HC Deb 29 January 1998 vol 305 cc613-20

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

10.21 pm
Mr. David Lidington (Aylesbury)

I am grateful to Madam Speaker for allowing me this opportunity to initiate a short debate on the future of Stoke Mandeville hospital in my constituency.

Stoke Mandeville is known nationally and internationally as the home of the national spinal injuries centre, but to people living in Aylesbury and the surrounding areas it is much more than that. It is a medium-sized acute hospital which serves the local population with a wide range of medical services. Its patients come from Buckinghamshire and parts of Bedfordshire, Hertfordshire and Oxfordshire. The hospital also provides specialist services in plastic surgery and ophthalmics to patients from other parts of the country.

Many men and women are treated at Stoke Mandeville. Each year it treats about 32,000 in-patients. Some 140,000 people attend as out-patients, and about 44,000 people attend the accident and emergency unit. The need for the hospital is not diminishing—far from it. Its catchment area is growing significantly. That is particularly true of Aylesbury, where significant new residential development is planned over the next two decades, but it is also true of some of the smaller settlements served by Stoke Mandeville, such as Princes Risborough, in my constituency, and Haddenham, in the constituency of my hon. Friend the Member for Buckingham (Mr. Bercow).

There is strong local support for Stoke Mandeville and the work that it carries out. That will, perhaps, be signified tomorrow when, I am delighted to say, the Prime Minister's wife will visit the hospital to open the new computerised tomography scanner, which has been made possible by money raised through voluntary contributions and donations from local people.

If I feel strongly about the future of Stoke, it is not just because it is of vital importance to the people whom I represent but because it is my local hospital, the hospital where my four sons were born, and on which I and my family personally rely. Its medical reputation is high, but that is not matched by the quality of the buildings.

Stoke was originally built in 1942 to provide temporary wartime accommodation, and those wartime units are still substantially in use today. Since then, there has been piecemeal development of variable quality, but it has included some first-class modern facilities, notably the maternity unit, which is probably the part of the hospital with which I have become most familiar over the past few years.

One result of the piecemeal development is that we now have a hospital which sprawls over 90 acres of land. It is larger than most teaching hospitals in the country, probably in western Europe. Many of the buildings are obsolete, and the site and the buildings are inefficient. The costs of treatment at Stoke are inflated by the overheads: maintenance, heating, cleaning and others, which are needed because of the inefficiency and the obsolescence of the buildings.

There is not only financial inefficiency but clinical inefficiency. That is, perhaps, best illustrated by the example of the paediatric unit, which is a third of a mile from the main operating theatres. It takes a minimum of several minutes to take a sick child from paediatrics to theatre, or to bring in staff or emergency equipment to the paediatric unit from elsewhere.

It is to the hospital's credit that, despite those handicaps, it has met both its financial and patient charter obligations year on year. I place on the record a tribute to all the hospital staff for that achievement. It is worth noting that the chief executive of Stoke Mandeville was asked by the regional office to chair the Anglia-Oxford working party on cutting waiting lists and ending bed blocking. Stoke's success in delivering high-quality medical care has been recognised by the NHS at regional level.

The need for redevelopment at Stoke Mandeville has been recognised since the 1970s. Various schemes have been proposed and, for different reasons, have foundered. At one time, the development of the new city of Milton Keynes and the urgency of its need for medical facilities took precedence in the decisions of the Government of the day. Subsequent schemes were shelved because of national financial pressures.

Mr. Brian White (Milton Keynes, North-East)

Will the hon. Gentleman give way?

Mr. Lidington

No, but I should be happy to leave time for the hon. Gentleman to speak later.

Another scheme was approved by the Department in June 1994, but that in turn was delayed when the private finance initiative scheme was introduced. A still later scheme was delayed last year when the newly elected Government decided to alter the rules on PFI.

I mention all that not because I see much point in going over old ground in detail tonight, but because some account of the history is necessary to explain the depth of feeling among my constituents about the importance of a project that is now being promoted by the trust and Buckinghamshire health authority, and to explain the feeling of cynicism among hospital staff and local GPs, who doubt whether the much-needed redevelopment will ever happen.

I have had extensive discussions in recent months, not only with the trust management but with Buckinghamshire health authority, the chief funder of the hospital, and with the Oxford-Anglia regional office. I am grateful for the patience and courtesy with which all those concerned have always listened to my representations, and for the seriousness with which they have engaged in the arguments that I have put on behalf of my area. Both the regional office and Buckingham health authority have told me firmly that they are committed to the successful redevelopment of Stoke Mandeville hospital.

