HC Deb 20 March 1998 vol 308 cc1598-604

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

2.34 pm
Mr. Julian Brazier (Canterbury)

I am most grateful for the opportunity to hold this Adjournment debate on the future of the Kent and Canterbury and the Whitstable and Tankerton hospitals. I am grateful to the Minister for Public Health, who has had to come, at the end of a long, hard week, to an empty Chamber to reply to the debate.

As I speak, my hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe) is on his way to the Kent and Canterbury hospital to hear its plans for reconfiguring the services in east Kent. I am grateful for the expression of concern from my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) and to the hon. Member for Dover (Mr. Prosser), who was visiting Buckland hospital in his constituency this morning. He has sent me a courteous note in which he expresses concern about the future of the Kent and Canterbury.

There is extreme concern. Since the middle of December, I have received well over 2,000 letters from constituents. There were no standard letters; they were each individually written. Many of them gave testimony of lives saved and conditions healed at these two splendid hospitals. I have also received literally hundreds of letters that I have had to redirect to neighbouring Members of Parliament.

Although it would be out of order for me to make any reference to the Public Gallery, the fact that many hundreds of people from many different communities in east Kent and all political parties have taken the trouble to come up to London today is a sign of the level of support for these two fine hospitals.

The new document produced by the Kent and Canterbury hospital, entitled "Tomorrow's Health Care for East Kent: A New Direction", offers hope in what was an extremely dark situation. Before I outline my reasons for supporting this exciting new proposal, I want to touch briefly on the four principal reasons why the Kent and Canterbury is critical for health care in east Kent as a whole. I do not intend to make, and I never have made, any narrow constituency points about employment or other local issues. I argue solely that the hospital is vital to acute health care in east Kent as a whole. I shall make some brief remarks later about the Whitstable and Tankerton hospital, which is also extremely important on the community side.

The first of my four reasons is the critical importance of east Kent's five regional specialties—cancer, renal, neonatal intensive care, haemophilia and neurophysiology. All five are based at the Kent and Canterbury, and their move would involve breaking up recognised centres of excellence. For example, the cancer unit is one of only three in the country to have received a recent chartermark for excellence.

East Kent health authority has admitted that breaking up the teams involves a considerable risk, but their move from the current site near the middle of east Kent would in all five cases reduce accessibility. In the cases of the cancer and neonatal units, the service would move right out of east Kent. Radiotherapy patients would have to travel all the way to Maidstone for daily treatment.

The second reason is a wider loss of access to a broad range of acute medical services. For many of the people with cars who live in the Canterbury city council area, which on its own has a far larger population than Thanet and extends well beyond my constituency, for the people who live in Faversham and for the tens of thousands of people who live in villages in east Kent, Canterbury, as the hub of the public transport system, is the only accessible acute hospital in east Kent.

It is ironic that some of the strongest representations about the closure of the Kent and Canterbury have come from communities in the Thanet, North and Thanet, South constituencies, such as Herne Bay, Sandwich and Wingham, where some of the best-attended meetings opposing closure have been held. Margate is inaccessible even to the people there, especially those who rely on public transport.

The third argument concerns quality. There is an increasingly tight national and international market in key medical skills. The Kent and Canterbury has every consultant post filled and every junior doctor post accredited for training. Its consultants include several of national distinction. The view of general practitioners is the best measure of quality, and their overwhelming support for the Kent and Canterbury hospital is reflected across many communities by the fact that those representing 240,000 people have given their backing to that hospital.

The fourth reason why the Kent and Canterbury is critical to health care is co-operation. Sadly, Margate hospital faces a recruiting crisis: six consultant posts are unfilled despite the fact that 19 Kent and Canterbury consultants regularly help out there. The recent reorganisation of paediatric services in east Kent has shown that the necessary critical mass for doctor training can be provided if departments in our three acute hospitals operate on three sites, but as one unit. However, if the Kent and Canterbury is removed from the picture, the extreme distance between sites—40 miles along one of the most congested roads in the United Kingdom—would mean that Ashford, on its own, would be unable to support Thanet.

