HC Deb 05 December 2002 vol 395 cc1159-68

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

7.3 pm

Mr. Nigel Dodds (Belfast, North)

I am grateful to have the opportunity to raise a matter of considerable importance to my constituents. The debate surrounding the future of the two hospitals in my constituency and the range of services that they provide arises from the document, "Developing Better Services: Modernising Hospitals and Reforming Structures", which was published by the Department of Health, Social Services and Public Safety earlier this year. That document contains the proposals of the previous Minister responsible for health in Northern Ireland on hospital services and the reform of organisational structures for health and personal social services in the Province.

I want to deal particularly with the proposal outlined in paragraph 4.19 of the report that Whiteabbey and Mater hospitals will be developed as local hospitals. Previously, the constituency of north Belfast, with its various needs, difficulties and challenges, had two hospitals providing a range of services. They provided acute services and addressed severe health and social and economic needs. This proposal means that we will be left without any such provision. I acknowledge that there is clearly a need for decisions to be made in this area, and that the Minister, in a speech yesterday in the Province, said that he would announce decisions and address those issues. That does need to happen. Decisions need to be made about the location of hospitals and the administrative and management structures for health and personal social services.

Change in itself is not a problem. The problem comes when change does not meet the health needs of the local community, does not lead to efficiencies and greater effectiveness and ignores what is happening and what is needed on the ground. One of my concerns, which is shared by many of my constituents, is that the report, particularly in relation to the Mater, appears to focus more on the needs of professional standards, training and practice and less on the patients, the community and people's needs. It is essential that what happens in relation to the Mater and Whiteabbey be in the best interests of the people and communities of north Belfast, and in the best interests of addressing social care needs and the health of the community. No other agenda should drive the proposals.

There is no doubt that the proposals, as set out by the previous Minister, will have a severe impact on the local community. They will lead to the loss of a range of key acute and emergency services and the loss of many local job opportunities in an area of severe unemployment. They will dent morale considerably at a time when it is recognised that north Belfast requires attention at the highest level of Government, not least by the setting up of the community action unit, as a result of the community action project, which addresses a range of issues in north Belfast. To remove the Mater hospital with its acute and emergency provisions and a wide range of other services would denude the constituency of a major facility that is supported across the political spectrum and across the community. That would leave a gaping hole in north Belfast.

I want to set out the positive context of some of the things that are happening in health and personal social services in north Belfast. On Monday, I had the great honour and privilege of attending the launch of three new healthy living centres in Duncairn gardens, in which cross-community groups and people from a wide spectrum across the community divide are coming together to provide £2 million worth of investment in north Belfast. The north and west Belfast health action zone has been established. Proposals are coming forward from the North and West Belfast Health and Social Services Trust on new health and well-being centres.

All that will be undermined if the Government say that they will downgrade the Mater and Whiteabbey to the status of local hospitals. The proposals are not logical, they follow no previous consistent argument, and the proposals in relation to the Mater hospital were a bolt out of the blue. No Government proposal or document had indicated that that was the thinking, and it did not follow from the conclusion of the Hayes report. The acute hospital review group suggested no such way forward; indeed, it suggested the retention of acute and emergency services at the Mater and a partnership with Whiteabbey hospital.

Seventeen out of the 20 wards in north Belfast are among the 25 per cent. most health-deprived wards in Northern Ireland. The Mater hospital is situated in Crumlin, the most socially and economically deprived ward in the whole of Northern Ireland. Ten out of the 20 north Belfast wards are in the 25 per cent. of wards in Northern Ireland with the highest ratio for cancer. There is clear evidence to suggest that that is linked to the high level and incidence of social and economic deprivation. We have a major problem with suicide rates, particularly among men. Mental health is another severe problem and we have some of the worst levels of drug and substance abuse anywhere in the Province or, indeed, in the United Kingdom. When we take all that into account, it is unthinkable that the Government should continue with the proposals set out in the document "Developing Better Services". I urge the Minister to examine those proposals and to reject them and, instead, to decide to retain the Mater and Whiteabbey hospitals in their current form.

It should also be noted that the Mater is the biggest single employer in Northern Ireland, with 1,000 employees, many of whom live in north Belfast, an area that does not have many major employers. The civil disturbances, the trouble and the violence have had disproportionate effect on the greater Shankhill and north Belfast area and the Mater hospital has throughout provided a dedicated and magnificent service to the people there. The accident and emergency ward is one of the busiest and biggest in Northern Ireland and it has demonstrated that it is meeting a terrible need in that part of the city.

In my previous role as the Northern Ireland Minister for Social Development, I played a part in setting up the community action unit. I know that the Minister has taken over responsibility for that, and is dedicated to it. It has targeted social need, which means concentrating Government resources on the areas of greatest need, and is carrying out the key objective set out in the document "Investing in Health".

