§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jamieson.]1.16 am
§ Mr. Andrew Mackinlay (Thurrock)
The subject of my Adjournment debate is Orsett hospital, which is situated in the borough of Thurrock. I speak on behalf of my hon. Friend the Member for Basildon (Angela Smith), who has yet to make her maiden speech. [Interruption.]
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. Adjournment debates are very important to Back-Bench Members, and we must give the hon. Gentleman a hearing.
§ Mr. Mackinlay
I am grateful for your assistance, Mr. Deputy Speaker. The debate is important to me and to my constituents, who are aggrieved by the way that the Basildon and Thurrock General Hospitals NHS trust has behaved over Orsett hospital. As I was saying before the interruption, I speak on behalf of my hon. Friend the Member for Basildon. I wish to make it clear that the Basildon constituency that she represents is different from the Basildon constituency in the previous Parliament. Approximately one third of my hon. Friend's constituency is situated in the borough of Thurrock, and Orsett hospital is just within the boundaries of her constituency.
By way of background, I wish to point out that Basildon and Thurrock are two separate urban areas. The equivalent of mountains and rivers separates them and there is no relationship between them that facilitates having one district general hospital for both areas. Going back in history a little, I should point out that Basildon is a new town and had large resources applied to it in decades past. It was deemed that the town should have its own general hospital. Nobody foresaw that policies would change and that the way in which health care was delivered would shift so that one district general hospital would serve the two urban areas of Basildon and Thurrock.
Thurrock has had a district general hospital, and it was known as Orsett hospital. The site of the hospital has been occupied for 100 years by buildings connected with the poor law or used as a hospital. Orsett hospital is situated between the two urban areas and was built some 30 years ago. It is a relatively modern building which functioned as a full district general hospital with an accident and emergency department, and it provided acute care, including intensive care, cardiac beds and maternity services.
Just over 10 years ago, the health authority decided to close the maternity unit and centralise provision at Basildon hospital. Understandably, there was a strong local outcry, but the health authority gave assurances to, primarily, the people of Thurrock—but also the people of Basildon—that better provision would ensue. It also suggested that that was the last change that would be made.
Then, in 1990, the then health authority announced its decision to close the accident and emergency department at Orsett hospital and to centralise all the facilities at Basildon, which is not a central point for the two urban 682 areas. It said that acute surgery and intensive care, including cardiac care, would also go to Basildon. Again there was a massive outcry, met by assurances—which are not worth the paper that they are written on—from the health authority about the future.
We think that the shift of A and E services to Basildon—along with many other services—is perverse, given Thurrock's riparian, industrial, Lowryesque urban area, which runs some 14 miles along the river. There is a large amount of industry: the Lakeside shopping park—which 25 million people visit each year—and the various petrochemical industries. Thurrock is probably the biggest and fastest-growing residential area in the south-east.
People may ask why anyone should make such a perverse decision of centralising at Basildon, rather than centring services in Orsett. One reason is that the surgeons and consultants who largely influence and run the health service wanted the convenience of being closer to the private hospital—Nuffield hospital, at Brentwood. That has been one of the driving factors in the perverse location and centring of so many important services.
§ Mrs. Teresa Gorman (Billericay)
I am sure that it was due to an oversight that the hon. Gentleman forgot to mention that my constituency also uses the Orsett and Basildon complex. I share his concern that Orsett hospital should be kept, and kept in good order, for the use of his constituents and those of the hon. Member for Basildon (Angela Smith). Is it not true, however, that the last Government found an extra £18 million that has helped to provide Orsett with a new eye unit that is servicing the whole of Essex, that there is a brand new minor injuries unit and that many of the maternity wings that were once a feature of Orsett hospital have been rehoused in very nice new facilities, including the Thurrock community hospital? Are there not three good new institutes in my constituency, in the Wickford and Billericay area?
§ Mr. Mackinlay
I am disappointed by the hon. Lady's intervention. She knows that much of what she has said is nonsense. She referred to the minor injuries unit. I do not want to introduce politics into the debate, but the mess that we are in is due to the stewardship of the health service by the Conservative Government sustained by the hon. Lady and the former Member of Parliament for Basildon. The minor injuries unit is an insult: it is little more than a temporary hut. It is a sop and a charade.
The trust that we now have has disregarded the wishes and legitimate interests of the people of Thurrock, primarily, but also those of the people of Basildon. It has no regard for consultation. I know that my hon. Friend the Minister cannot intervene in a management decision, but I hope that, as a consequence of my remarks, he may feel able at least to go back to the regional executive of the national health service and say that he is concerned about the stewardship of hospital facilities by Basildon hospital trust, in connection with both its style of management and the extent to which it consults. Time and again, it has said one thing and done another.
