HC Deb 08 November 2001 vol 374 cc465-74

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

6.53 pm
Dr. Richard Taylor (Wyre Forest)

I am deeply grateful for this opportunity to raise the matter of the drastic downgrading of Kidderminster general hospital, which as most people know is the main reason why I am here. I am especially grateful that, at this time of international crisis, we can still consider important local issues. If we were deflected from that, terrorism would have won a battle.

On 12 September I was lucky enough to visit a local primary school. The joy, optimism and hope on the faces of the children restored to me a real feeling that the world was still a good place in which to live and that life had to go on. After introducing me, the head teacher asked a five-year-old what my job was. The five-year-old said, "He helps the Prime Minister." In fact, that statement has hidden depth. As an Independent, I have the huge privilege of being able to support the Prime Minister if he is right and being equally able, without the Whips leaning on me, to oppose him if he is wrong. It is a unique position.

I am now daring to say that Ministers were wrong in their decision about the reconfiguration of acute hospitals in Worcestershire. My job is to prove that to the House and to show that Ministers have based their decision on inaccurate and incorrect information. When I left the school, the small primary children sang a jazzy little number about David and Goliath. They did not realise how exactly apt that was

. The decision was to remove all acute in-patient beds and the accident and emergency department from an acute general hospital to a new hospital 18 miles away. Let us remember that there are nearly 100,000 people within four to five miles of the original site. They are now 18 miles away from the new site, and a further 25,000 people can be up to 35 miles from the new hospital. The acute general hospital had received a charter mark, most of its buildings are only six to 23 years old and, in the words of a distressed local lady, it is woven into the fabric of Kidderminster life—since, in fact, the 1820s

How was the decision reached? I make no apology for referring to that because it allows me to alert other people facing threatened downgrading to the unscrupulous methods that managers may use to obtain their ends, and to why public consultation is in such disrepute. Divide and rule is one of the techniques; some are given enough to be kept quiet. That was shown by the responses to the consultation process. Of the 122 responses from official bodies, 50—nearly half—came from the 20 per cent. of the county's population living in the north-west part. Of those 50, 49 were rigidly against the plan.

The local medical committee, which represents all general practitioners in the county, rejected the proposals and found no evidence that they would provide a better, safer service. Another interesting response came from the hon. Member for Redditch (Jacqui Smith). She was reported by the Worcestershire health authority as saying that she supported the proposal for a new hospital in Worcester, but not one which would centralise basic services away from local people. That is just what the plan did for my constituents, but not for hers. Consultation has also been brought into such disrepute by the use of option appraisals. If hon. Members find them mentioned in hospital service reviews, they should beware. They are merely a method of wrapping up pseudo-statistics which are produced to confuse. In the Worcestershire case, the option appraisal was purely and simply a vote by the majority in the south and east of the county against the minority in the north and west.

What were the reasons for the decision? In these days of open government, we were staggered to find that communications between the NHS executive in the west midlands—now the west midlands regional office—and the Department of Health are entirely secret. Nobody can get at them. The reasons quoted are that the hospital would be unviable because of royal college guidelines for consultant specialisation and junior doctor training. That was absolute rubbish because the same guidelines were interpreted differently in many parts of the country

. Having forced through an unpopular decision, how does one realise it despite opposition? One allays the opposition—first, with spin. A comprehensive hospital will remain, dealing with the majority of both elective and emergency services. Those were the words of the health authority, but one could not go there with appendicitis, a heart attack or pneumonia. 85 per cent. of patients will still be treated"—

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

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

Dr, Taylor

The health authority continued: 85 per cent. of patients will still be treated there. Of course they will; that number is made up of the day cases, out-patients and investigations that one finds at any hospital.

If one puts the kiss of death on an acute general hospital, staff will leave. Most believed that there was no alternative. The next step is to denigrate one's opponents. Most of us were called medical dinosaurs, a few were called militant activists and I was called King Canute. Thus, it happened that consultants had to agree. The downgrading, or virtual closure, was engineered by loss of staff, which meant the hospital was unsafe, and happened on 18 September 2000.

