HC Deb 14 November 1997 vol 300 cc1208-16

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Robert Ainsworth.]

2.30 pm
Mr. Edward Davey (Kingston and Surbiton)

I am grateful to you, Mr. Deputy Speaker, for this opportunity to raise a matter of crucial importance to my constituents.

Although the state of local hospital services has been an issue of concern in Kingston and Surbiton for some time, the current London hospital review and the south-west London review have brought matters to a head. This debate therefore is extremely topical, and the Minister's reply will be much studied by all who care about the health service in south-west London.

I am delighted to see my hon. Friends the Members for Richmond Park (Dr. Tonge) and for Sutton and Cheam (Mr. Burstow) in their places. I know that they wish to let the Minister know of their concerns—and those of their constituents—in their parts of south-west London.

I should like to place it on record that the hon. Member for Putney (Mr. Colman) and my hon. Friend the Member for Twickenham (Dr. Cable) wanted to be here today to make similar points, but other pressing engagements have prevented them from attending.

The previous Government bear a heavy responsibility for the pressures and difficulties faced by hospitals in south-west London. Not only do we suffer from the underfunding that was the hallmark of Conservative NHS policy, but innumerable reviews, followed by indecision, have left a legacy of uncertainty and doubt over the future of some hospital services, in particular Queen Mary's hospital in Roehampton.

Uncertainty always causes problems in any institution: staff wonder whether their jobs are safe, many leave, morale sinks and, in a hospital setting, patient care is inevitably put at risk. In the Conservatives' NHS, with the chaos of the internal market, such uncertainty has proved even more damaging. Neighbouring trusts look at nearby hospitals with a question mark over their future and wonder whether they can increase their own income by appropriating, some of the threatened hospital's patients. Trained staff are wooed. GPs are contacted. Press releases are sent out. Instead of a rational, planned NHS, we have a chaotic, anarchic one. An uncertain situation becomes an unstable situation.

Queen Mary's hospital, Roehampton is experiencing just such problems with staffing. On general medical wards, the vacancy rate is currently between 40 and 50 per cent., compared with a typical rate of just 20 per cent. Of those vacancies, 70 per cent. are filled by nursing staff who have some knowledge of the hospital. However, 30 per cent. are filled with agency nurses who do not, which is not satisfactory for the hospital management.

The new Government have now to deal with this inherited mess. Indeed, they have started. They have set up the London hospital review and have found at least a little more money for the NHS. We welcome both steps, although the Minister will not be surprised to hear that we wanted more spent on the health service for this year and next.

My aim in seeking this debate was not, however, to focus on the reviews or the argument over NHS spending.

Mr. Paul Burstow (Sutton and Cheam)

Does my hon. Friend share my concern that the 1.35 per cent. increase provided to Merton, Sutton and Wandsworth health authority is inadequate and will lead to cuts in community health care services such as foot care and continence care, which will simply store up greater costs for the future both in the NHS or shunt costs on to social services? Does he agree that that represents a false economy?

Mr. Davey

I agree with my hon. Friend and I share his concerns. I am aware of the cuts that have been experienced by the local health authority in his constituency, which are similar to those that have been experienced in mine. We shall be grateful if the Minister will comment.

My primary objective is to focus attention on the transition period before Ministers can implement fully the decisions that they will take after the review and consultation period ends. I am especially concerned about patient safety during the transition period. I hope that the Minister will be able to give the House and my constituents assurances on patient safety when he replies.

I shall detail the problem. Hospital services at Queen Mary's have been in decline for some time. Local health authorities, faced with severe financial problems caused by the previous Government, have been forced to reconfigure services away from the hospital. There has been increasing concern that patient care in some services is no longer adequate at Queen Mary's.

The royal colleges have already withdrawn accreditation from Queen Mary's for the training of junior doctors in the accident and emergency department both as a result of financial pressures and as a result of new research that shows that patient care is vastly improved by specialisation, which requires large clinical teams—which are currently not available at Queen Mary's.

The danger now is that the royal colleges will withdraw accreditation from Queen Mary's in other areas, including general medicine. If they do that, junior doctors will not be able to train at the hospital. With no junior doctors, many key hospital services will be forced to close. The consequent loss of beds to the local hospital service would be large. It would be extremely difficult for nearby hospitals to cope, especially if they were not given adequate time to prepare. I understand from medical staff locally that there is a serious possibility, verging on certainty, that the royal colleges will withdraw accreditation from Queen Mary's next August. That is the key date that Ministers must bear in mind.

