HC Deb 14 January 2003 vol 397 cc654-62

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

7.20 pm
Mr. Andrew Turner (Isle of Wight)

I am grateful to you, Mr. Speaker, for offering me the opportunity to raise this subject in an Adjournment debate. Although the debate is about public services on the Isle of Wight, for reasons that will become apparent, I shall devote my speech almost entirely to health, and I thank the Minister for taking up the challenge.

I should like to acknowledge the hard work done by all those involved in the provision of health services on the island—and not only those at the front line, as the managers sometimes come in for undue criticism. I acknowledge with thanks the help that David Crawley and Graham Elderfield, respectively the managers of the primary care trust and of St. Mary's and the Isle of Wight Healthcare NHS trust, have given to me in preparing for this debate.

I wanted to raise four issues—dentists, financial allocations, HealthFit, as it is called, and the King Edward VII hospital at Midhurst—but the Minister and I had a little outing over dentists earlier today and I do not propose to repeat it. I shall therefore start with island health funding. The question that concerns many people on the island is whether we are to live a hand-to-mouth existence in health funding or whether the funding formula will explicitly recognise the island's needs. In autumn 2000, the case was made for recognition of the island's particular needs and it was referred to ACRA—the advisory committee on resources action—on 23 August 2001. ACRA made recommendations that led to Ministers turning down our case for the island's specific needs, and we were notified of that decision on 19 December 2001.

I recognise that the Government are putting an extra £37 million into the Isle of Wight primary care trust over three years, as was announced on 11 December last year. However, is that a recognition of the island's explicit needs or merely part of a funding uplift that the Government are imposing generally? The basis of the argument that has been advanced, which is set out in more detail in the document "The Isle of Wight Health Economy: The Island Factor", dated September 2000, is that the Isle of Wight is an atypical health authority or PCT. Indeed, it is a unique health authority—or PCT—as it is, first, an island. Things cost more on the island because of the cost of transport. There are diseconomies of scale on the island that cannot he met by merger with an adjoining health authority. Secondly, we have a population of 125,000 most of the year round, which is swollen to 350,000 by tourism in the middle of the year. Thirdly, we are one of only two non-ambulance trusts with responsibility for ambulances. Fourthly, our boundaries are defined not by arbitrary and easily adjustable lines on maps, but by something that is rather more difficult to adjust—coastlines and cliffs. Travel to the mainland takes about one hour and 45 minutes from St. Mary's hospital in Newport to the Southampton hospitals, or one hour 15 minutes to St. Mary's in Portsmouth.

The manifestations of our needs are that we have more consultant posts per head of population because they are needed to provide 24-hour cover. We have an increased cost of specialist residential care. For example, when patients go to the mainland for cancer treatment, they need to stay at the Abbey unit in Southampton. In their condition, they are unable to take two sea journeys a day, five days a week for up to six weeks. That is an additional cost, and there are additional costs in running the ambulance service. Of course, there is also unused capacity. It was estimated in 2000 that those additional costs, which are unique to the island, amounted to between £2.4 million and £2.8 million.

I recognise that the Government may argue that those costs have been met in 2003 to 2006, but I ask the Minister to confirm whether those needs are explicitly met in the funding allocation formula for PCTs or whether it is merely a matter of luck. If they are explicitly met, how has the formula been changed to take that into account?

The assumption underlying our argument is not like those for Scottish islands or remote rural parts of England, where there is a population of fewer than 30,000 or where there are road links to other hospitals. It is that 350,000 people in the summer and 125,000 in the winter must have an accident and emergency service, and therefore must have the 24-hour cover that supports that accident and emergency service, which has been described by the joint consultants committee of the BMA as acute medicine, acute surgery, trauma and orthopaedics, obstetrics and gynaecology, paediatrics, a full anaesthetic service, ITU, CCU and HDU, pathology and radiology, 24 hours a day, seven days a week, 52 weeks a year. That is a basic minimum without which A and E cannot function effectively or, indeed, safely. The excess cost of having that was £1.4 million in 2000.

The island also runs its own ambulance service and has made great efforts to improve the quality and efficiency of that service. The cost of patient transport is not covered by other activities as it is in other areas. I am asking the Government to recognise the continuing need for the accident and emergency service, for patients on the island to be treated within that golden hour within which they need to be treated if they are to have a good chance of survival.

That brings me on to a proposal that emerged only last week from the strategic health authority. It is bringing forward proposals which, if implemented, would undermine the argument that there is a minimum "must have" provision for the population as I have described. Last week it published Healthfit, a set of proposals with the effect of reducing from five to three the number of district general hospitals in Hampshire and the Isle of Wight.

