HC Deb 28 February 2001 vol 363 cc1007-16

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

10.1 pm

Mr. Michael Howard (Folkestone and Hythe)

I am very grateful for this opportunity to draw attention to the state of the national health service in east Kent. I asked for this debate for a very simple reason. I have had the great privilege to be the Member of Parliament for Folkestone and Hythe for nearly 18 years. In all that time, I have never received anything like as many complaints from my constituents about the NHS as I have in the past few months. Most of the complaints I have received relate to the William Harvey hospital, but before I come to the hospital, I want to make two other points.

The first relates to the reorganisation of primary care. I was not enthusiastic about the replacement of general practitioner fundholding by primary care groups, but the Shepway primary care group, covering an area almost exactly coterminous with Shepway district council and my constituency, has done well. It has built strong local links and developed a strong local identity. Now, barely two years from its formation, it is to be reorganised, and a possible form of reorganisation would involve a merger with Ashford primary care group. I hope that that merger will not take place. Local links are of great importance in the delivery of primary care. They should be maintained and strengthened, rather than diluted. They would be diluted if this merger were to go ahead.

My second point relates to one particular and specific respect in which health care in east Kent has deteriorated during the past four years. Heart disease is not trivial. Those who are suffering from it should be examined and treated as soon as possible. I am sure that everyone would agree with that. It is therefore worth examining how those who are suffering from heart disease are treated by the NHS now as compared with March 1997, immediately before the general election.

In March 1993, 63 people in east Kent were waiting more than 13 weeks for admission to hospital for cardiovascular surgery. By October 2000, the number had doubled to 124. The number of those waiting more than 13 weeks to see a cardiologist had increased from 40, in March 1997, to 220 at the end of last year. Those figures, alas, speak for themselves and the tale they tell is very bad news for my constituents.

I want to devote most of the time available to me to the state of hospitals in east Kent and, in particular, to William Harvey hospital, which is situated at Willesborough in the constituency of my hon. Friend the Member for Ashford (Mr. Green), but which serves most of my constituents.

The remarks that I am about to make are not directed at the staff of the hospital. For the most part, they are striving heroically in the most difficult of circumstances to give their patients the care that they deserve. However, in far too many cases, the patients are not receiving that care.

I have, of necessity, had to make a selection from the many complaints that I have received. Time does not permit me to refer to anything like all of them. I shall begin with the case of Mr. Duff, whose wife came to see me at one of my regular advice centres. This is what I was told by Mrs. Duff, as set out in a letter that I wrote to the chief executive of East Kent Hospitals NHS trust on 27 November. I wrote: Mrs. Duff's husband has a bone marrow problem which requires frequent blood transfusions. In the past these have taken place with no difficulty at all and Mrs. Duff is pleased with the way in which her husband has previously been treated at the William Harvey Hospital. More recently, however, Mr. Duff has had to put up with quite unacceptable conditions. On August 25 he had to wait in the Accident and Emergency Department for 27 hours. On October 2 he had to wait for 30 hours. Last week when Mrs. Duff phoned the hospital on Wednesday, she was told that no bed would be available for her husband until Monday or Tuesday of this week. I am sure that you would agree that this is a completely unacceptable state of affairs. The chief executive of the trust replied on 28 December. He said that the dates you have given for Mr. Duff's admission do not accord with our own records, nevertheless he would have experienced long waits in the period that you describe as did a number of other patients. As you know we are doing all that we can to improve the situation because it is unacceptable. My constituents, Mr. and Mrs. Horton, wrote to me on 20 November. This is what they said: We have a 43 year old son who is blind, mentally handicapped, spastic and confined to a wheelchair. He has to have everything done for him. At the end of last week he was taken ill. The local doctor said he should go to hospital. He was taken to the William Harvey at Ashford. With considerable restraint, my constituent continues: I am going to moan … With all of his ailments he had to wait 4 hours in Accident and Emergency at the William Harvey before he was seen by a doctor. He was then sent to a ward where he was looked after O.K. put on a drip with antibiotics plus his tablets. I'm not moaning at the treatment he received, it is the 4 hour wait. The waiting time to be seen at any hospital is disgusting. She adds: So much for T. Blair and Co. On 24 January, my constituent was sent an apology by the chief executive.

