HC Deb 07 March 2002 vol 381 cc524-32

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

7.10 pm
Mr. Julian Brazier (Canterbury)

I am grateful for the opportunity to raise once again the future of Kent and Canterbury hospital and of acute health services in east Kent. I am also grateful to my hon. Friends, including my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson) and the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt), for coming to support me here.

Since my last Adjournment debate, four formal options have been put forward and the consultation period has just closed. The crisis in our hospitals has worsened. I believe that all four options put out to consultation are dangerous, and that the formulation of those options—the process before consultation—was hopelessly flawed.

Time restricts me to describing just four factors this evening. The first is the failure of East Kent health authority and the East Kent Hospitals Trust to relate the issue of capacity to that of affordability. The second is their failure to include cancer. The third is the lack of support for, and consultation with, the medical and nursing staff, and the fourth is the issue of access.

Let us start with capacity and cost. Last year, 81 consultants—almost half of those in all three sites in east Kent—supported a motion stating that the quality of patient care was being undermined by a shortage of capacity. More than four fifths of junior doctors across the three sites signed a letter making a similar point. Since then the position has worsened. Individual cases, such as those of 97-year-old Connie Jones and 82-year-old Arnhem veteran Bill Holman, both of whom were left for two nights on trolleys in our accident and emergency unit, are sad examples of the worsening crisis. The queues outside the casualty departments at all three east Kent hospitals continue to grow. On some nights recently, we have had as many as 50 trolleys in the Kent and Canterbury hospital casualty department. Colin Baker, the distinguished ITN war correspondent making a programme for Trevor MacDonald, said that the situation was as bad as a Balkan battle zone. He should know; he was wounded in one.

Elective surgery has been disrupted to the extent that operating theatres are under-utilised due to a lack of beds. I shall give one example from the many. Yesterday I received a pitiful letter from a constituent who has had her hysterectomy operation—needed because of desperate bleeding—cancelled for the fourth time. Surely the most important issue for the consultation should have been to show how the revenue costs of each capital option would allow room for the extra beds that we so desperately need. Instead, all the options have been presented without any capital costing. There are no financial figures. Instead, the management continue to promise that their plans will allow for 175 extra beds. Asked about funding, they simply say that that is a matter for their political masters.

It will come as no surprise to you, Mr. Deputy Speaker, or to the lady Minister, whom I welcome to her place, to hear that it is not my job to defend a Labour Government. It would, however, place an unreasonable demand on any Minister of any Government if the management were simply to say that they were going to engage in a programme of colossal capital spending—with all the revenue implications that that entails—and that the funding consequences were a matter for Ministers.

Estimates for a less radical option A—the so-called Dobson option—have risen from £102 million to £150 million. The average overrun for larger private finance initiatives has been about 30 per cent., which would raise £150 million to £200 million. However, that would fall a long way short of the cost of the most radical option, option D. A typical annual PFI costs about 10 per cent. At a time when the south eastern NHS budget is desperately overstretched, can such a burden be afforded, even without adding any of the extra beds that we desperately need now?

My second point is that the cancer centre has not been included in the consultation process, although the document includes an appendix on cancer and Professor James, the director of cancer services in Kent, appeared at all the consultation meetings. He said again and again that he was determined to keep a full cancer centre in East Kent. He further told us that all three oncologists at Kent and Canterbury hospital—he referred to them by name—fully supported him and the plans in the document. Above all, he stressed that, with an oncologist post vacant, they could keep the oncology centre going with its new linear accelerator only if a positive atmosphere was generated to attract new blood to Canterbury, and we all agreed on that last point.

Unfortunately, the truth is that two of the three consultants to whom Professor James referred had already put their vehement opposition to the proposals in writing in public letters some weeks before, and the Minister has those letters. They pointed out the clinical dangers in the approach. I understand that the third oncologist has now denounced Professor James for misleading the public about her views.

The national cancer director, following a visit to the Canterbury oncology centre, has also refused to endorse the concept. He said in his letter only that "It might work". In fact, the text rules out keeping a cancer centre under two of the four options, and even says: For the longer term it is not possible to guarantee the continuous medical support … that is required for safe inpatient radiotherapy and chemotherapy services in Canterbury. Is that the positive language that will help to recruit a new oncologist to East Kent's cancer centre? Crucially, the Maidstone and Tonbridge Wells Healthcare Trust, which is responsible for cancer services in Kent, was not a signatory to the document.

The third issue is the exclusion of so many doctors and nursing staff in the formulation of the four options. No proposal is likely to work unless those that have to deliver it feel committed to the outcome. Obviously, that does not mean total consensus. However, everyone must feel that they had the opportunity to put their point of view, and a reasonably large majority of the doctors and nurses involved must agree with the broad outline of the outcome.