The Kent and Canterbury proposal is positive. I am delighted that it has the backing not only of medical, nursing and support staff at the Kent and Canterbury hospital, but of a huge number of local GPs and a growing number of consultants and other staff at Ashford. The essence of the document's proposal is that all three sites should continue to operate, but on a unified basis under one management structure.

The proposal emphasises that retention of the five core services—acute medicine, acute surgery, accident and emergency services, and maternity and paediatric provision—on all three sites is pivotal. At the same time, financial savings could be made in three key areas: first, through cutting management overheads by amalgamating the three trusts—a cynic would suggest that it is obvious why doctors at Ashford, who realise that the proposal is the right way ahead, and their management, who strongly oppose it, are divided; secondly, by cutting clinical costs by significantly increasing efficiency on individual sites—especially, as the EKHA has noted, at Ashford and at Thanet; and thirdly, by cutting support costs through rationalising certain supporting services, which do not directly interface with patients, on to individual sites at the hospitals.

Two of the most exciting Kent and Canterbury proposals—improvements in education and training, and improvements in research and development—would take advantage of the Kent and Canterbury's proximity to the university. That would add critical mass by allowing continuing activity on all three sites, but under a common, tri-site umbrella.

The package would provide east Kent with a hospital configuration that would attract top-quality staff, continue to offer maximum accessibility to patients, and protect key regional specialties, and would achieve savings on individual overheads and retain the necessary critical mass for doctor training.

This model may help to pave the way for future debates in areas throughout the country where tension is developing between patient accessibility and the continuing demand for more centralisation to deal with doctors' training. I note that three hospitals in Surrey and Sussex are moving towards a similar model. I welcome the re-establishment by the EKHA of a steering committee to examine the proposal in detail. I am particularly pleased about the appointment of Dr. Sue Atkinson as chairman of the clinical co-ordinating group, which will include general practitioners as well as a much wider range of consultants than were involved in the original document. Obviously, much detailed work remains to be done.

Whitstable and Tankerton hospital, which really deserves a debate of its own, was built after the first world war as a memorial to the dead of the area, to care for the living. That excellent community hospital is in an unfortunate position. In December, the EKHA arbitrarily said that it was thinking of closing the hospital. Although that proposal has been removed from the consultation document—rightly, in my view—concern inevitably remains among the staff. The hospital is very popular. It is in the centre of a town that contains many elderly people, a number of whom have no access to public transport. Huge sums have been raised by the league of friends, which means that much of the hospital's building is new.

Let me draw a rather unhappy analogy. In the context of mental health, care in the community has in many ways proved a disaster. The Government are now rightly returning to a residential arrangement—an arrangement which, in many instances, is more expensive than the original provision of beds in the old hospitals. Any proposal to replace community hospitals such as Whitstable and Tankerton with alleged extra provision—care in the community—would, to say the least, have an unhappy provenance. In my view, it would lead to disaster in Whitstable.

There are two drives behind the proposal for Kent and Canterbury, and the possible proposal for Whitstable and Tankerton. There is the need for critical masses in the training of doctors—the need to recruit and train doctors of the best quality—and there is the inevitable shortage of resources. Kent and Canterbury hospital has come up with a proposal that deals with both problems.

The EKHA's original options both involve radical change. One proposal is to close Kent and Canterbury hospital, or run it right down; the other is to do the same in Thanet. Even in principle, those moves would secure only small financial savings, and in practice they would lead to huge costs—hidden costs that are just starting to emerge, as always happens with radical change. The Kent and Canterbury document, "Tomorrow's Health Care for East Kent", offers the hope of a new direction.

2.47 pm
The Minister for Public Health (Ms Tessa Jowell)

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing the opportunity to debate a matter of such evident importance to his constituents. He referred to other hon. Members who have represented their constituents' interests in a matter that is obviously important to east Kent. I am grateful to him for doing so, but I want to add the name of my hon. Friend the Member for South Thanet (Dr. Ladyman) who, as the hon. Gentleman may know, took part today in the farewell to Ramsgate hospital.

