HL Deb 02 May 1990 vol 518 cc1108-26

7.41 p.m.

Lord Ennals rose to ask Her Majesty's Government why the proposed Westminster and Chelsea Hospital, costed by the Secretary of State at £135 million in December 1988, is now estimated to cost £226 million, and what effects this will have on capital expenditure for the rest of the North-West Thames Health Region.

The noble Lord said: My Lords, perhaps I may first say that I have letters of apology from the noble Viscount, Lord Tonypandy, who is president of the Westminster Hospital Development Fund and from the noble Lord, Lord Kissin, who, together with me, is one of the patrons of the fund. Both the noble Viscount and the noble Lord are unable to take part in the debate, although they would have liked to have done so. I also have an apology from the noble Lord, Lord Walton of Detchant, who is president of the Children's Medical Charity, in respect of which I am chairman of the trustees. The charity is concerned with funding vital research at the Westminster Children's Hospital. My noble friend Lady Phillips had hoped to take part in the debate but the timing is such that she cannot do so because of a previous engagement. However, I am delighted to see that the noble Lords, Lord Houghton and Lord Auckland, will be taking part in the debate.

Both these internationally famous and well-loved hospitals are to be demolished within the next few years—indeed, I think that it is within the next three years—together with two other hospitals in the City of Westminster, leaving Westminster totally without any hospital provision. In my view it is an act of extraordinary butchery by the Secretary of State for Health, the Riverside District Health Authority and the North-West Thames Regional Health Authority.

The Secretary of State's decision, which followed a very long debate—one which I might call "the people against the State"—was finally determined by Mr. Kenneth Clarke on 22nd December 1988. On that date he gave the go-ahead to what I believe to be a bizarre proposal, greatly to the detriment not only of the people of Westminster, its residents, its massive daily work population as well as many who come into London from all parts of the United Kingdom for work and pleasure, but also to the detriment of millions of tourists who visit London in increasing numbers. The accident and emergency service of these hospitals always takes emergency patients from every central London tragedy. It will be greatly missed—in my view, it will be terribly missed.

The St. Stephen's Hospital, part of which was only commissioned in 1973—in fact, 260 beds were commissioned at that time—has now been totally demolished to clear the ground for the newest and most expensive hospital ever established in the United Kingdom. It is located on a site in Fulham just a mile away from Charing Cross Hospital and it is hopelessly located. Its access by ambulance and car is fearfully hampered by narrow, crowded streets. Tests lave been carried out which show how long it would take to get very sick patients to the new site. I believe that if the hospital is ever opened the public will be staggered to think that anyone could have conceived of such a location for a modern hospital when the Westminster Hospital is so conveniently located.

Many of us here owe our lives to the Westminster Hospital. I suspect that that includes the noble Viscount, Lord Whitelaw. As we do not know who will be the occupants of Westminster City Hall by tomorrow evening, I feel that I should point out that all parties in the Westminster City Council opposed the Secretary of State's decision to embark upon this ill-fated project, as did the Community Health Council and a massive proportion of the population in Westminster.

So concerned was I at this proposal that, with the support of the noble Viscount, Lord Tonypandy, and the noble Lords, Goodman, Kissin and Wigoder, and others, I was involved in submitting in great detail, with professional advice, an alternative plan which was eventually, even after presentation, rejected by the district, the region and the Secretary of State. That is the background to the subject of my Unstarred Question this evening.

The submission of the North-West Thames region to the Secretary of State showed that there were eight possible options in Riverside of which either a rebuild or a refurbishment in Westminster would be financially more viable than Riverside's own scheme (the one which is now being implemented). On 21st December 1988 additional billions of pounds for the 14 regions in England and Wales were announced and the then Minister of Health, Mr. David Mellor, stated that evening on LBC Radio that no hospitals would now need to close for reasons of revenue saving alone—a hostage to fortune if ever I heard one.

On the following day, 22nd December 1988, Mr. Kenneth Clarke announced his approval of Riverside's plan, costing, according to his press release, £135 million. On the same day, the North-West Thames' press release referred to a figure of £155 million for the project. The Secretary of State's press release stressed that the scheme, will greatly improve health service in this important part of the Capita".

I can only say that if the term "economic with the truth" has now become popular, it applies to that statement more than any other that I have heard. As a consequence, on 3rd February 1988, the 10 cot level 3 special care baby unit at Westminster Hospital, opened by the noble Viscount, Lord Tonypandy, in 1979, was closed to make way for the decanting of patients from St. Stephen's. The babies in the unit were sent to the level 2 special care baby unit at the West London Hospital which does not provide 24-hours a day surgical care.

On 2nd March 1989, as a result of representations, Mr. Clarke confirmed to me by letter that when the new Westminster and Chelsea was commissioned it would have a 15 cot level 3 special care baby unit replacing the level 2 unit at the West London Hospital and also the closed level 3 unit at the Westminster Hospital. In the interim, no arrangements were made for any re-provision at level 3 while the new hospital was built. I hope to hear some assurance from the Minister about that promise.