Where do we go from here? The unfairness is obvious. Hexham, Kendal, Bishop Auckland, Banbury and Neath—to name but a few—are smaller concentrations of population, with similar or fewer journeys, which have retained far more than we have.

Looking to the future, there is an admission that bed numbers were wrong. Also, there was an admission that elective in-patient surgery has to return to Kidderminster. We are looking forward to the time when primary care trusts will take control, because we can talk to our trust.

Matthew Green (Ludlow)

Does the hon. Gentleman agree that there is concern that the primary care groups will not be in a position to form the primary care trusts in our region in time for the 1 April deadline? Does he agree that we need to seek guidance from the Minister tonight on whether there might be some sort of delay?

Dr. Taylor

There is real concern among primary care groups who are not yet primary care trusts that they will not be ready. When that is coupled with the drastic reorganisation that produces strategic health authorities, we have a double reason for being worried about the future. I am pleased that we are working with the primary care trusts because these are people that we can talk to.

Miss Julie Kirkbride (Bromsgrove)

On behalf of other Members of Parliament from the region, may I say that we all agree with the hon. Gentleman's comments and that we are looking forward to the Minister's response to his legitimate concerns?

Dr. Taylor

I am grateful to my hon. Friend for her support and for that of hon. Friends who cannot be here tonight.

We are delighted with the changes that are occurring at the top of the Worcestershire acute hospitals NHS trust. With the appropriate replacements, I and the primary care trust may start to have meaningful dialogue, which has been impossible to date.

I am delighted that the Royal College of Physicians and the Nuffield trust are looking at models that will provide emergency services at local hospitals. That is crucial for us in our battle to regain emergency services for Wyre Forest and south Shropshire. It is crucial to hospitals such as Crawley, Canterbury, Haslar, Penzance and, possibly, Pontefract, where emergency services may be threatened by larger neighbours. It is crucial to restore fairness and equality in the provision of emergency services across the country.

In this way, there may never again need to be such an unnecessary revolution as that which put me here. Purely selfishly, I am extremely grateful to be here, as this is the most superb job. I promote it as the best way for a retired doctor to enhance his pension, and I must say that I am enjoying what I do.

I do not believe that there is any other concentration of population of nearly 100,000 people that does not have an accident and emergency department within 18 miles. Despite frequent assertions by the health authority and others, the changes are not in the best interests of patients; that is the opinion of most local doctors, whose opposition was removed when they were led to believe that the changes were the only possibility for the future of hospital services in the county. It is not true that the Royal College of Surgeons, as has been said, was about to withdraw junior hospital doctor training recognition before the review.

I, and the 28,000 people who put me in this place, request the Minister to allow fairness and equality to return to local emergency hospital services throughout the country, by supporting the studies by the Royal College of Physicians and others to find workable models for emergency care in local hospitals.

Mr. Peter Luff (Mid-Worcestershire)

My hon. Friend knows that I disagree with him about the future chairmanship of the acute hospitals trust, and I am concerned that the point that he has made about bed numbers and the need for an improved A and E service at Kidderminster may be underplayed by any future chairman. Does he share my concern that the chairman who takes over from Mr. Harold Musgrove should not be a Government placeman who does the Government's bidding but one who argues robustly for the interests of Worcestershire, as I believe that Mr. Musgrove is now doing?

Dr. Taylor

I am delighted with my hon. Friend's intervention because, although we disagree about that particular personality, we are both determined that the person who succeeds him will be someone who welds together the hospital services of the whole county into one system, which really works. He must be someone with the management skills of King Solomon, if King Solomon had them, because it will be a tremendous job to weld together consultants who work differently, with three very separate communities. It is so important that we get the right person, whom we—the GPs, the hospital consultants, all MPs—can really talk to

Mr. Luff

And who will argue with the Government.

Dr. Taylor

I am very grateful.

