HC Deb 11 February 1998 vol 306 cc285-308

Motion made, and Question proposed, That this House do now adjourn.—[Ms Bridget Prentice.]

9.34 am
Mr. Roger Gale (North Thanet)

I am grateful for the opportunity to raise an issue which is of the utmost importance to my constituents living in Herne Bay, Margate and the Thanet and Herne villages. It is important to the wider community of east Kent and throughout the county, the south-east and the country.

I know that colleagues on both sides of the Chamber wish to catch your eye, Madam Speaker. If I am not interrupted too often, I hope to be as generous as possible with the time that you have afforded me and to confine my remarks to the minimum necessary.

The health authorities in Kent face painful decisions. Despite a painstaking and collaborative process by the national health service family, the choices have still set medical staff against medical staff, brother against brother, and caused political strife. The position has not been helped by some hysterical and irresponsible campaigning.

Mr. Richard Collins, speaking as director of surgery at Kent and Canterbury hospital, said that these were "complex issues" and that the debate was not assisted by the intervention of vested interests, including doctors and shroud wavers. He was right. These are complex issues and they require careful and measured consideration, not the abuse of position and knowledge by people who, for their own interests, rather than the interests of public health, in some cases deliberately seek to mislead.

I want to use the next 20 minutes or so to offer what I hope will be a constructive contribution to a consultation that will last for nearly three months before a document for final decision thuds on to the desk of the Secretary of State for Health. I do not envy his task. Like any Health Minister—of any Government or any party—he has to work within a climate of change, and I do not believe that this is or should be a party political issue.

We must all recognise that funding is not unlimited, that the pattern of work and training for medical staff is changing and that advances in medical science, often dependent on fiercely expensive equipment and drugs, make many life-saving procedures possible. That, in turn, raises public expectation, demand and faith in the medical professions to almost intolerable levels. Thirty years ago, a cataract operation or a hip or knee replacement was a major procedure and a rarity; now, new eyes, hips or knees are the order of the day.

Junior doctors' training years and working hours have been reduced. A young hospital doctor who used to work more than 100 hours a week now works 56, and that figure is destined to decrease further. General practitioners who used to work day and night after day and night, now may not carry out night calls at all and work a much shorter week. However, the requirements of the royal colleges demand that, before they are let loose on the public, young doctors must be exposed to a given number of patients in a given number of specialties and under the right conditions. That is right. No one here would like even an appendectomy to be carried out by someone who said, "Oh, this is interesting—I have never seen one of these before."

As well as the importance of exposure to procedures during training, evidence clearly shows that, when the experienced consultant and his or her team carry out many of the same procedures, the outcome for patients—the real measure of the quality of the service—is better than when the same team cares for a wider range of patients. That is sub-specialisation. Therefore, if medical students and trainee doctors are to see enough patients in a shorter time, it is axiomatic that throughput must be greater and the hospital larger. To allow consultants to sub-specialise, there must be more of them, working in larger teams and caring for a larger population. I believe that it is that demand, rather than simply or even a cash shortage, that is causing many of the tensions that we now feel.

There are well over 30 24-hour accident and emergency units in the south-east region. I am told that it is likely that that number will have to be reduced by perhaps 10, with a consequent transfer of some other services. Throughout Kent, throughout the south-east and throughout the country, because no one is immune from the process, that will mean a great deal of heart-searching and not inconsiderable anger. We are experiencing that in east Kent, as I know only too well; we shall not be alone.

West Kent currently has hospitals in Dartford, Medway, Maidstone, Tunbridge Wells and Pembury, and the West Kent health authority told me: We recognised that improvements in clinical capability, professional opinions about safety and training, combined with financial realism and the need to meet health needs other than acute ones, all lead towards some traditional hospital services being reorganised to serve larger populations. We accept that in-patients will increasingly be seen at locations specialising in a particular service; but matched by better local access to day-case surgery and out-patient clinics.

Miss Ann Widdecombe (Maidstone and The Weald)

Will my hon. Friend give way?

Mr. Gale

My right hon. Friend has told me that she will have to serve on a Committee later this morning and will be unable to make a speech in this debate. I am pleased to give way to her.

Miss Widdecombe

I am extremely grateful to my hon. Friend for giving way, and particularly for taking on board my reasons. Maidstone is a centre of excellence in its oncology services. As we are told that the East Kent health authority now plans that there shall not be cancer services at Canterbury, it is inevitable that those will be exported mainly to Maidstone. Does my hon. Friend share my view that it is necessary that the West Kent authority is able to respond to that by expanding the service at Maidstone and not by expanding the queue?

Mr. Gale

I believe that it is necessary that West Kent is able to respond positively. Later, I shall deal in a little detail with the future of oncology services in east Kent.

In its concluding remarks to me, the West Kent health authority—in perhaps the most important sentence of all—said: We do not believe that the status quo is tenable for both professional/clinical and financial reasons. The status quo is also not tenable in east Kent, where we face the prospect of redistributing the work currently performed by three district hospitals—Ashford, Thanet and Canterbury—to create two main 24-hour accident and emergency hospitals, backing up perhaps a city hospital in Canterbury, the Buckland hospital and a chain of, I hope enhanced, local hospitals, including Faversham, the Whitstable and Tankerton, the Queen Victoria hospital, Herne Bay, the Victoria hospital, Deal, and the Royal Victoria hospital, serving Hythe and Folkestone.

It is perhaps appropriate that I am initiating this debate, for my constituency straddles population centres that use two of the three main hospitals: the Kent and Canterbury, on the Ashford side of the city of Canterbury, and the newly built Queen Elizabeth the Queen Mother hospital in Margate.

I have been involved in the development of hospital health care in east Kent—through the preservation of the Queen Victoria hospital, Herne Bay, the closure of the Royal Seabathing hospital in Westbrook and the building of the new Queen Elizabeth the Queen Mother hospital in Margate—for the whole of my 15 years as a Member of Parliament.

There are those who say that the debate on health services in Kent has been going on for only a matter of months. It has not; it has been going on for years. Under the old Canterbury and Thanet health authority, Conservative Members fought our own Government for increased funding under the resource allocation working party formula. Both Thanet and Canterbury hospitals—the former more than the latter—were starved of cash while inner London took a disproportionate share of the available funds.

We have watched the roads develop with the population around the coastal strip, and we have worked to ensure that developments in health care matched the shift in gravity of the population away from the centre to the coast, and the social need and deprivation in, particularly, Thanet. It was the recognition of that need which led the health authority and the previous Government to fund development of the Queen Elizabeth the Queen Mother hospital in Thanet.

More recently—for the best part of three years—acute service working parties, with strong medical representation from all the major hospitals in the area, have been wrestling with the disposition of neonatal, paediatric, haematology, pathology, renal, oncology, ophthalmology, orthopaedic, cardiac and other services.