Given all the problems in north Belfast, to suggest that workers could simply relocate to other hospitals does not take into account the problems that people have with access. People in north Belfast do not have as much access to private transport as people do in other areas, and there are also problems in getting through parts of north Belfast. As we know, there are severe community segregation problems. It is not an answer to say that people can go elsewhere. People from all communities and backgrounds feel safe in the Mater. I urge the Minister not to deprive the people of Belfast of that facility.

I referred earlier to the cross-community and all-party support for the views hat I am expressing. Belfast city council has unanimously supported the same view and in the last debate in the Northern Ireland Assembly before suspension all parties across the board unanimously supported the retention of these services. The support did not come just from the representatives from north Belfast but from those from elsewhere.

A strong and vigorous local community campaign has been under way. Tens of thousands of signatures have been gathered, and the campaign has actively engaged the community. From greater Shankhill through to all the other parts of north Belfast, the response has been magnificent. It has come from the trade unions, professional bodies and the North Belfast Partnership Board, which is representative of nationalist and Unionist communities. They have all thrown their full weight behind the campaign for the retention of the Mater and of acute and emergency services throughout Northern Ireland. People are appalled at the suggestion that the proud traditions of the Mater could be lost and that services could be taken from the people of north Belfast.

I recently toured the hospital and looked at the magnificent facilities in the new McAuley building. It was built at a cost of £17 million, and not a penny of it came from public money. To think that that investment could be set aside arid that the hospital could be downgraded would involve a terrible misuse of the money that went to provide the people of the area with the services to which they are entitled.

In terms of financial targets, activity and capacity, the Mater has met its targets, is increasing its capacity and its service performance compares well with any hospital of a similar nature anywhere in the Province. The Minister has been grappling with the problem of waiting lists in Northern Ireland. It is incredible to think that such a proposal will not have an adverse effect on Belfast waiting lists. He will have seen some of the evidence adduced by the Mater Hospital Trust, which shows that waiting lists would increase.

Some people have suggested that it might be a good idea to turn the hospital into a local hospital, but given the services that will be lost, the word "local" needs to be explained. Let us consider what will happen if the proposals are implemented. We will lose accident and emergency services, intensive care, intensive general medicine, the in-patient cardiology and coronary care unit, in-patient diabetic services, in-patient respiratory medicine, in-patient general surgery, in-patient gynaecology and the laboratory and anaesthetic services. Other services will also go. That is not acceptable.

The report suggests ways to develop better services, such as the hospital taking on rehabilitation beds, intermediate care and step-down beds. I cannot understand how those services could be provided if all the other services have gone. Who on earth will provide the back-up in an emergency or when someone needs intensive care if there are no doctors, medical staff or beds? It has also been suggested that maternity services can stay, but if everything that is needed to have a maternity unit in situ is removed, then the report is simply paying lip service to that idea.

For many decades, the Mater hospital has provided an environment for the training and teaching of nurses and medical staff. That proud tradition will go if the proposals are implemented. Paragraph 4.35 of the report says that the Mater will be ideally placed to play an even more significant role in contributing to the training of doctors, nurses and other health professionals of the future", but that is not feasible if the range of services that I outline disappear.

It is clear that the proposals run counter to the suggestions of Dr. Hayes's acute hospital review group. He suggested a partnership between Whiteabbey and the Mater. That idea has disappeared. He suggested that acute services be retained for the foreseeable future. Indeed, he opposes the idea of a transitional phase that leads to the establishment of a local hospital. He referred to a regional service located in the Mater. That idea seems to have disappeared too.

The health and social care needs of the local community must be a priority. The people of north Belfast and the Newtonabbey area, which are served by Whiteabbey hospital, deserve better. I accept that there are issues that the Minister must address for Northern Ireland, but the proposals run counter to the general thrust of Government policy on north Belfast given the amount of attention, resources and efforts that are focused there to deal with deep underlying social, economic and political problems.

It is wrong to rip from the heart of a community a hospital that has served everyone. It has the support of the entire community—nationalist and Unionist, Protestant and Catholic. Indeed, nationalists, Unionists, Protestants and Catholics all work in it. The idea that it should be run down and that the investment and years of proud tradition should be cast aside without a consistent argument to support the proposition up to now cannot be allowed to stand. I know that the Minister has taken the trouble to speak to people about the proposal and that he is interested in the issue. I urge him to reconsider and to discard the proposals in the report.