On Sunday 20th August the London Ambulance Service, dealing with the "Marchioness" riverboat emergency at Southwark Bridge, nominated St. Thomas's Hospital as the receiving hospital and Westminster Hospital as the first supporting hospital. What happened then demonstrated that for any real disaster or emergency in central London, the retention of a hospital on the Westminster site was crucial if large numbers of casualties were to receive adequate attention.

On 31st March 1990 we had the poll tax riot in Trafalgar Square. Very many of the 339 injured policemen and 86 members of the public were taken to the nearest local hospital; that is, the local Westminster Hospital. On 16th May 1989, in response to a Written Question from Mr. Frank Field, the chairman of the Social Services Select Committee in another place, the junior Minister, Mr. Roger Freeman at col. 152 said: Westminster and Chelsea Hospital…Year of start 1989/90… Estimated year of completion: 1992-93 … Estimated total cost: Original/Current £116,070,000".

That was just over a year ago. Look at what we are dealing with now. On 18th January this year the North-West Thames Regional Health Authority decided to adopt the emergency regions revised 10-year capital programme which included the Westminster and Chelsea Hospital's total estimated cost as at 11th January 1990 of £203,785,900; but, in addition, the five nursing homes, the health centre and decantation separate estimates took the then total budget figure up to £226,297,000—roughly double the figure confirmed only 12 months previously.

The doubling of such a large sum results in a great deal of money. The region and its patients are now faced with a new hospital in London SW10, a mile only from Charing Cross, at this stage of estimates costing, as I said, a massive figure—an escalation of some £125 million. What is the explanation? Is someone making a massive profit at the taxpayers' expense, or were the original calculations totally wrong? There is a revised 10-year capital budget with most projects either abandoned or deferred. The decision to put that amount of money into that sort of hospital is devastating the prospects for improved hospital services or even the maintenance of them in other parts of the region. The decision was hopelessly wrong.

At the same time as those huge capital sums were being committed, through lack of revenue both now and during the summer months a large number of beds will be closed in the central London teaching hospitals now available; namely, St. Mary's Hospital in Parkside, Charing Cross in Riverside and St. Thomas's in West Lambeth. On Thursday, 26th April 1990 the Riverside Health Authority announced the closure of a further 102 beds at the Charing Cross and Westminster hospitals to add to the already nearly 500 beds closed this year by West Lambeth, Bloomsbury, Parkside and Wandsworth health authorities, mostly in the major great teaching hospitals.

The Riverside district general manager, Mr. David Knowles, stated that the closures were, in order to enable the authority to live within its statutory requirements to balance its budget".

He also said that the total effect on patients would be very significant indeed. It is, to the tune of 500 beds. We now have a situation in which well over £226 million is spent on providing 667 new beds in west London on an obviously unsuitable site when almost that number of beds is being closed for statutory revenue reasons alone.

The revenue from that figure of £226 million, if placed on deposit on the money market at 15 per cent., would produce for those London district health authorities nearly £34 million per annum, which would keep all those beds now closed, or due to close during the next few weeks, open every week for each year that the money was invested. It is a mad hatter's tea-party! It is crazy for the Government to decide to take that action. I presented to the Secretary of State an alternative which would have provided the same number of beds, better located, at a figure totally different from that which the country now has to face. It is gross maladministration on a scandalous scale.

The Government always reel off statistics relating to NHS expenditure. This is one item that they could save right now. I go further. There should be an immediate ending to this grotesque situation, even though some million pounds has already been spent in digging out the foundations.

Before I sit down perhaps I may ask the Minister some questions of which I have given her advance notice. First, once a district scheme such as this undermines the finances of one of the four London regional health authorities, how can the continuation of the project be justified without it adversely affecting the immediate and long-term future hospital care facilities for the vast majority of the region's patients? Why was it allowed to go forward?

Secondly, how can any properly run or controlled regional health authority, without maladministration, get itself into such a mess over a project which will be one mile only from another of the same district's teaching hospitals? Thirdly, can it be confirmed that to rectify the deferred or abandoned projects in the former North-West Thames 10-year capital programme additional funds will be made available centrally to ensure that the vast majority of patients in the region do not suffer as a result of that crass mistake? Fourthly, can Mr. Duncan Nichol, the chief executive of the NHS, explain how in his letter to North-West Thames region dated 31st January 1990 he congratulated the region on its achievement during the past 18 months—he pinpointed, the approval in principle of the Westminster and Chelsea project"—

bearing in mind that on 18th January the hopes of the people in the rest of the region were dashed by the cancellation of projects to which they were looking forward?

Penultimately, following the poll tax riot on Saturday, 31st March, 1990 can I be assured that on public policy grounds a Westminster hospital will be retained and that for the good of all the North-West Thames region's patients the building of the Westminster and Chelsea Hospital will be immediately abandoned and the moneys saved used to keep beds open and available at all the central London hospitals? Finally will the noble Baroness ask the Secretary of State now to set up a proper independent inquiry fully to investigate the project and give it power to cancel it with a view to saving most of the £200 million not yet thrown away?

7.56 p.m.