Since the spring of last year—not July or August, as some suggest—minds have been focused on the "Future of Hospital Services in East Kent" document. It saddens me enormously that some of the medical staff who took part in that process, who did not raise any public or even on-the-record private concerns, and who pressed, then and since, for concentrating services on a single site are now, in the light of the debate that has been generated, seeking to present the process as flawed and to criticise the health authority officials who managed the process.

I pay tribute to the regional chairman, Sir William Wells, to the chairman and the chief executive of the East Kent health authority, Jo Hawkes and Mark Outhwaite, and to their team for the work that they put into the discussion document published on 2 February, and their continuing work—in the face of fierce criticism and not a little personal and unwarranted abuse—in the consultation and decision-making process. I do not find it attractive that there are those who are seeking to have the document withdrawn on the basis of, at worst, some very minor or, in a couple of cases, typographical errors.

A five-option shortlist was produced. On 4 November last year, the options—a green-field site hospital; a single hospital based on the existing Kent and Canterbury hospital; and combinations of Thanet and Canterbury, Canterbury and Ashford, or Ashford and Thanet—were put to a meeting of all concerned at the Kent county cricket club, which included the working party, again including medical staff from all three major hospitals involved, and general practitioners' representatives.

Laurie McMahon, of the widely respected and independent Office of Public Management—an organisation specialising in NHS matters—asked all those present whether, in addition to the five options on the table, there were any other realistic and practical alternatives that should be considered. Significantly, no voice was raised to suggest that the work that was done was anything but thorough.

On the day before that meeting, the acute futures group held an unofficial meeting—at the request of Dr. Robin Withrington, clinical director of the Kent and Canterbury hospital—to discuss a submission based on the single-site option. A note prepared by the secretary of the group says that the submission was withdrawn because the health authority was to consider that option further, regardless. Subsequently, the consultants Messrs. Davis, Langdon and Everest prepared a report stating that the single-site option should be ruled out, because it would take too long to deliver and implement, would be inordinately costly and, most important, would cause the biggest loss of public accessibility.

It has again been suggested that specialist doctors at Canterbury were not consulted. The facts are that each trust provided representatives to the project, and each trust undertook to establish its own internal briefing mechanisms to ensure that other staff were involved and had the opportunity to contribute through their representatives. That seems to have worked at the Ashford Hospital NHS trust, Canterbury and Thanet Community Healthcare NHS trust and Thanet Healthcare NHS trust, and the written evidence provided by the heads of the specialties—such as the neonatal intensive care unit and renal unit—was provided direct to the health authority, along with other options from external experts.

If Canterbury specialists feel that they were not properly consulted, that would appear to be the fault of their medical director, who was a participant in the project.

At a meeting at Dover town hall before a wider audience, the authority presented its preliminary findings and presented two options for main hospitals: Thanet and Ashford, or Ashford and Canterbury. On 11 December, a preference for the Thanet-Ashford option was expressed by the East Kent health authority. The authority based that preference and those options on the available evidence. Again significantly, while much heat has been generated, no light has been shed by those complaining on what the Office of Public Management described as a "realistic and practical alternative".

There are those campaigning—I think quite dishonestly—for a solution of three acute hospitals, based on the maintenance of all three 24-hour accident and emergency units. On the available evidence, that is a cruel deceit and not a realistic proposition because of the required training and—we must be brutally honest—the financial constraints faced by any Government.

What is the solution? On the answer depends a likely pattern that will develop throughout Kent, the wider south-east area and, indeed, the country. Many of my constituents living in Herne Bay—many of them personal friends—have been angered by threats of so-called "cuts" or the "transfer of services" to locations that they regard as remote or inaccessible. They have also been frightened by wild talk of the "closure" of the Kent and Canterbury hospital, which, of course, is not threatened with closure at all. Indeed, only two days ago, a young journalist covering the story asked me whether I was not surprised that people would be upset because their hospital was going to be closed". It would have been easy, and politically much more comfortable, for me to back the three acute hospital option and to leave the burden of decision on the "wicked" health authority. It would also in my view have been as profoundly dishonest as the behaviour of the medics and local politicians currently peddling that view, because I believe that, while there is much room for manoeuvre in the discussion document, the health authority has got the framework broadly right in its expressed preference.

Geographically and demographically—in terms of population density and social need—the two prime medical centres in east Kent should be in Ashford and Thanet. Once that has been recognised, it becomes abundantly clear that attention must be given to public transport within east Kent; but that will be true whatever the outcome of the review.

I am very aware that bus services between Herne Bay and the Queen Elizabeth hospital, for example, leave a great deal to be desired, as does the bus service from Herne Bay, via the centre of Canterbury and with a change, to the Kent and Canterbury hospital. My right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) has expressed to me his concern about services from, for example, the Elham valley to Ashford that will be needed by his constituents. Other routes will also need attention.

That is why the health authority is already working on a transport plan to meet patient and visitor needs, and why I have already had preliminary discussions with the county council to consider possible changes better to serve all our hospitals.

However, that does not gainsay the fact that the overwhelming majority of callers at hospitals, whether as patients or visitors, travel by car. The travel-time analysis on which the preferred option has been based is calculated not on raw population figures or "I can get from A to B faster" research, but on actual hospital activity—the use of real services by real patients. It demonstrates a clear advantage for the Thanet option, especially in the sensitive area of paediatrics.

The second, or Canterbury-Ashford, option put forward by the health authority for consideration would place two 24-hour accident and emergency centres within 14 miles of each other, while denuding the largest centre of population—Thanet—20 miles away of its acute services. However, that demographic reality should not be allowed to preclude the building of a brand new city hospital in Canterbury, which I whole-heartedly support and have promoted. Such a hospital would, of course, house the more than 80 per cent. of existing services that, even under the health authority's current proposals, will remain in Canterbury—hardly the "closure" that some have sought to portray in the local press and on public platforms.

I support the creation of a single east Kent health trust to manage the services and—here I part company with the health authority—the preservation and development of the services at all the local hospitals that I named earlier. Moreover, I believe that, while it is indubitably true that, if these proposals are adopted, some patients will have to travel further for some treatment by some specialists, as some already travel to Maidstone, to the Medway towns and to London, it is also true that, for many purposes—through a much wider choice of consultant outreach clinics and the development of day surgery—many of my constituents in Herne Bay will not have to leave the town at all. Why should they not be seen and treated in our own hospital, the Queen Victoria, closer to home? Following major procedures in another hospital, why should they not be able to recuperate in the Queen Vic, with friends and family close at hand?

I hope that Herne Bay's GPs will soon take advantage of the offer made to them by Dr. Alan Jones, the accident and emergency consultant at the Queen Elizabeth the Queen Mother hospital, who is pioneering telemedicine in the area. As a result of modern technology, patients at Deal will soon be treated with advice from the consultants in Thanet, and the same opportunity is being offered to Heme Bay. I am sure that our excellent and far-sighted local GPs will not wish to deny my constituents that service.

