Mount Vernon Hospital, Northwood (Hansard, 6 March 1998)

§ Mr. John Wilkinson (Ruislip-Northwood)
I am privileged to have secured this Adjournment debate on the future of Mount Vernon hospital, Northwood, which worries my constituents more than any other local issue. The hospital's future has been an underlying concern since I was first elected to the House as the local MP in 1979, but the Minister of State, Department of Health, knows that this background anxiety has become a grave preoccupation in recent months. He received most courteously a constituency deputation which included the pressure group Community Voice, representatives of the Northwood and Ruislip residents associations and the community health council.
The hospital is part of the Mount Vernon and Watford Hospitals NHS trust, and the only hospital in my constituency that offers general medical as well as surgical and, most importantly, specialist cancer and related services. It has built up a formidable reputation as a regional cancer centre. It is the largest on a single site in England, supporting burns and plastics, oral and maxilla facial and other surgical services.
So good has the reputation of the hospital become over the years that a number of world-quality research and complementary facilities have been drawn to the site. Among those are the Gray laboratory for cancer research, the Reconstruction of Appearance and Function Trust—RAFT, the Marie Curie research wing, the Michael Sobel House hospice, the Paul Strickland scanner centre and the Bishopswood private hospital. They are mutually supportive because of the physical investment and, above all, the high intellectual calibre of the world-class personnel who have been drawn to Mount Vernon to do research and clinical work at the frontiers of medicine.
Like so many great British institutions, Mount Vernon hospital is not the product of some grand strategic design. Since its inception in Edwardian times, it has grown in a somewhat higgledy-piggledy fashion to meet local and national demand, so that today, it is a remarkable blend of listed architecture, single-storey hut-style constructions, and ultra-modern ward blocks and facilities. What makes it all work so effectively is the spirit and dedication of the staff and their common sense of purpose.
The hospital's geographic location at the extremity of so many health authorities, boroughs and county boundaries is symbolised by the hospital's non-appearance in the Government's document, "Health services in London: a strategic review", which was published last month.
The Mount Vernon business plan for this financial year was summarised by the outgoing chief executive Stephen Ramsden, to whom, along with the outgoing chairman David Swarbrick, I pay warm tribute. The summary states: Our strategic objectives are to provide: the best local specialist health services, the leading plastic surgery and burns services in the country, a world class cancer service. 1363 The Trust's plans for change have already taken shape with the establishment of a single Accident and Emergency Centre at Watford General Hospital with Mount Vernon concentrating on specialist services and services for referred patients. The Trust faces a difficult financial agenda with expenditure continuing to increase at a higher rate than income. In addition the Trust faces an unprecedented reduction in Health Authority income linked to a forecast reduction in emergency admissions, which has not materialised. Regrettably, it is inevitable that services will be reduced in the short term to meet these pressures and we will strive to protect services for emergency and clinically urgent patients, and secure a long term solution. During 1997/98 the Trust will continue to influence the planning of the reconfiguration of services throughout West Hertfordshire. Active collaboration with the St. Albans and Hemel Hempstead NHS Trust and the West Herts Community Services NHS Trust will be a key feature of this. The Gray laboratory, which is a leading centre for radiation research applied to cancer treatment, has sent me a document, which I will submit to the Minister, to complement the paper which the local Mount Vernon support group, Community Voice, handed to him when I took them to see him, as part of our delegation, a few weeks ago. It is entitled, "The threat to research at Mount Vernon". The main points in the document summarise the essence of local constituency concerns, as well as the professional anxieties of all who work at Mount Vernon.
Financial solvency has proved to be an increasing problem in recent years, and losses have been sustained largely by general surgery. The special centres for cancer and plastic surgery treatments have been financially stable and, to a large extent, they have subsidised the general services on site. Because of the crisis that is due to the overspend, the West Hertfordshire and Hillingdon health authorities have engaged in reviews, concentrating on an assessment of the requirements for acute services in the district general hospitals. The West Hertfordshire review is considering the rationalisation of services at Mount Vernon and Watford, Hemel Hempstead and St. Albans, favouring concentration on only one site.
The proposed changes may lead to general medicine and surgery leaving the Mount Vernon site. The future of plastic surgery there has been the subject of reviews, and at least six options are being considered. Changes that are occurring at the Chelsea and Westminster hospital, where plastic surgery services have been developed in response to the closure of Queen Mary's hospital at Roehampton, complicate the picture.
The movement of other services from the Mount Vernon site threatens to destabilise services for cancer patients and for those who require plastic surgery. The close integration of other specialties in medicine is essential to both those specialties for the achievement of a high standard of care. The reviews have focused on the requirements of surrounding areas for district general hospital services, and the destabilising effect on the major centres for cancer treatment and plastic surgery and burns and the enormous commitment to research have been given a low priority.
