§ On resuming—
§ Mr. Peter Viggers (Gosport)
I am grateful for the opportunity to raise an issue of overwhelming importance to my constituency and to everyone in the armed forces. I congratulate the Minister of State on his promotion, and look forward to seeing him in Gosport when he visits Haslar hospital on 2 November. He will find that loyalty to the armed forces—Army, Navy and Air Force—is second to none in Gosport. He will be greatly impressed by the fervour with which local residents wish the hospital to be retained.
Although I welcome the Minister, it would have been appropriate if he had been accompanied by a colleague from the Department of Health. This matter has two aspects—defence, and health and the local civilian population. We can agree on two points. First, we can agree on the importance of defence medical services. Medicine is an integral part of defence. Every ship carries medically trained staff and every four-man Army stick going out on patrol—wherever it may be—has one man who is trained in medicine. The medical background involves proper training somewhere, and there must be a centre of medical excellence.
That centre is Haslar hospital and the accompanying Blockhouse, which contains the Royal College of Defence Medicine. Between them, they provide background basic training for everyone in the armed forces. Specialist staff are also trained in other hospitals, but the centre is Haslar.
The second point on which we can agree is that defence medical services have been through an exceptionally difficult period. The Government's document "Defence Medical Services: A Strategy for the Future" points out that the armed forces are manned by only 50 per cent. of the doctors required and only 75 per cent. of the nurses. That is a serious situation. With the collapse of the Berlin wall and the end of the cold war, it was possible and appropriate to reduce our armed forces. Across the board, the forces have been reduced by about 25 to 30 per cent., but the reduction in medical services has been greater, at around 40 per cent.
The number of hospitals in the armed services has gone from seven, to five, to three, to one in a surprisingly short time. In 1994, the Government, knowing all the facts and having investigated the subject with extreme care, produced "Defence Cost Study 15", which suggested that there should be a single tri-service hospital. After a great deal of further discussion, it was decided that that hospital should be Haslar, then renamed the Royal Hospital Haslar. It was proposed that the hospital should be increased from 200 beds to 375. The fact that that was never done is the root cause of our present difficulties.
The Select Committee on Defence, of which I was a member, has been much quoted after saying in February 1997:We can only report to the House our fine view that the state of morale at all levels of the Defence Medical Services is lower than we have ever encountered in the armed forces.401 Some other criticism has been similarly quoted, but a sentence that I helped to write, at paragraph 71 of that report, has been less quoted:In view of the fundamental changes which have been made over the last five years, nothing would be achieved by imposing on the Defence Medical Services any further structural changes.We were adamant that that was the case. It would be quite wrong to deal with defence medical services by trying to change them dramatically, yet that is exactly what the Government did with their astounding decision in December 1998 to close Haslar.
Broad reasons have been given for the closure. First, the Ministry of Defence hospital units at Peterborough, Derriford and Frimley have proved a good means of training and retaining medical staff. The Ministry has said that MDHUs work well. They may work satisfactorily when it comes to providing medicine, and it may be that they are adequate for training staff. However, they do not give armed forces personnel what they joined the forces for. I talk to many people who say that the MDHUs are all very well, but—they always use the same words—they are not what they joined for. If the Government rely too much on MDHUs, they will lose even more staff.
The Ministry's second reason for closing Haslar is that there has been a change of strategy by the local NHS trust, which is in a period of some movement. Queen Alexandra hospital, Cosham, which has 600 beds, is in the process of taking over the acute function of St. Mary's hospital, Portsmouth, which has 550. That will provide turmoil enough for one period. It is not thought that the new construction, backed by the private finance initiative, will be commissioned until 2005. We face five years of intense movement involving Portsmouth hospitals. The PFI bid does not include a military element. The Minister will find, if he is accurately advised by those in the locality, that the Portsmouth area is most uncertain about accepting an MDHU at Cosham. Nor has the Ministry yet got round to specifying what the unit might be.
The third reason given for the closure of Haslar is that the running costs are quite high. In a letter to me, placed in the Library following a parliamentary question about the costs of building new military hospital facilities to replace Royal Hospital Haslar, the Minister wrote:As far as building costs are concerned, these will fall to the private sector partner … The Ministry of Defence will not pay direct running costs since Portsmouth Hospitals Trust will recover these costs through its treatment charges".I think that the Minister was saying that the costs of replacing Haslar would be nil. That does not bear proper financial scrutiny.