There is a tremendous role for our local hospitals to play. I pay tribute to the League of Friends and all those who have worked so hard to provide beautiful new out-patient and other facilities at the Queen Victoria hospital. Similar organisations have no doubt achieved equivalent improvements at the other smaller hospitals, too.

I know of no reason—again, I question the health authority's view—why the Canterbury arm of the Maidstone- Canterbury cancer centre, which provides excellent non-surgical oncology services, as well as some of the specialist surgery carried out at other cancer units in, for example, the Queen Elizabeth the Queen Mother hospital in Thanet, should not be transferred to a new city hospital.

Consultants working in Canterbury have sought to suggest that non-surgical oncology is not possible without the back-up services that go with a 24-hour accident and emergency unit. Try as I may, starting with Professor Calman's office, working through Dr. Graham Winyard's office to the NHS executive and the regional cancer co-ordinator, I can find no one who is prepared to say that that is so.

I shall be told that the Royal Marsden, with its twin sites at Sutton and on the Fulham road, the Christie in Manchester and the proposed Bart's development, none of which has 24-hour accident and emergency units, are special cases. But are the Cookridge near Leeds, which is a stand-alone hospital in the countryside, or the Clatterbridge—neither of which has 24-hour A and E units, but both of which carry out non-surgical oncology—special cases as well? If so, it is perfectly possible—I am sure that the consultants will recognise this—to move the more modern linear accelerator from Canterbury to Thanet where there will be services that the consultants claim are required. My personal preference, however, would be for that well-established unit to remain as part of the new city hospital in Canterbury.

There is at present no definitive view about what services are essential, rather than desirable, to support a non-surgical oncology unit as part of a full Calman-Hine cancer centre. That being so, I can only repeat that it would be a sad irony if those taking an intransigent all-or-nothing approach to the issue were to paint themselves into a corner from which we cannot extricate them. They and, more important, the community that they wish to serve have a great deal to lose by that approach.

It is also time that we challenged the fact that Kent has no teaching hospital. It must surely make sense to seize this opportunity, for it can be either an opportunity or a threat, to establish, based on the university of Kent—I am sure that the vice-chancellor, Robin Sibson, would be the first to remind us that it is the university of Kent, not the university of Canterbury—a medical school founded on the East Kent health authority proposals and using the specialties, facilities and the undoubted expertise available at all our hospitals as the practical training ground.

Let me make it clear that I am not advocating a back-door route to a single-site centre at Canterbury; nor will I support the siphoning off of SIFTR money—the service increment for teaching and research—for medical students to one single hospital. There is a case for a medical school in Kent, based on and using the best of all the facilities in all the hospitals that we have on offer. In that context, it should perhaps be placed on record that, for example, the QEQM hospital has a critical care floor with a specialist complex of four operating theatres, an intensive care unit, a cardiac unit and a high-dependence unit all in close proximity, on the same floor and managed as a single unit. I think I am right in saying that the only other such unit in Britain is at Addenbrooke's in Cambridge.

The QEQM looks forward to a GP service alongside the new A and E department, with extended waiting space and a triage centre at the core that will allow GPs to keep more patients out of hospital and will free accident and emergency beds to handle the real emergencies. That is, of course, in line with the implementation of the White Paper's recommendations for medicine based on primary care groups.

The hospital offers good facilities, a good training opportunity for doctors without excessive hours, and access to sub-specialisation—the career path of tomorrow. It is right that these opportunities, and those at our other hospitals, should be made available to tomorrow's doctors—and they can be made available within the health authority framework.

It would be good to be able to end there. However, a situation is developing that has the potential to place at risk not only the reorganisation of services in east or west Kent, but the reform of the national health service nationwide.

I have already said that, following the announcement of the East Kent health authority's preferred option for two specialist hospitals in Thanet and Ashford, the Kent and Canterbury team began systematically to seek to undermine the work that had been done, in some cases by their own staff, to produce a blueprint for the future. That has grown into a campaign of misinformation, propagated in skilfully stage-managed and well-orchestrated medico-theatrical performances at public meetings. It has more to do with the abuse of power than people power, and could easily be replicated with interest in other parts of east Kent, throughout the county and beyond.

The purpose of the exercise is plainly to drown reasoned debate with noise, to force the East Kent health authority to resign en bloc, and to recommence the process of deliberation. The hidden agenda is to secure a single-site centre in Canterbury which would result in the tens of thousands of people who live on the coastal periphery and in the Ashford area no longer being within easy reach of the acute services that they currently enjoy.

Let me give a couple of examples of the misinformation. It has been suggested publicly that the Kent and Canterbury hospital is the most efficient hospital in east Kent and that Thanet is one of the least efficient". The perpetrators of that lie—for that is what it is—have been made aware that the figures on which the claim is based date from before the closure of the Ashford hospital, before the closure of the old and inefficient Ramsgate hospital, before the extension of new day surgery treatments, and, most significantly, during the transition period when the Royal Seabathing hospital in Margate was closing and the services were being transferred to the Queen Elizabeth the Queen Mother hospital, which was a time of great disruption. The new figures are different, but the lie is still being peddled.

A consultant paediatrician working in neonatal intensive care in Canterbury, seeking to bolster the case for a three acute hospitals solution, claims to have blazed a trail by brokering a three-centre solution for paediatric care in east Kent". He is being more than a little economical with the truth. The facts are different. He argued for a single site—at the Kent and Canterbury hospital—for paediatrics in east Kent. That would result in children from the most deprived area in the south-east—Thanet—and those from Ashford having to travel to Canterbury with their parents for all in-patient treatment. With paediatrics would have gone obstetrics and most of the maternity services from the area where many of the region's babies are born.

That is what that consultant and his colleagues were trying to impose on my constituents. They fought that corner before 20 witnesses, including me, at the Queen Elizabeth the Queen Mother hospital. He pursued the same self-interested line at the university of Kent during two days of discussion on the health service. In the words of one present, he expressly and robustly argued for a single centre in Canterbury. I am told that only when he was confronted with the reality that there was likely to be a two-centre solution to paediatric care at Ashford and Thanet did he change his tune and press for a three-centre service.

That is the truth, but not much of it is to be heard at public meetings, where teams of consultants and those who support them abuse their medical position to mislead. They have the power of life and death, but why should we believe their claims when we know that they have been less than honest in the past?

I now have to raise some highly sensitive issues about the health service in east Kent on behalf of those of my constituents from Herne Bay and Margate who have been subjected to the pathology services at the Kent and Canterbury hospital. It is widely believed that the senior medical staff at the Kent and Canterbury hospital were well aware of the shortcomings of its histo-pathology and cytology services, but chose to cover up the situation. That is why I have asked the General Medical Council to study the report of the inquiry into the circumstances under which eight women died and many others had needless operations. I am pleased that the GMC has confirmed that it is investigating the issues relating to cervical cytology screening at the Kent and Canterbury hospital".

