§ Mr. John Wilkinson (Ruislip-Northwood)I am grateful for the opportunity to raise the subject of the future of St. Vincent's hospital, Eastcote, Middlesex. The hospital lies in an ideally peaceful location—at about the highest point in my constituency—on Haste hill, on the edge of Ruislip woods nature reserve. From the windows of one of its sadly now-unoccupied wards, one can look down across the broad sweep of Middlesex towards London airport at Heathrow.
St. Vincent's has been in this perfect setting for some 75 years. It is a religious medical charity, registration No. 1014889, and a company limited by guarantee, No. 2721809, under the auspices of the Sisters of Charity of the order of St. Vincent de Paul. Their tradition of devoted, selfless care of patients has been St. Vincent's enduring characteristic to this day, and that tradition is maintained by the admirable clinicians and staff who work there.
That is exemplified by the inspiringly radiant photograph and the warm tribute to three St. Vincent matrons in the May 1999 newsletter of the hospital's dedicated league of friends. The newsletter says:
Our Photograph shows three generations of Matrons who between them have served St. Vincent's for 56 years. Sister Angela Murray first came to St. Vincent's in 1943, and was appointed Matron in 1959. She was later followed by Sister Carmel Cussen who first came to St. Vincent's in 1964, and was Matron for 20 years, until Jacquie Scott took over from her at the beginning of last year.I pay tribute to Jacquie Scott and all those under her who are driving the process of change forward and seeking to ensure a long-term viable future for the hospital. The newsletter continued:Sister Angela and Sister Carmel have guided St. Vincent's through many great changes in both the world around them, and in the services provided by the hospital. Jacquie Scott, who, in keeping with the times, has the title of Director of Nursing rather than Matron, has also been appointed Head of the Hospital, and she will undoubtedly be guiding the hospital through many more changes in the coming years.Sister Angela is at last retiring to her native Lanarkshire, where we wish her well, while Sister Carmel will continue to be available to us, as she resides in the Sisters' home at the hospital and is now able to devote her time to pastoral care. So, although Sister Angela's departure undoubtedly marks the end of an era, it is all part of the continuous process of evolution of the service that our hospital provides, under the care of the Sisters of Charity of St. Vincent de Paul.It is instructive to give a brief outline of the hospital's history. At the turn of the century, Archbishop Bourne, who later became Cardinal Bourne, set up a home for 25 boys, mostly victims of tuberculosis and polio. Without this home, their chances on the streets of London—as hopeless incurables and social outcasts—were slim.In 1906, the fate of the home and the children was in jeopardy through lack of funds, as the Archbishop failed to obtain financial support. The future looked bleak until, in 1907, an old coaching house was found in Clapham, and the Sisters of Charity of St. Vincent de Paul agreed to take over its running. This was founded as the St. Vincent's home for crippled boys.
Three years later, Mr. McCrae Aitken, a surgeon, visited the home and treated 19 of the children. As a result of his skill, 12 were earning their own living within three 365 years. The work expanded and, in 1912, the home moved to Eastcote, Pinner, and became known as the Eastcote cripples home. That is its present location. An operating theatre was built and a physiotherapy department added in 1923.
In 1923, St. Vincent's adopted the name of St Vincent's orthopaedic hospital, becoming only the second orthopaedic hospital to be opened in this country. In 1925, a ward of 20 beds was opened for girls, and this was followed by yet another ward in 1930, which accommodated a further 25 patients. St. Vincent's continued to treat children and it was only during the second world war—when it had to care for casualties—that it first began to admit adult patients as part of the emergency medical service.
In the post-war period, the hospital's orthopaedic work has, until recently, continued on a major scale, although, as I will explain, it has had to be phased out to a large degree. The hospital has had a high reputation and was always immensely appreciated by the local community, which has selflessly supported the hospital's summer fetes and other activities and has recently helped to finance the opening of a shop on the site.
The range of services provided by the hospital includes work on joint replacements, care of the young chronically disabled and treating patients with severe multiple sclerosis and those who have had strokes or brain injuries. In 1996, the name was changed to St. Vincent's hospital to reflect the fact that orthopaedic surgical work was being phased out and to demonstrate that the hospital had a wider role as a community hospital.
