HC Deb 12 May 1999 vol 331 cc291-8 1.28 pm
Mr. Christopher Gill (Ludlow)

Opening the rural health forum conference on 26 October last year, the Secretary of State for Health said that the Government had looked at the special needs of each area, including the particular features of rural areas, and that the major factor in addition to low density of population and correspondingly fewer services was the distance to travel. There is now less public transport in rural areas, and there has been a tendency for care and treatment delivered by both health and social services departments to be concentrated on particular centres. That has made the position much worse. Moreover, those who are least likely to have their own transport are likely to be those with the greatest health needs: the less well off, the elderly, women and children.

That makes the case for retaining the full range of services at Kidderminster very eloquently. The Secretary of State's words could scarcely be improved on: they reflect the sentiments of my constituents, and people living in other parts of the country—particularly those in Worcestershire—who are served by this fine hospital.

In the same opening address to the conference, the Secretary of State pointed out some of the effects of the changes and developments in the national health service and in medicine generally: There are still major pressures for concentration of services and the needs of local communities must be represented to the Royal Colleges involved in these proposals. Short-term considerations now should not leave us with having to rebuild small hospitals in a few years time when the new technology takes effect. Again, he got it absolutely right, but unfortunately his words have not been translated into deeds.

Members do not have to take my word for that. I draw the House's attention to the headlines that appeared in the Shropshire Star last Friday: Poll backing for NHS fight. Hospital campaigners get vote of confidence with elections triumph. People living in the area that is served by Kidderminster district general hospital are so incensed about what the Government are doing with the hospital that 15 people stood for election at last Thursday's district council elections on a "Save Kidderminster hospital" ticket. Of those 15, 11 were elected, six of them knocking out Labour councillors on Wyre Forest district council.

What is interesting is that, after those results were announced, the Secretary of State was interviewed on television. I did not see him myself, but I am reliably informed that he said that the council elections would make no difference. What arrogance to say that the expression through the ballot box of an enormous number of people's concern for the future of the hospital that serves their area will make no difference, notwithstanding the fact that six Labour councillors were voted out in Wyre Forest district. One can perhaps look forward to the next general election. It looks likely that the strength of feeling on the issue will mean that there will be a change of Member of Parliament as well.

I see the hon. Member for Wyre Forest (Mr. Lock) in the Chamber. I gave him notice of the debate, so that, if I say anything about him, he will not be unprepared. I remind him of what he was telling the electorate of Wyre Forest before the general election. He was saying that it was a question simply of money and that the future of Kidderminster district general hospital could be assured if money were forthcoming.

Mr. David Lock (Wyre Forest)

Will the hon. Gentleman give way?

Mr. Gill

No, I will not give way to the hon. Gentleman. He knows that, when I wanted to intervene on him on the question of Kidderminster district general hospital in a similar debate in June, he would not give way, so I will not give way to him. If he wants to intervene on the Minister, I am sure that the Minister will be more understanding.

Under the Conservative Government, in the 10 years from 1987 to 1997, £25 million of capital was spent on Kidderminster district general hospital: £20 million on a building programme; £5 million on equipment. Those of my colleagues who know the area—I am pleased to see my hon. Friend the Member for Bromsgrove (Miss Kirkbride) in the Chamber—will know that Kidderminster is a fine hospital. It enjoys a fine reputation. It is successful on every count. It is popular. It has conducted its affairs within its budget. In 1997, it attracted a charter mark for excellence, yet the Government want to downgrade it and to remove its accident and emergency facilities.

I remind the Minister that hospital admissions via the accident and emergency department at Kidderminster have increased every year for the past five years. If he looks at the statistics relating to 1998, he will find that the number of admissions via Kidderminster's A and E department increased in each quarter of that year.

I was speaking about money. I was explaining that the Conservative Government had spent an enormous amount on Kidderminster district general hospital. In a speech in the House on 15 March, the Secretary of State was bragging at column 708 about the fact that, under the new Labour Government, £1 million had been spent on the accident and emergency department at Portsmouth. He clearly thinks that £1 million is a lot of money. By anyone's standards, it is, but the point is that the Conservative Government spent £25 million on Kidderminster hospital and now the Labour Government are prepared to see it downgraded, the accident and emergency department closed and many of the services removed to Worcester.

I remind the House of what else the new Labour Government have said in terms of finance. On 16 February, the Prime Minister announced that £30 million from the NHS modernisation fund would be spent on improving England's accident and emergency services. Not to be outdone, the following month the Secretary of State for Health announced an additional £100 million, again to modernise A and E departments. What is going on? How can it possibly be right that the Government are prepared to close a modern A and E department, on which £25 million has recently been spent, at the same time as they boast about modernising 50 A and E departments in other hospitals in other parts of the country?