Mr. McNee is a urology consultant who is based not at the Kent and Canterbury but in Ashford. He said: I am extremely angry about the consultation document. I first came across it at llth January 02. My clinical director Robert Insali had not seen it until I showed him.… At no point has there been any discussion with the body of urology consultants. Another Ashford doctor, John Sewell, who for 21 years has been a consultant physician in emergency care, has condemned the proposal on eight grounds ranging from cost to the risk of service collapse. He sent a confidential letter, then courageously scrubbed out the word "confidential" and made it public.

The pattern among consultants is repeated among the junior doctors. All three East Kent branches of the Royal College of Nursing, Canterbury, Thanet and south eastern, have come out against the proposals in a joint document, which states that the RCN believes that the proposals could fundamentally undermine future quality of care for patients in East Kent, particularly older people". They also condemn the failure of the document to cover community services. It seems absurd to do such a radical reappraisal of acute services without covering community services.

Is this the way to treat dedicated professionals? They are the very people who will have to deliver the quality health care that we need in East Kent in the future. Is that the way options should be formulated?

Finally, I turn to the question of access. Canterbury is the centre of east Kent, the hub of the bus and rail system. Canterbury and Faversham GPs belong to by far the largest primary care group in east Kent. They have voiced their opposition to the proposals in the strongest possible way. Both Dover and Shemk ay district councils faxed their replies to me this afternoon, rejecting all four options. One council calls for an independent review, and the other uses similar language. I understand that all the councils in Kent, apart from Ashford, have demanded that the cancer centre be kept in east Kent, and in practice that has to mean that it be kept at Canterbury.

The independent hon. Member for Wyre Forest (Dr. Taylor) has asked me to pass on to the House his apologies, as his broken arm prevents him from attending this debate. He is organising a rally for 25 March to get new thinking into emergency provision, based on ideas from the Royal College of Physicians. I hope that Ministers will listen to him.

In summary, the formulation of the proposals is deeply flawed. Many of the crucial people—the doctors and nurses who have to deliver the services—appear not to have been consulted. The cancer centre was excluded from the process, and its needs were pushed in a cowardly and unsound manner into the back of the document. Issues of access were simply glossed over.

Above all, the desperate and growing capacity crisis has been simply ignored. A fig leaf of nominal extra beds has been produced, while the authors of the proposals have ducked away from considering whether the proposals will allow us to fund even the existing number of beds, let alone some extra beds.

When the proposals come before the Minister and the Secretary of State, I urge that they be sent back to East Kent health authority, which will dissolve at the end of the month. I hope that the Minister will ask its successor authority, the new Kent and Medway strategic health authority, to start again with properly formulated proposals based on consultation with the doctors and nurses who will have to implement them.

7.21 pm
Mr. Derek Wyatt (Sittingbourne and Sheppey)

I0for Canterbury (Mr. Brazier) on securing this Adjournment debate. I almost want to call him my hon. Friend, as he has been outstanding in keeping me informed about everything that has happened in this matter. Cross-party support in the matter has been evident for four years, and the hon. Gentleman and I have gone together to see Secretaries of State. We have displayed our anger together, and sometimes we have found it impossible to understand the answers that we have been given.

At this late stage, I hope that my hon. Friend the Minister will consider seriously the points made about cancer by the hon. Member for Canterbury. That is the health service's top priority, and I honestly do not feel that we will have a centre for cancer in east Kent of which we can be proud.

I also want to draw my hon. Friend the Minister's attention to the fact that the Kent and Canterbury's accident and emergency department is a disgrace. She must recognise that immediately—that is, now. I do not believe that we can he proud of something that is so bad. Are not there hit squads that can be sent in to improve matters, or is no extra funding available? Are there no mobile rooms that we can use to help matters? There must be a way to take people off the trolleys. The A and E provision is demeaning, degrading, disgusting and awful. I ask my hon. Friend to reflect seriously on the urgent answer to the problem. We need that answer tomorrow, not in three or four weeks.

Finally, is it possible for my hon. Friend the Minister—or the Secretary of State, or another health Minister—to make an unannounced visit to Kent and Canterbury hospital? In that way, the state of the A and E department can be seen. It beggars belief.

7.23 pm
Hugh Robertson (Faversham and Mid-Kent)

I want to make three key points on behalf of my constituents in Faversham—a town of 18,000 people that was not even mentioned in the consultation document.

The first point has to do with transport. The transport links to Ashford and Margate are atrocious. There is little or no public transport, and Faversham has many elderly or disadvantaged people. Both groups tend to be heavy users of the health service, but in effect they are being disfranchised by the process.

