HC Deb 02 December 1998 vol 321 cc1017-22

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

11.50 pm
Mr. John Wilkinson (Ruislip-Northwood)

It is only nine months since I secured an Adjournment debate on 6 March on the future of Mount Vernon hospital, Northwood. Many of the fears that I expressed then have been realised, notwithstanding a petition of some 80,000 signatures in support of the hospital being built up and not run down, and the public's particularly strong backing for the preservation of its regional burns, plastic and oral maxilla-facial surgery unit.

Now, the future of Harefield hospital nearby is in question and I crave the House's ear again, even though I have no illusions about how difficult it is to influence the direction of the national health service in favour of those who finance it: the taxpayers.

On Wednesday 18 November, the hon. Member for Hemel Hempstead (Mr. Mc Walter) secured a debate about West Hertfordshire health authority, which, among other health authorities, funds the treatment of patients both at Mount Vernon and at the regional and national cardiothoracic specialist hospital at Harefield. He complained that, despite the language of the West Hertfordshire health authority, which talks about a new super-hospital, the proposal represented a substantial cut in the facilities available to the people of west Hertfordshire. The hon. Member for Watford (Ms Ward), whose constituents attend Harefield hospital with chest and heart illnesses, echoed those complaints.

There was a shared and relevant anxiety in the debate, which was also expressed by my hon. Friend the Member for South-West Hertfordshire (Mr. Page), whose electors, too, are treated at Harefield and whose community health council has formally objected to West Hertfordshire health authority proposals. The Government will not grant money to maintain the status quo, which is crucial to build up existing centres of national excellence such as Harefield and Mount Vernon, but they have a predilection in favour of the construction of new hospitals funded through the private finance initiative.

When the Minister of State, Department of Health, the right hon. Member for Darlington (Mr. Milburn), responded to that debate—I am glad to see that he is present again—he admitted that the Government's modernisation programme was "extremely ambitious". I would not, however, contradict the conclusion that was drawn by the hon. Member for Hemel Hempstead about the proposals of the West Hertfordshire health authority. He said: implicit in its plans must be a substantial reduction in the asset base, which means that an awful lot of hospital closures that have not been accounted for must be in the pipeline. The Minister of State boasted that work has started on the construction of eight hospitals under PFI and boasted about the biggest new hospital building programme in the history of the NHS-31 new hospitals worth almost £2.4 billion, 25 of which will be built through PFI, with a total value of almost £2.2 billion."— [Official Report, 18 November 1998; Vol. 319, c. 917–18.] Where does that leave existing specialist centres of national and, in the case of Harefield, international excellence, which need, by comparison, very modest

additional capital funding to modernise their facilities? If the dire precedent of Mount Vernon is anything to go by, they are left in a very vulnerable position. At Mount Vernon, between a mere £5 million and £7 million are required to modernise a superb burns, plastic and oral maxilla-facial surgery unit. However, West Hertfordshire health authority would like it to be moved into its new £150 million green-field site, private finance initiative hospital. Hillingdon health authority would like it to go to the new, costly inner-city Westminster and Chelsea hospital.

Harefield is known globally as the hospital that has done more heart and lung transplants than any other: well over 2,000 since 1980. Professor Sir Magdi Yacoub's internationally famous team has done an immeasurable service to the reputation of British medicine worldwide. It will be remembered that Diana, Princess of Wales attended, masked and medically gowned, an operation there.

Harefield hospital also has an extensive programme of heart and lung operations, more than 3,000 a year. The hospital makes a profit. Doctors from 60 countries have been trained, and patients from as many countries treated, there. Surgeons trained at Harefield have taken their skills of heart and lung transplantation back to the countries of their birth.

