St. Mark's Hospital, London (Hansard, 25 June 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, there is widespread recognition of the valuable specialist services and postgraduate training provided by the clinicians at St. Mark's. There are no plans to close St. Mark's but all parties are agreed about the need to relocate these services. It is also recognised that essential support service needs are best provided within a major hospital. In the Department of Health we welcome the continuing constructive dialogue 487 taking place between the region, City and Hackney District Health Authority and senior clinicians at St. Mark's.

§ Baroness Masham of Ilton
My Lords, I thank the Minister for that reply. Does she agree that it is unwise to close a national centre of excellence which serves patients from all over the country who have serious, dangerous and difficult conditions? The hospital trains senior registrars from all over the country. Will the Minister urgently consider setting up a committee to look into the special needs of such specialised hospitals before any decisions are taken?

§ Baroness Hooper
My Lords, medical technology has become increasingly sophisticated. The problems associated with being a specialist hospital on a separate site have therefore increased. Although St. Mark's provides a wide range of high quality specialist support services, it lacks some facilities. I understand those facilities will be available at the proposed new site. However, no final decisions have yet been taken.

§ Lord Mulley
My Lords, I strongly support the plea made by the noble Baroness, Lady Masham, that this hospital and its facilities should be saved. I have personal knowledge of the hospital. If the term "centre of excellence" had not been invented, it would be most appropriate to invent that term to describe the work that the hospital has carried out over many years. Its research facilities are excellent. As a result, bowel cancer, if operated upon in time, is no longer the killer it was. The work of Cuthbert Dukes and Basil Morson has been enormously important in this area. Does the Minister really believe that such facilities can be offered and such research carried out in two or three wards of Bart's Hospital with limited operating facilities? Will the Minister confirm that because of the uncertainty that exists, St. Mark's is having to refuse grants from the Imperial Cancer Research Fund to carry on invaluable research, particularly its research into the hereditary aspects of cancer of the colon? All of this work will be lost if St. Mark's is to be given only two or three wards in a big general hospital.

§ Baroness Hooper
My Lords, I have already said that we recognise that St. Mark's offers valuable specialist services. There are no plans to close St. Mark's. No final decisions have been taken, but in the event of the district health authority deciding to implement any substantial change in services, which could include relocation, it will be required to consult with the community health council. Thereafter, there is the possibility of an appeal to the Secretary of State. We shall take account in the ongoing discussions of any offers of financial help from whatever source made to the hospital.

Lord Winstanley
My Lords, does the Minister accept that we on these Benches fully understand that it is impossible to provide the highest standards of excellence in every specialty of medicine in every hospital in every part of the country? It is therefore essential that in certain narrow specialties, high standards of service should be provided in one 488 hospital. Is it not a fact that this hospital is unique in Britain, and perhaps even in Europe, in concentrating on diseases of the large bowel, the colon and the rectum and in training surgeons and nurses in the treatment and management of those conditions? The hospital takes patients from all over Britain, not just from Greater London. Is it not also a fact that if the hospital is merged into another, there is a danger that the high standard of excellence I have referred to will be diluted and that we will lose from the National Health Service a centre of excellence?

§ Baroness Hooper
My Lords, if we were not aware of the dangers of such a relocation before, we certainly are now. Discussions have taken place over several years about the benefits of relocating facilities for this specialty within a multi-specialty acute hospital. Discussions have taken into account the need to ensure access to a full range of support services, the need to reduce overheads associated with operating on a second site, and the need to tackle the conditions of the present site.

§ Lord Trefgarne
My Lords, is my noble friend aware that a few years ago the conditions at St. Mark's were quite deplorable? I speak from personal experience. It is therefore very much to be welcomed that a new site with better accommodation and better support facilities is to be found.

§ Baroness Hooper
My Lords, I agree with my noble friend. There is a need to do something about the facilities on the present site. There is a need to relocate those facilities. Every consideration is being given to the need to ensure that the identity of St. Mark's and the important work it carries out are preserved.

§ Lord Walton of Detchant
My Lords, the Minister has agreed that this important hospital is a centre of specialisation, teaching, training and research in colon practology. Does she not also agree that the hospital is a major national and indeed international resource? Will she ensure that its crucial importance as a national and indeed international referral, research and training centre in this field will be impressed upon the City and Hackney health authority? If the facilities of St. Mark's were to be transferred to the site of St. Bartholomew's Hospital, will the Minister endeavour to ensure that St. Mark's identity is preserved and its viability assured as a centre not just of high quality patient care but also of postgraduate training and research?