I consider the management incompetent. I bear no malice towards the chief executive, but she is a woman who has been promoted completely out of her depth. I noted that you, Mr. Deputy Speaker, served on the Parliamentary Commissioner for Administration Select Committee, which invited that woman to reconsider her position. She is not competent to run the trust.
683 The whole style of the trust, including the executive and non-executive directors, leaves a lot to be desired. I understand that the chief executive is the spouse of the clinical director. That is not good, sound management, given the line management responsibility. The whole problem should be examined root and branch, because there is no confidence in the conduct of the trust. I cannot overstate that point.
In 1994, during the last stages of the old health authority, the closure of Orsett hospital was considered. We feel that that is now the trust's underlying intention to effect that closure. The King's Fund was invited to consider the proposal to close the trust, which it found to be flawed. The health plans were subsequently altered.
The community health council, Thurrock borough council and I have always been realistic. We have never wanted to fight yesterday's battles. We have never suggested that we can put the clock back and restore everything to Orsett hospital, certainly not in the medium term. However, we thought that we had reached an agreement whereby the health service and hospital facilities would gradually be developed throughout the borough. We thought that the Orsett hospital site would be retained, and that a network of extensive and real minor injuries units would be provided around the borough and in the Basildon area.
The hon. Member for Billericay (Mrs. Gorman) talked nonsense. No doctor is available in the so-called minor injuries unit placed at Orsett hospital, and its structure suggests that the firm intention is that it should be only a temporary provision.
In January 1996, the new trust submitted a planning application to develop five sixths of the Orsett hospital site without consulting the health authority. The community health council was not consulted—as was its statutory right, and neither were the borough council and the local Members of Parliament. That is indicative of the trust's arrogant behaviour. We extracted some recognition of that from the chief executive of the health authority at a planning inquiry just under two weeks ago. He said that a planning application was premature.
Subsequently, a new planning application was submitted: it was a minor variation on the same theme. The health authority has now approved that latter proposal. Well it would, wouldn't it? No one believes that it is anything other than the health authority and the trust closing ranks. It shows the arrogant approach that is being taken, and it is to the disadvantage of my constituents and those of my hon. Friend the Member for Basildon.
I want to stress the fact that the community health council has not been consulted. The trust recently argued that it had consulted on the health plan for Thurrock, as it was a change in service provision. However, neither the trust nor the health authority have denied the fact that there was no consultation on the proposal for the disposal of the land asset. That is fundamental. No consultation has taken place on the proposal to declare the land at Orsett redundant or surplus to health service requirements. The community health council and others are entitled to be consulted on that.
The decision is perverse because Basildon hospital has a problem of capacity. It cannot absorb and meet the legitimate needs of the people of Basildon and Thurrock. 684 The planning application is being bounced through the trust's decision-making process and that of the health authority. If it is allowed to proceed, the option for wiser counsels to prevail in future years and for major hospital services to be returned to the Orsett site will be closed down. Those services will demonstrably be needed if Thurrock grows. The existing health plan for Thurrock has limited time horizons because its figures extend only to 2001. As I have said, it is one of the fastest-growing areas in the south-east of England.
I implore the Minister to consider this wholly unsatisfactory state of affairs. I know that hon. Members feel aggrieved that, all over the country, accident and emergency departments are being closed and specialist services are being centred in one area. I understand the argument about creating areas of excellence, but this is different, because we are not debating one urban area. The services are not located between the two urban areas, so there is no logicality. The people in many parts of Thurrock that are furthest from Basildon hospital are among the poorest, most disadvantaged and least mobile anywhere. Basildon hospital is far from them.
The people of Basildon and Thurrock have found that the management, competence and delivery of services leave a lot to be desired. You, Mr. Deputy Speaker, served on a Select Committee which showed the incompetence of the current management. I understand that the chief executive's total remuneration package in 1995 was £88,000 a year. The highest-paid director has a total remuneration package of £95,000 a year. I mention that in passing.
It is grossly irritating to the people of Thurrock to know that those people are being paid such large sums when the experience of everyone in Basildon and Thurrock is that the hospital provision is not being delivered competently. The people who run the trust have been grossly selfish and the non-executive directors are insensitive and largely unknown to the communities over whose interests they are supposed to have stewardship.