Research at Harefield is integral to the work of the hospital. As with the superb cancer and burns research facilities at neighbouring Mount Vernon, the research has been made possible by an impressive combination of public and charitable funding. As Sir Magdi has said about the Harefield heart science centre: Most of our work to date has been on the fault repair side of the heart and lung business. I believe it should be possible within a generation to identify the causes of heart and lung disease with a view to their prevention and thus deprive fault repair surgeons like me of their jobs. Phase 1 of the heart science centre was completed in 1993. It has developed the artificial heart, evolved therapies to reduce transplant tissue rejection and analysed the processes of heart degeneration and the causes of cardiovascular disease. Building phase 2 will cost £2.5 million at 1996 prices, plus revenue costs, but its work on the prevention and treatment of cardiomyopathy and studies of the molecular and genetic origins of heart disease and of means of preserving donor organs longer will save the NHS millions of pounds in the longer term. Above all, it will save countless human lives.

Harefield hospital owes its origin to the Australian great war hospital on the site at Harefield park where many thousands of wounded Anzac soldiers were treated when they were brought back from the battlefields of Gallipoli and France. The hospital has a numerically small, but inspirationally famous, focus on children. Giving children born with heart problems a chance to lead a healthy life is an important part of its work. When Harefield received funding as a supra-regional transplant centre, the next project was to raise money for a new children's ward. The give-a-child-a-chance appeal was most successful, and in July 1989 the ward was opened by Her Royal Highness, the Princess Royal. Sadly, this ward is due to be closed and its facilities moved to the Royal Brompton, although out-patient paediatrics may remain at Harefield.

When the Royal Brompton and Harefield hospitals merged this April, it was my private fear that asset stripping at the expense of the country cousins at Harefield would occur, not only in terms of equipment and facilities but of its supreme asset, its personnel. This is now a grave risk, starting with paediatric surgery.

A west London cardiothoracic review was initiated. In mid to late October 1998, its conclusions were lodged with the Department of Health. It suggested three possibilities. First, that the Royal Brompton and Harefield NHS trust should maintain its services in the existing locations. That would be the wise course, building on the hospitals' respective strengths and complementing effectively their talents and expertise.

Alternatively, it was suggested services at Harefield should be concentrated at the Royal Brompton, which could only involve a diminution of facilities and beds, to the detriment of patients in need of cardiothoracic treatment. It would also be a breach of faith with the joint message in the merger consultation document issued by Sir Geoffrey Errington, the then chairman of Harefield, and Sir Philip Otton, who now chairs the joint trust, which made no mention at all of closing Harefield, but spoke only of improvement of care for patients and better coordinated research.

Finally, it was suggested that both Harefield and Royal Brompton hospitals could be combined in a new hospital, to be built alongside St. Mary's on the Paddington basin site. We are told that it could still keep the proud title of Royal Brompton and Harefield NHS trust, but what consolation is that to the wonderful people who stand to lose their jobs? I do not know how much the project would cost or how it would be financed—perhaps through the private finance initiative, such as the project in west Hertfordshire. I also would not presume to know whether Chelsea needs another Lanesborough hotel, such as that constructed on the old St. George's hospital site at Hyde park corner.

I do know that closing Harefield hospital would tear the heart out of Harefield village. It is the only major source of employment in the last village left in what remains of rural Middlesex. In the words of the author of its history, the cardiothoracic surgeon Mary Shepherd, who worked there for some 20 years, Harefield hospital is "the heart of Harefield", the place where in the great war 50,000 wounded Anzacs were treated, and close to where 114 of their number remain to lie in St. Mary's churchyard, in graves bedecked and garlanded with spring flowers by local school children every Anzac day.

Between the wars, Harefield hospital treated the scourge of tuberculosis. In the second world war, Harefield dealt with casualties north of the river Thames and, with St. Mary's hospital, Paddington, enlarged its scope to deal with general and thoracic surgical war casualties, hence its current expertise.

Harefield hospital is, in short, a special place, and covetous eyes are cast upon its skilled and devoted staff—even Northwick Park hospital, in Harrow, might aspire to employ them. Its asset value must tempt potential developers, too. However, surely modernising the NHS means building on its strengths. Harefield, in peace and in war, has won a place not only in the hearts of its staff, of the villagers and of its patients and their families, but of the nation. Surely that transcends property valuations.