7.20 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Desmond Browne)

First, I congratulate the hon. Member for Belfast, North (Mr. Dodds) on securing the debate. I am grateful to him for his comments, which have allowed me to hear the concerns for the future of hospital services in his constituency. I stress that I have made no decisions in relation to the proposals for acute hospital services set out in "Developing Better Services: Modernising Hospitals and Reforming Structures", but I am mindful of the real deprivation in the hon. Gentleman's constituency, and in other constituencies in Northern Ireland, and I will want to reflect carefully on his comments. I know that the issue of the future of the Mater hospital was the subject of an Adjournment debate in the Northern Ireland Assembly—it was the last debate before suspension—which drew strong cross-party support for the retention of acute services at the hospital. I am aware also of Belfast city council's position on the issue.

The proposals for modernising hospitals set out in "Developing Better Services" are a recognition that the complexities of hospital services, and what they can deliver, have changed enormously over the past 30 years. However, the fact is that in Northern Ireland the necessary investment has not been made to keep up with the pace of change. As a result, it is becoming increasingly difficult to sustain services in some hospitals and the service is facing critical and mounting problems. Far too many people are waiting too long for hospital treatment, with pressures growing annually on hospital beds. What were once considered winter pressures have become an all-year-round occurrence.

The fabric of many hospitals is in disrepair and staff are trying to cope with outdated equipment and facilities. That is not acceptable and cannot be allowed to continue. It will require radical and sustained change in the operation and delivery of hospital services if we are to achieve the sort of modern dynamic hospital service that is capable of delivering the very highest standards of care, to meet the health care needs of the 21st century.

Some of the pressures facing our hospital system are inescapable. People are living longer and in their later years they are more likely to suffer from chronic illness such as heart disease, diabetes or arthritis. Consequently, they require more care by a wide range of staff in hospitals, the allied health professions and by those in the community. At the other end of the spectrum, many more children and young people are suffering chronic health problems such as asthma and diabetes. Many conditions require long-term care, often with complex hospital-based treatments throughout their lives.

At the same time, as perhaps never before, we are seeing significant developments in health care, with new medicines available to treat and relieve the symptoms of both chronic and acute conditions, such as malignant disease, heart disease, rheumatoid arthritis and multiple sclerosis. There are also advances in surgical techniques, with less invasive forms of surgery requiring shorter hospital stays, with many procedures now being carried out as an out-patient or day procedure, which previously would have required a long hospital stay.

Perhaps one of the most significant changes in the past 20 years has been the advance of medical engineering technology, such as medical imaging using CT, MRI and recently, PET scanners. Advances also in information and communications technology are beginning to transform how information is used and shared in and between hospitals. Telemedicine in particular, which allows images to be transmitted from a GP surgery to a consultant for advice, perhaps many miles away, is already making an impact on the way in which care is being provided.

We cannot expect doctors and other hospital staff to become expert in every new method of working. Instead, many are now focusing their interests on particular specialties or sub-specialties, bringing with them increased expertise and even greater advances in treatment and care. It also means that the era of the medical generalist trained to provide a wide range of clinical services is coming to an end.

We must also embrace the much more stringent requirements covering the degree of supervision and the specific nature of the work that is being undertaken by medical trainees. Increasingly the jobs available to junior doctors and other professional staff do not provide the opportunity to develop the sort of skills and experience that are necessary for modern practice.

Improving the standard of hospital care and the environment in which care is provided must be a major priority. The requirement for trusts to provide quality care will soon become a statutory responsibility, and accountability for the delivery of services will be strengthened by robust clinical and social care governance arrangements. The proposals in "Developing Better Services" recognise those inescapable drivers for change, and set out a pattern of hospital care which aims to concentrate regional and specialist acute care in an acute hospital network which can foster and develop the range of specialist skills required to deliver modern high-quality acute care. But the proposals also recognise that advances in medical treatment and technology mean that many procedures which currently require attendance at an acute hospital no longer need to be provided in that setting. The majority of out-patient and day procedures can now be completed safely outside an acute hospital setting, and so too can high-quality diagnostics, linking to the acute network through telemedicine or linked digital imaging systems. Those are not advances of tomorrow, but opportunities for today, and I agree with the underlying logic of the proposals.

"Developing Better Services" has proposed that the present pattern of 15 acute hospitals should be reconfigured to nine, with the remaining hospitals providing a wide range of local services, such as a minor injuries unit, out-patient and day procedures, high-quality diagnostic services and a number of step-down beds for people who have received treatment in an acute hospital, but no longer need to be there for the remainder of their hospital convalescence, thus freeing up much needed beds for others. As the hon. Gentleman said, it is proposed that the Mater and Whiteabbey hospitals be reconfigured to provide a range of local services, such as those that I have outlined, and operate as local hospitals linked to the acute hospital network.