Lord Auckland

My Lords, I intervene in the debate more in sorrow than in anger. I apologise to my noble friend the Minister for intervening late in the day, but I was not sure what the parliamentary timetable would be. I have no direct financial or any other interest in the Westminster Hospital, but I am aware, as are most noble Lords, of patients who have been there. Over the years I have known various nurses, nursing sisters and doctors who worked there.

Both this House and the other place could, I suppose, be accused of special pleading. It is, after all, the hospital to which any of us may be taken. We are obliged to the noble Lord, Lord Ennals, for having put the Question. A number of distinguished Members of both Houses of Parliament have been taken to that hospital and their lives have been saved.

What I am not certain about—there is a great deal of confusion here—is how much of Westminster Hospital will be closed, what the timetable is, and what the reasons for the closure are. All right, it is an old hospital. It does not need someone experienced in hospital management to realise that much of it has needed rebuilding. I happen to know the Fulham area quite well. I know Fulham Road. I know the old St. Stephen's Hospital. It is a good hospital. The noble Lord, Lord Ennals, has rightly pointed out the length of the journey from here to Fulham. The point has been made many times. Even if there were a police escort with the traffic lights set at red, I reckon that it would take 20 minutes to half an hour to get a patient there. That does not allow for roadworks, of which there are many in London now. Although it may be a fait accompli and certain decisions may have been taken, I believe that it is worth making these points in your Lordships' House even at this late hour.

Suppose somebody has a serious road accident or a coronary near Westminster. Half an hour can make a great deal of difference. That does not mean that our ambulance drivers do not do a marvellous job. They do. But some people need specialised treatment. St. Stephen's Hospital is a long way away.

I shall not go into all kinds of figures but it seems to me that the increase in costs over a period of 18 months is absolutely amazing. I hope that my noble friend the Minister will be able to give some explanation as to how the costs have been incurred. It may well be that if any government of any party had been advised that the scheme would take place they would have implemented it. I do not blame the Minister necessarily for having made the decision. It could well have come under any administration, but whoever thought this up needs to have a rethink.

There are one or two alarming points. I believe that the authority stretches right out to Middlesex, Bedfordshire and Hertfordshire. I know Hertfordshire quite well. I lived in Baldock for a number of years. As your Lordships know, there are a number of special hospitals there. Watford and St. Albans—how will their funding be affected? There is the new Lister Hospital at Stevenage, which is a very fine general hospital. There is Queen Elizabeth's Hospital at Welwyn Garden City. I remember going round it before it was officially opened. How will its funding be affected? The House needs to know whether the increased expenditure will mean any decrease in the capital allowances to these hospitals as a result of this decision. It is a disturbing matter.

There is concern about Charing Cross Hospital. I happen to know the main professor of anaesthesia there. I went round the hospital, as I mentioned to your Lordships, a few weeks ago. I was taken round the dialysis unit. There is the threat of closure of some functions there because of shortage of staff. All these matters make the decision most distrubing.

I have spoken long enough. I have made certain points. Other noble Lords present are much more experienced in these matters of management and therapeutics than I am. They know these hospitals better and know that it will be a great tragedy. We should bear in mind that Pimlico has a fairly large residential population. What will happen there? Some may say that people can be taken to St. Thomas's Hospital, but that has had ward closures. There is much that the House would like to know. Quite apart from the enormous increase in expenditure, as the noble Lord, Lord Ennals, quite reasonably said, the citizens of Westminster will be deprived if the decision goes ahead.

Lord Ennals

My Lords, before the noble Lord sits down, did he notice an interesting statement in a recent press release on 6th February 1990 by Mr. Roger Freeman, the Parliamentary Under-Secretary? He said: Our Victorian forefathers were excellent builders. They built hospitals to last, and it seems to me to be economic nonsense to demolish a soundly-constructed building simply because it looks shabby". He might have been talking about Westminster Hospital.

Lord Auckland

My Lords, I cannot but agree wholeheartedly with the noble Lord.

8.5 p.m.

Lord Houghton of Sowerby

My Lords, by inadvertence my name was not put down to speak but I wish to support my noble friend. He prepares his cases with consummate skill and attention and he presents them with an enthusiasm which is quite remarkable for one who has spent so long in parliamentary life. I greatly admire what he does and the matters on which he has so much experience and great knowledge. I am most anxious to encourage him in what he is doing in regard to Westminster Hospital.

I have been a resident of Westminster for many years. When I first came to London the old Westminster Hospital still existed near Parliament Square. The new Westminster Hospital was a vision in the minds of a number of people who had a great desire for a better hospital for Westminster. It was erected by voluntary effort. I doubt whether there was a penny piece of government money in Westminster Hospital until it was taken over under the National Health Service. It is very much a hospital that belongs to Westminster. To take it away and bury it in Fulham is almost like shifting the Houses of Parliament to Brixton.