In my view, the Government are very good at ideas, initiatives and words. I want to quote to the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), whom I am delighted to see in the Chamber, some of her own words, which are absolutely crucial to the future of the national health service. In the letter that was circulated with the consultation document on involving patients and the public in health care, she wrote: The culture within the NHS needs to change, so that the views of patients and citizens are not only valued, but listened to and acted upon as well. Those are excellent words and excellent aims. Can the Government deliver?

Mr. Luff

As the extra time is available, Mr. Deputy Speaker, is it in order to take two minutes of the House's time?

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. As this has become a debate of 37 minutes maximum, it is possible for other hon. Members to take part, but I hope that they will have regard to the fact that the originator of the motion deserves a full ministerial answer.

7.8 pm

Mr. Peter Luff (Mid-Worcestershire)

I shall speak for no more than two minutes.

I was very interested to hear the speech by my hon. Friend the Member for Wyre Forest (Dr. Taylor), and I agreed with almost everything in it. However, I believe that he did not sufficiently emphasise one issue—the contribution that Kidderminster general hospital can make to increasing total bed numbers in the county. That is no criticism of what he said; it is just an observation.

There is now a consensus in the county that bed numbers are far too low. The Government's own figures show that, and privately health managers believe that the Government figures underestimate how low they are. I am one of those who actually took an optimistic view of bed numbers, and in a sense I am making a confession that I believe that I got that judgment wrong.

I hope that, in her remarks, the Minister will specifically consider how Kidderminster general hospital can contribute to increasing total bed numbers in the county, and—if it is not taking the debate too wide—will consider guarantees about bed numbers at the new Worcestershire royal hospital, which, working with Kidderminster, should address what could otherwise be an exceptionally serious problem. I hope that the Minister will respond on the bed numbers issue in Worcestershire as a whole and Kidderminster's contribution to solving that problem.

7.10 pm
Miss Julie Kirkbride (Bromsgrove)

Before the Minister responds, I remind her that a rather cynical promise was made in the general election campaign that a review would be held of the situation with regard to Kidderminster hospital. I hope that she will say more about that review, and that she will take account of the consensus that has emerged with regard to bed numbers, which even includes the outgoing chairman of the NHS trust hospital. The House, and people in the Strangers Gallery, would be thrilled to hear more good news from the Minister.

Mr. Deputy Speaker

Order. I should explain that there is no such thing as a Strangers Gallery, and that there is just the Chamber.

7.10 pm
(Ms Hazel Blears)

I am delighted to be able to bring what I hope will be good news to the House, and I congratulate the hon. Member for Wyre Forest (Dr. Taylor) on securing this debate on Kidderminster hospital. I am fully aware of local concerns about the current and future level of services provided by the hospital. The very presence of the hon. Gentleman in the House is evidence of how key those issues are to the local community.

I am also delighted that the education service in Wyre Forest is working so well that primary school children think that the job of all Members of Parliament is to help the Prime Minister. I am sure that my right hon. Friend will be delighted at that news.

I do not want to go back over old ground, and the hon. Member for Wyre Forest has set out the way in which decisions about Kidderminster were reached. However, the proposals in the "Investing in Excellence" strategy document were aimed at ensuring that we improved the quality of health services for patients across the whole of Worcestershire.

The consultation process carried out in 1998 uncovered a huge strength of feeling among people in the Kidderminster area, with many voicing their concerns about the possible closure of Kidderminster hospital. I emphasise that it was never the case that that hospital should close. There has been much confusion about that.

