HL Deb 06 December 1994 vol 559 cc902-14

7.51 p.m.

Lord Howell rose to ask Her Majesty's Government what action they propose to take to ensure that South Birmingham Health Authority provides adequate hospital services for patients.

The noble Lord said: My Lords, first, my noble friend Lady Fisher has had to go home. She has not been well recently and has had to withdraw from this debate which I am sure your Lordships will understand. Secondly, I believe I am right in saying that according to information which has reached me rather late the Minister spent a considerable amount of time in Birmingham yesterday visiting the hospitals and no doubt acquainting herself with what she believed I might say and getting the answers. Perhaps I may say how much I welcome that. It is very good—especially in the context of these hospitals—that Ministers themselves are trying to investigate and come to grips with the story as I shall unfold it. Although I am critical I want the noble Baroness to know that her visit was appreciated.

I have initiated the debate because it is no longer possible to tolerate the disastrous state of affairs governing the management of the South Birmingham hospitals. There has been financial and administrative chaos in this hospital group for many years past. Vast sums of money have been abused. At least an extra £6 million was provided to bail them out of their financial predicament, following which specific assurances were made to the Public Accounts Committee which have not been met. Now redundancies and closures are taking place on a grand scale. The essential point of this debate; namely, the health service of the good people of Birmingham is being sacrificed on the altar of financial book-keeping to which this hospital group management now gives top priority over patient care.

These are strong words, but I intend to prove every one of them. There is a long history of this matter, but I do not need to detain the House over much about it. It became so notorious that the Public Accounts Select Committee of the other place held hearings about it and issued two of the most damning reports I have ever read in 40 years' membership of Parliament. They ought to produce resignations or sackings, but no such events occurred; nor did the appropriate Ministers of the day—they are not the present Ministers—think it right to accept any responsibility.

Perhaps I may comment that every penny of public money is a Treasury and ministerial responsibility. It matters not whether it is spent by a quango or a health authority. If there is abuse, or worse, it is the ultimate responsibility of the department and the Minister. No such responsibility has been accepted in the affairs of the South Birmingham Health Authority.

In its first report issued in October last year, the Public Accounts Committee says that serious shortcomings in the management control and accountability of the regionally managed services led to a waste of at least £10 million, this at the expense of health care for sick people in the West Midlands. The PAC says that it was astonished that the privatisation of the supplies branch proceeded without the knowledge of the regional health authority. There were serious failings at all levels of management and a serious failure by members of the RHA and its then chairman.

A second hearing of the PAC took place and it reported as recently as July of this year. In the interim the RHA had provided an additional £6 million of funds to meet redundancy costs and to balance the books. The questions and answers at this second hearing on 16th February this year are the starting point for my anxieties.

My colleague, Mr. Terry Davis, Member of Parliament, took the lead. Again and again he asked for assurances that after the £6 million payment and the previous report, the financial affairs of the South Birmingham Health Authority were now in order and that it now had enough money to balance the books and to provide treatment for all who need it. He asked: is it a question of overspending or underfunding? Sir Duncan Nichol told the committee that he thought so but that he relied on the judgment of the region. Yet he was the chief executive of the National Health Service.

The same question was then directed by Mr. Davis to the chairman of the West Midland Region, Mr. Brian Baker. That revealed that an extra £11.2 million was given to the South Birmingham authority in 1992 to clear up its accumulative debt. Sir Duncan Nichol believed that the authority had now been allocated enough money year by year to meet its obligations and to ensure that there was no underfunding; so did the regional chairman.

I must now ask the House to consider the present chaos, which I shall describe, in the affairs of this group of hospitals in the light of those specific assurances. There has been a most serious and continuing deterioration of services; a serious collapse of morale affecting consultants and nursing staff; and a continual worsening of services for patients who have the right under the law—the National Health Service Act—to receive full and immediate treatment for their illnesses.

I spell out some of the factors: a daily fight to get very sick patients into an inadequate number of beds; routine cancellation of operations for seriously ill patients; no ophthalmology service now available for this large area of Birmingham; a pioneering gastro-intestinal unit has disappeared; the world-renowned burns unit is under threat. The consultants there wrote directly to the Secretary of State in September. I ask the Minister whether any action has followed their approaches to the Minister. Varicose veins patients are now shipped to Manchester for treatment which could be provided much more cheaply in Birmingham. One hundred waiting heart patients were contracted to receive treatment at the infamous Clydebank hotel, or Clydebank hospital, which has now collapsed. It is now hoped to send them to King's College Hospital in London. I shall return to that matter shortly.