I hope that the Minister will say that, although he may want to examine what I have said, he will nevertheless tell the regional executive of the national health service that there must be greater scrutiny of the actions and decisions of the trust in future. In addition, the health authority needs to show more backbone in standing up to the trust and in protecting its rights and those of the people it is trying to serve.
The community health council is entitled in law to be consulted, and I hope that, as a result of this debate, there will be a moratorium on the progressing of the planning application for land which is demonstrably not redundant or surplus to requirements. That would give great heart to people in Thurrock and Basildon.
§ Mr. Alan Hurst (Braintree)
I agree with the comments of my hon. Friend the Member for Thurrock (Mr. Mackinlay). My interest in this matter is that, while I represent a north Essex constituency, on the county council I represent the division of Orsett and Stifford.
I entirely support my hon. Friend's conclusions about the hospital and its site. He will recall that, when the health authority attempted to consult local people, it could not at first find a hall big enough to accommodate all those who wished to attend. When it eventually used 685 almost the largest public hall in Thurrock, hundreds of people had to stand outside on a bitterly cold night. Despite that, the health authority proceeds apace with plans that clearly are not in accord with the wishes of the people of Thurrock.
As I say, I endorse my hon. Friend's views about the hospital, and I hope that, even at this late hour—both in terms of the people we represent and in our terms—the whole issue of the proper use of the site will be reviewed.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
I congratulate my hon. Friend the Member for Thurrock (Mr. Mackinlay) on securing the debate and on arguing his constituents' case so forcefully. I thank the hon. Member for Billericay (Mrs. Gorman) and my hon. Friend the Member for Braintree (Mr. Hurst) for their remarks.
My hon. Friend the Member for Thurrock knows that, in a previous guise, I visited Orsett hospital to accompany my hon. Friend the Member for Basildon (Ms Smith) when she was the prospective parliamentary candidate. I am delighted to see her in her place. I am familiar with some of the background to some of the issues that my hon. Friend the Member for Thurrock raises.
I can understand the concern of local people about the closure of Orsett's accident and emergency department in 1991. I also appreciate the concern about plans to move services away from Orsett and to dispose of some of the site. In the circumstances, I can appreciate why my hon. Friends would like the whole Orsett site to be retained in the national health service so that, at some future time, the hospital might be expanded and an accident and emergency department for Thurrock residents reintroduced. I shall return to that issue.
The current position, as my hon. Friend the Member for Thurrock is aware, is that Basildon and Thurrock General Hospitals NHS trust, which owns the Orsett site, is seeking planning permission for housing on part of the site that it will not require. Progress on the development of alternative services at Basildon hospital and disposal of property at Orsett depend on the outcome of the planning inquiry, which took evidence last month.
Whatever we may think of the decision to move hospital services away from Orsett, it must be right to dispose of property that no longer has a health service purpose in the most appropriate way possible. Proceeds from the disposal of surplus assets are ploughed back into patient care. I am sure that hon. Members on both sides of the House would like more resources to go into front-line patient services since we know that they are desperately needed.
The reconfiguration of hospital services is part of the local health strategy—the health plan for Thurrock, developed by South Essex health authority. I need therefore to talk briefly about the plan. My comments should not be taken as providing any sort of ministerial endorsement or otherwise either of the plan itself or of the process by which it was developed but rather just to aid our understanding of the local situation.
First, I appreciate the concern of my hon. Friend the Member for Thurrock about population growth in the Thurrock area. He is quite right to highlight that issue. Industry and commerce are being attracted successfully 686 into the Thurrock area, and the population is increasing at a faster rate than in the south Essex area as a whole. The forecast growth in Thurrock's population is clearly rapid, and it is important that local health services are developed accordingly.
The health authority takes the view that the population increase does not justify an additional general hospital in the foreseeable future and that to allow for one would not be a good use of health service resources. Of course, the health authority accepts the need for improved services, and that is reflected in the health plan, which, as my hon. Friend the Member for Thurrock knows, has two main elements: investment of more resources in community and primary health care services and the development of high-technology, general hospital in-patient health services at Basildon hospital to provide a single centre of excellence serving the population of Basildon and Thurrock.
My hon. Friend the Member for Thurrock has expressed his concern about the accessibility of Basildon hospitals to Thurrock residents in correspondence with me. It is a very important issue and I hope that the health plan recognises the need for improvement on it. I understand, for example, that car parking at Basildon hospital is planned to be almost doubled in the near future. The health authority is discussing public transport and the possibility of enhancing the hospital and voluntary transport scheme with Essex county council and Thurrock borough council.
