George's than from any other hospital. Yet in the wake of all those signals, the chairman and the chief executive demonstrate an utterly inappropriate, arrogant and complacent attitude, rejecting all criticism.

No one who has expressed concern about King George's has criticised the dedicated doctors and nurses. Neither I nor any of my colleagues would dream of using our concern about King George's as a political football; a good hospital service for our constituents motivates us. The fact that the only response from the management is to blame the messenger simply reinforces my belief that something is badly wrong at King George's.

I have published a dossier, which represents the human reality behind the statistics. It contains the testimonies of my constituents who have endured pain and poor-quality care. In some cases, such poor-quality care could have been avoided, and in most cases, the pain could have been lessened. The stories are the tip of an iceberg. Most people do not come to see their Member of Parliament or use the complaints procedure, and only a very few, persistent and dogged people will go to the ombudsman. To measure quality solely by the number of people who complain is mistaken. People are scared to complain, too compliant to pursue their rights, too distraught to relive the experience, or simply too relieved to be out of the situation.

We therefore need to take those stories seriously, because they are not the gripes of an irrelevant, minuscule minority. What do the stories tell us? Among them, of course, are the stories of people who, like those elsewhere, are left in pain because of delays caused by lack of funding—elderly people waiting for hip or hernia operations, for whom the delays are the difference between dependence and independence. Only last week, my constituency caseworker—who had been told that the removal of her gall-bladder was classified as urgent—was told that "urgent" meant a nine-month wait, with continual pain and discomfort.

In the dossier are the stories of those who experience poor service in the accident and emergency department, such as a 79-year-old woman who was left waiting for a morphine injection for 17 hours, and for whom it took 34 hours to find a bed. There is the story of an elderly patient left in a wheelchair for five hours waiting for an ambulance; of a pensioner suffering from angina, left for seven hours before she was seen without being given any food or drink, so that she did not even take her angina tablets; of a mother who was forced to burst into tears before she could get anyone to look after her ill baby.

Perhaps most worrying are the cases of those who experience poor standards of care and those who are victims of too many mistakes. The elderly, the confused and the uncomplaining are most likely to suffer from poor-quality care. Relatives of one woman said that their mother was left unattended on a commode for three-quarters of an hour. A man was left unwashed for three days, despite the fact that he had soiled himself in the bed, and when he struggled alone to get a urine bottle, he fell on a radiator. Another woman was left unsupported in a chair and fell, bruising her face and arms. For members of one family, pursuing their complaint after their father died proved too distressing, so they dropped it.

Finally, there are stories of things going wrong and mistakes being made. The scale of those errors suggests that there is something wrong at a deeper level—more seriously wrong than the occasional avoidable mishap. Last week, I met a woman who became wheelchair-bound after an operation for a hip replacement went wrong.

One woman went into King George's hospital for a termination. During the operation, her womb was perforated, something that occasionally happens, but in her case, while the doctors were repairing her womb, some instruments became entangled in her intestines and she lost part of her intestines. When she first visited me, she was unsure whether it was her intestines or her bowels that had been removed. I advised her to contact lawyers without bothering with the complaints procedure.

The tales from Barking, the experience of other Members of Parliament, the complaints to the ombudsman and the patients charter record suggest that problems at that hospital are caused by more than a lack of resources, although I have no doubt that that is an important factor. I urge the Minister to act.

I reiterate: we need an independent inspector for our hospitals. At present, we depend on a reactive, not proactive, set of structures. People can complain, but only after things go wrong. The purchaser is not equipped to measure quality. The Audit Commission is not the appropriate body. To me, the patients charter represents just the start of a clear set of quality standards. We must build on that to include a range of quality measurements, and then we must establish a strong, rigorous and independent inspectorate to intervene where necessary.

The alarm bells are ringing at King George's hospital and an inspection is essential. Only when that takes place will I, the other local representatives and, most important, the people in Barking feel reassured and certain that their health care is safe in the hands of the local hospital.

1.12 pm
Mr. Mike Gapes (Ilford, South)

I congratulate my hon. Friend the Member for Barking (Ms Hodge) on her success in obtaining this Adjournment debate. Since I became Member of Parliament for Ilford, South in 1992, many anxieties have been brought to my attention about the way in which King George's hospital operates. It is a new hospital, opened in September 1993. I received so many complaints that in May 1995 I called for an independent inquiry into the administration and running of the hospital.

In previous debates, including the debate on the Queen's Speech on 25 October 1996, I have drawn attention to problems of funding, staffing and morale at that hospital. Regularly, matters have been drawn to my attention by staff who are afraid to speak out—a national problem.

I do not criticise the hard-working, dedicated staff at the hospital. They work under enormous pressures in difficult circumstances. Anyone who, like me, has visited the accident and emergency department at half-past 10 on a Friday evening knows how difficult those circumstances are.

I am especially worried that there is no flexibility in the system. The constituents of my hon. Friend the Member for Barking come to King George's hospital because it is the nearest hospital to where they live. It is estimated that, when Oldchurch hospital accident and emergency department is closed, 20,000 additional people will come to a hospital built for 50,000, which deals with 70,000 a year. Those extra people cannot be accommodated in an extra large facility because of lack of space.

