HL Deb 30 November 1993 vol 550 cc492-4

2.54 p.m.

Baroness Masham of Ilton asked Her Majesty's Government:

What is their response to the recommendations of the London Implementation Group Renal Review that treatment for kidney patients at the Royal Free hospital should be moved to the Middlesex hospital.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, the Government are still considering their response to the recommendations of the specialty reviews.

Baroness Masham of Ilton

My Lords, I thank the Minister for that reply. However, is she aware that there are hundreds of ill and worried kidney patients at the Royal Free hospital who feel that their service may be fragmented? Is she further aware that the Royal College of Surgeons feels that kidney and liver transplant units should work closely together?

Baroness Cumberlege

My Lords, I am aware of the disquiet that there is in London and the worry that people have. It is the Government's intention to make a decision as soon as possible in order to dissipate those concerns. Yes, we are aware of the advice from the Royal College of Surgeons.

Baroness Robson of Kiddington ;

My Lords, does the noble Baroness agree that there are some specialties that might be suitable for centralising, such as orthopaedic surgery, which on the whole necessitate one visit and one hospital stay? However, renal patients who have to attend hospital for treatment as often as three days a week or more may have to travel from the neighbourhood of the Royal Free hospital to the Middlesex hospital. What compensation will they receive for the time they lose and the expenses they incur in travelling there?

Baroness Cumberlege

My Lords, I appreciate that renal services are different from many other services. However, these are factors which will be taken into account when the Secretary of State reaches her decisions.

Lord Mellish

My Lords, is the Minister aware that this matter has been outstanding for months and months? When will we be given a decision? Why in heaven's name are we transferring anything from the Royal Free hospital?

Baroness Cumberlege

My Lords, many things have been happening during the summer. Hospitals such as the Royal Marsden and the Royal Brompton have put in individual trust applications. They are out to consultation at the moment. The consultation ends for the Royal Brompton on 10th December and for the Royal Marsden on 3rd January. Consultation ended on 15th November on the merger of St. Marks with Northwick Park. I could go through all the hospitals in London explaining to your Lordships the very many moves that are taking place at the moment. Everything we do requires consultation. Those consultation dates are all different. We need all that to be completed before the Secretary of State makes her decisions.

Lord Ennals

My Lords, when the Minister takes the decision does she look first at the economic consequences of moving a unit from one hospital to another? Does the noble Baroness believe the report that I have heard as an all too frequent patient at the Royal Free hospital that economically the unit there represents value for money?

Baroness Cumberlege

My Lords, the Royal Free is recognised as a well run, cost-effective hospital. The capital and resource consequences and purchasing intentions of district health authorities will be taken into account when any changes are considered. It is evident that there is now skill and expertise to treat patients locally rather than sending them to London.

Lord Stallard

My Lords, is the Minister aware that these proposals have been discussed widely throughout the London area, particularly among hospital patients? Is she also aware that the London Kidney Patients' Association, which represents many thousands of kidney patients from all over London, held a meeting on 18th August this year when it was unanimously agreed, that the Renal Review of Specialty Services is without reservation seriously flawed; and that if the recommendations are to be followed seven renal transplant units in London, north of the River Thames, will have their work carried out in three hospitals; and that should fears of closures of London hospitals be justified all that work will then be concentrated in one hospital, The London Hospital"? In other words, there will be one hospital left for the whole of north London to deal with these patients. I understand that these proposals are fairly well advanced. Whatever has happened to patients' choice?

Baroness Cumberlege

My Lords, one of the factors which is evident in London is the number of different specialist centres, not only for kidney transplants but also, for example, for coronary care. At the moment we have 11 renal units in London, yet we have only four in the rest of the shire counties. There seems to be a discrepancy. There is a problem in trying to ensure that there is enough expertise within all the units in London and that they maintain their viability.

As I have said, there are now many specialist units in other parts of the country which are doing equally good work. We are seeing few patients being referred to London. Those factors have to be considered, as well as the general fall in the population of London.

Lord Rea

My Lords, will the noble Baroness look more closely at the main argument put forward by the specialty review team in its report, which she mentioned in her first Answer, for transferring renal transplant surgery from the Royal Free; namely, that University College, London, and the Middlesex have a stronger academic and scientific base? While that is true for biomedical science as a whole, is she aware that the Royal Free unit has made a very important contribution to research on renal medicine over the years? For instance, in the past three years the Royal Free unit has published 50 per cent. more papers on nephrology and renal medicine than UCL/Middlesex. That includes the three Ps—the former kidney hospitals which are now housed in the Middlesex.

Does the Minister agree that the decision of the specialty review team should be reviewed in the light of the above and of the points made by other noble Lords this afternoon about the damage that could be done by breaking up an established and carefully built up expert team?

Baroness Cumberlege

My Lords, Ministers would not agree that the specialty reviews are seriously flawed. The people who carried out the reviews have excellent reputations. They come from other parts of the country and are not directly concerned with services in London. However, their report is just one of the pieces of information that has been submitted to my right honourable friend the Secretary of State. There are other considerations, some of which I have mentioned this afternoon. They are issues concerning hospital sites, the views of local purchasers and the views of academic and research staff. It is a question of balance. I have listened very carefully to the noble Lord and to other noble Lords this afternoon.

Baroness Masham of Ilton

My Lords, can the Minister give the assurance that patients' views will be taken into consideration and also such issues as space and parking?

Baroness Cumberlege

Yes, my Lords. That is always part of the consultation when major moves are being put forward.