HC Deb 18 June 2004 vol 422 cc1049-58

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

2.32 pm
Tom Brake (Carshalton and Wallington) (LD)

I am pleased to have secured the debate in the pre-consultation period of the "Better Healthcare Closer to Home" project, which is otherwise known as the clinical services review or strategy. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) hopes to catch your eye, Mr. Deputy speaker, and I shall leave him some of my time to raise other points with the Minister.

I had friendly discussions with the Minister's spy at yesterday's seminar and I understand that the spy has been in touch with him and that he has been fully briefed. I therefore hope that he can respond to the points that I shall make.

First, I support the concept of the strategy, which is that there should be a critical care hospital and several local care hospitals. Yesterday's meeting was well attended by representatives from many health organisations, patient groups and so on. There was support for the initiative at the meeting. People asked for more information but they also wanted to make progress. A problem with such projects is that the time scales are inevitably long because of the need for consultation, reforms, the building process and so on. If steps are not taken, there is a risk that the project will die an unceremonious death when some new initiative supplants or replaces the current one. People want progress to be made.

St. Helier hospital and Sutton hospital clearly need to be rebuilt. Anyone who has visited those hospitals will know from the state of the structures that they require urgent attention. I understand that parts of St. Helier hospital are off-limits to patients because of health and safety concerns. Measures such as the working time directive make the need for the development of such concepts even stronger, and the proposed changes would probably happen in any case.

Whatever configuration is arrived at for the local care hospitals and critical care hospital, the highest priority must be to ensure the best quality of patient care. It is also important that the critical care hospital should be as close to the centre of the area that the trust serves as possible, with that centre adjusted to take into account the health profile of the catchment area. St. Helier is an area of my constituency, and of the London boroughs of Sutton and Merton, that has significant health needs to be addressed.

Accessibility and employment considerations will also be factors in determining where the critical care and local care hospitals will be located. St. Helier, which crosses the London boroughs of Sutton and Merton, is one of the areas with the highest level of deprivation in those two boroughs, so the employment impacts will be significant. Accessibility for a population many of whom do not have access to their own transport will also be important. One measure that could significantly improve the accessibility of St. Helier hospital, which is already good, would be the extension of the Croydon tram to Sutton. If the Minister is a good friend of Ken Livingstone, perhaps he will have a word with him about bringing that tram to Sutton. We would certainly welcome that. The location of the hospital will of course be dependent on other factors such as the availability of land and planning considerations, but taking all those criteria into account, the St. Helier site is likely to be the most appropriate for the development of a critical care hospital.

I should point out that although I think that the development of such a hospital would be welcome in the area, some residents who live on the proposed new hospital site would be affected quite significantly by it and might have some objections. I intend during the next few days to write to the residents who would be most closely affected to ask them for their views and to bring to their attention the fact that although there is nothing concrete about the plans yet, there are proposals of which they should be aware.

If the St. Helier site is developed, because the proposed land is metropolitan open land the Office of the Deputy Prime Minister will have to approve the change, although I understand that there is likely to be compensation in terms of metropolitan open land being provided at another location close by, which might address that issue.

Another site, the Sutton site, is also being considered, as is the Epsom site. There is an issue specifically in respect of the Sutton site on which I hope the Minister will respond. The site is close to the Royal Marsden hospital, which has, as the Minister will know, recently secured foundation status. If the Sutton site were to be developed, I have no reason to believe that the Royal Marsden, were it approached and asked to contribute some of its land, would refuse such an approach. In fact, I understand that some positive discussions are under way. However, I pose a hypothetical question to the Minister. If such a trust or foundation hospital anywhere in the country were approached and asked to participate in a project that the community felt was in the best interests of the local health community, and that foundation hospital decided that it did not want to take part, would the Minister have the power to direct that foundation hospital, and would he use that power if he had it? I hope that he will be able to respond on that point.

Another point on which I hope the Minister will respond is the proposal that some have mooted that if the St. Helier site, for example, were developed, the Epsom site would declare UDI and go its own way. Has the Minister had a chance to consider that suggestion? What does he think of its viability?

I have a couple of points on the consultation process. The formal consultation will run from 1 September to 30 November, and my hon. Friend the Member for Sutton and Cheam and I intend to hold a large public meeting in September to hear people's views on the proposals. For the consultation process to be meaningful, options setting out the probable or likeliest location of both the local and critical care hospitals will have to be provided. It must be seen as a package. Given that the range of possible locations for the critical care hospital is limited, it should be possible to identify the probable locations of local care hospitals at the same time. We will need to know what the range of services provided by those hospitals will be, too.