There is at present a total ban on non-emergency admissions. The intensive care unit had to refuse 60 emergency patients during the year because there were no beds. The breast cancer unit was left without a consultant surgeon when he left saying: it is not possible to provide a top quality service under the financial restrictions". Fracture clinics are cancelled due to the shortage of junior doctors. The consultant urologist says, he is ashamed of the service he can offer after having his bed complement reduced from 52 to 22". In that department 1,000 patients have been waiting for up to two years for treatment. That is a most serious matter and one can imagine their discomfort.

In its policy document Looking Forward the RHA proposes to axe 1,100 beds and replace them with community care. That is in just one group of hospitals. Not only is there no money for such a programme, but the community care programme is now being asked to transfer money back to acute services to keep those acute services alive. The same policy document forecasts a reduction of between 332 and 482 beds —that is 43 per cent. of all beds—by 1997–98. In fact, the programme has been accelerated to such an extent that a 375-bed loss has already been achieved in 1994—not 1997. Staff cuts of the magnitude of 1,200 have been ordered by the region. In fact, 300 went last year, 775 this year and another 400 will go next year when the general hospital loses its acute unit.

It is my contention that the care and treatment of patients is the National Health Service's supreme duty. All financial management and book balancing are merely mechanical factors to enable patients to be treated. That is the purpose of the National Health Service, but that is not the position in that group of hospitals. The very opposite is the case.

On 11th April this year, Mr. Bryan Baker, the chairman of the West Midlands Executive, wrote to Mr. Brian Stoten, the chairman of the South Birmingham Authority and demanded a robust action plan to achieve real savings. He promised £6 million for redundancy costs and another £10 million for price support. He confirmed in his letter the 1,200 staff reductions in the acute unit and the additional 400 to be added from the general hospital. He concluded by expressing his concern that the: Corporate information care plan and the quarterly monitoring information have been rendered largely meaningless". That is a disgraceful letter. It contains not one word of concern about the effect of all that on patient care and the services provided for the sick, which is the prime responsibility of those gentlemen and that authority.

The authority is now taking refuge for its policy of mass destruction in the hearings held before the Public Accounts Committee, which is why I went into detail about them earlier. In a letter to the British Medical Association dated 12th May 1994, Mr. Michael Waterland, the chief executive of the acute services unit, says that the focus of the PAC hearings was on its fiscal duty. So it was, but equally compelling were the assurances that were sought and given that funds are adequate to meet patient needs, as I have already shown.

In his letter to the BMA, Mr. Waterland says that, irrespective of quality, his hospital group has three priorities. I shall quote what he stated in his letter. He said that priority No. 1 was "income and expenditure balance"; that priority No. 2 was "income and expenditure balance"; and that priority No. 3 was "income and expenditure balance". When he made the same point to the Community Health Care Council, I understand that he added: patient care is a secondary consideration". That is quite intolerable, quite contrary to the purpose of the health service and, I believe, quite contrary to the purpose of the Government. So it is, and that is the gravamen of my charge. Patient care and attention, the first duty of the health service, has been sacrificed in those hospitals on the altar of financial expediency.

Finally, I turn to the effect of all that on waiting lists and staff morale. The waiting list deterioration is quite deplorable and totally in contrast to the Government's wishes and claims about improvements. In March 1993, 218 patients had been waiting over one year. By March this year, that number had increased to 1,037. In September 1993, 20 urology patients had been waiting for more than one year. By June this year, that figure had increased to 227. In general surgery, no patients had been waiting more than a year in September 1993, but by June this year 235 patients were waiting. In ENT, the number of patients waiting for treatment for more than a year rose from 36 in September 1993 to 135 in June 1994.

I could give many examples of the suffering that that is causing very sick people. I shall content myself with just one case. Mr. Anthony Damms lives at 111 Eastfield Road, Bordesley Green. In June 1993 he suffered a heart attack and was treated at the Heartlands Hospital, from where he was referred to the Queen Elizabeth Hospital in December last year. He was told he needed bypass surgery and that that would take place in six to eight weeks' time. In April this year he was told he must wait until July or August. In August he was told it may be another 12 months. However, on 21st November—a month ago—he received a call to report for tests on 25th November with a view to being operated on on 2nd December—last week. Told to check the position on the day before—1st December—he did so only to be told not to come in as there were no beds available.