This is the second occasion in a matter of weeks that we have had an opportunity to debate the review of hospital services in east Kent. That is a testament to the amount of local interest in the review and, more fundamentally, to the commitment of the people of east Kent to securing a high-quality national service for themselves and their families. It is proof that the national health service is as relevant to the lives of people in east Kent and, indeed, the rest of the country as it was when it was established 50 years ago.

The hon. Gentleman spoke about some developments that have taken place during the short time since the House previously debated this matter. Before I touch on them I should like to reiterate some of the key points that were made by my hon. Friend the Minister of State in the previous debate. They provide the context in which hon. Members who represent east Kent will consider the review of hospital services and take account of their constituents' views.

I remind the House that the health authority's proposed reorganisation in east Kent is not financially driven. The Government have already provided extra money for health and social services. In east Kent, we have provided £1.66 million to help alleviate winter pressures that, in the past, have caused suffering and difficulty in local hospitals. We are anxious to relieve those pressures. We have also announced an increase of £5.3 million in real terms for next year.

Even with extra investment, change is needed in east Kent and the review is about the ability to deliver safe and effective care to patients in the district. As the hon. Member for Canterbury said, the relevant factors include the supply of doctors and their training needs and working practices. They are of the essence in delivering high-quality health care. Clinical quality requires a minimum work load, which is important in building up experience. In an acute hospital without a minimum work load, doctors cannot be properly trained, and senior doctors cannot maintain the expertise to ensure the best treatment and care for patients. Money alone cannot resolve those issues.

Since the previous debate on this subject, NHS chief executives and leading doctors have written to all NHS staff in east Kent confirming their acceptance of the need for change. That change is necessary to meet the pressures that face the NHS locally, and it reflects the broader and continuing need for national change. We applaud their efforts to explain to staff and local people the underlying rationale for change. Those people are undoubtedly anxious about what the future holds for services in the district. We do not for a moment underestimate the anxiety and concern about the prospect of any change for whatever reason.

The second important point about the consultation is that it is an attempt to establish the best way forward in the long term for services in East Kent. The consultation is genuine. I assure the House that no decisions have been taken or can or will be taken until the consultation period ends on 8 May. The debate provides an important opportunity for Ministers to be made aware of the developing concerns and views of hon. Members from east Kent.

At the end of the consultation period it will be the duty of the health authority to take account of the comments that it has received and, in the light of them, to weigh different options. Local accountability is especially important, because the way in which services are run and developed must be in tune with local needs and views, and inspire the confidence of the people who use them. That is why we hope the consultation can proceed in a spirit of consensus and with the objective of delivering a broad consensus about the right way forward. That would be in the spirit of our recently published White Paper about the NHS's future.

Should the final option chosen by the health authority be contested by either of east Kent's community health councils, the final decision will rest with Ministers. If that should happen, Ministers' responses will be fully informed by the health authority's detailed consultation and will be based on a balanced assessment of the proposals, which should themselves reflect the NHS White Paper that made clear that services should be based on integrated care and on partnership between NHS bodies and local agencies, all intended and designed to deliver a better service to patients through improved quality and efficiency.

It is important to offer, and to have the capacity to offer, prompt, high-quality treatment and care that is built around individuals' needs. It is important, too, that the new arrangements provide prompt access to specialist services that are linked to local surgeries, but we must preserve the integrity of consultation. That imposes a real discipline on Ministers.

At this stage, the discipline must be to listen rather than to comment on any of the proposals that are the subject of consultation, but I assure the House—I hope that hon. Members will make this absolutely clear to their constituents—that no decisions have been taken by Ministers, no minds have been made up and no commitments have been given. However, the need for change is, as I have said, recognised by all parts of the NHS. Of course, when consultation comes to an end in the next few months, it will be the time for discussion and debate to stop, for decisions to be made and for the East Kent authority to work together to implement the decisions, putting the uncertainty of the review behind it.

