§ Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]
11.35 pm§ Mr. John Wilkinson (Ruislip-Northwood)Today, the public consultation period for the proposals on modernising specialist acute hospital services in west London put forward by Kensington, Chelsea and Westminster health authority on behalf of the West London Partnership Forum of four health authorities in west London comes to an end.
This speech is my submission not only to Kensington, Chelsea and Westminster health authority but to Parliament and the country on behalf of my constituents, and on behalf of the thousands throughout the United Kingdom and overseas who are appalled by the planned closure of Harefield hospital. They have expressed by letter, phone, fax, e-mail, petition and their presence at the five public consultation meetings in the Hillingdon borough their rightful indignation about what is proposed.
I have consistently sought to put the truth before the public, not only in my Adjournment debate of 2 December 1998 but in the summer Adjournment debate of 28 July 2000, in numerous parliamentary questions, in meetings with Ministers, letters to Ministers and in contributions at every consultation meeting held in the Hillingdon borough.
There has been little controversy over the proposals for specialist paediatric and renal hospital services in west London, but that a supposedly responsible national health service forum should propose the closure of Harefield hospital, the most famous cardiothoracic hospital in Britain, without even putting forward its modernisation and development as an option for consultation, has caused outrage.
Harefield has undertaken more transplants—more than 2,000—than any other cardiothoracic hospital in the world. Under the leadership of Professor Sir Magdi Yacoub, voted by the nation's television viewers as man of the year only a few weeks ago, its reputation for excellence and total devotion to patient care is unsurpassed anywhere. This is something that the general public understand. They accord the highest esteem to the human and even spiritual values represented by the dedication of Harefield's staff to the healing of broken hearts and lungs.
By contrast, what the West London Partnership Forum seems to hold in the highest esteem are the asset values of Harefield and the Royal Brompton hospitals. That is an unworthy and narrow perspective, as the future of Britain's most famous heart and lung hospital transcends west London or even the capital as a whole. Its patients come from far and wide, and only just over 10 per cent. come from the Hillingdon borough where it is situated.
The motives of those who would transplant idyllically tranquil rural Harefield to one of the most congested, polluted, noisy, crime-ridden, overcrowded, concrete jungles of inner London are bound to be criticised and scrutinised. They merit further deep investigation.
The conduct of the consultation process was unseemly from its inception in late July at the height of the holiday season. There was overwhelming public opposition to the 778 destruction of Harefield, which the West London Partnership Forum had proposed, but the NHS representatives in their total intransigence showed a disturbing contempt for democracy, and utter lack of interest in any proposals other than their own. I hope they now give the impressive written responses from the Heart of Harefield campaign, residents associations, the borough council, Community Voice, the community health council, patients groups and individuals the genuine consideration that they deserve.
The Secretary of State too, if he is a democrat, should demand to study those responses. He knows the strength of public feeling, and has had letters of public protest enough. On 26 April, a petition with more than 80,000 signatures was delivered to the Prime Minister at 10 Downing street—an event which can hardly have passed him by, especially as it was well televised and led by an eight-year-old double heart transplant former patient, Sophie Park, and by the then leader of Hillingdon borough council, councillor Richard Barnes, now the Greater London Assembly councillor for Ealing and Hillingdon.
If care of patients were poor at Harefield, the fiercest critics would be its patients past and present. However, the Hamsters—the Harefield transplant club, which represents those who have had transplants there—are its staunchest supporters, as are members of the Rebeat club, which is affiliated to the British Heart Foundation and has some 400 members nationwide—people who are, or have been, patients at Harefield hospital, and their close relatives.
Were there a cogent case for Harefield hospital's closure, I as the local Member of Parliament would have had it represented to me by my electors, but I have not. Moreover, all parties on Hillingdon borough council would not have voted together to save and develop the hospital unless that were the wish of local residents.
There is much rhetoric about the NHS's response to the views of patients and the public. Indeed, the heading of the first chapter of the NHS national plan describes its vision as
a health service designed around the patient.To modernise Harefield would cost a tiny proportion of the £180 million net capital cost of building and equipping the new hospital at Paddington basin, whose gross cost would be about twice as high were it not for the proceeds from selling the Royal Brompton and Harefield sites.What is more, the outline business case projects that the closure of the Royal Brompton and Harefield hospitals will be set against a requirement for only an extra nine cardiothoracic beds by 2006, which is when the new hospital is due to be completed, and an extra 27 by 2011. In relation to the overall number of beds in west London in the hospitals affected by the proposed changes, only an extra 24 beds are projected by 2011—an extra hundredth of a bed per 1,000 population.
