Guy's Hospital (Hansard, 12 December 1997)

§ Mr. Simon Hughes (Southwark, North and Bermondsey)

I am grateful for the opportunity to raise the subject of Guy's hospital and the London health review, within a few days of the expected announcement of the results of the review.

In opposition, the Labour party made a number of welcome and ambitious promises about the national health service. For example, it made a general promise to save the NHS. It also made many particular promises. One, oft repeated, was to save Guy's hospital.

I have five different leaflets produced by the Labour party and circulated by my opponent during the general election. On each of them is a sentence or two similar to: Shadow Health Minister Chris Smith has already pledged … that he will stop the Guy's closure programme on Day One of a new Labour government … Remember—if the Tories get back into government, then Guy's will close. Well, the Tories did not get back into government—there is a Labour Secretary of State for Health and Labour Ministers. Today, before the announcement of the outcome of the London health review, I seek to ensure that the Labour party remembers its pledge. Labour said things like, "Others will talk, but only we can deliver." Now comes the time of truth.

On 20 June, the Secretary of State announced the details of the Government's review of health care in London. He announced that the review would be carried out by an independent advisory panel and, at that time, I welcomed the extent and the nature of the review. We now know that the review panel's report has gone to Ministers, but it has not yet been published. Will the Minister tell us explicitly when we can expect the report to be published; and do the Government intend to allow an interval between publication of the report and publication of their response to the panel's recommendations?

Day one of a Labour Government has passed; indeed, it is 32 weeks today that Labour entered office—more than 201 days. It is now clear that the future of Guy's hospital does not lie with the review panel; it has moved on to Ministers' desks and is clearly in the Government's hands. Today's debate represents a final effort to persuade the Government not only of their responsibility, but of the appropriate decision that I hope they will soon announce.

For those who are not aware, Guy's hospital is the older and more academically prestigious of the two hospitals that now form the Guy's and St. Thomas's hospital trust. The background is that the previous Government endorsed a strategy to run down Guy's hospital—to reduce the number of beds from about 1,000 to about 100 and move large numbers of its internationally renowned services away from the London Bridge site. That was a political decision by the then Secretary of State, and Labour 1334 Ministers will have to make an equally political decision on whether they follow the recommendations of the independent advisory panel chaired by Sir Leslie Turnberg, either in part or in whole, or whether they reject them.

The public do not yet know what the recommendations are, but Ministers do. Labour will be forgiven for the fact that they did not save Guy's on day one of a Labour Government. However, by the people who use Guy's and work there and by the million and more people who sent to the House in the previous Parliament a petition in support of the retention of Guy's hospital—one of the largest petitions ever presented to Parliament—the Government will be forgiven only if they act to save Guy's when they make their announcement in the very near future. I hope that the Government understand that there is both huge public support and an extremely strong set of arguments for their reaching precisely that conclusion.

I notice that, coincidentally, there is large article in today's Evening Standard by the health correspondent Jo Revill, who interviewed the new chief executive of the King's Fund, Rabbi Julia Neuberger. The quote at the top of the article is: Labour must listen to the people on London hospital closures and health care. I am sure that Rabbi Neuberger's strong views will also be heeded.

The Minister used to work within the shadow of Guy's hospital at B. M. Birnberg & Co., solicitors in my constituency. His old firm is one of the strongest advocates of the hospital's cause, for which I am grateful. He will know that Guy's is a three-phase hospital development. The original hospital, built in the 18th century, has given way to something that has effectively been rebuilt in its entirety since the last war.

New Guy's house was built in the 1950s. In the 1970s, to mark the hospital's 250th anniversary, a 30-storey tower was built, which is now one of the great—although perhaps not architecturally—landmarks south of the river. The third building, Thomas Guy house, has just been opened for public use. The Queen, who opened the second building in 1976, has agreed to open the third building on 18 March 1998.