As the hon. Member for Wyre Forest knows, the Government have stated our commitment to modernisation and to driving forward reform and improvement. I do not intend to dwell on what has happened in the past, and I think that the hon. Gentleman has been generous enough in meetings with other Ministers to say that he too wants to look to the future and to try and secure the best services for his constituents. In May of this year, as the hon. Member for Bromsgrove (Miss Kirkbride) mentioned, at the request of the then hon. Member for Wyre Forest, my right hon. Friend the Secretary of State announced that, on re-election, the Government would establish an independent clinical review of future elective services at Kidderminster hospital. On 26 June, the Government confirmed that the review would be undertaken by Professor Ara Darzi, professor of surgery at St Mary's hospital in London. The review was also to take place in the context of the new opportunities for planned increases in elective surgery arising from implementation of the Government's NHS plan

. Professor Darzi got to work extremely quickly and submitted his report on 31 July. As the hon. Member for Wyre Forest is aware, the Minister of State for Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and Professor Darzi visited Kidderminster hospital on 27 September to announce that the Secretary of State had accepted the review's recommendations in full.

The review recommended that the new £13 million diagnostic and treatment centre at Kidderminster hospital should be expanded to include up to 20 more beds. It also recommended that the range of surgery provided at Kidderminster should be increased, thus reducing waiting times and increasing access for local people, and that Kidderminster should have three operating theatres rather than two, so that more operations could be carried out.

The review also recommended that better links between Kidderminster and other local hospitals should be established, especially in connection with transport for relatives. It also recommended the development of telemedicine links for the doctors involved.

As I said, my right hon. Friend the Secretary of State has accepted all the recommendations in full. Their implementation will enable Kidderminster hospital to carry out a wider variety of common operations, including tonsillectomies, prostate operations, hysterectomies and gall bladder operations. It will also be able to carry out more orthopaedic operations, and more procedures—including procedures for children—in connection with eye, ear, nose and throat surgery.

Dr. Richard Taylor

I want to emphasise the urgency of those changes. Forgive the clinical detail, but some of my constituents with prostate problems have to get up 15 times at night and cannot go to work because they are so desperate, and they require simple prostate operations as soon as possible. I fear that that will not be possible for many months because the trust wants to make major structural changes. It must be made possible, and the facilities already exist. In my constituency, the men of my age—luckily, I am not quite troubled in that way yet—must be able to get their prostates seen to within the next very few months, please.

Ms Blears

The hon. Gentleman makes a very important point. Not just for people in Kidderminster, but for people throughout the country, trying to reduce waiting times is clearly a key priority for us, so that they are seen as soon as possible.

Mr. Luff

Will the Minister confirm that the new surgical facilities that she mentions at Kidderminster are intended to serve not just Wyre Forest, but the whole county? Will she take on board the fact that none of the county's other MPs has been informed of the outcome of the report to which she has alluded? We have relied on press reports. Will she encourage her colleagues in the Department of Health and, indeed, in the health authority to make greater efforts to explain that those new facilities will serve the whole county? It is very important to ensure that that is understood.

Ms Blears

Yes, the new facilities will serve the whole county, but they are primarily directed in the first instance at serving local people. because they are the people who will have access to them. As the services develop, they will improve for the whole county. I certainly will undertake to try to ensure that the information is made available to as many people as possible. After all, this is extremely good news, and it is certainly in everyone's interest that that information is broadly available.

Matthew Green

The Minister keeps referring to the county of Worcestershire. Is she aware that about 15,000 people in my constituency used Kidderminster hospital? That number is now declining because they have to travel further afield. She talks about the services being available for Worcestershire, but will she also include the many residents in the South Shropshire and Bridgnorth districts?

Ms Blears

I am aware that the hon. Gentleman's constituents have used the facilities at Kidderminster for a long time, and the intention is to provide facilities for as many people, who want to use them, as we can in the area. As the facilities develop and begin to come on stream, local people will be the first priority and then those across the county. Under the new organisation of the health service, it will be a matter for primary care trusts to commission appropriate services for their populations, but clearly they will want to consider the range of facilities available, irrespective of county and administrative boundaries.

We must consider where it is appropriate for patients to go and where it is best for them to get their local services, so I do not view administrative boundaries as an artificial cut-off. The patient flows and clinical networks are important, and putting the power with the primary care trust will enable local communities to commission appropriate services for local people, which will be a significant improvement.