I recognise, of course, the continuing need to obtain greater efficiency and improved patient care, but the health authority itself states: It is clear that further centralisation per se will not be tolerated by communities. It proposes two primary care diagnostic and treatment centres with a range of functions, and it looks as though it is proposed that St. Mary's hospital in Newport should be one of those centres. Two sites would lose under those proposals—Winchester, which, of course, can speak for itself, and the Isle of Wight.

It is curious that the document states elsewhere: The issue of access in an emergency situation is particularly sharp for the…Isle of Wight."— I certainly recognise that— However, the emerging view of the Healthfit event was that greater thought needs to be given to emergency access to the mainland rather than treating the Solent as a barrier". Let us examine what the closure of accident and emergency services means. It means that 2,000 people in February and 3,000 in August would have to travel to the mainland accident and emergency services. Air ambulances at present are used about once a month. Emergency transfer by ambulance and ferry can be undertaken within 35 minutes, but what would the walking wounded do? What would those who do not need an ambulance do? What would happen when the ferry was fully booked? Would private cars be able to jump the queue if it were claimed that somebody needed accident and emergency treatment? What would happen at night, when ferries do not run for two hours and the high-speed service does not run at all? What about the occasions—only two or three days a year, perhaps—when the high-speed ferries are cancelled, and those occasions—fewer, but there are still some—when all ferries are suspended? That has to happen when there is a force seven gale or worse. As the Isle of Wight Healthcare NHS trust has said, There have been several occasions in the past few weeks where ferries were unable to run and helicopters could not fly. Safe transportation of patients in a critical condition has been shown, through experience, to be difficult and the last option of choice. Indeed, it is not an option of choice at all, as my constituents know to their cost.

What about maternity provision? I had the privilege of visiting the maternity unit at St. Mary's on the Friday before Christmas. The report says that a relatively small number of units offering the most high-tech care to women were required. In terms of Hampshire and the Isle of Wight, it was suggested that two units at Southampton and Portsmouth would be sufficient. The group recognised the particular needs of the island, which it says will need careful thought. My reading of that proposal accords with that of the overwhelming majority of islanders. The Isle of Wight County Press described the report as "explosive". A packed meeting of the community health council last night rejected the proposals. The trust says that islanders will not take any change, meaning a reduction in services, lying down. The strategic health authority obviously thinks that it is Moses and can make the seas part. I fear that it is more like Canute, because the islanders are not the children of Israel and accident and emergency services in Portsmouth are certainly not the promised land. If the Department of Health is really putting as much new money into the NHS as it says, the proposals should be unnecessary. Whether or not that is the case, they are unacceptable to my constituents and to me. I very much hope that they are unacceptable to the Minister, too.

Finally, I come to the receivership and possible closure of King Edward VII hospital, Midhurst. One hundred of my constituents were brought together at 24 hours' notice on Friday, and were joined by many more people today from across the south of England. My hon. Friend the Member for Chichester (Mr. Tyrie), I suspect, will seek to catch your eye in a moment, Mr. Speaker, to add to my comments. It was an appalling and terrible shock to hear that that fine hospital was in receivership on 30 December. The immediate reason is clear—the failure of NHS purchasers to offer dependable contracts. Patients and supporters on the Isle of Wight have been harrying me, quite rightly, since my election to prevent the cardiology contract being moved to Brighton. The primary care trusts reckoned that eight patients could be treated at King Edward VII for the same sum that could be used to treat 10 at Brighton, which has greater capacity. However, waiting times at King Edward VII were three months, but are six months or more at Brighton. Brighton only counts waiting times—this is idiosyncratic in the extreme, with one doctor describing it as scandalous—from the point of the first appointment with a consultant. Patients are now being sent to Oxford, Tooting and further afield. The PCT has to pay the trust from patients' choice funding to send the patients elsewhere, despite the fact that Brighton cannot fulfil its contract. Last Wednesday, the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), said: The Government…believe in the NHS. It can become the service that we want it to be, offering more choice to patients over where and when they are treated, greater access to higher quality care and faster, more convenient treatment."—[Official Report, 8 January 2003; Vol. 397. c. 276–77.] I asked him about King Edward VII—words came aplenty, but answer was there none. I shied away from expressing my view on the PCT's decision when it was made—after all, I have to live with its members and have no reason to distrust them. Now, however, I know of other business taken from King Edward VII by hospitals across the south of England, and can report the view of a doctor in my constituency, who told me on Monday that overwhelmingly, the motivation was political. I cannot begin to understand why a hospital that was built and upgraded at no cost to the NHS is good enough for the NHS when the NHS fails to meet its waiting list targets, but not at other times. I cannot begin to understand why it is wrong for a PCT to make a contract with a hospital, but it is right for a trust to sub-contract to the same hospital. I cannot begin to understand why 400 opportunities for cardiac intervention a year are lost while my constituents are waiting—and one or two of them regrettably die on the waiting list.