Consultation with patients and future patients will have to be extensive, because the existing forums, which were put in place after the abolition of community health councils, are in their infancy. Consultation will have to encompass not just the people who were present at yesterday's meeting but those who have traditionally been excluded such as black and ethnic minorities, the unemployed, single parents and so on—it must go beyond the usual suspects. Does the Minister believe that the effectiveness of the forums would be enhanced by allowing them to sit as observers on the programme board for the clinical services strategy? I understand that they currently do not have observer status.

The battle over community health councils was lost, but their replacement is in many ways much more complex and underfunded. Does the Minister agree that the original indication was that patient forums would have about 15 volunteer representatives, but that the number has been reduced to 10? Will he explain why? I have been told that that is to save on their expenses, which, incidentally, are lower than those of staff, which I do not quite understand. Will he assure us that the Secretary of State's recently announced cull of quangos will boost the funds that will go to local forums?

Is the Minister aware of a letter that was sent from the collective forums of the south-west London strategic health authority to the chief executive of the Commission for Patient and Public Involvement in Health, in which Barbara Price expresses concern that owing to a lack of information that the forums and forum support organisations receive from the commission, they are struggling with some of the essential administrative and financial aspects of this role? They are concerned that no timetable has been set in which their concerns will be addressed. I hope that he will pick up on that point.

To return to the specifics of the "Better Healthcare Closer to Home" initiative, and to conclude to allow my hon. Friend the Member for Sutton and Cheam an opportunity to speak, it is important that residents who remember the breach of trust that occurred when a previous NHS trust failed to provide a separate children's hospital on the St. Helier site are reassured that the total package will be delivered. They will also need assurances that the reorganisation will not affect existing services and will not exacerbate problems that still exist between the Epsom and St. Helier hospitals, which have not been addressed since their merger a number of years ago.

Mental health issues must be brought to centre stage because they are currently on the periphery, and I welcome the fact that the programme board has agreed that it will present a paper covering the subject. The impact on other trusts needs to be properly quantified and assumptions about how many patients will choose to travel to an alternative hospital will need to be verified against actual changes experienced elsewhere in the country. Nothing will progress without funding, and I hope that he Minister can provide some reassurances on that.

"Better Healthcare Closer to Home" should be good news for patients. It should improve outcomes and make health care more accessible. I hope that the Minister's response will make it clear that the Government will give their backing to these plans. Without the Government's financial support, "Better Healthcare Closer to Home" will be nothing more than a pipedream.

2.44 pm
Mr. Paul Burstow (Sutton and Cheam) (LD)

I thank my hon. Friend for the opportunity to take part in this debate and for his initiative in securing it. It is timely to have the opportunity to discuss this matter, not least because the organisation of health services in the London borough of Sutton and beyond has been an issue of long standing. Over almost the past 10 years, there has been a series of attempts by the Epsom and St. Helier NHS trust to come forward with a set of plans that held together and would be viable. Yet we are still waiting, with out-of date building stock. We are still waiting, in particular, for St. Helier hospital—which is almost ancient—to be replaced. One conclusion that I drew from yesterday s event in Addington is that it is almost universally accepted that, whatever happens, St. Helier needs to be rebuilt to be fit for the 21st century, whether it is a critical care or a local care hospital.

I want to emphasise several points made by my hon. Friend. One thing that emerged from yesterday's debate in Addington was concern about the lack of clarity so far in the process of deciding what local care hospitals are to be. If the new model of care proposed in the local clinical services strategy is to be realised, and people are to buy into it through the area covered by Epsom and St. Helier trust, it is important for us to know how many sites there will be, where they will be, and precisely what services will be provided by the local care hospitals.

The Minister will probably empathise with one point raised yesterday. So far, the opportunity to include social care in the services provided by local care hospitals has been missed. There is an immense need to co-locate and integrate social care, and I hope the Minister will ensure that the opportunity is not lost in Sutton and Cheam or in Carshalton and Wallington.

As a result of the lack of clarity over local care hospitals, the focus has tended to be on the critical care hospital and where it will be. It is not surprising that Members of Parliament and others have fierce loyalties to their existing hospitals, as do our communities. My hon. Friend has already outlined some of the concerns that he and I share with the London borough of Sutton. The local authority feels that the new critical care hospital must be at least as accessible as St. Helier. I would go further, and say that the St. Helier site seems to offer the best fit strategically for a new critical care hospital.

I want to raise two or three issues about consultation. As has been pointed out yesterday and today, we should ask whether a two-site solution is viable. People will want to know, and will want to see demonstrated in the formal consultation, that the two-site option has been properly evaluated. If it is not viable, it should be shown why. If that does not happen, it will inevitably fuel the view of those who think that this is an exercise to get rid of the hospital and have just one acute hospital in the area.