Clearly, more than health economics is involved. I suggest the answer lies in the strategic objective to regenerate the Paddington basin in central London, to which aim Harefield hospital and its staff are intended to be sacrificed. I do not think that the prognosis for the Paddington basin site is good, because it was flooded on 2 November.
Kensington, Chelsea and Westminster is the health authority in the West London Partnership Forum, which is leading on the forum's proposal to sell Harefield 779 hospital and put the proceeds together with those from the sale of its hospital trust partner, the Royal Brompton, into the development of a new cardiothoracic hospital in Paddington as part of what the forum, in its outline business case, describes as
the most significant land development programme in London since Docklands.The House should note that the arbiter as well as the conductor of the public consultation process is the Kensington, Chelsea and Westminster health authority. In an ethical world, the arbiter would be independent and objective, such as a health authority outside the area concerned. However, in this case the vested interest of Kensington, Chelsea and Westminster is clear, as it is progenitor, proposer, arbiter, prospective executor and beneficiary of the proposals.
Were there natural justice, such a flagrant business and pecuniary interest on the part of the Kensington, Chelsea and Westminster health authority would invalidate the whole consultation process because, to quote the West London Partnership Forum again:
St. Mary's NHS Trust and Kensington, Chelsea and Westminster Health Authority are both members of the Paddington regeneration partnership. This group of landowners, business and local stakeholders has the objective of establishing Paddington as a premier residential and business district of London and to provide sustainable economic vitality for the area ensuring that the products of regeneration benefit the surrounding communities.Over the 10 to 15—year development period, the combined schemes are due to create more than 30,000 jobs. Little thought is given to the jobs to be lost at Harefield, which has little employment other than the hospital, and hardly any of the hospital's staff are willing to move to Paddington.The problems of access, parking, accommodation for visitors and staff, road user charges and physical safety for rehabilitating patients and their relatives are plain to all—except the West London Partnership Forum. The problems of travelling to Paddington should alone invalidate the Paddington basin site. However, Harefield is the optimum location: set in green belt in rural Middlesex with ample gardens and lawns, it has a helipad, cheap and friendly accommodation and easy access to the M4, M40, M1, M25, Heathrow, Luton, Northolt and Denham airfields, the tubes at Uxbridge and Northwood and rail services at Watford and at Denham.
History repeats itself, but each generation is reluctant to accept the lessons of the past. In her history of the hospital, "Heart of Harefield", the former consultant surgeon at Harefield, Mary Shepherd, points out that, in response to a report by the London Health Planning Consortium, which had similar centralising plans in 1979, Harefield commented on that report's lack of evidence for cardiac centres located in general or in teaching hospitals performing better than those that were not. She said that
on the contrary the available evidence suggests otherwise the proposals … for relocation … are not based on the preservation and development of existing standards of excellence for the benefit of the public but on the sterile logic of planning and perhaps the personal predilection of the authors…For service to patients teaching should be a subordinate consideration.It is noteworthy that Harefield's finest work has been done in the past 20 years—since it beat off the threat to its survival from the London Health Planning Consortium. 780 I again quote from its historic and mercifully triumphant response of 20 years ago:
We must point to a simple truth … nowhere acknowledged in the report —nor in this one, for that matter —the peculiar genius which inspires a team in our demanding speciality cannot be uprooted and expected to flourish elsewhere … talk of transplanting this excellence is simply a euphemism for its destruction.Industrial relations and service to the public are excellent. It has the space and ability to expand. Its location is more convenient for patients who come from all over the country and the world than any of the hospitals amongst whom it is proposed to divide its work. The quality of its treatment and the quiet peace of the surroundings outweigh all other considerations. The public is entitled to hear better reasons for its destruction.Founded in 1915 as a hospital for Australian soldiers wounded in the great war—No. 1 auxiliary hospital of the Australian Imperial Forces—Harefield hospital has performed devoted service to the sick in peace and in war. As was written of the ANZAC casualties, who are still commemorated by the schoolchildren of the village every ANZAC day when they lay flowers on the 107 graves in St Mary's churchyard,
For here in Harefield for them some corner of a foreign field, brave hearts find peace under an English heavenLong may it remain.
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on securing the debate. It gives the House an opportunity to discuss the existing disposition of some of the specialist services in west London, and the case for change that underpins the proposals for reorganisation that are currently the subject of public consultation. As the hon. Gentleman said, public consultation is about to close.
Although I shall inevitably need to rehearse some of the arguments lying behind the proposals that are currently out to consultation, it is important that I do not prejudge, or give any sense that I am prejudging, the consultation. Ministers will clearly need to approach the consultation, if and when it finally comes to us, with a fresh and open mind in regard to the issues that are raised. I hope the hon. Gentleman will forgive me if, for that reason, I do not engage in a detailed debate with him about some of his points. I think that would be wrong, given the present stage of the public consultation.