Whatever the outcome of the review of hospital services in south-west London, whatever the consultation process produces and whatever decisions are made by Ministers, the royal colleges' decision on accreditation is likely to go ahead from August next year.

It could be argued that Ministers could still pre-empt the royal colleges with oodles of cash to turn round services. Indeed, many of us would like to see significant injections of cash to do just that. My hon. Friend the Member for Richmond Park has campaigned furiously for many years for just that to happen. Liberal Democrats throughout the region have supported such campaigns, but will such moneys be forthcoming now? They should, but when we are debating patient safety there is no other place to live than in the real world of the Chancellor's published spending plans. The right hon. Gentleman's current plans provide no scope for the type of sums that would be required.

If the Minister is so minded, however, I hope that he will confirm that Queen Mary's will not close and that even under current spending plans this historic hospital will continue to provide vital and modern hospital services—even if he is unable to guarantee sufficient funds to restore it to its former glory.

The proposal in the south-west London review to continue hospital services at Queen Mary's should be seen as the very minimum, given current spending plans, that Ministers should support. The key issue is that if substantial new sums are not provided after the review, the royal colleges are virtually certain to withdraw accreditation next August. That would mean a huge reduction in the number of hospital beds in south-west London from that date.

Faced with that possibility and the real danger to patients' lives that would ensue, it is incumbent on health managers and health Ministers to plan to reduce or eliminate the risk of massive, destructive and dangerous bed shortages next summer.

Local hospital managers at Kingston have drawn up contingency plans. They have worked out precisely how they could provide temporary additional beds as quickly as possible. Those beds would be needed if Kingston had to meet the demand that would follow if Queen Mary's lost its accreditation, but even these plans would take 26 weeks to implement.

Hospital managers cannot even begin to implement such contingency plans until the end of the three-month statutory consultation period in February or March next year. There could be a judicial review if the Minister pre-judged the review and acted earlier, even if the need for contingency plans has been sparked off by the likely actions of the royal colleges rather than by the review.

A 26-week lead-in time for the provision of temporary beds starting from the end of February would take us to August, which is just when the beds crisis is forecast to blow up. Will the beds be ready by August? Perhaps. Maybe. If there is no slippage, or if nothing goes wrong. That is the nub of my concern: perhaps is not good enough. Lives could be put at risk if beds were not available. We should not run our health service in that way.

My main request is simple. Will the Minister ensure that proper contingency plans are in place and will be given Government backing, financial or otherwise, if their implementation proves to be necessary after the reviews? Will he ensure that such plans can be implemented before August if necessary?

I am delighted to inform the Minister that the local Conservative-controlled neighbourhood committee has acted responsibly: last night, it gave planning consent to the hospital's proposals for a temporary beds unit. All local parties are acting responsibly to ensure that the potential risks are tackled. I hope that the Minister, on behalf of the Government and the Labour party, will assure the House that he will play his part, so that no major reduction in beds at Queen Mary's will occur unless and until alternative facilities are open at Kingston hospital and ready to meet the demands of the locality.

Will the Minister detail for me as clearly as possible the timetable for receipt of the reviews and the subsequent consultation period and the timing of announcements of decisions following consultation? Will he assure me that his diary and those of his ministerial colleagues will be cleared for the days directly after the end of the consultation period so that they can give their urgent and undivided attention to these decisions? Decisions should be implemented and any necessary transitional arrangements should be established as soon as possible.

Will the Minister prevail on the Secretary of State to ensure that if a few decisions prove extremely difficult following the consultation, they will not be allowed to delay other decisions that hospital managers will need to be taken to prepare transitional arrangements? I cannot overemphasise the time factor. If we are to avoid a potential catastrophe some time next year, Kingston hospital must be supported so that it can provide enough temporary beds within an extremely limited time frame.

Finally, I urge the Minister, when he and his colleague consider the reviews, to back the case for major capital investment at Kingston hospital. It is a superb hospital. It serves a population of more than 300,000: it currently has 440 beds with a full range of diagnostic and treatment services and clinical support. It achieves one of the highest levels of day surgery care in the country and has introduced changes to create larger specialist teams, as required by the royal collages and as recommended in the Calman report, but Kingston hospital's buildings can no longer cope. Even if no patients were transferred to it from other hospitals as a result of decisions taken following the reviews, there would still be an urgent need for major capital build, such as a new accident and emergency wing, expansion of the maternity unit and new elective surgery units, to name but three.

The staff at Kingston hospital are tremendous. They perform magnificently, often under pressure. The management is innovative and committed to the best for the NHS. Will the Minister therefore give me an assurance that Kingston hospital has his backing and that it has a major role to play in south-west London in the long term?