I hope that the General Medical Council and the Department of Health will also inquire fully into the other cytologies and histologies relating to lung, rectal and breast conditions. My constituents and I have a right to know what other loss of life there was at that hospital as a result of misreporting. I want to know whether consultants were using outside pathology for their private patients because they did not want to expose them to the suspect services in their hospital. I want to know who, outside the pathology services, knew what was going on and said nothing. I want to know whether they are still treating my constituents from Herne Bay and Margate in the Kent and Canterbury hospital.

I have already asked for a further inquiry into the full histo-pathology service at the Kent and Canterbury hospital, over which doubts still linger. It is time that the hospital came clean and told the whole truth. I do not believe that it has done so yet.

I also want to know how general practitioners dare—one certainly has—to tell consultants at the Queen Elizabeth the Queen Mother hospital that they will not allow their patients to be treated by them any more, other than at the Kent and Canterbury hospital. What does that have to do with health care, when the consultant may have a unique skill that patients need and that may save a life?

I wish to make myself understood by those in the House and those outside it. I am not seeking to punish the Kent and Canterbury hospital for the malpractice of some of its medical practitioners. I want the truth and I want to know with certainty that all those who have been responsible for putting lives at risk and for loss of life are no longer working in the health service in east Kent or anywhere else. If that includes some eminent and hitherto respected people, so be it.

My family has used the Kent and Canterbury hospital and may have to use it, or a new city hospital, in the future. I have a high personal regard for the care and dedication offered by the nurses, by most of the medical staff and by the others on whom Kent and Canterbury and other hospitals depend. It is in all our interests that the issues should be resolved thoroughly, once and for all.

Finally, I return to my other concern. Some in the Kent and Canterbury hospital and the elected membership of the local authority are seeking—not in the interest of the health service provided to our constituents, but in the interest of their professional aggrandisement and comfort zones—to overturn, through intimidation and cacophony, the work done by the health authority and the rest of the NHS in east Kent on ensuring that the options are fully, honestly and openly explained and are understood by those who will be the users at the end of the process.

If he who makes the loudest noise is allowed to hold sway and the needs of institutions are put before people, if some of the most deprived in the country in Thanet and the elderly in Herne Bay and throughout east Kent are sacrificed to pacify those who are orchestrating the campaign, and if the recognition in last week's Green Paper of the link between social conditions and health is ignored, not only east Kent, but west Kent and the rest of the health service will lose. This will be a benchmark for the future. I urge my hon. Friend the Member for Teignbridge (Mr. Nicholls) on the Front Bench and the Minister to consider that, rather than party politics, when they respond.

I have taken more time than I wished. The East Kent health authority has courageously and methodically shown the way forward. It has said that it is willing to consider any practical and viable new proposals. I have made some workable suggestions for improvement, which I hope and believe will be listened to. We must remember that we in politics and those in the health service will have to work together when this difficult and painful process is over. I hope that all those of good will throughout Kent will shun those who are deliberately seeking to cause public strife and will concentrate on how best we can make the necessary reforms work.

Several hon. Members


Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. Many hon. Members from the county would like to catch my eye. I appeal for brevity in the remainder of the debate.

10.7 am

Mr. Gwyn Prosser (Dover)

I am grateful for the opportunity to take part in this important debate on health care and hospitals in Kent. The hon. Member for North Thanet (Mr. Gale) has spelt out some of the background of the pressures and changes that have brought us to the current situation. I shall not rehearse those issues. I certainly do not want to be involved in the hostile war of words raging between constituency and constituency, trust and trust and even consultant and consultant.

As we try to develop a new atmosphere in the health service, with the Government seeking ways in which trusts can co-operate and work together, looking for more unity among health authorities, it is a matter of great regret that the background to all the good words in the White Paper is being muddied by some of the practices in east Kent.

I was hopeful that the debate would provide an opportunity to draw some lines and find some ways of working towards a solution which would benefit people, patients and potential patients in east Kent, rather than highlight and inflame what is already a very difficult process. However, those are slim hopes.

I have been proud to be part of long-standing campaigns in Dover to maintain services for local people. In 1993, when there was a threat that services at Buckland hospital would be centralised at Ashford, 27,000 people signed petitions opposing the plans. In 1995, when there was a threat that the children's ward—the paediatric services—would be transferred from Buckland to Ashford, 40,000 people marched through the streets of Dover opposing the changes or presented petitions to the local health authority.

No one doubts the people's attachment to their hospitals. It is part of human nature to be loyal to one's hospital and have confidence in it, but times and the way in which health care is administered change, and we must understand and take notice of such factors. The same factors that drove proposals for changes in the past are driving the present proposals.

The review that the hon. Member for North Thanet has described has been conducted in a different atmosphere and a different way from previous reviews. Its analysis and recommendations were not dreamt up by bureaucrats and suddenly thrust on us from above. The so-called acute future groups comprised doctors, nurses and managers who practise in the health service, and involved the entire east Kent NHS family. We need to recognise the difference between how changes have been sought in the past and the way in which the latest process has been carried out. I welcome the method by which the changes have been sought—if not all the details and results. The results and recommendations are not infallible just because of the process. I have made it clear that the proposed cuts in Dover and Deal are totally unacceptable. However, the change of method gives a certain extra legitimacy to the exercise.

The consultation process will give us all an opportunity to challenge the recommendations and suggest different arrangements. The consultation document assures us that the changes are not driven by resources or costs. On page 1, it says: It is a problem that cannot be solved simply by more money. Money has not caused it". I welcome the hope expressed by the hon. Member for North Thanet that we can keep the issues out of the political sphere. I hope that his colleagues, present and past, will share his view that the important thing is to find solutions for people in east Kent rather than to kick about political footballs.

Although the plan concentrates acute services at Thanet and Ashford, there is still an option for change. If someone came forward during the consultation period with a plan to provide acute cover on all the present sites and meet all the criteria, it would, of course, be everyone's favoured option—both in the House and in my constituency. In reality, the fundamental change of concentrating acute services on two sites will probably prevail.

I shall concentrate my efforts this morning and in future on ensuring that hospitals in Buckland, Canterbury and Deal, and others mentioned by the hon. Member for North Thanet, are protected. We want to ensure that the impact of the proposed changes is not nearly as intense or damaging as those described in the consultation document.

If we are fully persuaded during the consultation process of the need for centralisation at Ashford and Thanet, and convinced that blue light admissions should no longer go to Buckland, Canterbury and others, that does not mean that Buckland and Canterbury should not continue to provide beds for acute or near acute recovery and convalescence. I think that we are all agreed on that.

People might be persuaded that, in their moment of crisis during their acute episodes, they must be ambulanced to a top-notch centre of excellence in the next town, which is complete with the best trained consultants, the best diagnosis equipment and the best access to specialised services. However, they will not accept that, having been diagnosed, having received their immediate treatment or having recovered from their operation, they should have to spend two, three, four or five more weeks recovering in a distant hospital, away from their homes, relatives and would-be visitors.