There seems to be a subtle psychology about the movement of London hospitals. Charing Cross is no longer in Charing Cross. When I was in that hospital not long ago a friend of mine went to Charing Cross to look for it. St. George's, which is known to be near Hyde Park Corner, is in Tooting. The Royal Free is in Hampstead. Now we are to have the Westminster and Chelsea Hospital close to the Charing Cross Hospital in the same part of congested London. Access to both the Charing Cross Hospital and to the St. Stephen's site where the new hospital will be is a nightmare. Relatives visiting the hospital will find that it is a serious inconvenience. I reckon that it will cost up to £6 to take a taxi from Westminster to the new Westminster Hospital. If people look for Westminster Hospital in Westminster they will find that it has moved beyond their reach.

I am not impressed by the boast of the Secretary of State that the new hospital is the biggest ever. I am not one of those who believe that the biggest things are necessarily the best. Often psychologically they can be forbidding. I did not like Charing Cross Hospital. The whole atmosphere made me scared of going into it to be attended to or to have surgery. I managed to escape. When I was all prepared to go down to the operating theatre for a tonsillectomy at the age of 90 which I ought to have had when I was nine, I was asked, "Have you had anything to eat today?" I said, "Yes, you put off my appointment for the theatre twice during the day and I went downstairs and bought a bar of chocolate". Panic stations set in. They told me they were sorry but they could not go on with the operation and that I would have to go home and make a fresh appointment.

I found that it was difficult for a Member of your Lordships' House to make an appointment to have an operation during the Christmas Recess in order to return to your Lordships' House for the resumption of business. The end of this little story is that I had to have the operation done privately. That cost me £1,500. However, I must say that I enjoyed the comfort of the private hospital. That was my experience of Charing Cross Hospital. The same consultant who was due to operate on me in Charing Cross Hospital operated on me in the Cromwell Hospital. Therefore, one gets the same man either way but it costs a lot more to get him in the place where he collects fees as distinct from the place where he does not.

I suppose that that is just my experience of the health service. I am sure that everyone has their own stories of the health service. I believe that the general pattern of the hospital service today is bewildering for the general public. Presumably there are general principles behind the service, but one suspects that the arbitrary cuts which the Government make in order to save money on the National Health Service are at the back of some of the decisions that are taken. That is disturbing because the public have made it clear more than once that they are quite ready to put more of their resources into the National Health Service if only a way of doing that can be found. There is an association at Westminister Hospital called the Friends of Westminster Hospital, but it appears that nothing can be done to keep the hospital in Westminster by voluntary effort or support. That is not provided for in the new scheme.

I have attended meetings to try to find ways of saving the hospital. At those meetings a lot of canvassing was taking place, but one feels that the decisions are predetermined and that the wider financial strategy has already been decided. However, whether future needs can be estimated with any degree of accuracy is unclear, though one thing is almost certain and that is that during the period between deciding on a project and completing it, nearly all the calculations will have gone wrong. That is due to the pace of change in the price factor, in demographic considerations, in building operations and in the density of residential populations. There will be a greater residential population in Westminster in the years to come because people are not prepared to put up with the expenses and discomfort of commuting into central London.

A large rebuilding operation is to take place in Horseferry Road and Marsham Street, where the Ministry of Agriculture, Fisheries and Food was situated. Some 27 shops have been swept away and people have suffered considerable inconvenience. However, Westminster City Council has been vigilant and has insisted that the terms of the planning permission for the new building are followed. Residential accommodation will form part of that building. Previously there was no provision for residential accommodation. Those factors have to be taken into account.

I wish I could be convinced that what is proposed will be a good thing. Certainly the siting of the new Westminster and Chelsea Hospital so close to Charing Cross Hospital will lead to congestion and traffic blocks. It will be a nightmare. There may well be casualties in central London which need attending to. Have the Government not considered that they might need special hospital accommodation for the casualties of poll tax demonstrations? If those demonstrations continue until the general election, we shall need a special hospital to accommodate the casualties. Seriously, however, with the numbers of tourists who are around in central London, the thousands of other people who are about and the work that is being carried out along the river, a grave incident could well occur and those people might need hospital accommodation speedily. That accommodation will not exist. St. Thomas's is only a shadow of the vision that was originally entertained for the development of the hospital across the river. It was envisaged that the building would comprise five blocks whereas the present hospital only has one. There has been no replacement of decrepit buildings which have been allowed to fall into disrepair. Those buildings look desolate and, to some extent, unoccupied.

I have watched from my apartment in Marsham Court the deterioration in the condition of Westminster Hospital. On the ground floor the external part of the building is filthy and the whole place is now becoming unattractive. Beds are left unoccupied and one gets the feeling that the whole place is on the way out and that what is left is only a temporary provision until people can be shifted elsewhere. That is a very unpleasant atmosphere to exist in a place like Westminster. I wonder whether anyone has borne in mind the fact that a place like Westminster needs a more prestigious hospital. In my opinion the building is beautiful. I saw it go up. It was a tremendous triumph for those who had worked so hard to provide the funds for it. The site, which is of great value, was really a free gift to the National Health Service. Now it looks as though the health service is going to cash in on it.