On 26 November, my constituent, Mrs. Anita Law, wrote to me, and this is part of what she said in her letter: My husband has recently died at the William Harvey Hospital from in particular, abominable sepsis and infection from MRSA. He went into the hospital for the reversal of a colostomy following an operation for bowel cancer the previous year. He was clear of the cancer and was informed that the operation would involve a week's stay in hospital. At no time was he counselled as to the risks of any post-operative infection or given any facts that would have given him any reason to refuse the operation at that time. He entered hospital on July 13th and eventually died on the 20th September 2000. I am writing to you following the recent press and TV coverage of the problem in our Hospitals. As a trainer and assessor within the Hospitality Industry, during the daily visits I made to the William Harvey I was dismayed at its dirty conditions and standards and practices of cleaning and nursing staff. Standards which would not be acceptable to the Catering and Hotel Industry but are deemed perfectly OK for our sick, both young and old… My daughter, whose husband is in the Army, was recently in hospital in Germany following a miscarriage after the death of her father. I visited her there and was extremely impressed at the hospital's standards of cleanliness. It was built just after the end of World War II, probably by us! If our continental neighbours can do it, why not the UK?

Mr. Damian Green (Ashford)

As my right hon. and learned Friend says, the William Harvey hospital is in my constituency, and I echo his remarks about the conscientiousness of its staff. However, my experience reflects his. When I last visited the hospital, people had been waiting on trolleys in the accident and emergency department for 24 hours. I have received a constant stream of letters and telephone calls from people complaining not about the standard of care, but about the standard of cleanliness and, in particular, of food, which is so important for convalescence. In the years that I have been associated with Ashford, I have never known the health service in a more parlous state.

Mr. Howard

I am grateful to my hon. Friend for confirming what I am saying.

I shall quote from one more letter. As I have not been able to contact my constituent to obtain her permission to do that, I shall not mention her name. She made an official complaint on 8 August about what she rightly described as the appalling treatment that she received after the delivery of her baby at the William Harvey hospital on 26 June. He was born at two minutes to 5 in the morning. My constituent and her husband expressed concerns about him a number of times during the day. It was not until 10.30 pm that an auxiliary nurse took the baby to the special care unit—an act that might have saved his life.

My constituent's letter of complaint then deals with what happened in the following 24 hours. She was told that her baby might be suffering from Down's syndrome, but that it was not necessary to telephone her husband. Despite her earlier requests, a telephone was not brought to her until 6 am.

When her husband arrived at the hospital, he had trouble getting into the maternity ward. No one seemed to be expecting him and he was told that his wife was on the delivery ward. He asked for a wheelchair to take her to the special care unit, but was told that she had to have breakfast and a shower before she could see her baby. Eventually, after a confrontation between her husband and the staff, she was allowed into the unit and the doctors, who were doing their rounds, were able to explain the situation to her.

It was suggested that she should be moved to a separate room where a video link would be set up so that she could see her baby in the incubator, but when she returned to the ward she was told that the room was not ready because workmen were in it. She was subsequently told that it did not have a working video link anyway. By late afternoon, she was moved to another side room.

Lack of cleanliness is a common theme of the complaints that I have received. My constituent found the toilet in the side room so unclean that she had to put baby wipes on her feet and clean the floor. Her bed sheets were not changed for three days. She eventually changed them herself.

My constituent needed to have her breast milk expressed every few hours so that her baby could be fed down a tube in his nose. To do that, she needed a breast pump. Although she asked several times for it to be sterilised, she often had to wait more than an hour for that to be done. Some of the staff did not know how to sterilise the pump. In the end, she and her husband asked to be shown how to operate it and did the sterilising themselves.

I have not mentioned all the complaints listed by my constituent. She made her official complaint on 8 August last year. Not having received a substantive response, she wrote to me on 21 December. She said that her baby son was suffering from atopic eczema and rubbed his face raw at night. The waiting list to see a skin specialist was 30 weeks, so she and her husband paid for a private consultation. In her letter, she said: The National Health Service has failed my family. Who could disagree?