During all my discussions with health officials over past years, I have always been assured that Buckland beds would always be needed and that there would always be facilities for recovery locally. Unfortunately, that philosophy seems to have changed over the past few months—if not during the review. Now, health professionals are telling us that the recovery process is hampered, hindered or set back if a patient is moved from an acute hospital to their locality. They are telling us that the full range of acute services must be on hand during nearly all the recovery period. We cannot accept that change. We need to strike a balance between the need for fast, efficient recovery and the need of patients to be closer to home.

In my constituency, there is a disproportionate number of elderly people and households that do not own or have access to cars. The changes will be particularly to the disbenefit of patients and their families. If the people I represent in Dover, Deal and Aylesham are to swallow the bitter pill of losing acute services at Buckland, the pill must at least be sweetened by the prospect of retaining a significant measure of acute recovery services in local hospitals. Unless we can claw back some of the services, we shall lose a total of 500 beds in Canterbury, Deal and Buckland, which will be totally unacceptable to local people.

I am pleased to say that the South Kent Hospitals NHS trust shares local concerns with respect to Buckland. Its concerns have been included in the consultation document, and I hope that they will be taken into account. As well as increasing the number of beds at Buckland and other local hospitals, we see a case for 24-hour casualty cover at Buckland and the need to increase community health services in places such as Aylesham, Elvington and others mentioned by the hon. Member for North Thanet. Parallel to the campaign to maintain beds is the need to boost support for our general practices and health centres. If the health authority is to achieve the changes that it believes will benefit all the people in east Kent, it must take note of their very strong feelings.

10.18 am
Mr. Julian Brazier (Canterbury)

My local community faces two serious threats: the rundown of the Kent and Canterbury hospital to a virtual cottage hospital and the closure of the much-loved Whitstable and Tankerton community hospital. As time is so short, I shall focus only on the Kent and Canterbury hospital.

Members of all parties agree that doctor training and working practices are driving the proposal. Hence, it is astonishing that the proposal has been prepared without any consultation with the royal colleges, and that the Royal College of Physicians has written to denounce the cornerstone of the findings.

Perhaps that should not surprise us, because during its studies East Kent health authority did not consult any of the royal colleges, the British Medical Association or the unions, and did not even speak to its neighbouring health authorities.

I understand the strong feelings of my hon. Friend the Member for North Thanet (Mr. Gale), but I wish that he had felt able to take the tone of his speech from Sian MacGregor, one of the cytology victims, who recently spoke out to defend the Kent and Canterbury hospital. She said: The whole hospital must not be blamed for the sake of one small department. After compensation has been paid, she said, we must move on".

Let us remember that that department is being closed, the three consultants responsible have gone, the chief executive has resigned, and even the chairman of the hospital, although exonerated in the report, has resigned. I was pleased that Sir William Wells made similar points in his report.

I have sent 1,200 individually written letters to the Secretary of State—the bundle that I have here represents the last three days' worth—and I have passed back to other Members who are here in the Chamber on both sides of the House many dozens of letters from their constituents supporting the Kent and Canterbury hospital.

However, I shall base my case not on my own constituents but on one central theme: the fact that the plans of the East Kent health authority—EKHA—for the reorganisation of services in east Kent represent a potential disaster for the whole region.

East Kent has five regional services, and all are located at the Kent and Canterbury hospital. The cancer centre has just won a charter mark for excellence—laying to rest the ghosts of the cervical smear tragedy. Only three hospitals in the country obtained a charter mark for cancer treatment last year.

When the EKHA carried out its studies on the future of our hospital services and rushed them through without consultation in the four months for which the clinical teams met, the teams were repeatedly told by the authority, supported by consultants from other hospitals, that the regional services, including those for cancer, could be operated independently of a major acute site with intensive care and other related facilities.

At the eleventh hour, the EKHA finally had to concede that it was impossible to run such services outside a major acute site, and that they would all have to go. Instead of reopening the clinical study groups, it decided to categorise that as a "risk factor". It certainly is a risk factor to break up five excellent teams.

To make matters worse, the EKHA planned to take many of those services out of east Kent. How are radiotherapy patients without cars expected to get to Maidstone for treatment, on some of the most congested roads in the United Kingdom? How can anyone think of moving neonatal intensive care to Chatham? How many tiny premature babies will die as a result? After all, they are the most vulnerable patients.

The second argument rests on quality. The Government have made it clear in their White Paper that the views of general practitioners are to be of paramount importance. Every GP, both in the Canterbury district council area and in Faversham and Sandwich, has opposed the plans for the Kent and Canterbury. Those GPs speak for 160,000 patients—40,000 more than the entire population of Thanet; yet they are being ignored.

On the EKHA's own figures, the Kent and Canterbury is the most efficient hospital in east Kent. I heard what my hon. Friend the Member for North Thanet said, and I understand why he feels able to criticise the EKHA's table. None the less, we must bear in mind the fact that the table also showed that the Kent and Canterbury was more efficient than all the hospitals in west Kent.

The third argument rests on the public transport issue. We heard a senior officer from Kent county council say as recently as last week that it is not possible to reconfigure a bus service on the basis of patients' use. According to the EKHA's population figures, 212,000 people live in the villages of east Kent. That is nearly two fifths of the population, and almost all of them are closest to either Ashford or Canterbury. Canterbury is, of course, the hub of the bus system in east Kent.

In contrast, it is extremely difficult to reach Thanet by bus from almost all the villages. Indeed, I understand that the hon. Member for South Thanet (Dr. Ladyman), who will no doubt contribute to the debate, recently had a hard time with his constituents in Wingham because of their problems in reaching the hospital in Thanet even from there.

That brings me to my final argument—hospital co-operation. I do not call for the closure of the hospital in Thanet, which is the only alternative option that the EKHA recognises. I believe that what has really initiated the crisis that is forcing the EKHA to propose the closure of a hospital, just after heavily investing in regional facilities there and working out the three-site solution for children's services, is Thanet's inability to recruit adequate numbers of consultants.

That problem has existed ever since I became a Member of Parliament, but it has worsened recently. The EKHA seems to believe that if Kent and Canterbury were closed, Thanet could somehow be made more attractive, but, for years, consultants have been attracted to east Kent to work at Thanet by offering them joint posts with the Kent and Canterbury. No fewer than 19 Kent and Canterbury-based consultants work regularly at the Thanet hospital. Canterbury, with all the attractions of a regional centre of excellence and with a whole range of services, can sugar the pill of having to work at a comparatively remote location.

If the hospital in Canterbury is closed, the much greater distance to Ashford—nearly 40 miles on one of the worst roads in England—will make the operation of joint working and training arrangements impossible, not least because of the factors affecting junior doctors' hours that have already been alluded to. That means that, if recruiting problems continue, a multi-site option will no longer be available because the middle one of the three sites will have been removed.