Dr. Mark Connaughton, the heart doctor at St. Mary's hospital, Newport, told me: South coast hospitals simply cannot cope. He said that King Edward VII is of good provenance…There is really no problem that would stop you referring patients there. Most people who need cardiac intervention are old. They have paid into the NHS since its inception, yet in their hour of need they are told to wait, despite capacity being available. That is quite simply something that neither they nor I can understand. I hope that if the Under-Secretary can understand it, he can explain it.

7.34 pm
Mr. Andrew Tyrie (Chichester)

I should like to say a few words that follow on directly from what my hon. Friend the Member for Isle of Wight (Mr. Turner) was saying about King Edward VII hospital. The closure of that hospital, if it takes place, will indeed be dire for the citizens of the Isle of Wight and will make life difficult for many patients throughout the region.

I just want to put a few points to the Minister, so that they will be clear in his mind. First, the King Edward VII is not a private hospital. It is an independent charitable hospital that has taken roughly 50 per cent. of its patients from the NHS sector for the past 50 years. In many respects, it is a prototype of exactly what a foundation hospital should look like—that is, a genuine public-private partnership. As my hon. Friend said, many capital costs are borne by the private sector. The NHS reaps all kinds of benefits—some tangible, some less tangible—from having such a superb hospital available for its use. That is reflected in the fact that it generates enormous local charitable giving. People are keen to give to it; they want to support it. It has achieved exactly what the Secretary of State for Health has said he wants foundation hospitals to achieve: a genuine partnership with the local community.

The main reason the hospital is in trouble is that there has been a sharp drop in the NHS work being referred to it. The figures for patient discharges over the past 18 months show a drop from 270 per month to 112 per month. NHS funding has gone down 40 per cent. in the past six months. One of the reasons given for that is that the hospital is more expensive to run than others—that it costs more per unit of treatment. I notice that a press release from the strategic health authority today suggested that a coronary bypass costs 38 per cent. more at King Edward's than in Southampton. I have discussed that figure with experts, who tell me that it may look all right, but that NHS figure excludes all costs relating to consultants. There is no consultancy fee in the NHS comparator, so the figures are not comparable. I know from my time in the Treasury—I am sure that the Minister is becoming aware of this—that who really bears the costs in the NHS is a hugely complicated question. Most of the comparator figures that he is being given are questionable, to say the least. The more he delves into them and scratches them, the more he will discover that.

What will happen if the King Edward VII hospital closes? Patients from the Isle of Wight will find themselves on very long waiting lists at other hospitals—in Southampton, Portsmouth and Guildford, in particular. What will happen to waiting time targets for radiotherapy, for example? Those targets are already not being met. There is no way that the 2004 targets that have been published will be met by those hospitals, even without the closure of King Edward's. King Edward's has superb radiotherapy facilities, which would no longer be available. While all this is going on, patients are being sent abroad—for orthopaedic care, for example—at a much greater cost than that of the treatment they could get just up the road. That includes patients from the Isle of Wight. There really must be an absurdity in the NHS funding system if that is what is going on.

There is more to the closure of some hospitals than patients going through them like pieces of meat through a sausage factory. Here, we are talking about a centre of excellence. King Edward's has not just been a private hospital doing some routine surgery. It has been at the cutting edge of research, treatment and innovation, particularly in orthopaedics, in some aspects of cardiac care and now, with the equipment that it has, in radiotherapy. I implore the Minister to look at how these extraordinary decisions to cut NHS funding at such short notice have been taken. The constituents of my hon. Friend the Member for Isle of Wight will be gravely affected by this, as will mine in Chichester.

7.39 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)

I congratulate the hon. Member for Isle of Wight (Mr. Turner) on securing a debate on a subject that is important to the NHS and, especially, to his constituents. National health service and social services provision on the island is rightly of particular concern to him and he eloquently expressed the reasons for that. I assure him from the outset that the Government are committed to providing high-quality health services for everyone, wherever they live.

I am pleased to respond to the debate because it enables me to put on record the developments and improvements on the Isle of Wight in the past few years. Not only has health care provision been reorganised but the Government have invested considerably in NHS infrastructure and service delivery.

Health services are never stagnant: they adapt to new opportunities and challenges as they appear. That applied especially when the Government introduced the NHS plan and the "Shifting the Balance of Power" initiative. In accordance with those policies, it is up to strategic health authorities and primary care trusts, with their specific local knowledge and expertise, to plan and develop health services in line with the needs of their local communities.

It might help if I dealt with the hon. Gentleman's point on special status for the island immediately. As he knows, the advisory committee on resource allocation—ACRA—considered any additional cost that is associated with being an island in September 2001. The announcement was made in the following December.