The second point is that there is no funding to build up local cottage hospitals, such as the Faversham cottage hospital. That hospital could not take over from the Kent and Canterbury, but it could help.

The third point has to do with cancer care. The out-patient model proposed by East Kent health authority is unproven anywhere in the UK. It has been rejected by all consultants, and by the Royal College of Radiologists. The Maidstone hospital—to which all inpatients would transfer, under the proposals—is already overstretched. The proposed model simply could not cope.

I shall end by quoting a letter that appeared today in the Faversham Times. It was written by the chairman of the Faversham branch of the Labour party. He said simply this: To people living in Faversham, it is hard to understand why our services appear to be getting worse". I could not have put it better myself.

7.25 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper)

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing a debate on an issue that he has raised many times. I know that he did so in a debate that was replied to by the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears).

As the hon. Gentleman said, East Kent health authority published a consultation document on 5 December on the modernisation of health services in east Kent. It set out four options for acute-service reconfiguration. As the hon. Gentleman also said, the three-month consultation period ended last week, and the responses are now being considered in the health authority.

All the options enable the hospital to treat the majority of patients whom it currently sees in its accident and emergency department, and to have a 24-hour nurse-led minor injuries unit as well as providing day surgery and out-patient services, orthopaedic services for older people, community assessment and intermediate care. The options also include provision of a day-care hospital, out-patient clinics, midwifery-led low-risk maternity services and cancer services.

East Kent will also benefit from an increase in bed numbers as a result of all four options. Each option would involve an increase of at least 175 beds throughout the trust.

There has been intense consultation, arousing passions and strong views in all parts of the health community and the local community in general. I am advised that staff at Kent and Canterbury hospital were consulted extensively on the shortlisted options between March and August last year, and that staff consultation included one-to-one with consultant staff to review the case for change and the shortlisted options.

I am also advised that four workshops were held and were well attended by consultant, nursing and therapy staff. Four seminars also took place across east Kent to involve staff in the evaluation of the shortlisted options. All consultant staff, senior nurses, therapists and managers were invited. Three workshops were apparently held in January to review the "network of care" arrangements in east Kent. Members of the clinical policy board and three other lead clinicians, two of them from Canterbury, have worked to specify the relationship between east Kent's hospitals. At the last of the workshops, specialist services were discussed in depth.

I am advised that the consultation gave all involved an opportunity to comment and express their views. I am also advised that the community health councils were content with the consultation process.

The exercise was carried out by a joint sub-committee of East Kent health authority and East Kent Hospitals NHS Trust hoards, which draws its membership from across the health community. The sub-committee set up a reference group to examine the processes of the consultation to ensure that it had been robust and inclusive, and had allowed all interested groups to have their opinions heard.

Mr. Brazier

I hope the Minister realises that I am not criticising the consultation process. I am criticising the formulation of the four options that were presented. The Department has had all the letters I referred to for weeks. How does the Minister—who has sensibly used the phrase "I am advised that"—reconcile the letters with the picture she paints of the putting together of the proposals?

Yvette Cooper

I understand the points that the hon. Gentleman is making. Clearly many of them concern the options themselves, and must therefore be taken into account by the health authority when it considers its responses to the consultation. I am also advised, however, that there were extensive consultations on the shortlisted options before the period between March and August last year, and I understand that the community health councils are content that the consultation process has been robust and proper.

The process from here on in is that a joint sub-committee of the trust and health authority boards is responsible for considering all responses and making recommendations to both boards by around the end of March. The two boards will then decide how to proceed, and a recommendation will be passed to the new strategic health authority, the Kent and Medway, which will make recommendations to Ministers. It is the boards' responsibility to base their decision on the consultation responses. If community health councils object to the recommendations, they will be referred to Ministers.

The hon. Gentleman will therefore understand that if we are to ensure that those processes are properly carried out, it would be inappropriate for me to pre-empt not only the boards' decisions but those that Ministers may have to make if the recommendations are referred to them. However, I will attempt to respond to some of the points raised by the hon. Gentleman and other hon. Members during the debate.

My hon. Friend the Member for Sittingbourne and Sheppey (Mr. Wyatt) asked if Ministers could visit Kent and Canterbury hospital. I can tell him that the Under-Secretary of State for Health, my hon. Friend the Member for Salford, intends to visit the hospital in the coming weeks and will have the chance to listen to views at that time.

Hon. Members also raised issues of capacity in the area. I can tell them that there has been considerable extra investment in east Kent. I agree that capacity in the area needs to increase, and that East Kent health authority continues to need additional investment, as does the NHS throughout the country. Next year, East Kent health authority will receive an increase of 9.85 per cent. in cash terms, which is an increase of 7.17 per cent. in real terms. The Government are determined to continue those increases in funding because clearly we are dealing with issues of long-term underfunding and lack of capacity throughout the health service. We will continue to address those issues.