The tide is turning as regards ideas about the size of hospitals. Recently, it has been believed that larger hospitals are more efficient. However, I refer the Minister to an authoritative article in last week's British Medical Journal, which noted:The literature shows quite conclusively that there can be no general presumption that larger units produce better outcomes for patients.The summary of the article says:Service planners would do well to give more prominence to the importance of ensuring that hospital services are local and easily accessible.The consequences of closure will be dramatic for defence. Already, there is overstretch in the armed forces, as the Minister well knows. The overstretch in defence 402 medical services, which have requirements to man areas including Bosnia, Cyprus, the Falklands, Northern Ireland and others, is dramatic. Only one figure is required as an example: the establishment for orthopaedic surgeons at Haslar is eight; the hospital had six, but five have resigned.
What the Government plan for defence medical services might work. But it will not work next year, or in three or five years' time. I submit that it will take 25 years to rebuild the defence medical services and the consultancy skills of those leaving them. That serious national problem has an immediate local focus for Gosport and the surrounding area. Haslar is effectively the district general hospital for Gosport, and it has superb facilities. In the past 10 years, £35 million has been spent there, and it has excellent MRI and CT scanners, a hyperbaric unit and a much needed accident and emergency unit in an area where road access to the next closest hospital can be slow.
§ Mr. David Chidgey (Eastleigh)
I have long and close family associations with the hon. Gentleman's constituency. I should like to put it on the record that I know how valuable the emergency services at Haslar are. A member of my family owes her life to the fact that after a serious road accident she was able to go to Haslar for excellent long-term treatment which restored her to health. In the absence of those services, the road link to the Queen Alexandria hospital in Portsmouth is totally inadequate for getting people in emergencies to hospital in time.
§ Mr. Viggers
The hon. Gentleman has been staunch in his support of Haslar, as have colleagues from all parties. I am grateful to him for his support today. He knows, because he was there, that the reaction to the closure of Haslar in the Gosport area was instinctive and dramatic. When I announced a rally and march, I thought that we might get a few hundred people, but 22,000 turned out. The Library cannot find a record of a rally or march of that size anywhere about the closure of a hospital. Petitions were signed by 250,000 people. I presented a parliamentary petition signed by 45,000. We had "Save Haslar" in lights and we have received thousands of letters. The reaction has been overwhelming.
The more people locally look at the issue, the worse they find it. Travel from Gosport to Queen Alexandra hospital, Cosham is either by bus, boat and then two more buses, one of which goes once an hour, or by the other way, which is longer, by bus and similarly inconvenient. Car parking at that hospital is notoriously difficult and a taxi costs £11. My constituents who might have to travel there as patients or to see friends or family would find it incredibly inconvenient.
The area is calculated to need 13 intensive care beds. There were 10 such beds at Queen Alexandra hospital and four at Haslar. The Haslar beds have closed, so we now have 10 of the estimated 13 required. On accident and emergency cover, almost 20,000 people are seen each year at Haslar. Of those, on the health authority's own figures, it is estimated that 5,000 will need to go each year to Queen Alexandra hospital by ambulance. That is 13 visits a day and a dedicated ambulance will be required simply to run A and E cases to Cosham.
I asked the local ambulance trust if I could do a practice run. I thought of simulating rushing a heart attack case to Cosham at 7.30 am. The word "rush" is misleading, 403 because the notorious Gosport bottleneck, with only two main roads to take people in and out of the peninsula, would probably mean a journey of 45 minutes. There is no doubt that lives will be lost on the roads between Gosport and Queen Alexandra hospital if Haslar is to close.
There has been a local consultation procedure about the alternative to an accident and emergency unit at Haslar. The health authority suggested a nurse-led casualty unit somewhere in the Gosport area. The response to that was vehement and unanimous: thousands of people said no. The health authority has now advertised for a nurse for an exciting new venture: a nurse-led casualty unit in the Gosport peninsula. The Minister looks surprised. It may be that he is unsighted, as civil servants say, on the issue. It would have been helpful to have one of his colleagues here to advise him on the point.
Ministers have given every kind of assurance. The document in my hand shows their happy smiling faces promising that Haslar's services will be saved. All the assurances that I have here are worthless because there is no doubt that health services on the Gosport peninsula will deteriorate if Haslar hospital is closed. What a mess. My constituents want me to express that not in sorrow but in anger and frustration that Ministers do not appear to be listening to local views and the health authority appears not to be taking account of the representations that have been made. There is no doubt that if this hospital closes, lives will be lost.