While I am talking about the hypocrisy of what the Government are proposing, let me remind the House that, today, in the Worcester and Kidderminster hospitals combined, there are more than 800 beds. In three years' time, when the Government's plan is fully implemented, there will be fewer than 600 beds; but the House does not need me to remind it that, for the whole of the current Administration and indeed in the run-up to the last general election, the Labour party was saying that the health service would be improved, and that there would be better facilities and better services for all our constituents.

I am sorry, but the Government would have a job to sell that idea now in south Shropshire and Wyre Forest. We have a saying in the country: "If you want to meet a fool in the country, you have to take him with you." The people will not be fooled by all the words of the Secretary of State and Government generally when they see for themselves that the hospital that they love, the hospital that has served their area so well for so long—incidentally, the hospital to which so many of my constituents have contributed through their generosity to the league of friends, which has provided so much additional equipment—is being downgraded, with many of its services transferred to other hospitals. How can they possibly believe all the words and fine sentiments that the Government keep propounding?

Miss Julie Kirkbride (Bromsgrove)

My hon. Friend makes a relevant point: what is wrong with the people of Worcestershire; why have the Government broken their promises to them? When discussing the electoral consequences of those broken promises, will he bear in mind the fantastic results that we achieved in the local elections in Bromsgrove, which were the result partly of the closure of Kidderminster hospital, which serves a third of my constituency, and partly of the closure of the accident and emergency department at the Alexandra hospital in Redditch, which is also to be downgraded to a local emergency centre? The people of Worcestershire, and of Bromsgrove in particular, are most concerned about that.

Mr. Gill

My hon. Friend is a doughty fighter for her constituents and has been a staunch ally in the fight to preserve Kidderminster hospital. That must be an object lesson to the hon. Member for Wyre Forest, who should have fought harder for his constituents; his party might then have done much better in the local elections.

Mr. Lock

Will the hon. Gentleman give way?

Mr. Gill

No. The hon. Gentleman has heard what I have to say on the subject. Had he been generous in giving way to me in earlier debates, of course I would have given way, because I like debate; I like to be able to answer his arguments, but he has had time enough in previous debates.

The pressure to keep Kidderminster hospital going on the present basis comes not only from me and my constituents or my hon. Friend the Member for Bromsgrove and her constituents but from right inside the constituency of the hon. Member for Wyre Forest. The Kidderminster and district community health council continues to be totally opposed to the plans, but it is getting nowhere with the Government, who appear impervious to local opinion.

It might interest the Minister to know that a formidable action group fighting for the retention of Kidderminster district general hospital is to go to the High Court at the end of this month to seek permission for judicial review. That is how strongly my constituents and others feel about the issue. One does not seek judicial review lightly. That is the action of an enormous number of people in desperation at the Government's insouciance in the face of their representations.

I invite the Minister to comment on the fact that, whereas Worcestershire health authority says that the downgrading of Kidderminster hospital will save £4 million a year, the finance director of Kidderminster hospital trust, who should know something about it because he is employed at the hospital, says that the savings will be at best only £300,000 a year.

Which of the figures is correct? My constituents want to know, because one of the figures must, obviously, be wrong. Major decisions are being made on the strength of the figures provided, and it behoves the Minister to tell the House exactly what figures are being used in the considerations.

Worcestershire health authority has a preponderance of representatives from the south and east of Worcestershire, who have clearly voted against the minority of representatives from the north-west of the county, where the Kidderminster hospital is. My constituents feel very sore about the fact that the future of our area is being decided by people from an entirely different part of the country, who have a vested interest in the new hospital that is proposed for Worcester.

We have seen the arrogance of a Secretary of State who is totally dismissive of public opinion and the hypocrisy of the new Labour Government, who say one thing and do something entirely different. He says that he has considered the special needs of every area; that he recognises the problems of low population density; and that the distance to travel is an important factor—but he does absolutely nothing about it. My constituents look to the Government to review the decision and allow the district general hospital at Kidderminster to continue with a full range of services.

1.45 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

I congratulate the hon. Member for Ludlow (Mr. Gill) on securing time to debate a subject that I know is important both to him and some of his constituents and to the people of Kidderminster and all who value the services provided by Kidderminster district general hospital. It is customary on these occasions to congratulate both Opposition and Government Members on their thoughtful and positive remarks; sadly, on this occasion I will not be able to do that.

I would like to state clearly from the outset that the Government see a very clear and positive future for Kidderminster hospital in the context of our decision on Worcestershire health authority's strategic review of services. That view has been echoed by the health authority.