In addition, the Government are providing £845,000 from the modernisation fund to improve patient access schemes in east Kent; £935,000 to help the move to six-day working for day surgery; additional money for dermatology and orthopaedics; £2.1 million to help to ease Kent-wide problems associated with delayed transfers of care; and £250,000 to streamline accident and emergency services and provide support for rapid access to therapies, diagnostics, pharmacies and porters.

Hon. Members referred to accident and emergency services. The Government have acknowledged the severe pressures on A and E, particularly during the winter months. The trust has acknowledged that Kent and Canterbury hospital has faced considerable pressures, particularly in the A and E department. The Department of Health's winter and emergency services team visited the trust recently. It recognised the excellent work being done by staff at the trust, but identified some areas that must benefit from improvement, and made several recommendations.

An intensive support team of six people has been identified to work with the trust over the coming months. That team, comprising experienced doctors, nurses and health care professionals, will help to develop plans to modernise the A and E department with emphasis on the clinical governance agenda. It is important to be clear that the issues are not simply additional capacity and investment. We need reform and modernisation to make sure that care is provided in the best possible way and using the most up-to-date methods.

Hon. Members also referred to cancer services and I can assure them that their points have been heard by Ministers. If community health councils refer these issues to Ministers, they will certainly be considered.

Mr. Brazier

I am grateful to the Minister for giving way a second time, but I seek clarification on a further point. The outcome of this will have a profound effect on cancer services, but they are not part of the consultation process and Maidstone and Tunbridge Wells trust was not among the consultees and did not sign the document. Do the community health councils have the legal power to refer those matters to the Secretary of State?

Yvette Cooper

If the matters under consideration as part of that consultation are referred to Ministers by the community health council, Ministers will take account of the points that hon. Members have made in this House about cancer and related issues when they come to consider those subjects.

The Kent cancer network has looked at the national cancer plan in order to determine the future vision for the delivery of cancer services in Kent. It is clear that cancer services will continue to be provided at a number of hospitals, including the Kent and Canterbury. I am advised that the vast majority of patients requiring cancer services will continue to be treated in Canterbury under each of the four options. The few patients in Kent who need specialist cancer services will continue to be treated in centres that are able to provide the specialist care that they require. That is entirely appropriate and follows good practice and is the most effective means of offering access to high-quality care for all patients.

Cancer services at Kent and Canterbury hospital are part of the Kent cancer network and it is important that they remain so as part of the national cancer plan, the standards of which ensure high-quality care.

The cancer strategy for Kent is currently being developed. It will set out the current arrangements and the priorities for future investment. The East Kent Hospitals Trust is working effectively with the Maidstone and Tunbridge Wells trust and the cancer network towards this aim.

I am advised that in none of the options is it stated that Canterbury will lose its ability to care for cancer patients. The consultation document has given East Kent residents the undertaking that the majority of cancer patients who currently receive treatment there will continue to do so.

Hugh Robertson

Is not the crucial point that even by the trust's own estimates ambulatory or out-patient treatment will account for only 80 per cent. of those currently treated at the Kent and Canterbury? That leaves a significant 20 per cent. of in-patients who will have to go all the way to Maidstone or to other hospitals in London for specialist treatment. That is a significant proportion of patients who will be worse off under this plan at a time when Maidstone, at the other end of my constituency, is telling me that it cannot cope.

Yvette Cooper

Again, I have to say that the issues around the options need to be taken into account first and foremost by the local boards. They must make their decision. It would be wrong for me to pre-empt that process.

When it comes to cancer patients and cancer care people want to be sure that they are getting the highest quality care, especially for life-threatening conditions. We need to consider issues around access, but also issues around the quality of care. That in the end is what the national cancer plan and the discussion of cancer networks was all about. Those factors need to be taken into account.

Whatever option in the re-configuration is chosen, the adoption of the national cancer plan will continue to influence and improve the final pattern of services to be delivered. As part of the cancer plan we need more nurses, doctors, radiographers and equipment, and we need to ensure that new drugs are available to those who can benefit from them and that people suffering from cancer get the highest possible quality of care.

Although many views on reconfiguration issues are being discussed in east Kent, I understand that there is agreement that the issues must be fully discussed and in an informed way. All parties recognise the important need for modernisation and for investment in the area. It is important that the debate has been aired widely and fully, and I know that the hon. Member for Canterbury has striven to do that at every possible opportunity.

I assure the hon. Gentleman, my hon. Friend the Member for Sittingbourne and Sheppey and other hon. Members that Ministers do not take the turbulence that the different views have created lightly. We consider it seriously and—

The motion having been made after 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 twenty minutes to Eight o'clock.