Out of the blue last Saturday morning, two days after he should have been admitted, Mr. Damms received a letter, not from the Queen Elizabeth Hospital but from the consultant he had seen 18 months ago at the Heartlands Hospital, telling him that he may still have a considerable wait and asking him whether he would consider treatment in London. His wife tells me that he also suffers very badly from arthritis and cannot walk across the road, much less travel to London

No citizen should receive such treatment. At this point I was going to ask the noble Baroness to look into the case, but such is the expedition that occurs when Members of Parliament raise matters in the House that I am glad to report that the television companies interviewing me today have informed me that Mr. Damms has now been told that he will have his operation on 29th December. Perhaps I may say how very pleased I am for Mr. Damms that we have achieved such a remarkable success, but I am bound to ask: What about the other 99 patients who have been waiting a long time and need an operation? Is somebody going to do something about them? However, we must be thankful for small mercies and on behalf of Mr. Damms and his family, I must express my appreciation.

I turn now to staff morale. It could hardly be worse. The number of consultants who have resigned is frightening. They include four consultants in haematology; one vascular surgeon; one general surgeon; and one microbiologist. Seven other consultants have taken early retirement.

In September and November last year one of the ward sisters felt it to be her duty to draw the serious situation to the attention of the directorate. Among other matters in her letter which I have seen she referred to the fact that her ward had been left with only two nurses on duty, no provision for meals or help for the manual handling of patients. Agency nurses were of poor quality. There were often no domestic services and no team cleaning. In September she wrote: In short, the ward is filthy. Nurses already stretched to the limit are having to clean toilets and baths. I have written to the hotel services manager to no avail. My ward has an excellent reputation. I have never known morale so low, my keen conscientious staff are looking elsewhere for other jobs where they will be valued".

Then in November the sister wrote again. She said that she had no alternative but to close the ward as patients' lives were at risk and the few remaining staff could not be expected to manage under those pressures. That shows an alarming situation which merits the most intensive investigation. Like all the facts that I have quoted, they speak for themselves. No embellishments are necessary.

Mr. Brian Edwards, the chief executive of the West Midlands NHS Executive, has kindly sent me during the past few days a copy of a letter he has written to the South Birmingham Acute Unit. I have no doubt that he has also sent a copy to the Minister in anticipation of the debate. It was obviously an attempt to anticipate what I was going to say. It expresses confidence that waiting list targets can be met and that performances will be improved. One can only hope so, but those generalised comments ignore totally the vast cuts in staff and beds that have taken place, and the vast increase in demands for admissions.

My belief is that the only way to restore confidence is to have an independent outside inquiry into the affairs of the hospital. That is not into the financial mismanagement—the PAC has done that—but into the level of patient care which is the sole purpose of the NHS.

Sir Duncan Nichol gave firm assurances that the action plan put in place to rectify the financial mismanagement in that area health authority would not damage the service. The truth is that it has not solved the financial problems, and it has damaged seriously the services provided for the public. That is why an independent inquiry is now essential to restore public confidence. If the Minister cannot grant me that request today, perhaps I may hope that she will continue to apply her mind to the hospital to ensure that the finances are put right and, what is most important, that the good people of Birmingham receive the services to which they are entitled.

8.14 p.m.

Lord Rea

My Lords, my noble friend has revealed a sad and serious catalogue of errors. It is hard to believe that a management team could have miscalculated so often, and gone against professional advice. It has been said, with some justification, that one possible beneficial effect of the Government's NHS legislation has been to remove decision-making power from the vested interests of the hospital consultants and move it to managers acting on behalf of patients and communities. But in South Birmingham that policy seems to have misfired totally.

What has happened is the equivalent of a ship dropping its pilot while it is still going through a dangerous passage, full of rocks and dangerous currents, and handing the wheel to the purser who is more skilled in financial calculation than navigation. However, even in financial terms, the Birmingham managers have managed to run the ship aground.

A further example of that, which was given to me by an orthopaedic surgeon, is the decision of the managers to ignore a carefully costed plan put forward by the clinicians concerned accepting that the famous Birmingham Accident Hospital had to be closed but proposing that the Selly Oak Hospital be the site of a new burns and trauma unit. However, that plan was rejected. The general hospital was chosen as the site for the accident and burns service which was created there at a cost of some £4 million. However, after less than two years the decision has been taken to resite the unit at Selly Oak, as originally proposed by the professional staff involved, at a cost of some £6 million.