I wrote to the chief executive of East Kent Hospitals NHS trust about her complaint on 2 January. On 9 January, he sent any constituent a letter informing her that a letter responding to her complaints had been prepared and that it would be signed and sent to her shortly. The chief executive wrote to me on 23 January saying that he had asked for a letter to be sent to my constituent as a matter of urgency. On 5 February, she still had not received the letter. I wrote to the trust again. The letter was not sent until 7 February. Her complaints were upheld.

It gives me no pleasure to recite that litany of abundantly justified grievances. I want my constituents and, for that matter, my family, who have used the accident and emergency department at the William Harvey hospital, to receive decent medical care from the NHS.

Mr. Julian Brazier (Canterbury)

My right hon. and learned Friend is making a compelling case. Is he aware that a meeting of 81 consultants—almost half of those in east Kent—passed a unanimous motion saying that a lack of capacity is preventing them from delivering quality health care? Is it not ironic that in the face of those problems, East Kent health authority is still committed to a £100 million reorganisation that, at best, will leave capacity unaltered and may even reduce it?

Mr. Howard

There is no doubt that the consultants' view gives rise to a great deal of concern. I do not pretend that the national health service in east Kent was perfect until four years ago, but I know that it has deteriorated during the past four years. I have never before received complaints of the kind, on the scale and in the number that I am receiving now.

Yesterday, I received a document entitled "Moving Forward: A strategic outline case for modernising hospital services in East Kent". It contained the following sentence: The NHS plan gives East Kent the opportunity to maintain the current bed baseline it 1,975, although there may be some realignment between the number of acute and intermediate beds within the health economy as a whole. That will give no comfort to my constituents who spent such lengthy periods in the accident and emergency department because no bed was available for them in a ward. It will give no comfort to all my constituents who fear that at any time they may find themselves in that position.

In the light of that sentence, I hope that the Minister, in responding to the debate, will not spin us fantasies about what may or may not happen in the far-off future. The condition of the NHS in east Kent today is unacceptable. My constituents and I want to know how and why that situation has come about and what the Government propose to do about it now. I look forward to the Minister's response.

10.16 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) on securing this debate. He wants high-quality health services for his constituents, and I can assure him that the Government want that too. That is why we are undertaking a major programme of long-term investment and reform in the NHS. The investment will bring more staff, more beds, more new hospitals and reform in the way in which health care is delivered. Patients will be treated in modern, high-quality facilities with the latest equipment and the best-trained staff. Reliability will be improved and waiting times will be cut. Of course, that will take time to deliver, but the NHS today is the fastest-growing health service of any major country in Europe.

Mr. Howard

Will the hon. Lady give way?

Ms Stuart

I will give way, ever though I am only one minute into my speech. If the right hon. and learned Gentleman wants me to answer certain questions, he might like to give me time to do so.

Mr. Howard

I am very sorry to intervene so soon, but the investment to which the Minister referred will not lead to more beds. The document that I received yesterday made it clear that an increase in bed numbers is not intended in east Kent.

Ms Stuart

I would be grateful if the right hon. and learned Gentleman would listen so that I can outline not only what we are doing now, but the overall direction of our policies and how they will improve matters. I remind him that the situation that he and the hon. Member for Ashford (Mr. Green) described did not suddenly occur on 1 May 1997. Opposition Members might reflect for a moment on the causes of that situation.

I turn now to an outline of our policies and how we are improving matters not only in the William Harvey hospital but in the whole of Kent. The right hon. and learned Gentleman is most concerned about how the reforms and investment will affect his constituents, and that is right and proper. East Kent health authority will receive £469.6 million in 2001–02. That is a real-terms increase of 6.2 per cent. on the previous year and around 40 per cent. on the £262.7 million that it received in 1996–97.

Significant additional funds have been made available to the health authority this financial year to address the pressures from emergency admissions experienced in recent months. Those include almost £2.2 million for accident and emergency admissions, almost £1.6 million to expand critical care services, £400,000 for elective capacity in the private sector to cut waiting lists, and £1.15 million to deal with winter pressures. As the right hon. and learned Member can see, there are good foundations on which to build.