I am disconsolate about this matter. I support the protest of my noble friend. I do not know what can be done, because the steamrollers roll on, contracts are placed and the senior staff at Westminster are dismayed at what is happening. I shall not repeat the words that I have heard from the people there whose opinions I value, but their comments are very unfavourable indeed. A hospital building of the size and content of the new Charing Cross and Chelsea Hospital has never been built before. No one has built a hospital of that size with the equipment that such a construction will need. This is a new venture in construction on a large scale. It will be undertaken by contractors who I understand have had little experience of this kind of work. We may even have some problems with that new hospital before we are through. I hope there is a possibility of fresh thinking on this matter. That may well be forced upon the health authority before the contract is completed. It may be worth while to seek a fresh assessment of what is afoot and what is likely to happen.

I cannot let this matter go without voicing my own discontent. I am hopeful that some fresh attention will be paid to the problem. In the meantime I sincerely hope that I shall never have to go to the new Westminster and Chelsea Hospital.

8.20 p.m.

Lord Winstanley

My Lords, normally I am extremely wary about poking my Manchester nose into London affairs. However, I have always had a soft spot for the Westminster Hospital. I used to attend postgraduate courses there when I felt that I was getting out of date. I do not do so any longer; I enjoy being out of date. In addition I often had occasion to send Members of your Lordships' House to Westminster Hospital and subsequently had the very great pleasure of seeing them return restored to full health. Therefore I am concerned about the fate of Westminster Hospital.

My noble friend Lady Robson has great experience in the matter and has been closely involved. She was to have spoken today but has another important public engagement and asked me to take her place. I said that I did not know a great deal about the details but she said that she would help. She gave me an excellent brief. However, she did not tell me that she had also given it to the noble Lord, Lord Ennals. Therefore I followed his speech with great interest. I said to my noble friend Lady Seear, "Is it in order for him to miss out two lines?" and "If only he would turn over two pages". However, he missed out what I thought were important points. Then, to my horror, in an intervention during the speech of the noble Lord, Lord Auckland, he added those as well. I shall return to them in a moment.

The whole business has been a chapter of accidents. I do not believe that the noble Lord, Lord Ennals, referred to the early history of the affair, which goes back to 28th January 1988 when the Riverside Health Authority announced a three-month consultation on its proposal to close the Westminster Hospital, Westminster Children's Hospital, West London Maternity Hospital and the St. Mary Abbot's Hospital in Kensington in 1992 after reproviding most of the beds in a new Westminster and Chelsea Hospital to be built on the site of St. Stephen's Hospital in London S.W.10.

From the start of the consultation the principal Riverside officers and representatives of the combined Charing Cross and Westminster Medical School made it clear that that was the only financially viable proposition which would provide for a new hospital while at the same time achieving across the district the required annual revenue saving of £15 million. I am told that the consultants at both the Westminster and St. Stephen's were told in mid-February, just after the consultation document had become available, that unless they supported the plan the closures would take place and there would be no reprovision.

The noble Lord, Lord Ennals, explained what happened subsequently in terms of the public consultations and the reaction of the community health councils. In the consultations nobody could be found who was in favour of the proposal. The ordinary members of the public did not believe that the beds would be replaced. They thought that they would lose beds. Nor were they very happy about losing the last of the central London teaching hospitals in exchange for St. Stephen's in S.W.10, rebuilt, with a new name.

We have heard the facts and much of the history. I do not want to go into much more detail. However, it was important that the noble Lord, Lord Ennals, should emphasise the case of the special baby units and how those are to be replaced. He asked a specific question on that point. I believe that it is important that we should know the answer because certain undertakings were given by Mr. Kenneth Clarke regarding the replacement of the cots which were lost in the Westminster and elsewhere and what was to be provided in the new hospital. We should like to hear more about that and how they are to be paid for.

As the noble Lord, Lord Ennals, said, in his press release way back whenever it was, Mr. Kenneth Clarke said that the scheme would: greatly improve health services in this important part of the capital". He said nothing about the consequences for the rest of the North-West Thames Health Region, much of which is not in the capital at all. It is those parts of the region which are concerned at the moment. The Question of the noble Lord, Lord Ennals, concerns the effects of the proposal on capital expenditure for the rest of the North-West Thames Health Region.

Since we are dealing with capital expenditure, it is relevant to turn to the part of our common brief which the noble Lord, Lord Ennals, did not quote in full. On 6th February 1990 Mr. Roger Freeman, the Minister responsible, issued a press release introducing shadow capital charging from 1st April 1990 in advance of the real thing one year later. The press release stated: First, the introduction of capital charges. This means that new hospital buildings will have to be properly depreciated and, for the first time, health service managers will have to pay regard to the consequences for revenue expenditure of capital spending programmes. Capital charges will enable more informed decisions to be taken about whether to build new hospitals or renovate old ones". At his press conference Mr. Freeman apparently gave an example showing that, including depreciation, property assets worth £100 million would attract an annual capital charge of £20 million. On £226 million, which is the cost of the new hospital, that would presumably mean a capital charge of £45 million, which would have to be funded annually from revenue. Is it any wonder that the rest of the region is alarmed about the prospect facing it? Is it any wonder that the noble Lord, Lord Ennals, put his Question down on the Order Paper and asked the supplementary questions which he has just put to the noble Baroness?