Following a joint fund-raising appeal by the hospital and the Alzheimer's Disease Society, a specialist unit day centre for Alzheimer's patients called the Templeton centre was opened in 1997. The Holding Hands appeal did a wonderful job, and the Templeton day centre—named after its inspired promoter, Hazel Templeton—has as its object to provide high-quality care for those with dementia and to provide assistance and facilities on the site for their carers.
In 1998, a change of Government policy insisted that NHS patients should be treated in NHS hospitals where possible, and not in so-called private hospitals. Although St. Vincent's is a wholly charitable institution, it was considered a non-NHS hospital, and that led to the decision to phase out orthopaedic surgery.
The board and management at St. Vincent's agreed to continue serving the community, and that work continued in its current community hospital role. It is worth looking at the circular issued on 3 September 1997 from the NHS headquarters in Leeds and, in particular, paragraph 17—which, paradoxically, comes under the heading, "Ensuring Fairness." The paragraph said:
In preparing for the new approach, Health Authorities, GPs and NHS trusts should explore the scope to make maximum cost-effective use of local NHS capacity before contemplating recourse to private sector hospital provision. Where care is nonetheless commissioned from private hospitals, the reasons must be reported to the Regional Office.This is an extraordinary ideological predilection to support NHS hospitals, regardless of local circumstances and the cost-effectiveness of other institutions such as St. Vincent's, which is a wholly charitable hospital whose profit—when there is one—is always ploughed back into the care of patients.366 With the demise of the internal market, change and adaptation have been uppermost in health care planning, and never more so than at St. Vincent's hospital recently, which has had to adapt drastically and fast.
GP fundholding ended this March and was replaced by primary care groups on 1 April. Both systems were set up to arrange health services for all local residents. They were intended to work with the providers of local health services to ensure that local people receive the best possible treatment and care, but, in the transition from fundholding to the new PCG approach, St. Vincent's suffered and, whereas once there was a thriving orthopaedic surgical unit providing care at operative, post-operative and rehabilitation and discharge stages, the hospital can now provide only non-surgical care management.
In 1998, orthopaedic surgery ended at St. Vincent's, and the Hillingdon health authority decided to build up the orthopaedic surgical facilities at Mount Vernon hospital nearby. Anomalously and strangely, surgical work is being reduced at Mount Vernon overall; the rationale between the first decision and the second is hard to fathom, especially as the other hospitals in the area to which orthopaedic patients are referred have historically had long waiting lists whereas St. Vincent's has always been short.
In November 1998, 48 members of staff were made redundant, extending right across the board to clinical, medical, surgical and ancillary staff. The hospital has only two wards open: a busy physiotherapy service and an X-ray department, which is also likely to close in the very near future. We do not know what services will be commissioned by the NHS at St. Vincent's. The future is extremely bleak unless favourable decisions are taken. Very little time is left if this cost-effective and dedicated institution is to survive.
St. Vincent's has a small contract with Northwick Park Hospital NHS trust to provide in-patient services focusing on post-operative rehabilitation for orthopaedic or trauma patients who have had surgical procedures and require more time to get back on their feet or are waiting for social services decisions. Many people have to wait many weeks for decisions about residential or nursing home places, so the service at St. Vincent's is very relevant and worth while, enabling Northwick Park to free precious beds that would otherwise be unnecessarily occupied.
St. Vincent's also offers respite beds, but they are not NHS funded. Physiotherapy is an expanding service, which St. Vincent's has provided for the local population since its inception. The service is immensely appreciated and the physiotherapy department, which has contracts with both Hillingdon and Harrow, has a waiting list, on average, of only two weeks, whereas the district general hospitals in the area have waiting lists of about six months.
The Government have made it clear that NHS patients are to use so-called non-NHS establishments only if there are no NHS facilities available for the service required. That is wholly illogical. St. Vincent's is cost-effective, with the lowest possible overheads. There are double standards involved, as about 98 per cent. of the work done at St. Vincent's has always been for the NHS.
367 The community services development plan for Hillingdon for the financial year 1999–2002 for services for older people is due for publication on 23 September. The content of that crucial document will decide much of the future, if not the eventual viability, of St. Vincent's.
I know that the hospital's geographic location in the north of the Hillingdon borough poses certain problems, because we have the excellent Northwood and Pinner cottage hospital—which was already in existence as a great war memorial hospital—and Hillingdon health authority is determined to build up Mount Vernon as a community hospital and to run down its burns and plastics unit and its oral and maxillofacial unit, which did greatly admired cleft lip and palate work that was prized by local people.