More beds and operating theatres will be provided at Kidderminster, and a wider range of surgical procedures will be available. That is extremely good news for local people. I am also pleased to inform the hon. Member for Wyre Forest that, as part of national commitments to reduce maximum waiting times for operations to six months by 2004, 6,000 more operations will be carried out in Worcestershire. Thanks to Professor Darzi's recommendations, it is envisaged that Kidderminster hospital will carry out about 2,500 of those extra operations. That should result in more local people being treated more quickly and more conveniently at Kidderminster.

The hon. Gentleman will also appreciate, given his background, that local clinicians and health care managers need to ensure that the Kidderminster diagnostic treatment centre is well planned, successfully introduced and provides high-quality services. Of course, we are anxious to avoid any delay in implementing Professor Darzi's recommendations, but the Health Act 1999 places a statutory duty of quality on the health service. We must ensure that we put in place arrangements to monitor the standards of the services provided.

As hon. Members have noted, the local primary care trusts will play a pivotal role in leading the development to ensure that the all health organisations in the area take part in developing the service and that they have a commitment to supporting it in the future. It will therefore be necessary to develop protocols for referrals, training and new ways in which new clinical services are to be introduced.

The local health community anticipates that the trust will be in a position to implement many of the report's recommendations before the planned opening of the diagnostic and treatment centre. We intend to get on with that as quickly as we possibly can. At the same time, we shall maintain the high-quality standards that local people are entitled to expect.

Miss Kirkbride

That news will be extremely welcome to my constituents. I enter a caveat, however. Is the Minister aware that the accident and emergency department that was at Kidderminster is now a minor injuries unit and that accident and emergency services are now provided at the Alexandra hospital and the Worcester hospital? Clearly, if in-patient surgery for people having fairly serious operations takes place at Kidderminster hospital, the present arrangements for accident and emergency will have to be beefed up so that more than the current service for minor injuries is provided.

Ms Blears

I commend the hon. Lady's ingenuity in raising the issue of accident and emergency services. I shall come to that shortly. However, I assure her that issues of clinical safety and those relating to high-quality services will be paramount. Therefore, the developments will take place in the context of the whole service. They will not take place piecemeal without any recognition of the knock-on effects that they may have. I am not convinced that that means there will be a full-scale accident and emergency centre at Kidderminster, but I will come to that point shortly.

In February this year, the Secretary of State announced that 26 new diagnostic and treatment centres will be opened to try to increase the number of routine scheduled operations that can be carried out. By separating them from emergency work and by protecting both streams of work, we can have a real impact on waiting times.

The new centre at Kidderminster will allow for virtually all the non-emergency, hospital-based health care to be provided for the Wyre Forest population locally. It will also attract those patients from elsewhere in the country—and, no doubt, from Shropshire—who wish to take advantage of the state-of-art facilities proposed.

It is important to stress again that Kidderminster hospital is not closing. In addition to day-case provision and a comprehensive range of out-patient services, Kidderminster hospital currently provides a purpose-built chemotherapy suite that supports cancer services, paediatric day assessment and home-based support, a midwifery-led unit, a minor injuries unit and a specialised medical rehabilitation ward providing services for patients recovering from medical conditions such as a stroke, together with a range of back-up diagnostic facilities. It is important to reassure local people that it will be a centre of excellent health care for themselves and their families.

Approval has already been given for the development of a new satellite renal dialysis unit to be housed in the Kidderminster diagnostic treatment centre. The centre will also have up to 20 short-stay surgical beds in single rooms with en-suite facilities.

Worcestershire health authority gave a commitment to keep all services running at Kidderminster hospital during the building of the diagnostic and treatment centre. The hon. Member for Wyre Forest will appreciate therefore that the decanting of services needs to be planned with extreme care to ensure that it proceeds as smoothly as possible.

The immediate development of short-stay in-patient facilities would almost certainly result in other services being moved around the site. That might make it difficult to keep all the existing services operating, so we need to make sure that the plans go forward in balance and that we recognise the effects on each of the constituent parts of the service. That requires extremely careful planning.