Where is the annual revenue to come from to fund and maintain, full operative, the 15-cot level 3 special care baby unit to reprovide for the closed vital unit at the Westminster?

The noble Lord asked whether there could be an independent inquiry into the matter. As I see it, of that huge sum, £26 million has already been spent. Another £200 million is to be spent in 1990-91, 1991-92 and 1992-93. At what stage does it become impossible to unscramble the egg? Looking from the outside, particularly from Manchester, it is very difficult to see what can now be done. However, it is quite clear that decisions have been taken which have been misguided. Better use could have been made of land which was available and of existing hospital provision and better plans could probably have been drawn up. I cannot attach blame—I am not sure who is responsible.

My noble friend Lady Robson funded a charity to look into possible viable alternatives. I am not sure what it found, but I am quite sure that the solution which has been arrived at is not the best one, for reasons given by those who know about the matter. Why concentrate three teaching hospitals in such a small area? Why leave a part of London in which a great many people live without any such provision? The noble Lord, Lord Ennals, was quite right. The "Marchioness" disaster demonstrated that we need a casualty department in Westminster. Without one, if there were any future disaster of that kind we should be in difficulty.

What options are available to us now? Can we rejig the matter in some way to make better use of what we have? We must find out why the prices have risen so astronomically. When the Riverside Health Authority first costed the proposal it seemed to think that it would cost only £3 million. It said that it would cost £78 million but the sale of old sites would bring in £81 million.

Lord Ennals

My Lords, will the noble Lord allow me to intervene? Does he accept that the purpose of making any change was in order to make revenue savings? That was the requirement of the department, and it has resulted in this monstrous row.

Lord Winstanley

My Lords, I have already said that the object was to make revenue savings. My point now is to ask what has happened to the capital cost. The original figures quoted by the Riverside Health Authority was that the cost would be £78 million and £81 million would be gained from the sale of sites which would become available. That looked like a very good deal. However, what has happened since? How have we arrived at these extraordinary figures?

I know that the Riverside authority explained that there has been a sudden slump in the expected return from the sale of the sites. I think that the figure will not be £81 million as was once thought but £30 million or £40 million. That is one aspect. The authority then found that the building would cost a great deal more, but the matter has gone on and on.

We are used to that. We are used to things like Concorde, which we were told would cost only so much, and we then found that it cost five or 10 times as much. The same is true of the Channel Tunnel. However, we should have had some experience with health service expenditure. We should by now be able to cost things a little more accurately than this rather than suddenly finding that we are spending well over £200 million on something which, from a capital point of view, would originally have cost almost nothing.

We shall not benefit greatly from finding out whose fault that is, but we shall benefit if we can find out what can now be done without wasting money. To stop the whole thing and start all over again would certainly waste the £26 million which has already been spent, but could something else be done? Is that possibility being considered? Surely the purpose of the Question is to ask the Secretary of State whether he will look again, seek advice and see whether there is a better, and possibly even cheaper, way of providing for the hospital needs of London as a whole and of this particular area. Is it possible to do that at this late stage without wasting the money which has already been spent? On the other hand, is it possible to stop the whole thing here and now and start all over again?

I am not a financier. I should not like to say which course one should pursue, but it has been a most appalling muddle. We want to know why. We want to know what decisions will now be taken in order to answer the important questions which have been put to the noble Baroness by the noble Lord, Lord Ennals. I look forward to hearing what she has to say.

8.32 p.m.

Baroness Hooper

My Lords, we have heard many and varied views on the Westminster and Chelsea project. I am grateful to all who have contributed and I welcome the opportunity to explain the background to the project.

Baroness Seear

My Lords, I am sorry to interrupt the noble Baroness so soon, but we have not heard varying views. We have heard uniform views throughout the evening.

Baroness Hooper

My Lords, I wish to indicate the varied points that have been raised. I appreciate the problems of dual briefing experienced by noble Lords opposite, but they coped well with the problem.

Lord Ennals

My Lords, I trust that I sent the noble Baroness the same briefing.

Baroness Hooper

Yes, my Lords, and I promise not to come back to it a third time.

As the noble Lord, Lord Ennals, mentioned at the outset, my right honourable friend the Secretary of State announced his approval in principle of the Westminster and Chelsea project in December 1988. The project was subject to full public consultation and the decision was reached after careful consideration of all the views expressed both in favour of and in opposition to the scheme. I dispute the suggestion of the noble Lord, Lord Houghton of Sowerby, that it was a foregone conclusion.

Riverside District and North-West Thames regional health authorities have identified the opportunity for a major change in the way services are provided in the district. The reconfiguration will result in more efficiency in the district and even better care for the people who live there, which I am sure is what we all seek.