Mr. Roger Casale (Wimbledon)

I know Kingston hospital well. It is close to my constituency and my mother worked there for many years, playing a small part in contributing to the fine reputation it now enjoys. Many of my constituents use Kingston hospital and I am aware of the knock-on effect of potential further closures at Queen Mary's. Will the hon. Member applaud the fact that the Government have immediately given £12 million to Merton, Sutton and Wandsworth health authority—considerably more than could have been expected under the previous Government's projections? Is it not now the task of local Members of Parliament in that health authority area, which includes my constituency and—

Mr. Deputy Speaker (Mr. Michael Lord)

Order. This is an Adjournment debate in which time is limited. The hon. Gentleman ought to stop there.

Mr. Davey

Of course new money is welcome, but there will still be a financial deficit in that health authority next year which will cause problems. The Government have a problem. They have to pick up the pieces left by their predecessors. I wish them well, but I urge them to realise that, in south-west London, they must act promptly and decisively if patient safety is to be maintained next year.

2.45 pm
Dr. Jenny Tonge (Richmond Park)

The previous Government should die with "Queen Mary's" etched on their collective heart, and I am grateful to you, Mr. Deputy Speaker, for allowing me to say that in the House of Commons. Queen Mary's is a spacious site and was once a fine hospital with easy access from all parts of south-west London and the suburbs.

The previous Government chose to build that white elephant the Chelsea and Westminster hospital in central London, where it was not needed, and ignored the potential of the Queen Mary's site and that hospital's links with the Westminster hospital. The previous Government's internal market followed and went in for the kill. The stronger management at Kingston hospital—which is also excellent—got the contracts for treatment.

Queen Mary's is now operating at what many of my colleagues consider to be dangerous levels and cannot continue in its present form beyond next August. As my hon. Friend the Member for Kingston and Surbiton (Mr. Davey) said, we need new facilities for out-patients and minor casualty and respite beds and we desperately need more beds and facilities at Kingston hospital. If we do not get them, not only will patients suffer, but the royal colleges—which appear to be the new NHS dictators—will say that the facilities at Kingston are inadequate and will withdraw accreditation from Kingston as well. Another fine hospital in south-west London will be lost and patients will suffer. I beg the Minister to listen and to act.

2.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)

This has been a worthwhile debate and has involved more contributors than is normal for an Adjournment debate. It has been helpful that there has been unanimity across the Chamber between Liberal Democrat and Labour Members on an issue of obvious concern to constituency Members of Parliament and to my Department. Conspicuous by their absence are representatives of the Tory party, who must take the lion's share of blame for the situation that exists in south-west London.

The House owes the hon. Member for Kingston and Surbiton (Mr. Davey) a debt of gratitude for bringing this matter before us. I commend him and others—including my hon. Friend the Member for Putney (Mr. Colman) and, of course, the hon. Member for Richmond Park (Dr. Tonge)—for raising the matter in the past with my hon. Friend the Minister of State.

The problems have not appeared overnight—we know their origins and have heard them discussed today. They have led to a situation in which the health service has been fragmented and in which south-west London has been put in a difficult position as a result of decisions made by the last Government. We have inherited a poisoned legacy in this regard, and we must build on the undoubted consensus that exists among those who represent south-west London, among its people and among the dedicated hard-working national health service staff to maintain the expertise, commitment and historic traditions of service to local people in these facilities. By building on that we should ensure that we create a health service of which we can be justifiably proud.

I welcome the frank debate on these issues in local communities. We have been anxious to ensure that we are a listening Government. That is why my right hon. Friend the Secretary of State for Health visited local hospitals in the summer to learn at first hand about the problems. He discussed the issues fully and frankly with clinicians, staff and the unions and with representatives of the local community, including the League of Friends of Queen Mary's. I pay special tribute to its voluntary effort on behalf of the hospital.

We acted. We provided extra money for both health and social services, to ensure that local services were strengthened, particularly at Kingston hospital where pressure was already building as a result of the interim measures that were taken locally in April to maintain clinically safe services. Genuine consultation is now under way to establish the best way forward for long-term services in south-west London. We are committed to the integrity of that consultation, and that imposes a real discipline on Ministers because we must ensure that nothing that we say or do prejudges the outcome of that consultation.