I am aware that the proposals for the Mater hospital in particular have engendered widespread concern, not only within the Mater Hospital Trust and its staff, but also across the community in north Belfast, as well as among elected representatives across the political spectrum, who have united with the Mater to support the retention of its acute services. The Mater hospital has a special place in the hearts of the community in north Belfast, fostered through the worst of the civil conflict in Northern Ireland over the past 30 years, and has provided a neutral haven of care for north Belfast, an area which has some of the worst deprivation in Northern Ireland, as we have heard. To date, some 35,000 letters and petitions have been received by the Department in support of retaining acute services at the Mater, as well as a number of detailed submissions which are being carefully considered as part of the post-consultation process.

No decisions have been taken on any of the proposals in "Developing Better Services", and before coming to a final decision, I will want to satisfy myself about the proposals to remove acute services from the Mater and whether the hospital, networking with the Royal group of hospitals and Belfast city hospital, could meet the longer-term needs of the north Belfast community. No one can be in any doubt of the significant effect of years of community strife on the community in north Belfast, which has suffered some of the worst sectarian violence of the past 30 years. Nor are such days behind us, alas. The legacy of sectarian strife will remain with the community, particularly the young people of the area, for many years to come, manifesting itself in mental health problems and drug and alcohol abuse. I pay tribute to the work of the many cross-community groups in north Belfast that are working tirelessly to lift north Belfast out of the legacy of the past and give new hope to the rising generation.

It is well recognised that areas of high deprivation such as north Belfast bring with them a range of chronic health care problems. I know that, for many, the Mater has become a lifeline for the diagnosis, treatment and care of chronic condilions such as chronic obstructive pulmonary disease, which is associated with emphysema and smoking. One of the other manifestations of deprivation is unemployment—the Mater hospital is a significant employer in north Belfast—and the proposals for change have brought with them a very real fear for job losses in the hospital. I would be extremely concerned if the net effect of the proposals were to mean job losses in north Belfast, and I want to look very carefully at that aspect of the proposals before coming to any final decision.

The Mater has given north Belfast long and distinguished service since it was established in 1883, and up until the deed of arrangement in 1971 was funded entirely by the Young Philanthropists, mostly by small donations invested in trust funds for the future. Many people in north Belfast have a very real sense of ownership of the Mater, and I understand why the proposals have generated such strong feeling in the community. Some £17 million has been raised entirely by the Mater Trust and the community to develop new facilities such the McAuley wing in the hospital, which has some of the most modern facilities of any hospital in Northern Ireland. I have not yet had the privilege of seeing those facilities, but in view of the number of responses and the concerns expressed about the proposals in "Developing Better Services", I hope to visit the Mater to see the McAuley wing for myself, as well as to take the opportunity to talk to staff and members of the wider community. I want to do that before reaching decisions at the end of January.

However, I know that both the acute hospitals review group and "Developing Better Services" proposed that acute services should continue at the Mater for some years to come. I would certainly agree with that. It has not been lost on me that, in an area so divided by sectarian strife in recent times, the Mater issue has united the entire community. Therefore, I can say now that for a considerable period ahead, the Mater will continue to provide a full range of acute services to the north Belfast area. My hope is that in declaring that intention now, I can significantly reduce the concerns of the very large numbers of people who have campaigned for the retention of acute services at the Mater ahead of final decisions.

Having said that, I also referred to the enormous changes that have taken place in hospital services in recent years and to the drivers for further significant change. It will be essential to regularly review the profile and configuration of hospital services, and it will equally be essential that the Mater develops close working relationships with the Royal Victoria and the Belfast city hospitals so that it becomes an integral part of a Belfast teaching hospitals clinical network.

Whiteabbey hospital provides a limited range of acute services and "Developing Better Services" proposed that it should become a local hospital providing a range of local services as I outlined, linked to the acute hospital network. Whiteabbey is situated between Antrim hospital and the acute hospital network in Belfast. I know that the acute hospitals review group report suggested that Whiteabbey should network with the Mater to provide hospital services. "Developing Better Services" did not address that recommendation, but it is worth considering such a network. If the Mater were to continue to provide a full range of acute services, there would be merit in developing Whiteabbey as a modern local hospital delivering a wide range of local services and networking both with Antrim hospital and the Mater, since I understand that many people in the Whiteabbey and Newtownabbey areas look to Belfast rather than Antrim for acute hospital services.

Once again, I want to reflect on the responses to the consultation and consider the long-term viability of the acute services that are currently delivered at Whiteabbey and the opportunities that a local hospital might bring to the wider Whiteabbey community. I do not want to pre-empt the outcome of the consultative process and I realise that I cannot give the hon. Member for Belfast, North all the assurances that he requires. However, I am very much alive to the concerns of the people in his constituency and have sympathy with them. My overriding aim is to get the best possible outcome from the proposals in "Developing Better Services" that will address the compelling need for change in hospital care.

I can, however, give the hon. Gentleman an assurance that, in common with all the proposals in "Developing Better Services", I will not come lightly to any decisions that will set the future direction of hospital services in Northern Ireland for many years to come.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes to Eight o'clock.