Harefield hospital's situation in rural green belt, at the nodal point of the M1, M25, M40, M4 and M3 motorway network, near to Heathrow and Luton airports, with its very own helicopter pad, ample space, surrounding quiet countryside, clean air and cheaper housing, is surely the right one to make it the right place for the country's premier cardiothoracic transplant centre, now and well into the century that is to come.

Developers, PEI financiers, and great and good committee men may have other ideas, but I simply pray that Our Lady of Harefield—whose image in glass glorifies a window in the hospital chapel—and of the parish church dedicated in her name may bring advent wisdom to Ministers and allow the work of the healing of hearts to continue in the village where England's first and only Pope, Nicholas Breakspear—Adrian IV—was born.

12.5 am

The Minister of State, Department of Health (Mr. Alan Milburn)

I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on securing this important debate on the future of Harefield hospital—one of the best-known heart hospitals in the national health service. I am grateful for the opportunity to describe the high regard in which we hold its services.

Coronary heart disease is the most common cause of premature death in the United Kingdom. It accounts for about a quarter of deaths under the age of 65 and is on the increase. In 1997–98 in England, 389 heart and lung transplants were performed, of which around a quarter were undertaken at Harefield.

The Government have recognised the importance of getting the treatment and the prevention of the disease right by making it a major national priority for the NHS. It will be one of the first two services to be subject to uniform standards through a new national service framework. The framework will be published in April 1999 and will seek to improve the quality and consistency of services by setting clear national standards for providing care.

Today's service must be of high quality, but we also need to invest in tomorrow's service by researching the disease and teaching and training the young doctors and nurses who will provide care in years to come. The Government's commitment to research on cardiac and respiratory diseases is unwavering. This year, NHS providers in England will receive a total of £349 million for spending on research. The Royal Brompton and Harefield NHS trust is the health service's pre-eminent provider of research into cardiac and respiratory diseases and is receiving £20 million—just under 6 per cent. of that total.

Many people are aware that, under the inspirational leadership of Professor Sir Magdi Yacoub, Harefield hospital has become a world leader in heart and lung transplantation. It has the largest transplant programme in Europe, as the hon. Gentleman rightly said, and has accumulated experience over the past two decades that is second to none, not just in this country or in Europe, but in the world. Since its programme was set up in the early 1980s, Harefield has completed well over 2,000 transplants. I pay tribute to Sir Magdi and the whole team at Harefield, who have helped so many people over so many years to live a rich and fulfilling life.

Harefield not only provides top-quality medical care, but makes a major contribution to world-class research into cardiac disease through its links with the Imperial college school of medicine. The research output of the cardiac and respiratory sciences department at Imperial has been recognised in successive assessments by the Higher Education Funding Council for England as of the highest international quality. Some 20 per cent. of the UK's research output in cardiac and respiratory diseases is completed at Imperial and its associated NHS hospitals. Perhaps even more impressively, two thirds of top-quality research citations in the UK are generated by the same department.

However, like all hospitals, Harefield is not immune to pressures and it would be wrong to try to ignore them. Some of those pressures are the inevitable result of its own pioneering effort. Following the success of Harefield's transplant programme in the 1980s, eight centres in England are designated to undertake heart and lung transplantation. Harefield continues to have the largest transplant programme, although Papworth hospital in Cambridge is now of a broadly similar size. All centres have benefited from Harefield's work and from the teaching and training that it has provided to young specialists, many of whom have gone on to work in other centres throughout the country. Through its success in sponsoring the development of other centres, Harefield has seen a substantial fall in the size of its transplant programme, with 98 transplants this year compared with 219 when the hospital was at its peak 10 years ago.