It is important to consider in more detail the local scene. Clinical quality requires a minimum workload. In the acute hospital setting, without a minimum workload doctors cannot be properly trained; senior doctors cannot maintain expertise; and clinical teams will not be large enough to allow doctors to sub-specialise to provide 24-hour specialist cover, or to allow sensible working hours for junior staff. That has been the problem afflicting south-west London—too many hospitals are trying to provide too many services for the size of the population that they serve.

Sadly, the problem is by no means unique in the NHS. As the hon. Members for Richmond Park and for Kingston and Surbiton said, the fault lies entirely at the door of the iniquitous internal market. We have to cope with hospital being set against hospital. We have a job to do and are in the process of doing it across the party political divide to rehabilitate the concept of co-operation in contrast to the policies of confrontation and competition which characterised the previous regime.

We understand and appreciate the royal colleges' concern about the viability of some services at Queen Mary's hospital and Kingston hospital. That led to a local short-term clinical review and the reorganisation of services at Queen Mary's, Kingston and St. George's hospitals. That was necessary and it was done. In this context, it is important to appreciate the role of the royal colleges. It is not about them deciding the future of the hospital but about recognising their role and responsibility.

The Specialist Training Authority is legally responsible for approving hospital posts for training purposes and for safeguarding the standards of postgraduate medical training in the UK. The royal colleges advise the STA and do work on its behalf, but decisions rest with the STA which includes NHS and patient representatives. That provides an important degree of consistency and excellence across a large number of medical specialties. It is right for that to be so. We do not wish to see doctors trained in less than satisfactory environments. It is right for the STA to insist that hospital posts meet certain safeguards if they are to be accredited for training junior doctors. That is the background against which decisions have to be taken and the issue has to be addressed.

Clearly, the south-west London review is vital. It reflects concerns that the reorganisation of hospital services should always promote patient safety. The hon. Member for Kingston and Surbiton expresses concerns—understandably, this is at the forefront of his mind and it should be at the forefront of all our minds—that we should do all we can to safeguard patient safety. That is what it is all about—putting patients first.

A reorganisation of hospital services has taken place. Clearly, the arrangements are not ideal, but they provide some time for more robust and satisfactory arrangements to be worked out. We have set up the review group to take that forward. It is representative of the local health community because we want to ensure that the serious attention to the problems in south-west London, which have proved so intractable, is informed by local concerns.

It is important also that the approach is consistent with what is happening elsewhere in London. That is why Sir Leslie Turnberg is overseeing the situation in south-west London and we have been keeping a close eye on progress.

The hon. Gentleman asks for specific reassurances. Consultation on the proposed service changes in south-west London commenced on 3 November and will close on 26 January. I expect the health authority to reach a formal decision on consultation in mid-February. We expect to receive Sir Leslie Turnberg's review shortly. The review and the Government's response to it will be published in due course.

The hon. Gentleman asked about Ministers' availability and the attention that they will pay to these issues. He requested that we keep diaries free immediately after the consultation. I understand that concern. He should know that we are concerned that all interested parties should make their views known during the consultation, so that they can be taken properly into account and given the serious attention that they warrant. He and all hon. Members should know that, by tradition in the House, the Minister's door is open to them. He and his colleagues are welcome to make their views known. The ministerial team is available to hon. Members and I have no doubt that he will use that access.

It is important that, in taking this process forward, we preserve the integrity of the consultation. We need to hear, and we do take into account, local people's deep concern after many years of uncertainty and diligent campaigning on their part to secure what they perceive as necessary services. I cannot comment in any detail on the subject matter of the consultation. I must not prejudge its outcome, but the hon. Gentleman can be assured there will be no asset stripping.

We will ensure that local services deliver the goods and we have made available the resources to ensure that, in coming months, winter pressures are coped with. Robust contingency plans have been drawn up to sustain services at Queen Mary's. They are aimed at ensuring the continuing confidence of general practitioners and of the public, and to prevent additional emergency admissions being diverted to Kingston during this period. We are determined to ensure that the pressures of the winter are met in a way that puts the patient first.

It would be wrong to speculate about the future, but let me assure the hon. Gentleman that, although it is important that we have a debate, and that there is a debate locally, about service configuration, we will ensure that the NHS Executive works closely with the trust and with the local health service to protect the interests of patients, to put them first and to build together, based on consensus, openness and a true understanding of the challenges that face the health service, a health service of which we can all be justifiably proud. Of that, he need have no doubt.

I thank the hon. Gentleman and all hon. Members for their contribution to ensure that we achieve just that. It is a great challenge, but the interests of patients demand that we be up to it. I have no doubt that the Government will be up to it and will ensure that patient safety, welfare and interest always come first.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.