There seems to be local agreement on the continuing need for an acute hospital in Aylesbury, and on the fact that that requires the redevelopment of Stoke Mandeville. There is also recognition, acknowledged by the trust management as well as the health authority and the regional office, that the new Stoke Mandeville must reflect in its configuration changes in medical treatment that have taken place in recent years and are forecast to continue. Those include the trend towards day surgery and increased specialisation, and are illustrated by the implementation of, for example, the Calman report on cancer care.

Stoke is looking actively to develop constructive partnerships with other hospitals, both within Buckinghamshire and in Oxford and Milton Keynes. The present proposals, which were endorsed this week by Buckinghamshire health authority, would involve building a new paediatric unit, a new ward block and changes to the theatre complex at the hospital. The number of beds would be reduced from 510 to 443, but day case places would rise from 23 to 30.

The plans provide for the hospital to treat about the same number of patients in the future as it treats today. They incorporate a partnership agreement with South Buckinghamshire NHS trust and the Aylesbury Vale community healthcare trust. The total cost would be about £23.2 million. The changes would bring significant clinical and financial benefits. Clearly, our constituents who use Stoke Mandeville would benefit from the provision of modern facilities that can deliver state-of-the-art medical care into the 21st century. The national health service as a whole also stands to gain a significant financial benefit.

The proposed plans would release revenue savings of more than £3 million a year. I note that the hon. Members for Milton Keynes, North-East (Mr. White) and for Milton Keynes, South-West (Dr. Starkey) are present. The release of revenue savings from a successful development at Stoke Mandeville is of vital importance to Buckinghamshire health authority if it is to meet its strategic commitment to shifting extra funding to GPs in Milton Keynes. Urban problems in that town have stimulated a need for medical care which has not been adequately met in the past.

Like the hon. Members who represent Milton Keynes, I will tussle over formulae and over my own patch, but it is recognised that Milton Keynes needs extra funding, and the release of those revenue savings is one way of achieving that objective.

Dr. Phyllis Starkey (Milton Keynes, South-West)

Do I take it that the hon. Gentleman accepts that the underfunding of Milton Keynes by about £4 million this year, as highlighted by the Buckinghamshire health authority, is justified? Does he recognise that mid-Buckinghamshire has been overfunded by about £5 million? He refers to the benefits for the whole of Buckinghamshire of the undoubted revenue savings from a developed Stoke Mandeville. Does he accept that it is important for Stoke Mandeville to be developed as part of the acute services strategy agreed by the health authority for all the hospitals in Buckinghamshire? The development of Stoke Mandeville should not create a hospital that is larger than the acute services strategy foresees, because that would entail continuing excess spending in mid-Buckinghamshire, which would prevent north Buckinghamshire from receiving the money.

Mr. Lidington

I agree with the hon. Lady's last point to some extent. The plan that has been endorsed by the trust management and by Buckinghamshire health authority is in line with that acute services strategy.

I would take issue with the hon. Lady over her assertion that mid-Buckinghamshire has been overfunded. This is not the occasion to go into the historical factors at work within the county and the application of the York formula to some county units. The hon. Lady and the hon. Member for Milton Keynes, North-East, and his predecessor, Mr. Peter Butler, argue the case passionately on behalf of Milton Keynes. Irrespective of what happens in the rest of Buckinghamshire, on the figures that I have seen, Milton Keynes has a good case for extra funding. As I said, the successful completion of the scheme at Stoke Mandeville is one way of helping to achieve that objective.

It is not only the revenue savings that are at stake. Surplus land worth £10 million at the minimum would be released by the redevelopment of Stoke Mandeville. That money could be ploughed back into health care either in our part of the country or elsewhere: that would be up to the Minister and his colleagues to decide. The NHS can ill afford to lose such a financial benefit. I hope that that entices the Minister and the regional office to look favourably on the scheme.

I want to put two brief questions to the Minister that he may reflect on if he cannot reply in detail now. The first is about the status of the £23.2 million bid. As I understand it, bids below a certain level fall to the regional office to decide, and bids above, perhaps at £25 million, must go to Ministers for a central decision. Can the Minister clarify that?

The second question is about interim strategic support, which was intended to tide Stoke Mandeville over until the rebuilding. It is due to end in 1999, and the earliest date at which new buildings can come into use is 2003.

Both the health authority and the regional office have told me that they continue to look actively for solutions. I hope that the Department will keep an open mind on whether to address the problem by arranging a deal with the potential private-sector partner, or to consider ways in which it and the NHS can cope with it. It is a real problem, but a time-limited one once the redevelopment is approved.