I know that the Minister has his brief, prepared for him by his officials. He may well believe, on the advice that he has been given, that he is doing the right thing. I have been a Minister, too, and, unlike every current defence Minister, I have served in the armed forces. I know the special loyalty and deference paid to Ministers and senior officers. Not for nothing was the television series called "Yes, Minister". When a general or admiral asks a man or woman in the armed services, "Everything all right?", he only ever gets one answer: "Yes, Sir." That is how the armed forces work. I know from talking to a wide range of people in the defence medical services—majors, colonels, many of them my friends—that they are deeply upset. Many of them are leaving and more will leave.
I have a solution. In November 1997, the Government announced the closure of the coastguard station in my constituency, and, just as today, I got an Adjournment debate. As today, I said that I thought that the decision was wrong. The Minister said that the Government would go ahead. We lost the battle, but in politics the important thing is to win the war. Someone with more wisdom than the Minister showed in turning my advice down suggested that Lord Donaldson, a man of wide experience, should investigate the coastguard service and advise the Government whether their decisions were right. He looked carefully at the facts and decided that the decision to close the Lee-on-the-Solent station was "not appropriate". The result was this headline: "Rescue Station Escapes Closure".
As the closure of Haslar involves local issues of defence and health, the Government should set someone with sufficient authority and wisdom to study the subject and decide whether the closure is the right course for both 404 defence and civilian interests. If the closure goes ahead, the costs in terms of money, suffering and even lives will be incalculable.
§ The Minister for the Armed Forces (Mr. John Spellar)
The hon. Member for Gosport (Mr. Viggers) has raised important issues. I am fully aware of his longstanding interest in the Royal Hospital Haslar and in the defence medical services generally, which he demonstrated in his speech. I am also pleased that other hon. Members with an interest in the hospital are here, notably my hon. Friend the Member for Portsmouth, North (Mr. Rapson) and the hon. Member for Eastleigh (Mr. Chidgey).
I recognise the concerns of people in the Gosport area about our plans for the Royal Hospital Haslar and about the recent changes in the hospital's paediatric and intensive care services. It is appropriate to remind hon. Members of the problems faced by Haslar and the reason we decided that it should close. The intention to close it is part of the future strategy for the defence medical services announced by noble Friend the former Secretary of State for Defence in December 1998. I assure hon. Members that that decision was taken only after very careful consideration and that closure will happen only when suitable alternative arrangements are in place.
As hon. Members know, Haslar was originally selected by the previous Administration to be the tri-service core hospital following the notorious defence costs study 15 in 1994, to which the hon. Member for Gosport alluded. It was expected to provide the number and variety of cases to enable our medical personnel to develop and maintain their skills and professional accreditation so that they could support operational deployments and provide a high standard of health care. In the event, there has been a considerable shift since then in conventional wisdom in the national health service towards much larger acute hospitals that can sustain a high degree of sub-specialisation. That does not apply only in this case; it is a much broader national debate.
Unfortunately, Haslar does not have a sufficient population fully to support modern specialised services or to maintain training accreditation for our medical personnel. In addition, it is fair to say that our working experiences of closer co-operation with the NHS at the three Ministry of Defence hospitals units in NHS district hospitals at Plymouth, Frimley Park and Peterborough have shown that there are many benefits to be had from such arrangements in this sort of organisation. At the same time, it has become clear that Haslar's running costs are significantly higher than possible alternatives. That matter has been carefully examined.
Our plans for defence secondary care in the Portsmouth area are, therefore, now based on the establishment of a new Ministry of Defence hospital unit in a local NHS trust hospital—the Queen Alexandra hospital at Cosham—swhich is represented by my hon. Friend the Member for Portsmouth, North. The Portsmouth Hospitals NHS trust plans to redevelop that hospital under a private finance initiative. Hon. Members may be aware that the trust's proposals were approved earlier this year. The Portsmouth and South East Hampshire health authority is leading the process in planning the shape of new services in the Gosport area, and our Defence Secondary Care Agency is a full partner in that process, together with local NHS provider units and primary care groups.