It would be nonsense and a scandal if the Queen were to be invited to open the third phase of what was the flagship hospital in the national health service at a time when the Government had endorsed the trust's proposal to mothball one of the buildings, not to use as many as eight floors of the tower building and not to use much of the brand new Thomas Guy house for the purpose for which it was built. It would also be nonsense if, during the next year or so, public money were spent on building other NHS buildings to do what the Guy's hospital buildings were specifically designed to do.

In the few minutes available, I shall present to the House the most up-to-date evidence that Guy's is needed as an integral part of the network of health services in London and beyond, and I shall do so in the context of previous debates, but without replicating any of the arguments that were made in them.

This is our fifth debate on Guy's hospital in the past four years. This is the fourth consecutive year in which there has been such a debate. Not all the previous debates were initiated by me; one was initiated by Conservative 1335 Back Bencher Sir Roger Sims when he represented Chislehurst, and the case for Guy's hospital has been widely supported from both sides of the House by hon. Members who are now Ministers and by members of the current Opposition. Uniquely, this fifth debate is probably the last chance to put the very strong case for Guy's hospital before a decision is taken.

The Tomlinson report, which all those involved in London health matters have studied, decided that there was no need for four accident and emergency departments in south-east London, and effectively deemed Guy's to be the most expendable, but the recommendation was acknowledged to be based on data that have since been shown to be flawed and inaccurate. Sir Bernard Tomlinson, who produced the report, said that himself. As long ago as 1995, in an interview with the Evening Standard, he admitted that he should have had more statistics in his possession before he made the recommendations that led to … the run-down of Guy's Hospital". Those recommendations were based on the assumptions that demand for emergency services was falling and that resources would be transferred from the acute sector to the community sector, reducing the need for London or south London hospital care. National and local trends over the past five years have disproved those assumptions.

Attendances at A and E at both Guy's and St. Thomas's are rising rapidly. That trend in emergency admissions is mirrored throughout the United Kingdom, especially in inner-city areas. The statistics matter, so I shall give them to the House. At the moment, there are just under 75,000 attendances per year at Guy's and just over 90,000 attendances at St. Thomas's: 165,984 attendances in all.

Assuming a 9 per cent. growth in accident and emergency attendances during the next five years, matching the growth in the previous five years, attendances at the two hospitals will be more than 212,000 in five years' time. Attendances at Guy's alone are projected to increase to more than 111,000. The relevance is that that number of attendances rivals and exceeds the numbers at some of the biggest and busiest A and E departments in the UK, yet there is still a proposal, as of today—a legacy of the previous Government—to consolidate both A and E departments to give an accident and emergency department attendance well in excess that of any other hospital in the United Kingdom, and way above the recommended size of any casualty department and accident and emergency unit.

The biggest accident and emergency department in the whole of England is Nottingham, which handles 127,000 attendances a year. The biggest in Scotland handles 91,000 attendances a year, and the biggest in Wales handles 87,000 attendances a year. It is clear that one hospital—at the moment it is proposed that it be St. Thomas's—not only could not cope with 200,000 annual attendances but should not be asked to cope with them. Hospitals generally cannot cope with that many people.

That is not just my view. The Minister may remember the Audit Commission's recent report on accident and emergency services. It made it clear that the minimum number of attendances per year should be 50,000. The commission argued that, if there were fewer than 50,000 attendances, it was difficult to defend accident and emergency departments, but that, if there were more than 50,000, their existence was justified. Guy's is likely to cope with double those figures.

1336 Even if some of the work load were taken elsewhere and even if the hospital could cope, we are looking at one hospital over the river taking almost double the number of attendances it has been designed to take, in its expanded form. It is obvious to anyone who has looked at the accurate and up-to-date figures that, if anybody were—I put this carefully—mad enough to follow through that proposal, there would be hugely longer waiting times, poorer outcomes and probably a total inability by the local trust to cope with demand.

I do not know what the recommendations are, but I ask Ministers to look at them in light of the latest figures I have given. They should accept that, on the basis of the figures and the academic support for them, there is a continuing need for the accident and emergency department at Guy's hospital.