The original intention was that the sale of the land owned by the Department would part-fund the Stoke Mandeville project. I understand that that will not now happen, but I hope that it will still be possible for the departmental land to be developed in conjunction with the trust-owned land. Both parties might well benefit from a scheme that could take place at the same time, and be attractive to the same private-sector partner.

Finally, let me make a plea that, if it is humanly possible, work on the paediatric unit should be brought forward to the earliest possible date. I explained earlier about the particular needs of paediatric patients. I hope that, either through a deal involving the land or through the terms of the contract with the private-sector partner, we can find a way of advancing the provision of a modern paediatric unit much closer to the operating theatres.

I am grateful for the opportunity that I have been given. When my hon. Friend the Member for Buckingham and I met the Minister last year, he listened to us with great courtesy and gave us a good deal of time. I thank him for his serious interest in the project in recent months, and I look forward to his reply.

10.36 pm
Mr. John Bercow (Buckingham)

rose—

Mr. Deputy Speaker (Mr. Michael J. Martin)

Has the hon. Gentleman the permission of the Minister as well as that of the hon. Member for Aylesbury (Mr. Lidington)?

Mr. Bercow

Yes, Mr. Deputy Speaker.

I am grateful for the opportunity to speak. What my hon. Friend the Member for Aylesbury (Mr. Lidington) has said is entirely correct, both in relation to the hospital and in relation to the courtesy and attentiveness with which the Minister has greeted our representations.

Although Stoke Mandeville hospital is in my hon. Friend's constituency, it also serves my constituents. It is especially—although not exclusively—important to those living in the south of my patch, but all my constituents have a real interest in and commitment to the hospital, and will its development. They are right to do so, and I hope that that will prove possible.

My hon. Friend referred to the quality of Stoke Mandeville hospital. In 1995, the hospital secured the charter mark for excellence in public service, but that is only one demonstration of the quality that it has achieved. It would be inappropriate for me to allow my first Adjournment debate to pass without also saying that the chairman of the Stoke Mandeville NHS trust is a constituent of mine, Mrs. Gillian Miscampbell. Naturally, I consider her a person of the highest calibre. She is a superb chairman, and a long-standing resident of the area. She has its interests at heart, and I think that she has a real conception of the way in which the hospital should develop in the future.

There is no doubt that, although the hospital's management is excellent, its medical staff are first-class and the number of people for whom it caters is very large, it cannot progress without substantial and early redevelopment. The Minister is well aware of the background of disappointment, delay and frustration that the hospital and those who use its services have suffered to date, and I shall not rehearse that now; but the redevelopment is necessary, not merely for purposes of administrative or logistical efficiency, but to attain the primary objective of improved clinical care.

The project to which my hon. Friend devoted the thrust of his remarks is designed not least to improve paediatric care, coronary care and cancer services in the future.

I want those services to be developed, and to be developed in a manner that enables Stoke Mandeville to make substantial savings. My constituents want that to happen, and my hon. Friend wants it to happen. There is a need to go forward. I have observed that need not only in discussions with my hon. Friend and with the hospital management but by direct experience of observing the hospital at first hand on a number of visits.

I wish Stoke Mandeville well. I do not doubt the Minister's good faith, but I shall listen with great interest to his reply to the debate.

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

I am delighted to have this opportunity to reply—my brief says to the debate of my hon. Friend the Member for Aylesbury (Mr. Lidington); well, he is almost my hon. Friend—this debate. I also welcome the hon. Member for Buckingham (Mr. Bercow) back from the dead, or at least from the Standing Committee considering the National Minimum Wage Bill. I congratulate him on all his work there. I congratulate also the hon. Member for Aylesbury on securing this debate, on a subject that is close not only to his heart but, as he explained, to those of his family and constituents.

Stoke Mandeville is a valued hospital serving the part of the world of the hon. Member for Aylesbury. It is valued not only by local people, but by the Government. As he will be aware, part of the Government's testimony of faith to Stoke Mandeville's future is the fact that we recently provided £2.2 million in additional funding for the Buckinghamshire health authority to meet the extra pressures of this winter. We have invested almost £200,000 in Stoke Mandeville to help it deal with emergency pressures.

As the hon. Member for Aylesbury said, Stoke Mandeville is more than simply a hospital serving its local community. It is also a hospital with a very fine and distinguished international reputation in working with people who have suffered spinal injuries. For both those reasons, Stoke Mandeville's future is a subject that is worthy of debate. Like the hon. Gentleman, I pay tribute to all the hard-working staff—the managers, clinicians and everyone else associated with the excellent work done there.