While the bulldozers are now pulling down the old accident hospital, and patients are being treated at a new unit at Birmingham General Hospital, contractors are building yet another new unit at Selly Oak. That has meant a loss of £4 million of taxpayers' money. That is at a time when the grave shortages, redundancies and bed closures which my noble friend described are taking place. The situation has become so uncertain that, as my noble friend pointed out, a number of senior clinical staff have resigned or taken early retirement. Among those are two general surgeons, Mr. Geoffrey Oates and Mr. John Harman, who have been re-employed in a private hospital which receives patients who cannot be accommodated at the acute unit. Despite that, as my noble friend pointed out, South Birmingham has a waiting list which has been increasing steadily.

I turn now to primary care which, as the Minister knows, is my own field. One of the key features of the RHAs Looking Forward … Moving Ahead strategy was the development of primary care. That involved, in particular, improving practice premises and increasing the number of nurses. But funds are needed for that, some of which were to come from the savings being made in the acute unit. However, as my noble friend pointed out, so rapid has been the run down of beds, and so great has been the disruption of services as a result, that money has had to be diverted to the private sector to contain the increasing size of the waiting list.

As a result, improvements in primary care have hardly been noticeable, except perhaps in fundholding general practices. Incidentally, in creating multi-fund administrative units of a rather luxurious nature, they seem to have no shortage of funds. Fundholders' patients are partially cushioned from the results of the administrative bungles which have been described—a further example, if one were needed, of the two-tier system that the fundholder scheme has created. Sadly that is a case of "to he that hath shall more be given", since poorer districts with the greatest health needs have the lowest proportion of GP fundholders.

In South Birmingham £500,000 has also been taken from the allocation for the psychiatric services—an area in need of more, not less funds—to buttress the acute unit in its difficulties. One answer often proffered by the Government —I have heard this from the Minister—when it is said that there has been too great an increase in the numbers of managerial staff, is that the NHS was previously undermanaged. The South Birmingham story shows, however, that far from improving services for patients these new managers have made them worse and wasted huge sums of public money in the process.

8.20 p.m.

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

My Lords, I am grateful to the noble Lord, Lord Howell, for this opportunity to debate with the select group here tonight the health services in South Birmingham. Although the Chamber is not crowded, I recognise that the subject is of enormous concern to the people of Birmingham. There has been room for misunderstanding and therefore I welcome the opportunity to go into some of the issues tonight.

As your Lordships will be aware, South Birmingham has been dogged with financial problems since its inception in 1991 when it was created out of the merger of the old Central and South Birmingham Health Authorities. I do not wish to retread old ground as to why the financial problems occurred or why it took so long for them to be rectified. As the noble Lord said, this has been thoroughly investigated by the Public Accounts Committee and was covered in detail in its 36th report, which was published last July and to which the Government responded via a Treasury Minute on 18th October 1994.

The Department of Health and West Midlands Regional Health Authority have accepted that senior managers failed to resolve the financial problems within South Birmingham Health Authority in the prescribed timescales.

New senior management teams for both the South Birmingham Acute Unit and South Birmingham Health Authority have been recruited and together they will work to resolve the immediate financial problems and ensure that the acute unit achieves a balanced income and expenditure position by October 1995. It will be announced tomorrow that John Boyak will be appointed chief executive of the acute unit and therefore both teams are fully appointed.

In parallel with these changes, new and exciting developments have also been taking place across Greater Birmingham. We should not lose sight of those. Your Lordships will appreciate that, as South Birmingham is an integral part of the city and comprises one of its two health authorities, anything that affects Birmingham as a whole has equally strong implications for health services in the South Birmingham conurbations.

Many cities throughout the country are becoming aware of the growing need to plan their health services so that they take account of today's rapidly changing demands and in doing so are in a strong position to carry them forward into the next century. As the noble Lord, Lord Rea, will know only too well, medical science and clinical practice do not stand still and we need to be aware of developments and harness them. That is good management and better quality care for patients.

Birmingham has recognised this need and accepted the challenge. On 9th December 1993 the health authorities in Greater Birmingham jointly published a discussion document called Looking Forward. This sets out broad proposals for reshaping health services in the city by recognising the important changes that are taking place. I assure the noble Lord, Lord Rea, that among those changes are plans to enhance and expand primary care.