A key component of the project is the new teaching hospital—the Westminster and Chelsea—to be built on the site of St. Stephen's Hospital. Other elements, as the noble Lord, Lord Winstanley, told us when he filled in some of the gaps, are the closure of the Westminster, Westminster Children's, West London and St, Mary Abbott's Hospitals. We fully recognise that all those have provided excellent health care over the years, but the time has come to replace them with the new hospital. We believe that services will be greatly improved when they are relocated in one modern district general hospital with all the back-up and support services available. The new 650-bed hospital will provide a modern, up-to-date environment to take health care into the 21st century. We believe that that will also help staff recruitment and enable the health authority to maximise the use of scarce, qualified staff.

However, there are other elements of the project which are no less important to the local community and to us in the Palace of Westminster. A new health centre will be built in Pimlico which will provide GP care, outpatients' clinics and a minor casualty service. Five new nursing homes are to be provided for elderly people who require long-term care in the community. Those elements are included in the costs of £226 million to which the noble Lord, Lord Ennals, referred and to which I shall return in more detail later.

Riverside health authority expects to achieve revenue savings of up to £15 million a year on completion of the project, so we are fulfilling the original objective. That not only means that there will be no revenue problems for the new hospital, as has been suggested, but that a large proportion of those savings can be redistributed to the shire districts in the North-West Thames regional health authority in line with its regional strategy. The release of those savings will mean a more balanced distribution of health services throughout the region in the future, a point on which there was unanimity in the contributions made to the debate.

We are confident that the new hospital is a sensible and practical way of meeting local health needs. It shows that the National Health Service can be innovative and flexible in providing services for local communities. Furthermore, it is due to be completed in 1992, which shows that the National Health Service can handle modern techniques and match the private sector for speed. That is something of which we can and should be proud. By sheer coincidence, I passed the site earlier today and was amazed at how visible the structure already is. The region is to be congratulated on the energy and enterprise with which it has pursued this ambitious project.

Perhaps I may now turn to a more detailed analysis of the cost of the project. The noble Lord, Lord Ennals, is particularly concerned about that and, quite rightly, has requested an explanation, as have others. When my right honourable friend the Secretary of State approved the project, he gave specific approval for the cost of the new hospital alone. The proposals had been thoroughly vetted by the Department of Health and the Treasury and some modifications were made, including those insisted upon by the local planning authority. My right honourable friend announced his approval in December 1988 and quoted the approved cost of the hospital as £135 million.

Noble Lords should note that that cost relates to the new hospital alone. It did not cover the other developments that I mentioned, such as the new health centre. The figure covered construction costs, equipment costs and professional fees, but, as is customary, not a weighting for site location. That is an element of construction costs which is volatile and difficult to forecast.

Lord Winstanley

My Lords, the noble Baroness said that her right honourable friend announced his approval on 22nd December 1988 and gave the cost in his press release as £135 million. On the same day, the North West Thames regional health authority's press release referred to a figure of £155 million. Do the additionals explain that discrepancy?

Baroness Hooper

My Lords, I was about to deal with the point of the discrepancy in the quoted figures. The departmental press release referred to the figure of £135 million, but that referred to a standardised cost figure, which did not include the local factors and the local constructive costs to which I referred. The regional health authority's press release which quoted the figure of £155 million included that additional load factor or weighting.

Work on the new hospital started on site in May 1989 under a management-type contract using fast track construction methods. With that type of contract, tenders are invited for different parts of the work as the project proceeds. North West Thames regional health authority forecasts, which take account of prospective movements in both national and local price indices over the duration of the project, suggest that, with the addition of fees and equipment, the total cost will now be around £203 million. The figure of £226 million quoted by the noble Lords, Lord Ennals and Lord Winstanley, is in fact that figure of £203 million plus the cost of the other schemes in the district which I have previously described, such as the health centre.

Lord Ennals

My Lords, as the noble Baroness says, the comparison is between £155 million and £226 million. That is the actual comparison.

Baroness Seear

My Lords, this is a matter of detail, but these additional things which are being added in this area would not have been necessary if the hospital had not been moved. They are costs incurred as a result of the move, are they not?

Baroness Hooper

Yes, my Lords, but also to provide a better service for the people in the area. We have covered that difference between the initial cost of the hospital alone and the revised figure of £203 million. The increase in cost, whichever basic figure one takes, is simply due to the movement in building costs in the London area over the past 16 months. It also takes account of the expected movement during the period to the completion of the project.

The noble Lord, Lord Ennals, asked me about the management of the scheme. We are monitoring the project closely, especially as it breaks new ground in terms of the combination of management contract and fast track construction methods. I can assure noble Lords that those aspects of the project that are within the control of the health authority and subject to regular monitoring by the department are proceeding satisfactorily.

With regard to funding, the North West Thames RHA has always planned to fund the scheme entirely from the proceeds of land sales achieved by the reconfiguration of hospital services. That is still the expectation. However, we recognise the considerable difficulties faced by the authority at present due to the current downturn in land values and sales, which is an area completely outside its control. Noble Lords may be aware that the capital programme in North West Thames has undergone a major review. The reasons for the review were as a result of the fall in residential land sales in the region and the high and increasing cost of building in London. Although North West Thames remains committed to its programme of capital investments in the region, a number of schemes have been deferred for 18 months to two years. However, it is important to note that these schemes have been deferred only, not abandoned. They will be implemented as soon as land sales pick up.