In the months since the ministerial decision last December, we have made strenuous efforts, with the assistance of my hon. Friend the Member for Wyre Forest (Mr. Lock), to explain that the solution that we have arrived at for Kidderminster is not a closure but a positive change reflecting the needs of a modern health service. I am sad to say that both the hon. Members who have spoken in this debate have given the false impression that we are closing the hospital. The hon. Member for Bromsgrove (Miss Kirkbride) made that allegation, which is untrue. Such misleading statements do nothing whatever—[Interruption.]

Mr. Deputy Speaker (Mr. Michael Lord)

Order. I would like to think that we could continue this debate without sedentary interventions from any part of the House.

Mr. Hutton

Thank you very much, Mr. Deputy Speaker.

Both hon. Members have misled their constituents about the Government's intentions. We have no plans whatever to close Kidderminster hospital.

Mr. Lock

I am very grateful to my hon. Friend for giving way, in stark contrast to the behaviour of the hon. Member for Ludlow (Mr. Gill). I welcome the cast iron, on the record assurance that Kidderminster hospital will not close. May I also have an assurance that 24-hour emergency services, led by a consultant, will remain at Kidderminster, and that the driving force behind the changes, as recognised by the "Save Kidderminster Hospital" campaign's own experts, is strictly medical, and not party political? Will my hon. Friend come to Kidderminster to repeat those assurances and to discuss issues surrounding the implementation of these difficult decisions?

Mr. Hutton

I can give my hon. Friend all the assurances that he seeks, and I will be happy to go to Kidderminster to explain the situation to his constituents.

The change is not a ruling from on high, but is based on expert clinical advice, sound financial judgment and a spirit of compromise and listening to local views. Let me explain briefly the background to the strategic review in Worcestershire and what it set out to achieve. The Government's White Paper on the future of the national health service emphasised the need for health services to be able to respond effectively to change. The NHS is moving towards modernisation of services provided by hospitals that may serve relatively small local populations.

Current and future medical developments require a complex, modern and comprehensive model of health care. The health service is responding to demands from doctors and other health professionals for the skills and experience that come from greater specialisation. This approach, known as centres of excellence, is aimed at providing patients with the very best that medical science and technology can offer, delivered in well-equipped hospitals with appropriate staffing levels. That was very much the backdrop for Worcestershire's strategic review—the need to secure clinical services that are safe for patients, of high quality, and sustainable in the long term.

Some have suggested, wrongly, that the review was driven by the need for financial cuts in the face of increasing deficits. It is the responsibility of every public organisation to balance its books, and Worcestershire health authority is no exception. On its formation in April 1996, under the previous Administration, the health authority inherited from North Worcestershire health authority an accumulated deficit of £3.8 million. The health authority has worked hard to contain that position, but overspends by GP fundholders and local costs pressures, especially at Kidderminster health care trust, have worsened the situation. The duplication of services at each 'of the acute trusts in Worcester has made the delivery of efficiency savings a difficult task in the county, and one certainly cannot sustain a pattern of services that will bankrupt a health authority. However, money was merely one factor in the decision, not a driver.

In reaching the decision, our primary consideration has always been the need to ensure access to clinically safe and viable services for the whole county of Worcestershire and its catchment area beyond the county, including the 12,000 south Shropshire people in the constituency of the hon. Member for Ludlow, who are currently served by Kidderminster general hospital. I am conscious of his concerns about increased travel times and I will, therefore, ask Worcestershire health authority to investigate the possibility of providing regular services to take visitors from Kidderminster to the Worcester royal infirmary during visiting hours.

The decision on Worcestershire was based on a very complex process of option evaluation and consultation. Locally, the health authority has been discussing the future of its health services with stakeholders since 1995. That culminated in early 1998 in the consultation document "Investing In Excellence", which evaluated seven options for change. During the extended consultation exercise, the health authority held 13 public meetings and received more than 1,500 written responses. Those were carefully evaluated by the health authority, and, following the formal objection of the local community health council, were fully and properly reviewed by Ministers.

In arriving at our decision, Ministers took the advice of clinical professionals, both nationally and locally, and we took seriously the issue of local access to services, which I know is very important in rural areas such as north Worcestershire. In short, everything was done to consult properly and fully with the public and local health professionals. We were satisfied that it was not possible to sustain three centres for emergency medicine and surgery in Worcestershire and that the accident and emergency service should be countywide. Some saw that, erroneously, as the end of all A and E services at Kidderminster. Nothing could be further from the truth.

Even now, the health authority is actively involving the local community in implementing the decision. Through the newly formed primary care groups, it has established local reference groups—including users and carers, patient groups and local authorities—to act as a proper sounding board as implementation proceeds. The fact is that, after three years of uncertainty, the service in Worcestershire can now move forward, with a critical, continuing and important role for Kidderminster.