Another question that needs to be addressed in the formal consultation is my hon. Friend's point about UDI. I do not think that it is as much a question of UDI as a question of whether there is merit in exploring the case for an amicable divorce between Epsom and St. Helier hospitals and the recreation of the pre-existing trusts. That is certainly a live issue in Epsom.

One of the things that puzzled me most about the criteria so far for evaluating the various site options was the low weighting given to health equality and equity of access. I hope that the Minister car reassure us that the Government take health inequality seriously when it comes to the reconfiguration of services.

At this point in the life of the project, the capital costs have been estimated at anything between £215 million and £228 million. Other Members with an interest in the project have rightly asked whether that will be deemed affordable. It would be helpful to know whether people are wasting their time with this enterprise, or whether the Government feel that the public purse can afford it. I hope that the Minister will also be able to consider my hon. Friend's points about foundation trusts.

The consultation must not he just for the vocal and articulate few. It must strive to reach the hard-to-reach groups, the vulnerable and those who do not have a voice; otherwise, it will risk letting the community down and not providing health care closer to home that will meet the needs of my constituents and those of my hon. Friend. My hon. Friend mentioned that we plan to hold consultation events of our own during the formal consultation stage. Given our desire to ensure that the hard-to-reach groups are reached, we shall want to hold more than one meeting, and we hope that the NHS will co-operate with us to ensure that factual information is provided to our constituents during the process.

2.50 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

This is an important subject and I suspect that, as the consultation proceeds, we shall not have heard the last of it in the House. I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this debate, and I thank the hon. Member for Sutton and Cheam (Mr. Burstow) for his contribution. They both made important points about the way in which the consultation should proceed and the need to focus on evening out health inequalities. The hon. Member for Sutton and Cheam made the particularly important point that the consultation should involve not just the loud mouthed and the pushy—it also needs to reach those whose voices are not normally heard.

I would like to begin by paying a brief tribute to all the NHS and social care staff in the South West London strategic health authority area. They are hardworking, dedicated and committed to the improvement of the local NHS and local services. Let me start my response to the hon. Member for Carshalton and Wallington by acknowledging the pressures on the NHS, not only in his constituency but throughout the country. A consequence of that is that we must increase capacity, which is why the Government are investing so heavily in doctors, nurses, technicians and new equipment. We must also work to raise clinical standards generally. In other words, it will not be good enough for us to keep doing more of the same; we have to take a radical review of how services are provided.

The NHS plan sets out a challenging 10-year programme for that reform. Far-reaching changes are often necessary to try to provide the best possible services for patients, and we must ensure that those services are accessible, flexible and designed around the needs of patients. However, we cannot do that from Whitehall. It is no good pretending that I know best what is right for the hon. Gentleman's constituency when I neither live there nor access health services there.

It is our policy to shift decision making to local areas. That is why we started the "Shifting the balance of power" initiative and why we now devolve funding decisions to the front line. It is now for the primary care trusts, in partnership with strategic health authorities and other local stakeholders, to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to do that because of their specialist knowledge of the local community.

As part of the modernisation programme, many NHS economies and organisations are using this freedom and responsibility to consider, with their local stakeholders, changes to the way in which they organise their services. They recognise that services cannot be static, and that they must change to reflect changing circumstances and to respond to local needs. In carrying out such reviews, they must take account of a number of different pressures on the local service, including changing medical practice, training-related issues, the working time directive, population distribution and travel times. The hon. Gentleman mentioned all those issues. They have an additional responsibility to live within their means. These issues and many others have to be taken into consideration. Of course, biggest is not always best. Local decision makers need to recognise that patients want more, not fewer, local services. However, that pressure has to be balanced with the need to ensure clinical safety and to develop excellence.

That brings me to the situation in south-west London. In terms of health care in the Sutton, Merton and mid-Surrey area, local stakeholders have looked at the local position and a general consensus has developed locally that the status quo cannot remain. The fabric of the estate at St. Helier hospital is poor, with problems of a lack of privacy and dignity on the wards, and of few toilets and bathrooms. The Epsom hospital is small and some of its building fabric is also poor.

There are challenges associated with recruiting clinical specialists to deliver services over split sites, and with supervising and training doctors. Sub-specialisation is difficult in the present circumstances and it is also proving difficult to create and sustain viable clinical rotas. There is also a duplication of services across the sites and the problems at each site are likely to worsen with time.

There is local recognition that things must change and that there needs to be a locally developed proposal with which to move forward. That proposal—I stress again that it is a local proposal, not one imposed from Whitehall—is to create several community hospitals, referred to in the proposals as local care hospitals, supported by one acute hospital, which is referred to in the proposals as the critical care hospital. This concept has received widespread local support from both consultants and GPs, and there is agreement on the model. There is also general consensus on the way forward that the model represents. It aims to separate the planned and emergency care processes and to redesign services around the patient.