The South Thames review on plastic surgery has taken no account of the impact of the proposed change on the Mount Vernon centre. The insecurity that surrounds the special centres at Mount Vernon has enormous consequences for work on patient care and research. The combination of a large clinical case load and important research that is of international interest has proved most attractive in the recruitment of high-standard staff in all 1364 disciplines and at all levels. The honours that have been achieved by staff and the demands that are made upon them to lecture nationally and internationally speak for themselves.
The continuing insecurity means that valuable members of staff may migrate elsewhere, and it may prove difficult to recruit able young people. It is already proving difficult to recruit support staff, such as secretaries, who are critical to the service. There is a vast investment of capital in research buildings and equipment. It totals more than £20 million and £5 million is currently committed to building and equipping new and continuing projects. Annual research expenditure totals £8.2 million.
In view of the uncertainty over the future of the hospital, £200,000 that was promised has been lost, but much more is at risk. Early clarification about the position of the major centres and their associated research is essential. Without such clarification, the collaborative research and clinical teams that have been developed over the past 40 to 60 years are in peril of disintegrating, and continued fund raising is certain to prove more difficult.
I have to mention RAFT, whose chairman is Sir Robin Chichester-Clark, the former Member of Parliament for Londonderry City and County. We should all recognise its remarkable work. It was established to help in research and education in the context of the thousands of patients who every year suffer horrendous burns, injuries or accidents, those who undergo surgery to remove cancers or those who have birth defects. RAFT can meet those needs only with the support of donors and friends. The research has already resulted in improved patient care for an enormous number of people, but it can continue only if the money can be found to pay the salaries and the laboratory costs of the team of 22 researchers. The cell and molecular biology groups, for example, jointly require £250,000 annually. RAFT relies entirely on charitable donations. Thanks to loyal supporters, last year was a successful one, and more than £1 million was donated.
RAFT—which is celebrating its 10th anniversary this year—has written to me that it has achieved remarkable scientific recognition, prizes and professorships. The letter goes on to say: The location on site at Mount Vernon of the following probably provides UNIQUE facilities for innovative, pioneering research and encourages close collaboration between surgeons at the patient's bedside". Such facilities are crucial to RAFT's future.
RAFT is a purpose-built centre at Mount Vernon and employs 23 surgeons and scientists. RAFT's letter goes on to state that it has received donations amounting to £600,000 from its generous supporters to expand its laboratory facilities, but until the results of the various reviews etc are known, the Trustees do not feel able to proceed with the planned extension of the facilities.
I can only reiterate the final paragraphs of Community Voice's submission to the Minister, which are endorsed not only by myself, but by the Hillingdon community health council and by the board of Mount Vernon hospital. The chairman of Community Voice, Mike Turner—to whom I pay tribute—wrote: To dismantle or separate any one aspect of the work"— 1365 at Mount Vernon— would have a very adverse effect on the present efficient arrangements. However Hillingdon Health Authority is considering an option to remove the Plastic and Bums Unit from this site. The Mount Vernon and Watford NHS trust, which manages the Cancer and Plastic Surgery Departments, has issued an official statement, 'If Plastic Surgery is closed at Mount Vernon, then the purchasers and Regional Office'"— of the NHS— 'need to be prepared to close the whole hospital as other surgical services are reliant on shared services with Plastic Surgery. Cancer is reliant on surgery.' Our consultation with both cancer consultants and plastic surgeon consultants confirms that they all feel that the present successful collaborative arrangement must remain It should go without saying that the collaborative arrangement between RAFT, the Paul Strickland scanner centre, the Gray laboratory and the fourth facility—the regional cancer centre, which is the jewel in the crown, and the heart of the hospital—should remain.
The letter continues: In these circumstances the four groups indicated at the opening of this report request the Minister to veto any proposal to remove Plastic Surgery from the Mount Vernon Hospital site", which is what I ask the Minister to do.
I add my voice to those urging the Minister to end forthwith any uncertainty over the future of Mount Vernon hospital at its current site, to confirm the admirable role that it plays not only in the local community but nationally, and to give it a really good—an optimistic—chance to expand further.

§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)
I am delighted to have the opportunity to respond to this debate initiated by the hon. Member for Ruislip-Northwood (Mr. Wilkinson), whom I congratulate on securing time for a debate on a subject of such importance to him and his constituents. I know that he has devoted much time to it.
We are indeed fortunate to have heard the hon. Gentleman's tribute to the staff of Mount Vernon hospital. I am sure that he speaks for all his constituents who are aware of the very real contribution that NHS staff make to the success of hospitals such as Mount Vernon, often working in difficult and challenging circumstances, not least the circumstances arising from the financial problems experienced in and around Mount Vernon.
I assure the hon. Gentleman that the Government are absolutely determined to secure for the nation and for his constituents a national health service of which the country has good cause to be proud by virtue of the quality and expertise that it contains and by virtue also of the rediscovery under this Government of the founding principles on which the NHS was established, principles which were, sadly, eroded by the previous Administration. The principles of fairness, accessibility and quality, which were all variable under the previous Administration, have once again become central to the delivery of health care in this country.