So that we can be clear, let me remind the hon. Member for Ludlow of exactly what was decided by the Government last December. Kidderminster will continue to have a consultant-led emergency service. Major trauma cases will no longer go to Kidderminster and the emphasis there will be on care provided by nurses, backed up by an effective telemedicine link to the countywide A and E service. However, the designated consultant, the post that my hon. Friend the Member for Wyre Forest did so much to secure, will be responsible for training and clinical standards at the new emergency centre at Kidderminster, and will spend a substantial proportion of his or her time at the hospital.

Our current best estimate is that nearly half the patients who currently use Kidderminster's A and E department will continue to use Kidderminster's emergency centre, but that figure does not take into account the expected advances in telemedicine before the changes at Kidderminster are implemented. Furthermore, all out-patient appointments will continue to be provided at Kidderminster hospital. That represents a much improved out-patient service because specialties currently only available at Worcester royal infirmary will now be available in Kidderminster.

We expect Kidderminster hospital to be a leading light nationally in the development of telemedicine. We have doubled investment in equipment to reflect that desire, enabling local clinicians working at the hospital to treat as many patients there as possible. Further announcements about additional investment will be made in the near future.

There are already some exciting local models of closer working between acute hospitals and primary care, for example, in east Worcestershire and south Shropshire, which includes the constituency of the hon. Member for Ludlow. With the continuing development of primary care groups, I expect the number of those initiatives to increase. I hope that the extra 35 GP-designated beds at Kidderminster hospital—another improvement that my hon. Friend the Member for Wyre Forest did much to secure—will be taken up by local GPs.

We also expect around 70 per cent. of elective cases to continue to be treated at Kidderminster hospital, along with most out-patient services. Furthermore, we expect Kidderminster to keep its one-stop clinics, specialist follow-up clinics, diagnostic testing and out-patient based treatments. Its rehabilitation facilities and cancer resource centre will continue to be developed and improved over the next few years. Indeed, the rehabilitation facilities will be used by patients returning from major surgery in Worcester. In all those areas, services will continue to be provided at Kidderminster hospital.

I pay a special tribute to my hon. Friend the Member for Wyre Forest. As a direct result of his strong and effective representations, the health authority's plans for Kidderminster hospital were amended to ensure the provision of safe local services, including, for example, a consultant-led emergency centre at the hospital; the doubling of the amount being spent on refurbishing and improving the hospital, including an extra £750,000 which the hon. Member for Ludlow conveniently forgot to mention; and making provision for 35 GP-designated beds at the hospital. Unlike the hon. Member for Ludlow, my hon. Friend the Member for Wyre Forest has done an excellent job on behalf of local people.

That is the framework that we have laid down for the health authority. Although the changes will by no means be introduced overnight, it has already begun work on the detailed implementation. Since the announcement on Worcestershire, the Government have signed up to the brand new £116 million private finance initiative hospital at Worcester, which was promised by the previous Administration but not delivered. If the hon. Member for Ludlow believes that his party's record of expenditure on the NHS was so magnificent, he might wish to offer an explanation of why the Conservatives suffered their worst ever election defeat in 1997. The truth is that people do not trust the Conservatives on the NHS.

My right hon. Friend the Secretary of State began the commissioning work for the new hospital on 19 March. The new facilities at Worcester have been planned to take account of the changes at Kidderminster hospital. There will be sufficient capacity in 2002, when the hospital is opened, to accommodate the anticipated number of emergency and elective patients. The new hospital will enable services to be configured in a way that is clinically and financially acceptable. In the interim, there will be moves towards implementation of some of the service changes agreed on—for example, the development of the ambulatory care centre in Kidderminster.

As part of the consultation, the issue of trust reconfiguration was raised and those consultations are proceeding. I assure the hon. Member for Ludlow that Ministers will be vigilant in ensuring that the health authority is mindful of its responsibilities to consider the implications of its proposals for out-of-county patients and will work with neighbouring health authorities, including Shropshire, to ensure continuity and equity of access to services.

There are often strong feelings expressed when local institutions of any sort need to undergo change. I understand those concerns, but we have to make a balanced and soundly based clinical judgment about how best we can provide a safe and sustainable local health service in the long term. The Government believe strongly that we have made the right decisions about the future of Kidderminster hospital, on behalf of the population that it serves.

I hope now that we can begin to look forward to the opportunities to develop the service at Kidderminster and to discussing the changes in a realistic and sensible manner. Sadly, the hon. Member for Ludlow has not contributed today to that serious debate.

Miss Kirkbride


Mr. Hutton

It is interesting that the Opposition like to dish it out, but they cannot take it back. That says something about the modern Conservative party.

The health authority has a difficult task ahead of it, but a task to which it is fully committed within the boundaries the Government has laid down. Kidderminster hospital has a secure future and it can be a pioneer for modern health services. That is particularly true of telemedicine. The decisions that we have taken are the right ones for the future development of the NHS in Worcestershire.

It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.