It is planned to open short-stay surgical beds on a Monday-to-Friday basis for patients with an average length stay of between 24 to 48 hours once suitably qualified staff have been recruited. That is an immediate step that can be taken as soon as staff are in place, and it will ensure that an overnight facility is provided. Additional operating lists have been identified that could take place in Kidderminster to increase the range of services available and these should be in place within the next three to six months. They will come on stream very quickly.

The full business case for the new centre is due to be completed by the end of this month. The current plan is for construction on the refurbishment of some buildings on the Kidderminster hospital site to commence in June or July 2002 with a view to full opening in the autumn of 2003. On completion, all Professor Darzi's recommendations will be implemented in full.

As for accident and emergency services, the decision to remove blue light services from Kidderminster was a clinical one, based on real concerns about maintaining high standards of clinical safety where three accident and emergency departments were fairly closely situated. Our overriding duty has to be to put the safety of patients first. I am not aware that any compelling evidence has been produced to convince the health community or Ministers that it would be both safe and viable to provide blue light emergency care from Kidderminster.

The hon. Member for Bromsgrove (Miss Kirkbride) mentioned the minor injuries unit, which is one of the most successful of its type. It has an overall throughput of 20,000 patients and is seeing 75 per cent. of the number of people who used to go to accident and emergency. It is a major part of the service and functioning extremely well. It has well developed protocols with the ambulance trust. The extra investment of £1.3 million has enabled the trust to provide additional crews with high-dependency facilities and additional front-line paramedics to support the ambulance service, which is also functioning extremely well, to ensure that patients are taken to the right place immediately. From April next year the constituents of the hon. Member for Wyre Forest will benefit from access to the new £87 million hospital in Worcester which will combine state of the art accident and emergency facilities with appropriate clinical expertise.

Dr. Richard Taylor

Emergency and accident facilities are the crucial issue. We cannot understand why small hospitals such as Hexham and Kendal have retained blue light services. I commend to the Minister the work of the Royal College of Physicians and Andy Black of Durrow Management. They have produced models in which some emergencies are still dealt with in local hospitals. We believe that a model could be designed for the whole country, based on the Andy Black model and on what is happening at, for example, Hexham, Kendal and Bishop Auckland. That would defuse the terrible anxiety about the loss of emergency services. We do not know—

Mr. Deputy Speaker

Order. The hon. Gentleman must leave the Minister time to complete her remarks. I remind him that interventions are distinct from speeches.

Ms Blears

I am aware of the work to establish other models for accident and emergency care, and am greatly interested in the outcome of that. It is important not to close our minds to a range of ways in which services can be provided. The work is relevant across the country and, in particular, in rural areas that sometimes do not have access to the types of centres that are available in urban ones. Everyone should have the right to receive the best possible services in the most appropriate clinical setting. Local health authorities are working together with primary care trusts and everyone in the local community to achieve that.

The hon. Member for Mid-Worcestershire (Mr. Luff) expressed concern about the appointment of the chair of the trust. I can reassure him that appointments are completely in the hands of the independent NHS Appointments Commission. The process will proceed. There is no question of chairs and other trust members being placemen of the Government or anyone else. I am sure that an excellent appointment will be made and he or she will take forward the health service in that community.

The proposals by Worcestershire health authority will ensure that local people are able to receive appropriate care in their local communities. Change is always difficult in the NHS. There are different and conflicting pressures from, for example, the royal colleges on training accreditation and from local people. The difficulty is to ensure that we balance and reconcile those different interests and that we do it with an eye always to high-quality services for local people. I meant what I said in the discussion document: we need to put patients and citizens at the heart of our national health service and ensure that their views are expressed, listened to and acted on. That is in the best interests of all our communities and, indeed, of our health service. If we go forward in partnership, we can avoid conflict and come to a resolution—

The motion having been made at Seven o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order

Adjourned at half-past Seven o'clock.