If Thanet is unable to recruit and fill its posts and its retention and accreditation problems continue, there will be no fallback position. Shortages of trained personnel are worsening nationally, so the outlook is not good. Let us remember that the Kent and Canterbury is the only hospital in east Kent with all the relevant doctors' posts fully accredited by the royal colleges.

The EKHA has announced out of the blue that a major hospital in east Kent, at which the authority has recently invested heavily in regional services, must close. Its only argument is based on the areas of doctor training, recruitment and working for which the royal colleges are responsible, despite the fact that the Royal College of Physicians has begged to differ with it.

I believe that, by integrating training across all three sites—the multi-site option is possible if the middle site remains—the royal colleges' requirements can be met. That has already been done with children's services.

The proposal would involve uprooting our regional facilities, closing east Kent's best hospital and leaving two sites too far apart for joint activities. That would be a disaster for east Kent as a whole. We need an evolutionary approach and the restructuring of management and of doctors' working practices, not the closure of hospitals.

10.28 am
Dr. Stephen Ladyman (South Thanet)

I have been made aware that a number of hon. Members want to speak, so I shall be as brief as possible.

I congratulate the hon. Member for North Thanet (Mr. Gale) on securing the debate, and I associate myself with almost everything he said. That is a rather strange experience for me. If anyone had asked me a year ago with whom I thought I would be fighting back to back in a huge political battle, I would scarcely have said the hon. Member for North Thanet, but that is how things have worked out. I congratulate him on taking a bipartisan approach to the issue and thank him for working with me to try to convey to the people of east Kent a more constructive message about the East Kent health authority proposals.

That has been difficult because of the huge campaign that has been whipped up about the Kent and Canterbury hospital. I understand the emotions of the people of Canterbury, but, having listened to the hon. Member for Canterbury (Mr. Brazier), the House will realise why 1,200 letters were written. For example, he said that the Kent and Canterbury is to be reduced to the status of a cottage hospital. That is not so. Under the health authority's proposals, the Kent and Canterbury will retain a casualty unit, maternity services, out-patient clinics, day surgery, rehabilitation wards and wards for the elderly. I believe that it could also retain a range of other services.

The hon. Member for Canterbury asked how many babies would die because the neonatal intensive care unit is to be moved. I tell him how many will die: none.

A baby's condition is stabilised before it is moved to a neonatal intensive care unit. At present, babies born at Thanet who require the services of the unit must have their condition stabilised before they are moved to the unit in Canterbury. It will make no difference that they will have to be moved somewhere else; the fact that they will have the best possible staff and services makes the difference.

A recent campaign in a Canterbury newspaper featured a front-page picture of a baby, with a caption saying that it would have died if the neonatal intensive care unit had not been at Canterbury. That is completely false. The baby's condition had to be stabilised before it was moved to the unit. The newspaper did not point out that the consultant who saved the baby's life had had to travel from Thanet.

Such scaremongering and shroud-waving has whipped up a campaign that is no longer in the control of the Kent and Canterbury trust and of those people who want a constructive debate. We now have to contend with a monster that is blind to the facts and deaf to argument. I appeal to all sides to take a more constructive line.

I come to pathology and the recent report on cytology. I stress the need for a much broader inquiry into not only cytology, but the range of pathology services at the Kent and Canterbury. That is not because I do not believe that the situation has been resolved—I am confident that the new unit is efficient and properly led with qualified and competent staff. However, I am not confident that all the lessons were learned from the pathology debacle, that we reached the root of the matter, or that everyone was called to account.

On 20 November last year, I tabled some parliamentary questions to shed some light on the issue; I hoped that the answers would give an idea of when clinicians in east Kent, especially at the Kent and Canterbury hospital, realised that there was a problem and whether they had dealt with the problem there and then. The questions that showed that pathology services had improved received a proper response, whereas those that would have revealed that problems were not identified soon enough did not receive full answers. I hope that my hon. Friend the Minister will look again at those answers.

I believe that a study of referral patterns over the past 10 years will show that there was a point at which Kent and Canterbury clinicians started to refer their private patients to a different hospital for pathology services while they continued to send their national health service patients to a hospital whose pathology service they knew to be flawed.

My hon. Friend the Member for Lewisham, East (Ms Prentice) is indicating that she would like me to come to a speedy conclusion, so I shall speak briefly about the process of rationalisation. The review process was agreed on all sides. It involved clinicians of all types; it did not include politicians. It was described at several public meetings. There were no complaints about the process until the downgrading of the status of the Kent and Canterbury hospital was recommended. All the hospital trusts were clearly instructed to consult internally, to ensure that the views of the hospitals were known.

I know that other hon. Members want to speak, so, in associating myself with the comments of the hon. Member for North Thanet, I make a final appeal for a much more constructive debate. We should prioritise outcomes; we must create a hospital service in east Kent that gives patients the best chance of recovery. Important as other issues, including transport, are, they must be secondary. As there is no practical option for a three-site acute service, we must, on the available evidence, accept the preference expressed by the East Kent health authority, which I hope my hon. Friend the Minister will ratify.

10.36 am
Mr. Michael Howard (Folkestone and Hythe)

I congratulate my hon. Friend the Member for North Thanet (Mr. Gale) on securing this debate. My constituency no longer has within its boundaries a hospital that provides the full range of services; that battle was fought and lost long before I had the honour to become its Member of Parliament. However, it does contain the Royal Victoria hospital, which is briefly described in the East Kent health authority's consultation document as having 92 beds providing care of the elderly and GP beds". Those few words do not begin to convey the excellence of the care that is provided in that hospital, the warmth and the tenderness with which the nursing staff carry out their duties, or the evident appreciation with which the patients respond.

I have long been associated with the Royal Victoria. Some years ago, I was able to persuade one of the East Kent health authority's predecessor bodies to establish a minor injuries unit at the hospital. I was there just a few days ago to visit John Jacques, a distinguished citizen and former mayor of Folkestone. I was deeply impressed then, as I always have been, by the way in which patients are looked after.

The health authority proposes to reduce the number of beds at the hospital from 92 to 70. There is a further proposal to relocate the Arundel unit—a mental health unit—from the William Harvey hospital at Ashford to the Royal Victoria. I am at a loss to understand the logic behind those proposals. The general case for fewer beds is apparently based on a report referred to on page 12 of the consultation document, which concluded that the people of east Kent use hospitals more than most. However, that does not apply to the elderly who use most of the beds in the Royal Victoria. The case for a reduction in the number of beds at that hospital has not been made.

The hospital is located near the centre of Folkestone and close to several schools, so it is an inappropriate site for the mental health unit that is currently at the William Harvey hospital in Ashford. The East Kent health authority's proposals for the Royal Victoria are mistaken and misconceived, and I oppose them.