Before I turn to the changes in east Kent, I shall deal with the right hon. and learned Gentleman's concerns about primary care trust reconfigurations. I understand that there is support for a stand-alone, shared-way primary care trust. The configuration of PCTs in east Kent is a matter for local determination, and I will ensure that the right hon. and learned Gentleman's views are brought to the attention of the health authority. The decision will be very much a local one.

I return to the foundation on which we have been building. We cannot maintain the status quo; that must be accepted. Health services in east Kent cannot stand still—they need to change. They need to be modernised to ensure that everyone receives faster, fairer and more convenient services.

The way forward has already been decided. The right hon. and learned Gentleman referred to the east Kent reconfiguration, which will centralise specialist services at Ashford and Margate and retain a core of local services at Canterbury. That was approved by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) following extensive consultation in 1998.

At no point during the process has the driving force for change in east Kent been financial savings. That force has been the need to modernise services. For that to take place, there will be expansion of the William Harvey and the Queen Elizabeth the Queen Mother hospitals and refurbishment of Kent and Canterbury and Buckland hospitals. On 15 February, my right hon. Friend the Secretary of State for Health announced that work will begin this year to procure these £102 million developments. They will ensure that everyone in east Kent receives the NHS services for which we are striving. We will not turn back from this.

In the shorter term, I appreciate that change is unsettling and that there will always be people who would have preferred an alternative course of action. However, the decision has been made, and I believe that it is the right one. Everyone must now work together to ensure that the changes are a success.

I want to be clear. I am not saying that everything is perfect in east Kent. Of course it has not been perfect, and the right hon. and learned Gentleman has provided examples to illustrate that. I want to focus on the direction in which we are heading. The expansions and refurbishments will take time to complete, and I am aware that the transitional arrangements are causing some concern. However, things are not as bad as they are sometimes painted. I shall give a few examples.

At the William Harvey hospital, a new ward with an extra 54 beds opened in July 2000 to allow transfer of acute medicine from Buckland hospital. A 19-bed medical acute assessment unit opened in August 2000, and the critical care unit was enlarged from six to 10 bed spaces in December 2000. At the Queen Elizabeth the Queen Mother hospital, the critical care unit was expanded from five to 10 bed spaces in December 2000, and a new block with an extra 75 beds, including a 23-bed medical acute assessment unit, was opened to accommodate catchment change from the Canterbury area in January 2001. At Kent and Canterbury hospital, December 2000 saw expansion of the surgical ward block by 18 beds, the establishment of a separate gynaecological unit and the expansion of renal in-patient beds.

More action is required in the interim period and other actions are due to come on stream in the near future. These include the completion of a new cross-sectional imaging suite at the William Harvey hospital, the opening of an extra operating theatre and the starting of a £1.1 million modernisation of the accident and emergency department at the Queen Elizabeth the Queen Mother hospital. At the Kent and Canterbury hospital, there will be the completion of the refurbishment of the day surgery area in April. There will also be the completion of a purpose-built unit for the health care of older people service, including two rehab wards, a stroke unit, a therapy centre and day hospital in June, and the opening of the new cataract centre in July.

I fully accept the right hon. and learned Gentleman's concerns that the situation in east Kent is not perfect. However, we are making steady progress. We are not talking about aspirations in the distant future; something really has happened. There are positive developments. The right hon. and learned Gentleman has given examples to show that the NHS in east Kent has failed a small number of patients in recent months. I say a small number, and I do not mean to lessen the seriousness of the individual cases, but we need to get them in perspective.

The right hon. and learned Gentleman spoke of how many more complaints he has received recently about the NHS. To get a sense of proportion, the East Kent Hospitals NHS trust received 266 letters of complaint between October and December last year. During the same period, it received 2,392 letters of thanks. As Members of Parliament, we all know how much more likely it is that a letter of complaint, rather than a letter of thanks, will be sent. We must not forget the many patients who do not have cause to complain.

Mr. Howard

I thank the hon. Lady for giving way. I have listened carefully and patiently to what she has said. She has spent considerable time speaking about her future plans. Can she please tell the House how those future plans, even the long-term plans, will address the problems that I described, if all they aspire to do is to maintain the current bed baseline in east Kent? If there are not more beds, how will people be admitted to the wards more quickly, rather than spending dreadful periods in the accident and emergency department?