We are also absolutely determined to bear down on the burdensome costs of administration that were the product of the internal market created by the previous 1366 Government. This Government put the emphasis on patients and patient care and on ensuring that we use resources cost-effectively so that every penny of additional spending is well spent.
We have seen this winter an example of how the additional £1.2 billion that we made available for the NHS across the country has been used to ensure that health and social services, working together, have helped not only to meet the inevitable demands of winter but to begin to redress the underfunding that characterised the previous Administration. The hon. Gentleman outlined the impact of that underfunding on Mount Vernon.
The recent publication of our Green Paper "Our Healthier Nation" and the White Paper "The new NHS" show the Government's commitment to building a healthier nation and a modern, dependable NHS. The abolition of the internal market and its replacement by a system of integrated care based on partnership between NHS bodies and other local agencies is designed to deliver a better service to patients through improved quality and efficiency, offering prompt high-quality treatment and care built around the needs of individuals. "The new NHS" forms the basis for a 10-year programme. We will renew the NHS over that period as a genuinely national service and improve it through evolutionary change rather than organisational upheaval.
There is a very real question in the hon. Gentleman's mind, and in the minds of his constituents, as to the future of Mount Vernon.

§ Mr. Gareth R. Thomas (Harrow, West)
Is my hon. Friend aware that many of my constituents, especially those in Pinner and Hatch End, also use and benefit enormously from the services currently provided at Mount Vernon? Will he assure my constituents that in any public consultation on future patterns of service delivery they will have the same right and opportunity to be consulted as the constituents of the hon. Member for Ruislip-Northwood (Mr. Wilkinson)?

§ Mr. Boateng
It is important that the consultation process embraces all those interested parties. We need to ensure that it is shaped and informed by those interests and is not in any way hurried or precipitate, because we need to get it right. We are seeking to take into account the broad range of views about the future. The review that has been under way since last August is being conducted by Hillingdon health authority in conjunction with a number of interested parties: Mount Vernon and Watford general hospitals, Hillingdon hospital, Harrow and Hillingdon Healthcare NHS trust, local GPs, the London borough of Hillingdon and community groups including the local community health council. We want all groups and agencies that have an interest to be given an opportunity to participate. The neighbouring health authority of West Hertfordshire has also been carrying out a local review of health services over the past 10 months. That, too, inevitably impacts on Mount Vernon hospital.
There is a problem about the underlying deficit. The trust's main purchasers are now seeking to withdraw funding in line with their own investment strategy, which was originally developed to manage the transition following the closure of the accident and emergency department in March 1996. The trust's cost base has not reduced in line with the proposed loss of income, which 1367 has adversely affected the trust's financial deficit. Had no remedial action been taken, the trust would have had a deficit of some £7.3 million in 1997–98. It was therefore important to agree a cost-saving programme that aims to reduce the deficit to a more manageable £4.8 million in 1997–98. It includes, as it was bound to, reprofiling of staff, budget controls and a temporary reduction in elective work.
The hon. Member for Ruislip-Northwood came to see Ministers about his concerns, as did my hon. Friend the Member for Watford (Ms Ward). We pay tribute to the work of the cancer centre at the hospital; it is obviously world class and world renowned, but it must be stressed that local services are also important.
The final configuration must be both clinically coherent and financially viable. It will be decided after the most careful consideration, which will take into account also the review of the plastics and burns service and the relationship between that service and the cancer service. Any proposals for significant service changes will need to ensure that financial balance and sustainable services throughout the health care economy in Hillingdon and West Hertfordshire are achieved. I can assure all hon. Members that all such proposals will be subject to full public consultation and involvement in the decision-making process.
1368 I should like to say a word about waiting times, which I know are of concern to all hon. Members with an interest in Mount Vernon. We are absolutely determined to get to grips with the legacy that we inherited from the previous Government and to deliver on our pledges. The most recent figures, released on 19 February, reflect that legacy, as well as the inevitable consequences of the winter. They are not good, and we are determined to address the situation.
Mount Vernon and Watford Hospitals NHS trust was the second worst performer in the North Thames region, with 126 over-18-month waiters on 31 December 1997. That is unacceptable. I am glad that we now learn that the trust will have got rid of those 18-month waiters by the end of March. We shall expect that improvement in the delivery of the service to continue, because the previous failures have been unacceptable.
We shall go forward together in the new national health service. The expressions of anxiety voiced by the hon. Member for Ruislip-Northwood and by my hon. Friends have been heard, as have those of the dedicated staff in Mount Vernon and throughout the NHS. I am sure that, ultimately, we shall achieve a reconfiguration that meets all the needs that hon. Members have outlined. That is the way forward—a final configuration that is both clinically coherent and financially viable.