The proposals are a consequence of the larger proposals that have been discussed in the debate. I approached them with an open mind. Most of my constituents use the William Harvey hospital at Ashford, to which I am a frequent visitor. I am impressed by the quality of care that it provides.

A substantial number of my constituents use the Kent and Canterbury hospital, however. It is particularly convenient for those of my constituents who live in the Elham valley. Public transport links between Elham valley and Canterbury are relatively good, but public transport between Elham valley and Ashford is virtually non-existent.

At my last surgery in Elham, Mrs. Monica Russell—the wife of the vicar of Elham—brought along an elaborate map that she had made of the public transport links between various parts of my constituency and the hospitals which serve them. It is a remarkable document, which she has supplied to the community health council. It brought home to me that the implications of accessibility involved in the proposals are even greater than I had originally thought. Accessibility is one of the key criteria by which proposals of this kind must be judged.

I am convinced that the disadvantages of the health authority proposals in terms of accessibility are severe. They would have a particularly harsh effect on those of my constituents who are least well-off. This applies not only to those who are patients, but to those visiting friends and neighbours who are patients. The disadvantages could only be justified by overwhelming compensatory advantages. I am not convinced that the consultation document identifies any such overwhelming compensatory advantages.

The problem it seeks to remedy is not, we are told, caused by money or the lack of it, and would not be solved by more money. At the heart of it are factors involving the supply of doctors, the way they are trained and the new ways in which they need to work. The document says that the royal colleges recommend a minimum population for a main hospital, although in a rural area—such as that with which we are concerned—the same advantages can be achieved by two hospitals working together more closely.

As my hon. Friend the Member for Canterbury (Mr. Brazier) has pointed out, the Royal College of Physicians has emphatically denied the health authority's claim. The case, to put it mildly, is nothing like as straightforward as the health authority suggests. I do not think that my hon. Friend the Member for North Thanet is justified in describing those who favour the retention of three hospitals providing acute services as "dishonest". There is room for honest disagreement.

I shall follow the consultation process closely and I shall listen with interest to the Minister. The arguments must be tested thoroughly over the next three months. As things stand, my judgment is that the case for the health authority's proposals is far from made out.

10.41 am
Mr. Damian Green (Ashford)

I shall be extremely brief, because I know that my hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe) wishes to speak as well. I give a partial welcome to the health authority's proposals, but I urge the Minister and the Government to make the consultation period under the health authority—and beyond, when the decision goes to the Secretary of State—a real one, and not simply a period of time-serving.

I associate myself with the remarks of my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), who said that there is the possibility of honest disagreement about the proposals. They may broadly be on the right lines, but there are flaws and deficiencies in the proposals.

Both the main options include the William Harvey hospital in Ashford as a significant provider of the full range of services. This is clearly sensible, for four reasons. First, the hospital is appropriately placed, only 100 yards from the motorway network. Secondly, most of the population growth in east Kent over the next decade will be in the Ashford area. Thirdly, the hospital has an excellent record in acute care and in certain key specialties. Fourthly, there is a possibility of expanding the site to absorb new services, given that a 20-acre site with planning permission restricted to health-related uses is immediately next to the current site.

There are other pressures which the health authority has not taken into account. A minority of my constituents look to the Kent and Canterbury hospital as their principal hospital provider, either because of its sheer geographical proximity or because they use the specialist services. One flaw in the proposal is the wholesale removal of those specialist services from Canterbury. Cancer has been much discussed this morning, and removing the cancer service from east Kent would put unnecessary pressure on Maidstone and would be bad for the population of east Kent. Clearly, change is needed in terms of the disposition of specialist services around east Kent.

Another potential flaw involves the future of the smaller hospitals. One such hospital which has not been mentioned is West View in Tenterden, which is searching hard for a solution combining NHS use with use by Kent social services and private nursing home beds to enable it to survive. The authority's move to close West View—after a long period in which proposals for a private finance initiative were discussed—follows the wrong kind of consultation. One hopes that that will not be repeated in the wider sphere of the consultation on these proposals.

The one-trust option would be bad for east Kent, as it would be an attempt at a bureaucratic solution which would not reflect reality. There may be evidence which has not yet been found for a three-site option. Clearly, the Secretary of State will need to have three things on his mind: the need to maintain the balance between the quality of care and the ease of access; the need to staunch the flow of money out of east Kent to, in the large part, the London hospitals which, for perfectly good reasons, are more expensive and thus cost the NHS more money; and the need to provide suitable training opportunities.

The decisions taken in the next few months will decide the quality of health care for the population of east Kent for the next 10 years. They require a serious and unemotional debate.

10.45 am
Mr. Andrew Rowe (Faversham and Mid-Kent)

I wish to raise a couple of points in the minute that I have. First, I am sceptical of the present proposals, not least because the costings seem to be extremely dubious. I understand that the estimate given by the health authority for moving the cancer services to Maidstone is about £0.5 million. The chief executive of the Maidstone trust, when consulted, said that he thought it would be much closer to £10 million. Since neither the Mid-Kent Healthcare trust nor the West Kent health authority was consulted at all by the East Kent health authority—they do not appear in the list of consultees—I cannot believe that the consultation is soundly based.

Secondly, the recent radio debate showed clearly that, on the whole, the layman—the non-medical professional-behaved in a more mature and sophisticated fashion than anyone else. I was absolutely appalled by the animosity between the various medical directors and the chief executives of the trusts. One of the great weaknesses of the consultation document is that no consultation at all has taken place with the sophisticated lay people who are the users and financiers of the NHS.

10.46 am
Mr. Patrick Nicholls (Teignbridge)

First, I congratulate my hon. Friend the Member for North Thanet (Mr. Gale) on introducing the debate, and on doing so with such style and vigour. This debate shows our system working at its very best. There is nothing more passionate than a Member of Parliament on either side of the House arguing passionately for what he believes to be in the very best interests of his constituents.

Even if time would allow me, I am a bit too long in the tooth to make the mistake of trying to appear as the deus ex machina at the Dispatch Box, trying to work out the rights and wrongs of everything my hon. Friend the Member for North Thanet drew to the attention of the House.

I was impressed when the hon. Member for Dover (Mr. Prosser) reminded us that there is a feeling of loyalty to a local hospital—and so there should be. Our whole political structure is based on the local Member of Parliament having a local feel for his local people, and arguing passionately for them. It can be difficult at times—and sometimes even inappropriate—for a Member of Parliament to look at things dispassionately. One takes a view and makes a decision about what is right in the interests of one's constituents, and one argues for that.

My hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe) was more brave about doctors than I will be. It has been my experience in my half century on this earth that doctors can be quite ferocious in their disagreements with each other. It would be a brave man who would say that any given collection of doctors was right or wrong. In defending the medical profession—in case I have to see a doctor in the near future—I must say that although they are arguing, as Sydney Smith said, from "entirely different premises", and therefore can never agree, they believe passionately in their case at the time. It makes it difficult for the layman to work out who is right and who is wrong.