Ms Stuart

I hope that the right hon. and learned Gentleman will not consider it presumptuous on my part if I profoundly and fundamentally disagree with his analysis of the problem. What I have described are not future changes; they have already happened. Change was needed because maintaining the status quo would not be acceptable.

The number of beds must be seen in the context of what has happened in respect of medical assessment units, better bed bureaux, better management, the intermediate care that is being put in place, and what we are doing together with social services with regard to home care packages. The national beds inquiry made it clear that the decline in the number of acute beds cannot continue, but a range of other provisions must be put in place.

I urge the right hon. and learned Gentleman to look at the package as a whole. The experiences of his constituents that he described are convincing evidence that change is needed in Canterbury and the whole of Kent. I was particularly struck by his comments about dirty hospitals. Yes, some of our hospitals have cut back on cleaning, and I remind Opposition Members how that came about. It is a result of the way in which the previous Government managed the NHS. It is no good hon. Gentlemen shaking their heads; that is the truth.

Mr. Green

I shall he brief, as I know that the hon. Lady does not have much time. First, my right hon. and learned Friend made it clear, as did I in my intervention, that we are speaking about managerial problems that have occurred in the past two years. That has nothing to do with what happened long in the past or what will happen long into the future. We are discussing care at the William Harvey hospital now.

The second point that the Minister has not addressed is that, in the end, we will have roughly the same bed numbers, yet her Government plan to increase the size of Ashford by 3,000 houses a year for the next 15 years. To say that the same bad numbers will be adequate for the population of east Kent is risible.

Ms Stuart

The hon. Gentleman simply has not listened. It is a matter not only of bed management and acute bed numbers, but of home care packages and rehabilitation. The situation must be looked at in the round.

I shall refer briefly to the comments of the hon. Member for Canterbury (Mr. Brazier). We have had Adjournment debates on his concerns. As an immediate response to the letter to which he referred, the acting regional director for the South East regional office asked the chief executive of East Kent Hospitals NHS trust and East Kent health authority jointly to undertake an urgent review of those concerns. The trust has agreed to some of the actions proposed

The status quo is unacceptable. I have outlined the steps that we are taking and the direction in which we are moving. I recognise that the reconfiguration in east Kent has been particularly unpopular in some quarters, but let us not be fooled—some of the opposition is based on self-interest, not the interest of east Kent as whole. Ministers must think of east Kent as a whole.

That is not to say that some of the issues raised locally are not valid. Of course they are. Let us be clear that the Government will take immediate action where NHS services are failing to deliver, but we will not allow much-needed progress to be derailed. If we did, the only people to lose out would be the people of east Kent.

The modernisation of east Kent will proceed. The programme of change has gone well so far. I acknowledge that there have been some problems in east Kent in recent months, but I stress that those have not been caused by the reconfiguration. They are a sign of the need to invest in and modernise the service in east Kent, and that is exactly what we are doing.

Apart from the changes that I have outlined, by March 2001 there will be better separation of emergency medicine and elective surgery, and the potential preparation of a dedicated gynaecology unit at the Queen Elizabeth the Queen Mother hospital. By April 2001, we expect to see the completion of a new cross-section imaging suite at the William Harvey hospital, an extra operating theatre is due to open at the Queen Elizabeth the Queen Mother hospital, and the refurbishment of the day surgery area is expected to be completed at the Kent and Canterbury hospital. By spring 2001, there will be a £1.1 million modernisation of the accident and emergency unit and the completion of a purpose-built health care and older people's services unit, including two rehab wards, stroke unit, therapy centre and day hospital at the Kent and Canterbury hospital. The transfer of services for the elderly from Nunnery Fields hospital will be managed much better. By July 2001, the new cataract centre is expected to open, subject to planning permission.

To say that no progress has been made is simply not the case. I accept that there are problems in the transition, but the direction of travel is clear. The outcome that we want is a better health service for all the people of east Kent.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes to Eleven o'clock.