Orsett hospital will continue to provide out-patient, day and diagnostic services. Indeed, there will be no change for an estimated 90 per cent. of the patients who currently use Orsett. I can assure my hon. Friend the Member for Thurrock that not all the surplus land will be disposed of. Some will be retained in case there is a need for some expansion of services on the site in future.
I listened carefully to what my hon. Friend said about consultation, and I have listened to the points that have been made to me directly by the community health council, which clearly feels that the consultation process has been far from adequate.
The health authority has provided me with a briefing that gives its perspective on the consultation that has been undertaken on the health plan for Thurrock. As consultation on substantial service change is subject to statute, it would be inappropriate for me to express an opinion on whether consultation has been undertaken properly in this case.
It is my understanding that the CHC was consulted on the plan during the formal consultation period, which began in early 1995, and that it received meeting agendas and reports on the plan, including the paper that set out in detail the decision to declare areas of Orsett hospital surplus.
A chief concern of the CHC is that land should not be sold without alternative provision being in place. I have received a letter from the local CHC arguing that case. I understand that the health authority has consistently given the undertaking that it would not discontinue or transfer any service from Orsett until appropriate alternatives were provided, either within the community or at Basildon hospital.
Once the planning situation is clear—it is likely to be some time before the outcome of the current planning inquiry is known—the trust will be in a position to refine 687 its plan for restructuring hospital services. The trust has been given outline business case approval for its restructuring plans under the private finance initiative on the basis of the outline proposals. It will need to obtain final business case approval from the NHS executive before going ahead with the procurement and associated disposals.
My hon. Friend has my assurance that the capital development will not be approved until we are satisfied that there are clear benefits for patients, and that the process of disposal and procurement can be handled in such a way that services are not closed before alternative services are made available. In view of my hon. Friend's concerns, which I know are shared by other Labour Members, I shall instruct the NHS executive specifically on this point. I hope that that goes part of the way towards satisfying the concerns of my hon. Friend and his constituents.
My hon. Friend made some remarks about the role of individuals. It would not be appropriate to comment on such roles, although it is incumbent on all servants of the NHS, whether in an executive or non-executive capacity, to ensure that the planning and delivery of local services properly reflects local views. My hon Friends may be assured that one of our priorities is to ensure that the boards of all NHS organisations are properly representative of the communities they serve.
I listened carefully to what my hon. Friends said about the condition of local health services. This and other such debates will inform the changes that we will need to make to restore the NHS to a proper condition with the services that local people should expect to receive. Those changes will be properly thought through and tested, and will be introduced sensitively, but changes there will be to ensure that local hospitals are able to provide a proper health care service in tune with our founding principles for the NHS.
It is particularly important, in my view, that we restore local accountability and local confidence. The way in which services are run and the way in which they develop must be properly in tune with local needs and local views. 688 One of our priorities is to ensure that those who lead local services are properly representative of the communities they serve.
In the meantime, I will want to see those responsible for health services in Basildon and Thurrock, like everywhere else in the country, making every effort, under the present arrangements, to ensure that local views are taken into account fully in the planning and delivery of local services.
§ Mrs. Gorman
On a point of order, Mr. Deputy Speaker. Is it appropriate for the Minister completely to ignore the fact that Basildon, Thurrock and Billericay are concerned in the hospital development? Billericay is my constituency, and it is not been mentioned once in the debate.
§ Mr. Milburn
I have already paid due regard to the concerns expressed by the hon. Member for Billericay (Mrs. Gorman). Moreover, as this Adjournment debate has been secured by my hon. Friend the Member for Thurrock, and because time is short, I am attempting to deal with his specific concerns. I should be grateful if, for a moment, the hon. Lady would contain herself.
I assure hon. Members that, so far as possible, the development and reconfiguration of local health services in the Basildon and Thurrock areas will go with the grain of local opinion. It is extremely important that we achieve that objective, and I expect everyone concerned to make every effort to ensure that we do so. Labour Members are right to insist that no facilities at Orsett should be closed until alternative services are available and that local undertakings on the matter must be honoured. As I said, I shall instruct the NHS executive to ensure that those guidelines are followed.
I hope that my hon. Friend the Member for Thurrock feels that such action shows progress and helps to meet some of the concerns that he has articulated so clearly in this debate on behalf of his constituents.
§ Question put and agreed to.
§ Adjourned accordingly at fifteen minutes to Two o'clock.