Dr. Jenny Tonge (Richmond Park)

Will the hon. Gentleman give way?

Mr. Nicholls

I am sorry, but time does not allow me to give way.

My right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) came to the debate with his usual silken analysis. He said that, very often in these situations of inevitable complexity, honest people will honestly disagree.

I cannot pretend to understand the merits and demerits of the minutiae of the plan, and it would be a brave person who said he did. However, I suspect that it is a situation in which honest people will passionately disagree from the best of motives. Fortunately, our system is eminently sophisticated. When irreconcilable positions have to be dealt with—when circles have to be squared and the judgment of Job made—we know that our opinions will reach the Secretary of State for Health and the Minister of State, from whom I am sure we all greatly look forward to hearing.

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

I shall have to employ the hon. Member for Teignbridge (Mr. Nicholls) as a warm-up man. I congratulate the hon. Member for North Thanet (Mr. Gale) on securing a debate on a matter of concern to him and his constituents, as well as the other right hon. and hon. Members who have contributed to the debate. I applaud all those who have raised the issue with me privately and in the Chamber, both today and on previous occasions.

I was pleased that the hon. Member for North Thanet said at the outset that the issue was not party political, a point borne out by my hon. Friend the Member for Dover (Mr. Prosser). The nature of the debate has fully testified to that approach. The debate has also highlighted that health service change in Kent, as elsewhere, is a complex and contentious issue.

As the hon. Gentleman said, the debate in east Kent has been going on for some time. I fully understand the real concerns about the future of hospital services in the area. Local communities rightly feel a strong attachment to their local hospitals and want to know what the future holds for them. As the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) suggested, that is a concern among patients and the public, as well as the hard-working NHS staff. I understand the anxieties aroused by consultation of the sort that is being undertaken, but it is vital that health authorities get decisions about the future of local health services right. The worst outcome is for decisions to be rushed and to be wrong.

I wish to make two points clear at the outset. First, I want to encourage local people and local organisations to participate fully in the consultation exercise. Many of the points that have been raised this morning are matters for response during the consultation process. Secondly, I wish to assure local people in east Kent—including the hon. Member for Ashford (Mr. Green) and his constituents—that the consultation is genuine. I read the consultation document yesterday with great care. It explicitly seeks views on one option, and it also asks for alternatives to be suggested in the next few months.

I shall dispose of one other misconception, and it is a point that was raised by my hon. Friend the Member for Dover. The proposals are not primarily driven by questions of finance. The major problem confronting the NHS in east Kent, as elsewhere, is the supply of doctors, the way they train and the ways that they need to work to ensure the best outcomes for patients. That is what we all want, and that is what unites all right hon. and hon. Members. Those who say that the answer lies simply in putting more money into the local health service have got it wrong. We can put more money in, and we will, and we can take money out of bureaucracy, and we will, but the fundamental problem will remain.

I am aware that work is in hand across Kent to review patterns of hospital services. West Kent health authority has faced similar issues to East Kent in terms of the need to consider the best future pattern for acute hospital services. I assure hon. Members—especially the right hon.

and learned Member for Folkestone and Hythe, who has had to leave the Chamber—that the two health authorities are working closely together to ensure that their strategies coalesce. I can assure the House that the NHS executive regional office will keep a weather eye on developments to ensure that the two proposals that emerge align for the benefit of patients.

Co-operation should be the order of the day in east Kent. We have already seen a huge collaborative effort from all parts of the NHS in the area. As right hon. and hon. Members know, the background to the issue arose from the preparation for the consultation exercise. Right hon. and hon. Members were right to point out that that preparation included the involvement of professionals from the secondary and primary care sectors. In addition, late last year efforts were made by the health authority to consult local community representatives, including local Members of Parliament and local authorities, before the consultation exercise. I am satisfied that consultation took place ahead of the consultation document being issued. That does not mean that every "i" that is dotted and every "t" that is crossed in the consultation document is necessarily right. I assure the House that the document is a genuine consultation document and is open to amendment.

I am also aware of the public commitment given by the chairs and chief executives of NHS organisations in east Kent to work together to ensure that the public debate about the future pattern of hospital services is as informed and mature as possible. As we know, that is no easy task, because emotions are inevitably running high and local people have real concerns and fears about the process. However, it is important that we conduct the debate maturely and as openly as possible. A start has been made with the establishment of three principles. First, it is recognised that chairs and chief executives of the trusts and health authority in east Kent have a responsibility for the whole health service in the area, as well as for their individual organisations.

Secondly, it is recognised that, within a broad framework, each organisation has a right to put its case and should do so, but—whatever the outcome of the review—the different parts of the NHS in east Kent will have to work together in the future. Joint work is critical to the successful implementation of change.

Thirdly, it is recognised that how a case is put is as important as the substance of the case. An informed debate will be marked by moderate language: an ill-informed debate will be marked by immoderate language. I applaud the commitment that has been given to those principles and I expect nothing less. However, if there were any evidence of intimidation and threats—and I have heard such suggestions from several quarters—I would be extremely concerned, as would the NHS regional office. We will not countenance such behaviour. We need an intelligent debate about the future of health services in the area.

I have been very encouraged by the decision of the health authority and the trusts' chief executives to reconvene the "Tomorrow's Health Care" steering group. The reconvened group will ensure a joint mechanism for assessing and discussing alternative proposals to the authority's preferred option, or variations on options, that may arise during the consultation. That reflects a continued willingness to try to put aside any sectional interests and to work together to find a way forward that makes the best possible sense for the NHS and the people of east Kent.

Right hon. and hon. Members will understand that I cannot be drawn into consideration of the merits of the authority's options, or any alternatives to them. Consultation on the options has just begun and it will end on 8 May. I assure the House that no decisions have yet been taken and there will be plenty of opportunity to scrutinise the authority's proposals, to review the assumptions that underpin them, to test them against alternatives and to make other suggestions. The health authority has signalled its willingness to listen, and I would expect no less of it. Should the authority's final proposals be contested by either of the local community health councils, the final decision will rest with Ministers. I must and will keep an open mind until then. If the decision comes to Ministers, it will be fully informed by the responses to the health authority's consultation, and based on a balanced assessment of the proposals.

One thing is certain. Standing still is not an option for the national health service. The NHS in east Kent has to change. I want it, as I am sure do all hon. Members, to become more modern and dependable. Precisely what form the change should take in hospital services is a matter of intense local debate. The NHS there must fulfil its duty to explain to the public why change is necessary and how it will strengthen the local health service. I am sure that hon. Members will continue to represent their constituents' interests both here and locally. I hope that they will use their enormous influence to play their part in persuading the people of east Kent that change is essential to a modern national health service. I expect the health authority to take into account all the points that have been raised this morning in considering responses to the formal consultation. I urge all interested parties to work together.

Mr. Deputy Speaker


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