The hon. Member for Canterbury referred to the role of Whitstable and Tankerton hospital. I should like to make it clear that the services provided by community hospitals form a vital part of the comprehensive network of NHS care but that their future does not form part of this current consultation.

As the consultation document makes clear, the future of individual community hospitals will be the subject of separate detailed discussions with local general practitioners and local communities. Those discussions will also help future primary care groups to focus their attention on the role that community hospitals play in improving the health of their local populations.

I understand that the health authority has established an elderly strategic planning group with representatives from primary and secondary care sectors and social services that will help to mastermind strategic development of community services. We welcome that. I understand that the community trust has also established local groups to review in detail the operational implications on local services in Faversham, Whitstable and Tankerton.

East Kent health authority has also emphasised that the aim of any change is to provide the best quality care in the right surroundings, that patients will not be transferred inappropriately to nursing homes and that beds will not be closed until new services are available and are shown to be working effectively, which is extremely important in underpinning the contract of trust between local health services and the local community.

If proposals emerge that constitute a substantial change to service provision, of course that would require public consultation. The health authority has given, and we expect it to meet, that commitment.

The hon. Member for Canterbury also referred to concerns about care in the community and mental health. We agree that the shift from institutional care to care in the community has failed to deliver the necessary levels of support in a number of areas. That is a cause for concern. Public confidence in the policy and its implementation by the previous Administration is low, but we can have no return to the grim Victorian asylums that never were community hospitals.

Mr. Brazier

At this very moment, admissions to the Kent and Canterbury hospital are having to be restricted, and the Whitstable and Tankerton hospital is full. I am relieved to hear the Minister say that, before we let go of any beds, acute or community, the Government will make certain that we have enough beds.

Ms Jowell

That assurance is an important part of building public confidence in change. People become ill and need care day by day and it is important that treatment is available, regardless of the point reached in the cycle of change.

I come now to the major issue raised by the hon. Member for Canterbury—the proposals set out in "Tomorrow's Health Care" by the steering group. The steering group's purpose was to ensure that a joint mechanism existed to assess alternative proposals to the authority's preferred option. Things have moved on. Doctors from Kent and Canterbury have developed an alternative option, set out in a companion document—and it should be seen as such—called "Tomorrow's Health Care for Kent: A New Direction". Their proposal is to retain in-patient services at Margate, Ashford and Canterbury. I commend the doctors at Kent and Canterbury for the spirit in which they have put forward their option. Papers recently presented to the "Tomorrow's Health Care" steering group committed it to further exploration of the option. That exercise will be conducted thoroughly.

I understand that a co-ordinating group of leading doctors from all the trusts in East Kent, under the chairmanship of the regional director of public health, will ask doctors—both specialists and general practitioners—from across East Kent to consider this proposal in the light of the other proposals on which consultation is taking place. The intention is that the "Tomorrow's Health Care" steering group will consider the results of that work in about six weeks.

It would be wrong to speculate about the future. However, it is important that hon. Members have the opportunity to debate those important proposals and their consequences for their constituents. Representing the interests and concerns of their constituents is one of the most important tasks that face hon. Members, and the hon. Member for Canterbury has responded actively to the proposed reorganisation of health care for his constituents. Whatever happens in the House, the important debate will take place locally.

I am confident that every opportunity has been extended to local people to take part in local meetings and lobby Members of Parliament to ensure that, when the decisions are taken, nobody is in any doubt about the strength and balance of local feeling. We will ensure that the NHS executive continues to work closely with the NHS in east Kent to protect the interests of patients, to put them first and to build together, based on a true understanding of the issues that face the NHS locally.

We are determined to ensure that the result of the consultation is high-quality treatment offering high-quality care to the people in the district so that they have a health service fit for the 21st century. I know that local trusts and the health authority share that commitment. I assure the hon. Member for Canterbury that Ministers will do everything they can to ensure that interested parties work constructively together to find the best way forward that inspires local confidence.

The motion having been made after half-past Two o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at four minutes past Three o'clock.