A report in this week's Ilford Recorder is based on a telephone call to the newspaper by a nurse who does not wish to be named. The nurse said that hospital governors were discussing drastic ways of combating overcrowding this winter"— before Oldchurch is closed. Each ward is equipped with a day room designed solely to offer relaxation and a place for patients to sit with their families. But Redbridge Health Care Trust … is considering turning them into bedrooms. The nurse claims that without adaptation the rooms would leave patients with no means of alerting staff in an emergency. She said: 'It's disgusting that trust head office should even think about this. All the beds in the wards have their own alarm bells, and beds in the day room would not have them. There is already a great deal of pressure on staff without the added pressure of having extra patients put out of sight in the day rooms.' She and colleagues are also concerned about … shortages of staff and about whether extra staff will be taken on to cope with the new beds. The trust said no decision had been reached: 'However, we are anticipating extra patients this winter and we will be trying to accommodate for this.' Last winter there was a crisis in the accident and emergency departments, not only in Redbridge but in neighbouring hospitals throughout north-east London and Essex. That is one of the reasons for the poor patients charter record of hospitals in the region. League tables show that Redbridge Healthcare NHS trust is the sixth worst in the country, and that the other hospital in the Redbridge and Waltham Forest health authority area, Forest Healthcare NHS trust, is the second worst.

The pressures are intolerable. A few weeks ago, it was reported that 12 nurses in the accident and emergency department at King George's hospital had left in the space of a few weeks because of problems and their anxieties that management was not tackling their problems adequately. We face crisis today; in a few weeks, the position could be far worse. The problems highlighted by my hon. Friend the Member for Barking are such that, in the long term, unless something drastic is done about funding, administration, management and help for hard-pressed staff, we face unmitigated disaster.

I urge the Government: please do something now about King George's hospital before it is too late.

1.17 pm
Sir Michael Neubert (Romford)

As the Member of Parliament for Romford, I share the anxieties of the hon. Member for Barking (Ms Hodge), to whom I am grateful for allowing me to contribute briefly to this important debate.

King George's hospital is not in my constituency either. It is several miles down the Al2 for my constituents, but as a consequence of the mistaken strategy to abandon Oldchurch hospital for accident and emergency purposes in future and as a district genera hospital—something that I opposed at the time and still believe to have been an error—several hundred of my constituents already attend King George's hospital. Understandably, the stories that emerge from that hospital worry me deeply.

The decision to build King George's hospital pre-empted the possibility of Oldchurch hospital being available to serve my constituents, as it has for many generations. Under the present proposals, Havering Hospitals NHS trust will cede about 6,700 finished clinical episodes, up to a maximum of 8,600 FCEs, to King George's hospital in future. That will reduce the work load of Havering Hospitals NHS trust to 56,000 FCEs and call into question the training function.

It is obviously of the greatest interest to my constituents that King George's should function well. Recent reports have not been encouraging. I seek reassurance from my hon. Friend the Minister.

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

I am pleased to have the opportunity to respond to the hon. Member for Barking (Ms Hodge), and I congratulate her on securing time to debate King George's hospital, Ilford. Although it is located in the constituency of my hon. Friend the Member for Ilford, North (Mr. Bendall), whom I am glad to see in his place, it provides services for Barking and other surrounding areas. It is right and proper for hon. Members to represent the concerns of constituents who fail to receive proper and adequate health care from the national health service.

King George's hospital, part of the Redbridge Healthcare NHS trust, has been the subject of considerable attention in recent months. The health service commissioner detailed two cases from King George's hospital in his report, published on 14 November, on a selection of the 95 investigations that he carried out in the six months to September. A week later, representatives of the trust appeared before the Select Committee on the Parliamentary Commissioner for Administration to answer on two separate cases arising from criticism by the commissioner in an earlier report. We are therefore talking about a total of four cases in recent times.

I do not seek to defend or make excuses for the trust on any of those cases. In each case, the hospital was judged according to due process and found wanting. However, to give the trust its due, it has responded promptly to the commissioner's findings and made attempts to prevent similar cases arising in future.

As the hon. Member for Barking will concede, the services provided by the hospital are, for the most part, very good. The facts speak for themselves. King George's is a new hospital with modern facilities. Hundreds of dedicated and caring staff work there. Each year it treats around 35,000 in-patients and 150,000 out-patients, with 4,500 mothers giving birth in the maternity department. Only one patient in 1,000 has complained.

Waiting times at the hospital have been dramatically reduced. Eighteen months ago, 1,000 patients had been waiting more than a year for treatment. By April this year, the figure was down to 52. The hospital had inherited a serious backlog of surgery waiting times, so the improvement is a remarkable achievement. The quality of much of the work is high, and Redbridge and Waltham Forest health authority has moved work to the trust recently. For example, the district chiropody service was run previously in two separate centres. When it was unified as one service, the contract was put out to tender and the trust won. The fact that work from other areas is going into the hospital shows its quality.