The old plan skewed provision in a way that was almost impossible to justify. The current idea is that Guy's will be a planned care centre and that St. Thomas's will take the acute and emergency care. One might think that that implied that there would be an equal number of beds at each site, but, in fact, the proposal is for the opposite. Guy's has 400 beds, but the current proposals—which have varied hugely even during this year—are that there should be about 153 NHS local hospital trust beds at Guy's. One hundred of them will be for urology and orthopaedics, and 50 will have no very discernible use.

If the proposal goes ahead, apart from the illogicality of the odd 50 beds, we shall end up with the site that has all the out-patients, the site that has all the space, the site that has all the buildings and the site that has the medical and dental hospital having barely 100 patients. That is also mad. If we are to have a premier world teaching hospital, we need some patients with whom to teach students. We need to integrate planned care—elective care—for out-patients and in-patients. I accept that one can concentrate acute services on one site; that is perfectly logical. It is, however, illogical to say that we do not need all the specialist services for planned care to be in the same place as the specialist services for day admissions.

I give the Minister an example. We have just built, as part of Thomas Guy house, all the new wards for the ear, nose and throat specialty. A contract is waiting to be signed which would rip out the wards for that use and would transfer patients across to the other hospital site, although out-patients would still go to the Guy's hospital site. That is illogical and a huge waste of money, because it is likely to cost about £1 million just to remove the wards.

We would have a transfer of beds producing an absolutely illogical under-provision at Guy's under a plan that would not provide enough beds across both sites. I stress to Ministers—I think that they are sympathetic to this point—that all parts of the country need adequate beds. We need, of course, to have adequate services generally, but not having enough beds is the crisis that all Ministers have to face up to. I hope that they will be brave and strong enough to do that. If they are, we shall support them.

The United Medical and Dental School of Guy's and St. Thomas's, which, as a result of legislation passed in the previous Parliament, has just been merged with King's college in the Strand, is one of the most highly rated medical and dental schools not just in the UK but in the world, according to the latest medical school assessment. The dental school is the only one in England with a 1337 five-star research rating, and the medical school is one of only a small number with a four-star rating. Guy's continues to offer unique opportunities for first-class teaching. If it is to sustain its worldwide reputation, we must ensure that the research and teaching—pre-clinical, clinical and medical sciences—are carried out on the same site as the beds and the out-patient department. That is because it is in a brilliant place in terms of medical facilities.

Sadly, Southwark continues to be one of the most deprived local authorities in England. We rank 364th out of 366 in the Jarman index; we are only two from the bottom in terms of deprivation, based on social, economic and demographic criteria. We therefore need the best services for the local community, as well as to maintain Guy's worldwide reputation.

The issue may come down to cost, although I hope that the case is made on other arguments. The current proposal is to build a women and children's hospital over the river from here, at a cost of some £56 million but with a total spend of between £115 million and £200 million. It will not all be public money; some will be special trustees' money. It would not be acceptable to the rest of the NHS, which is desperately crying out for money, that public or charitable money is spent on a building on one hospital site when the other hospital site in the same trust has the facilities needed to carry out the work. We could have the women and children's service at Guy's. Those facilities should be used and not transferred.

When the Secretary of State took office, he said that he did not wish to become notorious for closing Bart's hospital. He said that he did not want on the wall of Bart's two plaques, one saying "Opened by Rahere in 1123" and the other saying "Closed by Frank Dobson in 1997". Will Ministers ensure that Guy's does not suffer the same fate? No logic or argument requires there to be a plaque saying "Guy's hospital—founded by Thomas Guy in 1726, destroyed by Virginia Bottomley, Stephen Dorrell and Frank Dobson in 1995–98".

The people want Guy's hospital; the NHS needs Guy's hospital; the arguments support Guy's hospital. I hope that the Minister understands the importance of making a decision which, in the next few days, secures the future of Guy's as one of the pre-eminent flagships of the British national health service.