The noble Lord, Lord Ennals, referred to Riverside's announcement that 102 beds would have to be temporarily closed for financial reasons. It is proposed that 48 local acute beds be closed at Charing Cross Hospital and 54 beds at Westminster. The bed closures involved are in line with Riverside's longer-term strategy once the Westminster and Chelsea Hospital is built. There will be effects on caseloads in those hospitals but the district is confident that the long-term viability of the specialties involved will not be placed in jeopardy. Bed numbers will still be in excess of those needed for the district's own residents.

Lords Ennals

My Lords, is the Minister saying therefore that those beds which are temporarily closing now will not in fact open at all? That is what I understood her to say. The announcement was that they would be closed for a year, until April next year. It seems to me that the noble Baroness is now saying that they will not be opened again.

Baroness Hooper

My Lords, my understanding is that it is part of the phasing out in view of the replacement of the facilities in the new project.

I turn to some of the specific issues that were raised. On the question of the future capital charges on the hospital and comparison with the hospitals due for closure, results of the land valuation exercise are not yet to hand. However, I think it is fair to say that the new hospital with a longer life expectancy would attract greater charges than an older hospital. Land itself will attract a capital charge. The new hospital will replace five existing hospitals, including St. Stephen's, and this will attract a much smaller capital charge for the land occupied.

The noble Lords, Lord Ennals and Lord Winstanley, also asked for an assurance about the future provision of neonatal intensive care in the new hospital. I understand that the specialist facilities currently provided for the care of the newborn at West London and Westminster are designated by the region as Level 2 units. The service in the Westminster and Chelsea Hospital—the new hospital—will be a Level 3 unit and will be one of five regional perinatal centres. Noble Lords may be assured that the neonatal care facilities are a vital component in the services that will be reprovided at the new Westminster and Chelsea Hospital.

Concern has been expressed that local residents in SW1 will be seriously deprived of health care when the Westminster Hospital closes. I must confirm to my noble friend Lord Auckland that it will close completely, however nostalgic some of us may feel about it. That is something which was looked at very carefully before the decision to approve the scheme was made. We are confident that the new primary health care centre will offer significant advantages to local residents. They will be very well served by a brand new hospital which will serve the part of the district which does not look to Charing Cross.

With regard to accident and emergency facilities when the Westminster Hospital closes, the new hospital will have an accident and emergency department capable of dealing with up to 60,000 cases a year. Also, let us not forget—it has not been forgotten so far in the discussion—the existence of St. Thomas's Hospital just across the river, although it will, as always, be for the London Ambulance Service to decide where emergencies are taken for treatment.

Lord Harris of Greenwich

My Lords, perhaps I may ask the noble Baroness a question on that matter. The point has been made about the disturbances in connection with the poll tax trouble in Trafalgar Square. Is she aware that there has been a whole series of major public disorders in what could be described as the greater Westminster area? Will additional facilities be made available at St. Thomas's Hospital to deal with such situations because, as has been pointed out, the delay in taking patients from Westminster to Fulham in the rush hour would create an extremely serious situation? It could easily take 25 minutes, as most of those who drive cars are well aware.

Baroness Hooper

My Lord, in the event of a major incident there are a number of designated hospitals within reasonable distance of the City of Westminster. These include Charing Cross, St. Mary's, Hammersmith, St. Thomas's, Guy's and University College/Middlesex Hospitals. Those are all hospitals that have sufficiently large accident and emergency departments to cope with such incidents and are able to provide mobile teams and a site medical officer if necessary. For what are commonly termed "the walking wounded" in Westminster—and I hope that there are not too many from this Palace—there will be new and up-to-date facilities available at the local primary health centre to which I referred.

Perhaps I may take the opportunity of making quite clear the answer to the question which was raised about beds closing in the Westminster Hospital. It appears that beds are temporarily closed for 12 months, when the position will in fact be reviewed. But once the new hospital is built the beds will net be needed any longer.

Finally, a number of noble Lords referred to this as one of the biggest hospital projects ever approved by Ministers in the history of the National Health Service. We are confident that it will greatly improve health services in this important part of the capital. It is a measure of the Government's commitment to the National Health Service and the staff who work in it.

Baroness Seear

The noble Baroness always tells us that she believes this and is confident about that, but she never tells us why she believes it or what her confidence is based on. We are interested not in her faith but in the facts behind it.

Baroness Hooper

My Lords, I have spent the last 18 minutes giving very good reasons why I am confident and why I have faith and I am sorry if the noble Baroness was not totally convinced.

Lord Ennals

My Lords, I am grateful to the noble Baroness. Does the noble Viscount wish to intervene?

Viscount Long

My Lords, no, I am waiting for the noble Lord's question.

Lord Ennals

My Lords, I believe that I have a right to comment briefly on the Minister's reply.

Noble Lords


Lord Ennals

I have not: very well.

Viscount Long

My Lords, I apologise to the noble Lord. I did not realise that my noble friend had finished her reply.