§ Baroness Hooper
My Lords, I believe that both the district and the regional health authorities are well aware of the special nature of the services provided at St. Mark's. We believe that because this specialist treatment is so well known and recognised, St. Mark's will continue to attract patients and, as a result of the National Health Service reforms, the income will follow.

§ Lord Ennals
My Lords, I hope that the Minister has been impressed by the breadth of concern expressed about the hospital. Does she accept that that concern is felt even more strongly by those who work at St. Mark's and whose future over the past few 489 years has been so uncertain? Does she further accept that a great deal would be lost by merging this fine hospital, with its specialisation, into a separate hospital?
Is the Minister aware of any proposals for a relocation within Bart's? The majority of the staff say such a relocation would be totally unsatisfactory and would not protect the identity of the hospital. The finance that has been mentioned for such a relocation is totally inadequate.

§ Baroness Hooper
My Lords, I do not accept that the identity of St. Mark's need be lost on relocation. After all, mere bricks and mortar, however well loved, are not the foundation on which the well-earned reputation of St. Mark's has been built. It is built on its history of excellent patient care, training and research. I am quite sure that that tradition will continue wherever the hospital is located.

§ Lord Beloff
My Lords, does my noble friend the Minister wish to comment on the remark made by the noble Lord, Lord Mulley? Far from dragging on, the matter is extremely urgent. It is a matter of weeks before a decision will be taken and in the interim the hospital has had to refuse a major research grant, which is very damaging to the image of the health service as a whole.

§ Baroness Hooper
My Lords, I have said that no final decisions have been taken and that discussions as to the preferred option are continuing. The proposals are under consideration by the regional health authority as part of its review of the region's capital programme. I understand that the results of those deliberations are due in July.

§ Baroness David
My Lords, have the Universities Funding Council and the Medical Research Council been consulted about this matter? If the hospital is to be relocated, will there be the same facilities for postgraduate visitors from overseas? I understand that last year there were 660 postgraduate visitors from 42 countries.

§ Baroness Hooper
My Lords, as I said, the well-deserved reputation of St. Mark's is such that it will inevitably attract income, including, I hope, income from overseas.

§ Lord McGregor of Durris
My Lords, as it is common ground that St. Mark's is a unique centre of excellence with a worldwide reputation and that those surgeons, physicians and scientists whose practice and research currently sustain that reputation fear the consequences of loss of identity if the hospital is to be moved, will the Minister give an assurance that no hasty disruption will be imposed upon the centre in advance of discussion of the proper conditions for safeguarding its future?

§ Baroness Hooper
My Lords, I see no reason why there should be any hastiness about any changes and relocation. As I said, the regional health authority's plans are due out in July. There are various procedures which can be followed if any exception is taken to the authority's plans. However, in view of the extended 490 discussions which have taken place, we hope that everyone's interests will have been taken adequately into account.

§ Lord Cledwyn of Penrhos
My Lords, the noble Baroness has not succeeded in removing the disquiet which exists in the minds of most noble Lords on all sides of the House. Against that background, will she give the House an assurance that she will talk to her right honourable friend the Secretary of State about the feeling in this House with a view to ensuring that St. Mark's, with its present expertise, is not closed until a similar hospital is built in another location, but not as an attachment to another major hospital?

§ Baroness Hooper
My Lords, I should have thought that I had been able to give adequate reassurance in the course of this Question. However, I shall certainly convey to my right honourable friend all that has been said today.

§ Baroness Robson of Kiddington
My Lords, does the Minister agree that at one time we had problems, which went back into history, concerning regional specialties and that in the end it was decided that no district could carry the cost and that the RHA should fund them? In the case of St. Mark's, it is not a regional but a national specialty. Should the Department of Health not make it a special health authority and fund it centrally?

§ Baroness Hooper
My Lords, under our reforms we offer the possibility that in the case of services which continue to attract patients, as a national resource of this kind can, the income will follow.

§ Baroness Masham of Ilton
My Lords, finally, if St. Bartholomew's becomes a trust, will there be any assurance that St. Mark's, if lodged there, could not be shut?

§ Baroness Hooper
My Lords, we have to take it as read that all such considerations are being taken into account by the interested parties in their discussions.