The future of district general hospitals such as Stoke Mandeville touches on much that is at the heart of the White Paper published last month by the Government. The White Paper sets out a 10-year programme of modernisation for the NHS. It particularly makes it clear that, in future, we want local hospitals to complement each other's activities, working in partnership rather than in competition.

I should like to reassure my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) that, from what I understand of the health authority's plans, its current acute services review says loudly and clearly that three acute hospitals are required now, and that they will be required in the health authority area for the foreseeable future. As she knows, the exact options, the exact configuration of services and the exact cash distribution are issues that are yet to be resolved. However, the future is clear for all three hospitals.

I am pleased that that spirit of partnership is already in evidence in Buckinghamshire—where trusts are co-operating with the health authority and with local family doctors, and where there is an interchange of expertise at the clinical level and, particularly, at the consultant level. The hon. Member for Aylesbury talked about the relationship between Stoke Mandeville and the Radcliffe in Oxford. We want such partnerships to continue.

Stoke Mandeville will undoubtedly have to evolve in the next few years. As my hon. Friend the Member for Milton Keynes, South-West said, its services will have to fit into a wider model to ensure the best use of resources while providing the best possible care standards.

I tell the hon. Member for Aylesbury that Stoke Mandeville is a hospital with a bright future. It has the strong support of its local population and of the Government. He kindly mentioned that, tomorrow, the wife of my right hon. Friend the Prime Minister will visit the hospital to open the new CT scanner suite, which was paid for by charitable funds. I pay tribute to all those involved in that fund-raising activity.

As the hon. Gentleman rightly said, some changes are long overdue. The sooner we can see the end of the wartime prefabricated huts, the better. The trek of about a third of a mile from the children's ward to the operating theatre is quite unacceptable in a modern health service. I know that the hon. Gentleman and his hon. Friends have made strong representations in the past.

As the hon. Gentleman said, the history of Stoke Mandeville in terms of capital development has been unhappy for a variety of reasons. The most recent attempt could not be approved, as the trust did not have a private sector partner when the Government decided to fast-track the more viable private finance initiative projects. As he knows, that strategy has paid dividends, with a stream of PFI hospitals now under way.

I understand that the health authority is fully committed to having three acute hospitals in the county and that the trust, together with the health authority and, as the hon. Gentleman rightly said, supported by the NHS Executive regional office, is putting together a strategic outline case for a £23 million development. It will get rid of the Canadian forces' huts and replace them with facilities fit for delivering health services in the next century.

The hon. Gentleman asked about the process for approving the bid. He will know that the capital value of the bid is about £23.3 million, which is below the £25 million limit above which major capital projects are now being prioritised on a national basis by the new capital prioritisation advisory group which I set up last December. As the hon. Gentleman knows, NHS need will be the driving force and the key criterion for the work of the CPAG. The group will assess schemes fairly, on a national basis, according to rigorous common criteria. Those approved will be the schemes with the highest NHS need on a national basis.

As the new Stoke Mandeville proposal now has a capital value of less than £25 million, approval is a matter for the Anglia and Oxford regional office of the NHS Executive. However, I should reassure the hon. Member that the region is using the same rigorous and fair CPAG methodology to consider the scheme. The developing business case has been the subject of extensive discussion with the regional office, which has been closely involved from the outset, and the final strategic outline case is expected at the regional office around the end of this month. That should allow a decision to be taken about approval by the end of next month. If the case gets approval, the trust will be able to advertise for bids from the private sector in the summer. I hope that there will be pretty speedy progress, but that will depend on the trust being able to attract a viable private sector partner. If it does, I hope that it will proceed pretty rapidly—good luck to it.

The hon. Gentleman asked about the sale of land. He should realise that the proceeds of any sale of land on the site belonging to the Secretary of State will be employed in the capital development programme by the regional office, and will be redistributed to any suitable schemes in the region. That may well include the Stoke Mandeville redevelopment, but it cannot be a foregone conclusion that the proceeds will necessarily be partially or wholly reinvested in the redevelopment of the hospital site.

There is no doubt there will be a local acute hospital for the people of Aylesbury well into the next millennium. In future, if there are specific proposals for changing the services provided at Stoke Mandeville, there will be proper, open consultation, to which I am sure the hon. Gentlemen and my hon. Friends will make a valuable contribution.

As I am running out of time, I shall reply to the hon. Gentleman's other questions in writing. In the meantime, we hope to be able to announce the first stages of a much-needed redevelopment of a precious NHS hospital as part of the 50th anniversary of the national health service. I can think of nothing more fitting.

Question put and agreed to.

Adjourned accordingly at twelve minutes to Eleven o'clock.