405 I should like to take the opportunity to make it clear once again that we are committed to retaining Haslar until our new MOD hospital unit is in place at the Queen Alexandra hospital. Any rumours that we have plans to close the hospital before that time are unfounded. I very much welcome the opportunity to reaffirm that. However, that is not to say that there will be no changes in the way services are delivered, as Haslar and the Portsmouth Hospitals trust work increasingly closely together. We have not said that exactly the same services would be provided on the Haslar site right through until its final closure. Hon. Members will, therefore, understand that the timing of Haslar's eventual closure will depend on the establishment of that new hospital unit. That, in turn, will obviously depend on progress on the redevelopment of the Queen Alexandra hospital by the Portsmouth Hospitals trust. As the hon. Member for Gosport will understand, we cannot say categorically how long Haslar will remain open. However, through discussions, we are aware that the redevelopment of the Queen Alexandra hospital is expected to take several years, and, once again, I can confirm that Haslar will remain open during that time.
The former Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), said that the people of Gosport are entitled to top-quality health care. That is why we are working closely with the Department of Health to ensure that the standard of health care is maintained throughout the transition to new arrangements. As hon. Members will be aware, a partnership board has been established to ensure effective management of local health care during that period. As hon. Members would expect, that board includes representatives from our Defence Secondary Care Agency, from the Portsmouth and South East Hampshire health authority and the Portsmouth Hospitals trust—as the main providers in that area.
We had realised that the partnership board might identify services that could sensibly be re-configured before Haslar's closure. That has proved to be the case in respect of paediatrics and intensive care services. The decision to close in-patient paediatric services was made as a result of low activity levels and child patient occupancy, and—an important point that carries weight in all these matters—the impact of those factors on the accreditation of paediatric staff by their professional organisations. On average, only two of the 12 paediatric beds were occupied. Children's acute in-patient and day-case services were thus transferred to the Queen Alexandra and Queen Mary's hospitals on 31 July this year.
I realise that that change caused understandable concern among local people. However, we are assured that the alternative care arrangements put in place will ensure that a high standard of care is maintained locally. Furthermore, out-patient clinics continue to be held at Haslar. The accident and emergency department there continues to treat children who are not seriously unwell, nor suffering from major trauma.
The transfer of intensive care services also became necessary as a result of low patient throughput, which additionally caused problems with the new requirements 406 for training accreditation in intensive care. That is a subject over which we have little control, because the matter is decided by the professional associations which provide accreditation. Furthermore, there were problems as to the availability of service personnel. The transfer of services to the Queen Alexandra hospital took place on 31 August this year. However, Haslar retains a high dependency unit, and there has been no reduction in the overall volume of intensive care services in the Portsmouth area.
Further re-configuration of services may be necessary. The hon. Member for Gosport has rightly drawn attention to local speculation and concerns about the future of the accident and emergency department at Haslar. He will be aware that the MOD, the Portsmouth and South East Hampshire health authority, Gosport borough council and the save Haslar task force are participating in a workshop on 22 October to review models of accident and emergency care. The workshop will explore alternative ways of providing services with the help of experts in accident and emergency care and emergency medical transport. When a decision is made on future arrangements, it will then be the subject of statutory public consultation.
The priority in any such changes is to ensure that high quality services continue to be available to residents of the Gosport area. The Defence Secondary Care Agency is working with the Portsmouth and South East Hampshire health authority and the Portsmouth Hospitals NHS trust to achieve that. I can assure the House that my Department will continue to work closely with the Department of Health on future health care in the Portsmouth area. The importance of joint management during the transition programme leading up to the closure of Haslar is fully appreciated by all concerned.
Under the local partnership board, a joint implementation management team and a clinical integration board have been set up to plan and manage the transition—including the move of services between sites where that is necessary in order to sustain training and patient care. There is also close co-operation at senior level between my Department and the Department of Health. That co-operation will be not only at official level. Shortly, I shall be meeting my noble Friend, Lord Hunt, the Under-Secretary of State for Health to discuss health care arrangements in the Portsmouth area and other related matters. As the hon. Member for Gosport kindly mentioned, I also look forward to visiting the Royal Hospital at Haslar on 2 November and discussing those issues with task force representatives.
I fully appreciate that the future of Haslar is of deep concern to hon. Members and their constituents. I can assure them that the Government recognise that concern. That is why my Department will continue to work closely with the Department of Health to ensure that effective health care arrangements are maintained both for the service and the civilian populations in the Gosport area—not only during the period up to the closure of Haslar, but beyond that time, as our new developments begin to bed in and the new services start to take effect.