§ Mr. Gareth R. Thomas (Harrow, West)Does the Minister recognise that concern about the future of Harefield extends beyond the boundaries of the constituency of the hon. Member for Ruislip—Northwood (Mr. Wilkinson)? In particular, does he recognise that my constituents' concern relates particularly to access to cardiothoracic services, and will he ensure that that is taken into consideration in the final decision about the future of Harefield?
§ Mr. DenhamI recognise the broad spectrum represented by those who are concerned about the issue. I have received letters from my own constituents about the future of Harefield hospital, and there is a wide range of issues—including those relating to access and transport—that will have been reflected in the public 781 consultation. If it is referred to Ministers, they will have to take careful account of those issues in the future. I acknowledge my hon. Friend's points, and his local concerns in particular.
The hon. Member for Ruislip—Northwood concentrated—as I think we all anticipated—on the future of Harefield hospital. It is one of the best—known heart and lung hospitals in the NHS, and I want to place on record the high regard in which we hold those services and the staff who provide them.
The hon. Gentleman has raised the future of Harefield hospital on many occasions on behalf of his constituents. I think we all know that, under the inspirational clinical leadership of Professor Sir Magdi Yacoub, Harefield hospital has been remarkably successful in its development of heart and lung services. It has also become a centre where research and development is an integral part of its work to improve life expectancy and the quality of life for those with serious cardiothoracic conditions.
Specialist care of the type that has been pioneered at Harefield is a crucial part of services that are provided for people with coronary heart disease. Services that begin with health promotion continue through primary care settings, with general practitioners and their staff assessing and diagnosing patients, referring them to cardiologists in the local acute hospital, As part of that pattern of service, emergency services are involved, including the highly trained paramedic ambulance crews who respond to the sudden and devastating coronary accident.
Many coronary heart disease patients are treated successfully without the need for referral to a specialist centre such as Harefield. Nevertheless, for those with particularly complex medical or surgical needs, the expertise available at Harefield and other centres of excellence can be the difference between life and death, and can give much improved quality of life and life expectancy.
No hospital is immune to pressures. Hospitals must modernise if they are to remain a vital and effective part of the larger entity that is the NHS. The willingness to embrace necessary change is key if we are to begin to build a modern NHS to meet the needs of patients both nationally and locally in west London. Harefield, along with the Royal Brompton, Hammersmith and St Mary's, is one of several centres in west London that provides specialist heart and lung services.
The hon. Gentleman is familiar with the background to the service reviews that have led to the public consultation by Kensington, Chelsea and Westminster health authority. The consultation has been on proposals for modernising specialist acute hospital services in west London. It has run for some four months from July until today. The fragmentation of specialist heart and lung, renal and specialist children's services has long been of concern to all those who wish to see continued improvement in clinical care and outcomes and in education, training and research.
The hon. Gentleman will know that, as part of the independent review of London's health services, the Government asked Sir Leslie Turnberg to assess the need 782 for change in west London. He was also asked to look at the process that had been developed involving both the NHS and its academic partners in shaping the change.
Sir Leslie was encouraged by the progress that he saw. His report registered a particular concern that the way in which the service is currently organised in west London might not be maximising its long—term contribution to national and international research. He advised the Government to ensure that plans for a more rational distribution of specialist services throughout west London were achieved. The hon. Gentleman may recall that, unlike the previous Administration with regard to many of the reviews that they commissioned, this Government did not cherry—pick the expert independent advice that they received.
In the Government's response to Sir Leslie's report, we accepted all the recommendations that it made. In taking forward recommendations, the NHS Executive asked hospitals and health authorities in that area of west London, along with Imperial College, to take part in a review of specialist cardiac and thoracic services. That review commissioned expert clinical input from a panel chaired by Sir Terence English, an internationally respected figure in heart transplantation who completed the first successful heart transplant in the UK, and a past president of the Royal College of Surgeons. The review was completed in July 1998. It broadly confirmed Sir Leslie Turnberg's impression that cardiac and thoracic services in west London were not organised in a way that would continue to support the highest quality service and academic endeavour.
Sir Terence English advised that three out of the four cardiac centres in west London were not seeing a sufficient number of patients to support the highest quality of patient care or research and teaching. He recommended that existing services should be focused on fewer, larger centres. He also advised that co—location of specialist cardiac services with other related specialties would bring benefits not available to single specialty hospitals such as Harefield.