The key to future success in the research of cardiac and respiratory disease is also changing. Increasingly, top-quality medical research needs to combine basic scientific research with more specialist condition-based research, which tends to take place closer to the patient. That is why we were pleased to announce the opening of the new £67 million basic medical sciences building at Imperial college in September 1998—£20 million was contributed by the NHS, a further £20 million came from the Department for Education and Employment and the remainder was funded by the university itself.

Recently, Imperial has expressed concerns that the level of fragmentation in specialist cardiac services in and around west London may erode the future international competitiveness of the university and the national health service's research base. Those are serious concerns and we need to look at them seriously.

As part of the independent review of London's health services, the Government asked Sir Leslie Turnberg to assess the need for change in that area of London. He was also asked to look at the process that had been developed involving both the NHS and its academic partners to shape the change. Sir Leslie was encouraged by the progress that he saw. His report registered a particular concern that the way in which the service is organised in west London may not be maximising its long-term contribution to national and international research. He advised the Government to ensure that plans were carried out for a more rational distribution of specialist services across west London. The hon. Member for Ruislip-Northwood may recall that we accepted all Sir Leslie's Turnberg's recommendations, including that one.

The NHS executive asked hospitals and health authorities in that part of west London, along with Imperial college, to take part in a review of specialist cardiac and thoracic services. The review commissioned expert clinical input from a panel chaired by Sir Terence English, an internationally respected figure in heart transplantation who completed the very first heart transplant in this country and who is a former president of the Royal College of Surgeons. The review was completed in July and broadly confirmed Sir Leslie's impression that cardiac and thoracic services in west London were not organised in a way that would continue to support the highest-quality service and academic endeavour.

Sir Terence English said that three of the four cardiac centres in west London were not seeing a sufficient critical mass of patients. He recommended that existing services should be focused on fewer, larger centres. He also advised that collocation of specialist cardiac services with other related specialties would bring benefits that were not available to single specialty hospitals such as Harefield.

We have also received advice on the national heart and lung transplant programme from the joint consultants committee, which comprises the royal medical colleges and the relevant specialist associations. The advice was that the NHS should be working to a position where such complex acute services are provided only from multi-specialty hospital sites.

Sir Terence English's recommendations are being considered, alongside the conclusions of parallel reviews into specialist paediatric services and renal transplantation in west London, by the west London partnership forum. The forum comprises the hospitals and health authorities in west London as well as Imperial college and the NHS. It is chaired by the noble Lord Newton of Braintree, for whom I have the highest regard; I am sure that he will do a very good job for NHS services in that part of London and, indeed, in the rest of the country.

As the hon. Member for Ruislip-Northwood rightly said, the forum is examining a number of options for the future of cardiac services. Those include consolidating all the work of Harefield at the Royal Brompton site in Chelsea, keeping Harefield as a specialist centre and investing in the site, and building a new major heart and lung hospital adjacent to St. Mary's hospital in Paddington. Any firm proposals will be subject to formal consultation.

As the hon. Member for Ruislip-Northwood knows, I cannot comment further, since I would have to adjudicate in the event of a community health council objecting to any such proposals. I can tell him that the Government recognise the unique nature of Harefield. The interaction of science, research, teaching and services is an enormous strength. We also know that, if the Harefield team were broken up, it would be very difficult—if not impossible—to reassemble it.

My right hon. Friend the Secretary of State has met with Sir Magdi and given him a personal assurance that, while the issues are being considered, planning blight will not be allowed and funding will be made available to ensure continuing essential investment at Harefield. I hope that the hon. Member for Ruislip—Northwood finds some comfort in those reassurances, and that he will think again about some of the language, about asset stripping and so on, which he deployed in his speech.

There are difficult issues to consider in this case, and we will take the time and the trouble to do so. We will take advice from leading clinicians in the land, we will listen carefully to what Sir Magdi and others have to say and we will listen to the proposals of Lord Newton and his team. We will then reach our conclusions, following a full and proper public consultation.

Question put and agreed to.

Adjourned accordingly at sixteen minutes past Twelve midnight.