St. Vincent's can make an invaluable contribution to the health service in many sectors, including the care of older people and respite management; physiotherapy and occupational therapy; radiography; the provision of a healthy living centre; locality phlebotomy; post-operative rehabilitation; in-patient provision for those waiting for residential or nursing home placement; out-patient services in chiropody and rheumatology; and day-care surgery.
St. Vincent's is exactly the kind of small unit that the Government should support if they genuinely believe in a wide range of health care provision for our people. In the whole period from 1979–97, I had occasion to request only one Adjournment debate on hospitals in my constituency: I asked in 1979 about the future of the accident and emergency department at Mount Vernon. In this Parliament, I have had Adjournment debates on 6 March 1998, on the future of Mount Vernon, and on 27 December 1998, on the future of Harefield hospital. This is the third time that I have had to request such a debate.
It seems that the Government are obsessed with big private finance initiative hospitals, such as the Paddington basin project or the great new hospital project in the west of Hertfordshire whose location we still do not know. If that is to the detriment of dedicated charitable institutions such as St. Vincent's, it will be a great tragedy. With good will and imagination, such a tragedy can be averted. The hospital can continue its admirable work if only it can have the contracts and backing that it and its staff fully deserve.
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on his success in securing this debate. I appreciate the importance of this topic to his constituents, for many of whom St. Vincent's is a much-loved and respected local hospital.
I do not believe that there is any connection between the Government's success in getting under way the PFI hospital-building programme—the largest ever in the history of the national health service—and the future of St. Vincent's. Nor do I believe that the connections made by the hon. Gentleman between other policies and what is happening at the hospital will stand examination.
St. Vincent's hospital, which is under the pastoral care of the Sisters of Charity of St. Vincent de Paul, has a long history of serving the community and the public at large. 368 Beginning in the early 1900s, it later began to provide surgery and treatment and in 1925 it expanded further to include facilities for girls as well as boys. The advent of the second world war meant a further change of direction, with services being provided for adults or casualties of the war as part of the emergency medical service. The hospital has continued to develop services over the years.
This debate provides me with an opportunity to pay tribute to the work of such charitable organisations. In the past, and in the present day, they have proven to be beneficial for their communities. I, too, wish to pay tribute to all those who have worked, or are working, at St. Vincent's hospital. It is clear that local people have benefited greatly from their endeavours over the years and the hospital has been, and continues to be, an important provider of local health services. It currently has a reputation for providing an excellent physiotherapy and rehabilitation service, and I am aware that local NHS patients have been very happy with the care and treatment they have received at St. Vincent's hospital.
The House will be aware, of course, that St. Vincent's hospital is a hospital outside the NHS and it might be helpful to set out several aspects of the relationship between the NHS and the private and voluntary sectors. Under the new arrangements for commissioning health services, general practitioners and consultants retain the clinical freedom to refer patients for the most appropriate treatment, and we would not have it any other way. However, it is still the case that health authorities, GPs and NHS trusts should explore the scope to make maximum cost-effective use of local NHS capacity before contemplating recourse to independent sector hospital provision.
When care is none the less commissioned from private hospitals, the reasons must be reported to the regional office of the NHS Executive. That was set out, as the hon. Member for Ruislip-Northwood said, in the planning and priorities guidance for 1998–99, which was issued to the health service in September 1997. The same applies to any hospital outside the NHS, be it a charitable organisation such as St. Vincent's or a voluntary sector provider of health care services.
It is clear that NHS facilities should be utilised where available and contracts with voluntary and private health care providers will be subject to the same standards of quality and effectiveness as NHS service agreements. The NHS has a responsibility to place its contracts with, and to commission, the voluntary and private sector only when it is most cost effective to do so after ensuring that the quality of services provided meets NHS standards. However, we accept that people should be free to choose private health care if they wish.
Ministers' relationship with the NHS is different from our relationship with the private and voluntary sector. We manage the NHS: we regulate the non-NHS sector. There is quite a difference. We have recently brought forward for consultation proposals for the regulation of the private and voluntary health care sectors.