We must remember that King George's is a new hospital. It has a new coronary care unit and cardiology department. It has an enlarged dedicated day care unit. It has developed a level 2 neo-natal intensive care unit for sick babies. It has a large, modern intensive treatment unit, double the size of that at the previous King George's hospital. Its new oncology unit was recognised by the award of Nurse of the Year in 1996. It also has leading-edge gynaecology services. That shows that it is a modern hospital providing good services.

Mr. Vivian Bendall (Ilford, North)

I have listened carefully to my hon. Friend the Minister. Like the hon. Member for Ilford, South (Mr. Gapes), I have visited the hospital at the weekend, at times when the accident and emergency department is extraordinarily busy. Having considered the problem for the past 12 months, I believe that the main problem lies in the accident and emergency facilities. The problem has been caused by the fact that the hospital is new, which has attracted a lot of people from outside its natural catchment area, including many from the constituency of my hon. Friend the Member for Romford (Sir M. Neubert).

Another dramatic cause of trouble is that, when accident and emergency facilities at Oldchurch, Forest and King George's have been pushed, King George's has often stood in for the other two, but when King George's is pushed, the other two do not stand in. I ask my hon. Friend the Minister to give careful consideration to the problems of the accident and emergency department, because I do not think that the hospital can cope.

Mr. Horam

I am interested in my hon. Friend's remarks. A great deal of what he says is accurate, particularly his comments about the attractions of a new hospital with new facilities. The accident and emergency department has clearly been extensively and generously utilised. The hospital trust has behaved extremely well in taking on patients from other parts of the neighbourhood and referrals from other hospitals.

Of course, the process is reciprocal. Having considered the experiences of accident and emergency departments last winter, we now have a more co-ordinated system. The chief executive of the NHS has an emergency team to look at the co-ordination of accident and emergency departments throughout the country and co-operation between neighbouring departments. I hope that the problem that my hon. Friend the Member for Ilford, North referred to will not occur this winter and that there will be good co-ordination between the various accident and emergency departments.

To complete the point that I was making about the quality of health care at King George's hospital, we should also remember that health care is not just about buildings and services, but about people. The hospital now has 20 consultant posts—a 30 per cent. increase over the past four years.

The hon. Member for Barking referred to the hospital's performance in the patients charter tables, but she selected only three areas in her dossier. There are performance indicators for more than 40 areas. In all the other areas, the performance of the hospital was much better than in the three that she singled out. It is easy to pick on some areas where the hospital is clearly not performing so well and to neglect whole swathes of performance indicators that are clearly much better.

The hon. Lady also brought up the old issue of underfunding. She knows that the money follows the patient in the NHS these days. For those of her constituents treated at King George's hospital, her health authority of Barking and Havering pays the bill either directly or indirectly, through GP fundholding. Barking and Havering health authority has more to spend on health care than ever before. Its revenue allocation this year was £173 million—£6.3 million more in cash terms and £1.7 million more in real terms than in the previous year. As the hon. Lady and the hon. Member for Ilford, South (Mr. Gapes) know, a huge increase of £1.6 billion was announced in yesterday's Budget.

Ms Judith Church (Dagenham)

Will the Minister give way?

Mr. Horam

I shall not because I have only four minutes left. Four hon. Members have already spoken.

An increase of £1.6 billion for the health service was announced. We wait to see whether the Opposition will match the real-terms increases that we have made year after year after year for 17 years and that we are committed to continuing year after year after year after year after year for the five years of the next Parliament. That is a huge commitment to the national health service that the Opposition cannot match. They do not say a word. They are like Trappist monks on NHS funding.

Ms Church


Mr. Horam

I shall not give way because I have only three minutes left now.

Ms Church

Trappist monks?

Mr. Horam

The hon. Lady is objecting to being called a Trappist monk. Perhaps we should call her a Trappist nun, but Labour Members are saying nothing about the crucial issue of funding. That is a great pity.

The treatment of the problems by the hon. Member for Barking has not been helpful. She has attacked the hospital by publishing a dossier at the same time as it has had the commissioner cases. She says that her dossier shows that the local health service is in crisis. She should think how the doctors and nurses must feel when a local Member of Parliament criticises their hospital. As a result, the hospital is vilified in the media. Patient confidentiality and professional ethics prevent the staff from responding, even though they know that her dossier is riddled with inaccuracy. They hold their heads up high as best they can and get on with their jobs, reassuring their patients. The dossier mentions 40 cases out of 750,000 attendances over the past three years.

Some of the cases in the dossier are simply a restatement of those in a dossier that the hon. Lady produced 12 months ago. We are not talking about new cases. The hon. Lady is simply recycling old news. The cases are anonymous, as they must be, but that makes it difficult for the trust to investigate them. The ones that the trust manages to investigate often contain implications and allegations that are simply not true.

When the hon. Lady was leader of Islington council, she reacted with outrage to the campaign by the Evening Standard claiming that there was child abuse in Islington council homes. Those claims were subsequently proved true.

Establishing the truth in the particular circumstances that the hon. Lady raised today is a complicated matter, and she should take a balanced view in the interests of the patients involved. She should also consider the morale in the hospital and the care of the patients. It is not good enough—

Mr. Deputy Speaker (Sir Geoffrey Lofthouse)

Time is up.