The committee concluded that the arguments in a local consultancy report on behalf of Isle of Wight health bodies did not constitute a convincing case. It recommended no adjustment to the Isle of Wight's target under the resource allocation formula. My right hon. Friend the Secretary of State accepted ACRA's recommendations.

Since 1997, there has been continuous investment in the Isle of Wight's health economy. It may help to remind the hon. Gentleman and the hon. Member for Chichester (Mr. Tyrie) of some of that investment, which includes: £28 million to refurbish mental health accommodation; £640,000 for personal dental services; £631,000 to implement the free nursing care policy; £400,000 to improve intermediate care; £100,000 to help reduce waiting lists; £100,000 for local capital modernisation funding; £38,000 for smoking cessation programmes; £29,000 for palliative care; £17,000 to help reform the emergency care that the hon. Member for Isle of Wight mentioned, and a further £10,000 for the booked admissions programme.

However, we are considering not simply investment but improving health care for those who live on the Isle of Wight. I shall give one example of service improvement. The Government set ambulance services a target of reaching 75 per cent. of category A—life-threatening—calls in eight minutes. In 1997, the Isle of Wight ambulance service reached only 55 per cent. of such calls in the target time. The trust informs me that, as of January this year, the figure is 81 per cent. I congratulate the men and women who operate the Isle of Wight's ambulance service on fulfilling and exceeding the target.

The trust also anticipates reaching the 12-month in-patient waiting time, the 21-week out-patient targets and the accident and emergency access target times this year. I am sure that the hon. Member for Isle of Wight wishes to join me in congratulating all members of his local NHS team on their industry and hard work.

Let me consider the increases in financial resources. In 1997–98, the island received an allocation of £68 million—a 3.48 per cent. increase over the previous year. That has risen considerably to £108 million in 2001–02—a cash increase of 9.6 per cent. By any standards, those are considerable increases in financial allocation.

In fact, next year the Isle of Wight's primary care trust will receive a further increase of 9.7 per cent.—some £11.6 million. That is one of the highest increases in funding across the strategic health authority, and higher than the national average increase of 9.24 per cent. Even the hon. Gentleman must acknowledge that, far from the cash available for improvements to health care on the island being reduced, resources have increased dramatically during the period of office of this Government.

I hope that the hon. Gentleman will also accept that that proves that the principles set out in the NHS plan were not just empty gestures. We have put the necessary money into the system to carry the reforms through and to support service delivery. Of course, we are not stopping there. In December, my right hon. Friend the Secretary of State announced the budget allocations that PCTs will receive in the next three years. For the first time since the inception of the NHS, local organisations can plan service provision years in advance, and according to local priorities and needs, many of which were articulated by the hon. Gentleman. As I said, the Isle of Wight PCT, which is the hon. Gentleman's local organisation, will receive a 9.7 per cent. cash-terms increase—a cash allocation of some £131.7 million. That is a significant amount of money.

The hon. Gentleman also raised the issue of HealthFit. HealthFit is a process that is taking place across Hampshire and the Isle of Wight to ensure that safe and sustainable health services are available for local people. We have a responsibility not just to provide health services today, but to ensure that they are fit for the future. The NHS in Hampshire and the Isle of Wight takes these responsibilities very seriously, and it is at the early stages of a process that will go on throughout this year and beyond, and which will include open discussion and debate with patients, the public and partner organisations. It will ensure that local people are fully involved in that process.

Both the hon. Gentleman and the hon. Member for Chichester mentioned the King Edward VII hospital in Midhurst. I do not want to make the point too strongly, but there is something of a paradox here. Both hon. Members are keen to ensure central intervention and investment in that local hospital, but in some senses that is in conflict with the policy position of their party. We are putting in the money, and ensuring that such local decisions are taken by local people.

Mr. Tyrie

If the money is going in, why is there a £60 million deficit in the strategic health authority's budget?

Mr. Lammy

The hon. Gentleman knows that, across the piece in Britain, different health economies find themselves in different positions for historical reasons. The issue that he raises goes back some considerable time, but we have reached a point where we are putting in significant investment. I should point out to him that a 20 per cent. cut would make the situation even worse for his local strategic health authority.

Much has been said in the media, and recently in this House, about the future of the King Edward VII hospital, and the issue has been raised again today. Let me state from the outset that the NHS remains prepared to continue with its current commitment to the hospital. Its refusal to provide the support that was requested immediately before Christmas related to serious concerns about the additional volume required, which was at a price and through a process that could not be defended in terms of accountability in the use of public money. Officials from both the Department of Health and the strategic health authority have held discussions with hospital representatives for a number of weeks, and all parties will continue to hold discussions with the hospital and with the liquidator. I can assure the hon. Gentlemen that there remains—

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

Adjourned at ten minutes to Eight o'clock.