The proposed strategy challenges the notion of what an emergency hospital should really be doing, while seeking to devolve the planned aspects of traditional hospital activity, so that they can be delivered closer to the patient's home. Those services will then be brought together with primary care services to challenge the traditional configurations within GP and health centres. The point that the hon. Member for Sutton and Cheam made about the need to involve social care in those activities is an important one, and he is right to press it.

The function of a local care hospital will be to offer more clinical services than can traditionally be offered in a GP surgery. They will include health surveillance and screening; elective work, such as day-surgery; the majority of high-volume, low-complexity out-patient appointments; some in-patient beds and intermediate care; minor injury and illness units; and diagnostic services such as X-ray.

The critical care hospital will deal with all emergency work, complex elective work and low-volume, high-complexity and multi-speciality out-patient work, supported by relevant diagnostics services. The advantages of placing these acute services in one critical care hospital include meeting national standards for clinical services; meeting national employment and training standards; providing capacity for planned growth in the number of patients needing services; providing flexibility for future needs; integrating clinical specialties in order to provide better care and to use scarce resources to best effect; and providing a better environment to help patients' recovery and staff recruitment and retention rates.

This new model of care will realise the ambitions of "Keeping the NHS local". It will also mean that the constituents of the hon. Member for Carshalton and Wallington will benefit from better, more modern health care services, delivered in a better and more appropriate environment that is closer to their homes. The proposals will also give the local health service the opportunity to improve the standard of the environment in which hospital services are delivered—for example, by providing more single rooms. They will also create an opportunity to rationalise NHS land holdings locally and, potentially, to release land for key worker housing.

It is important that I point out, however, that while consensus has been developed over the model of service, no decisions have been taken on the site of the critical care hospital or of the local care hospitals. As the hon. Members for Carshalton and Wallington and for Sutton and Cheam have rightly pointed out, the decisions on the siting of the local care hospitals and of the critical care hospital are of equal importance.

Mr. Burstow

The vision is widely supported, but both parts—the local care hospitals and the critical care hospital—have to be delivered to achieve it. If one part is not delivered, the whole thing will fall apart. Can we afford this package, and will it actually be delivered?

Dr. Ladyman

The hon. Gentleman will not expect me to give a blanket promise of funding for the new project in the middle of an Adjournment debate. What I can say is that we will work very closely with the local decision makers to ensure that they have appropriate guidance on what may or may not be feasible.

The siting decisions to which I referred must be made locally and not by Ministers. Formal public local consultation on the siting of the hospitals will take place during this September, October and November.

I understand that, so far, formulation of the proposals has been a very inclusive process. GPs, hospital doctors, nurses and other health professionals from the trust and from the two local PCTs—Sutton and Merton, and East Elmbridge and Mid Surrey—have been working together intensively throughout 2003–04, together with patient and public representatives and groups, to develop this new model for local health care I will ensure that careful note is taken of the comments that were made concerning those groups that may not nave been properly involved in the process. Informal discussions have been held with tenants and resident groups, with local authority overview and scrutiny committees and with the media and NHS staff. I understand that the process throughout has been carried out in an open and transparent manner. For example, detailed working papers have been made public—in March 2004 and again last week. Comments from stakeholders on the papers published last week have been invited by 7 July 2004.

I am also aware of yesterday's full-day meeting in which stakeholders received presentations and were able to ask questions. I was pleased to learn that it was a well attended event and that a number of hon. Members were present and able to participate with others in understanding the issues, debating the key points and identifying where further analysis is required. I am told that the day highlighted a high level of commitment to the model of care and that the key stakeholders debated the importance of delivering the elements of the reconfiguration in an integrated way. I hope that the event will have made a significant contribution to defining the further work to be completed before the formal consultation period.

It is always important that the local NHS strives to engage in a meaningful way with its local community as well as with all interested stakeholders. It is encouraging, then, to see that the NHS in south-west London is seeking to work in a different and more open way in the development of ideas and options—

Tom Brake

In the time available, will the Minister touch on the issue of foundation hospitals and clarify whether he will direct?

Dr. Ladyman

The position with foundation hospitals is that they have a duty of partnership. The Secretary of State is not in a position to give directions in quite the way that the hon. Gentleman has requested, but I can assure him that the duty is there for foundation hospitals to be involved in a partnership. An independent regulator will take a view on whether that duty is being fulfilled or not. Perhaps the solution to the problem will not be brought about in the way that the hon. Gentleman has requested, but I can assure him that I am satisfied that steps can be taken to ensure an appropriate resolution of the problem—

The motion having been made after half-past Two 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 two minutes past Three o'clock.