We have a number of specialist hospitals in the NHS that, through the immense talent and vision of a small number of specialists, have developed services of the highest quality and innovation. In certain instances, those hospitals find themselves with a relatively small number of patients. They can be geographically isolated from other hospitals and from other related specialties. There is growing evidence that suggests that clinical risk is best managed by ensuring that highly specialised services are undertaken in large, multi—disciplinary centres, where all appropriate support specialties are close at hand.
The hon. Gentleman is concerned about the possible future location of those services. I can assure him that the aim of the proposals—certainly, my aim in considering any proposals—will be to ensure that patients are winners in terms of being able to access services that are uniformly of the highest standard; and that staff are winners in terms of working in multi—disciplinary teams enjoying state of the art facilities and the best education and training opportunities. We aim to ensure that researchers are winners in terms of having the best opportunity to undertake programmes of excellence and innovation worthy of the 21st century.
The West London Partnership Forum, chaired by Lord Newton of Braintree, a Minister for Health under the previous Administration, was established to enable senior 783 clinicians and managers in the NHS to discuss with colleagues in Imperial College how they should respond to the call within Sir Leslie Turnberg's review of London's health services for a more rational distribution of specialist care in London.
On 14 February 2000, the forum announced that its preferred option was for a new specialist heart and lung hospital alongside specialist children's services next to a rebuilt St Mary's hospital, as part of the Paddington basin scheme, which is London's biggest redevelopment. The forum's preferred option would also see the Hammersmith Hospitals NHS trust become the west London centre for specialist renal services.
As soon as the forum had a set of proposals, it laid them before the public in a consultation exercise. During the consultation period, the NHS has made available to the public large amounts of information to support the arguments in favour of the forum's preferred option and the other options considered. It has certainly been one of the biggest ever consultation exercises on proposals for change in the NHS, with 12 public meetings and large numbers of people attending each of them. There is an internet site with the consultation document available upon it. There will also be a further special public meeting, on 29 November, before the health authority considers the outcome of public consultation at its meeting on 13 December.
My understanding is that every effort has been made to ensure that those with an interest in the future of those services have had the opportunity to make their views heard. As I said at the beginning, I am unable to comment on the possible outcome of public consultation, as my position as Minister prevents me from doing so. However, our aim is to ensure that any change that flows from the process will be to the benefit of patients.
I do, however, understand that some people in the hon. Gentleman's constituency have strong feelings about the proposed changes. Harefield village quite clearly identifies with the hospital as an institution and sees it as part of the local community. The letters that I have received about Harefield express concerns about the proposed changes.
I should like to take this opportunity to mention various decisions that demonstrate our commitment to Harefield, both the hospital and the wider community. I should also like to remind the House that, regardless of the outcome of public consultation, capital investment is both justified and continues to be made in the fabric and services at Harefield hospital. A new patient services centre, for example, is being built at a capital cost of £4.2 million. 784 We are also contributing £2.5 million towards phase 2 of the heart sciences centre, which is a research facility that was opened in 1992. The case has been made for further development of the facility, to provide new laboratories to facilitate research in the areas of gene therapy, chronic rejection, homograft valve research and tissue engineering. When he was Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), made a commitment to provide £2 million towards the project.
My right hon. Friend the Secretary of State for Health recently met Professor Sir Magdi Yacoub and, at that meeting, agreed to provide a further £500,000 towards phase 2 of the heart sciences centre. I think that that can be seen as reaffirming our commitment to support that centre.
The Secretary of State also heard more of current developments at Harefield and of the uncertainty that is inevitably felt at this time. Although there is no question of pre—empting the outcome of public consultation, he agreed to fund a feasibility study to explore the possible use of the Harefield site as a science park in the event that a decision is made to centralise clinical services elsewhere. I must emphasise that the feasibility study is being undertaken as a precautionary measure and in no way prejudges the outcome of the public consultation. I add that that study has been welcomed by health organisations in north-west London.
The common objective of all the Government's plans for the modernisation of the national health service is to ensure that the patient has equitable access to high—quality care and treatment. That is the objective of the NHS plan and of the national service framework for coronary heart disease. I believe that that is an objective shared by those who have been developing proposals for the re—organisation of specialist NHS cardiothoracic, renal and children's services in west London.
Whatever the outcome that follows from those proposals, the legacy of Harefield and its staff under the clinical leadership of Sir Magdi will be safeguarded for the benefit of tomorrow's patients. Harefield's contribution to the NHS is one that should be celebrated. I want to express my recognition and appreciation of that contribution—a contribution that will remain central to the success of clinical services, education and research for heart and lung disease and be recognised not only nationally, but all the way around the globe.
§ Question put and agreed to
§ Adjourned accordingly at four minutes past Twelve midnight.