The decision to commission services provided by voluntary and private health care providers is a local one and it will continue to be made locally and in the interests of patients. It is not the case that decisions are taken irrespective of local needs or circumstances. Indeed, two local health authorities currently have service agreements with St. Vincent's hospital. The local health authority of 369 the hon. Member for Ruislip-Northwood—Hillingdon—has a service agreement with St. Vincent's hospital for physiotherapy and for rehabilitation services. That service agreement covers 8,200 physiotherapy contacts and a rehabilitation service for 12 long-stay residents as well as on-demand respite care. Hillingdon health authority and primary care groups will invest more than £730,000 at St. Vincent's in 1999–2000. The health authority and local primary care groups are of the view that St. Vincent's provides excellent physiotherapy and rehabilitation services and that that investment decision, made locally, ensures that cost-effective, high-quality services are available to Hillingdon residents.
Brent and Harrow health authority and the five primary care groups in Brent and Harrow also have a service agreement with St. Vincent's hospital for physiotherapy services. That covers 3,500 treatments for local patients and means that more than £56,000 is being invested in St. Vincent's. That reflects the high regard with which the physiotherapy service is viewed by many Brent and Harrow GPs and by patients in the area. So far as I can establish on the information available to me, the transition from GP fundholding to primary care groups has had no impact on the utilisation of physiotherapy services by the doctors in the two local health authority areas.
It is true that St. Vincent's used to provide a variety of other services. It used to provide orthopaedic services for both NHS and other patients. It no longer does so following a hospital board decision, taken in summer 1998, to cease offering orthopaedic surgery as one of the hospital's services. The hon. Member for Ruislip-Northwood suggested that that was a reflection of the priorities guidance to which I referred earlier. My understanding is that the hospital was experiencing difficulty in maintaining surgical facilities to modern standards, given the prohibitive cost. That was certainly an important factor in the decision. However, as the hon. Gentleman said, a wide range of services is offered at St. Vincent's, including facilities for younger chronically disabled, post-operative rehabilitation, respite care, physiotherapy, and radiography.
Given that health authorities and primary care groups have a responsibility to ensure that they make the best use of the public money that they receive, Hillingdon and Brent and Harrow health authorities and PCGs have decided that it is more cost-effective and appropriate in terms of ensuring that their populations receive the highest quality of care to look to St. Vincent's hospital to provide physiotherapy and rehabilitation services. I must reiterate, however, that those decisions are made locally. I am sure the hon. Member will appreciate that it would be unfair for Ministers to get involved in such decision making. We want health authorities and primary care groups to have responsibility for local decisions because of their expert knowledge of the health care needs of the 370 local population. Our responsibility as Ministers lies in setting the strategic direction of the NHS, not in deciding which local service is most appropriate.
We are determined to ensure that the NHS in London provides Londoners with top-quality care. That is why better GP premises are being provided, new hospitals are being built, and more resources are being invested in mental health and community services. We also have a London region of the NHS looking at the capital's health needs Londonwide and providing Londonwide plans for improvement. A document, titled "The modernisation plan for the NHS in London 1999–2002", sets out what is planned for the next three years and beyond. So we have targets in place and we need to ensure that they are delivered
The key objectives of the Government policies for health and social services are longer, healthier lives; a reduction in inequalities in health and health care; and an NHS which is modern, dependable and there when it is needed. We want to focus on improving the health of all Londoners, including addressing cultural, social and ethnic diversity, and we want to work effectively with others to reduce inequalities in health. We also want to ensure that all Londoners have fast and convenient access to quality local services and that London continues to lead the way nationally and internationally.
I wish to make it clear to the hon. Member for Ruislip-Northwood that I understand that there are no plans to disinvest from the services that are currently provided at St. Vincent's hospital. I understand that that on its own may not be sufficient to secure its future, and I understand why that is a cause of concern. If the St. Vincent's board were to decide not to offer the services any longer, the local health authorities and primary care groups would need to consider how to ensure that people requiring those services were treated. That would, as I have said, be a local decision.
The Hillingdon health authority, local GPs and patients share the concern about the future of St. Vincent's. Hillingdon health authority has been in regular contact with the hospital, and discussions have been held to try to find a solution for the problems facing St. Vincent's. The hospital is seen as an integral part of the local health economy along with local NHS providers, and the health authority is encouraging St. Vincent's to look at what opportunities may exist locally and has entered into discussions with local social services on how to take that forward.
I am confident that St. Vincent's hospital is being included in local discussions and is viewed as a stakeholder when future service provision is under consideration. A local community conference will be taking place in north Hillingdon on 29 July and St. Vincent's hospital will have every opportunity to be involved and to contribute to that conference. Its role must, however, be viewed in the context of the needs of the local NHS and of other NHS providers in the area.