I am well aware that in developing its health care services Birmingham has had many false starts. It is an enormous task and quite understandably local people have a right to be sceptical over this latest attempt. However, it was with this scepticism in mind that the Greater Birmingham purchasers ensured that Looking Forward was subject to as much public discussion and consultation as possible. They listened carefully to local people's views and amended the proposals to meet their concerns.

On 1st July the West Midlands RHA announced the outcome of these consultation exercises. None was formally opposed by the Birmingham Community Health Councils and this meant that the planned £100 million plus investment programme for Greater Birmingham could now begin.

In South Birmingham this involves investment of more than £70 million. It includes the planned transfer of the Children's Hospital from its present dilapidated location to a refurbished Birmingham General Hospital at a cost of more than £20 million; the development of a high quality accident and emergency service throughout the city and in particular a new £6.8 million accident and emergency department at South Birmingham Acute Unit; and the development of a new £8.5 million oncology centre for cancer sufferers at the South Birmingham Acute Unit.

During my visit to Birmingham yesterday I was told that Professor David Kerr, a leading cancer specialist of international renown based at the South Birmingham Acute Unit, has rejected the opportunity to move to a number of other leading cancer centres in this country because of the excellent facilities in South Birmingham and the encouragement and respect he has had from the management. Also planned is a new £6 million neurosciences centre, again at the acute unit; a £14 million refurbishment of Birmingham Women's Healthcare NHS Trust; a new health centre at Quinton as part of a £23 million investment in primary care across the city; and a major investment in the fabric of hospitals in South Birmingham, including £37 million on upgrading and improving facilities at Selly Oak Hospital, part of the South Birmingham Acute Unit.

Some of these initiatives are already under way and others are scheduled to take place over the next few years. In all, they represent a significant investment in local services across both the primary and secondary care sectors and all will considerably benefit the people of South Birmingham.

The noble Lords, Lord Howell and Lord Rea, drew our attention to the bed closures taking place in particular at the South Birmingham Acute Unit. As I have already pointed out, improved medical technology and clinical practice means that more patients are being treated more quickly using fewer beds. Since 1987 the average length of stay in hospitals in the West Midlands has fallen substantially. For example, in the past six years the average length of stay for general surgery has fallen from 12 to eight days and for eye surgery the fall has been from five days to three.

Day case surgery has become a more common method of treatment. In South Birmingham since 1987 the number of day cases treated has risen by 234 per cent. In the West Midlands about 40 per cent. of cases are now treated on a day case basis. The West Midlands RHA believes that a target of 60 per cent. is reasonable. This is good news for local patients. Credit must go to those who planned, built and now work in the new £640,000, 18-bed day case unit which has recently opened at Selly Oak Hospital and which will benefit the people of South Birmingham.

However, in the midst of all this investment there is a complicating factor. In the past, many health authorities have sent their patients to the South Birmingham Acute Unit for treatment. These authorities are now developing services more locally and this means that fewer patients are being referred to Birmingham. This is better for patients but means that the acute unit has had to look at the various services it provides. It has had to match the changes in demand to the income that it now receives. This is one of the key issues underlying the acute unit's current financial situation.

The noble Lord quoted from a letter from the chief executive citing the importance of having a sound financial position. Every health authority must live within its means, and there is nothing more demoralising for staff or miserable for patients than having services that are expanded one moment and cut back the next. South Birmingham has to get its house in order and regain the stability which staff and patients so badly need.

Inevitably, the review of services has had an effect on the acute unit's organisation, although actual permanent bed closures at the unit have been minimal; a total of 42 since January this year. A significant number of these have been the result of major refurbishment taking place elsewhere in South Birmingham, necessitating short-term bed closures. Unfortunately, there have also been a number of temporary closures at the acute unit because of a shortage of nurses with the required specialist skills. An example is the cardiac unit, where 10 of the 62 beds are currently closed for this reason. This matter is being addressed by the health authority, which is seeking to recruit suitable staff as soon as possible. Interestingly, the situation at the Royal Orthopaedic Hospital and Birmingham Children's Hospital is the reverse, where there has been an increase in the number of beds available over this same period.

Noble Lords have also drawn attention to the redundancies taking place. I wish to say, first, that it is always regrettable when redundancies are necessary but in this case it is essential in order to ensure that South Birmingham lives within its resources.

No significant redundancies have occurred at the Royal Orthopaedic Hospital or the Birmingham Children's Hospital; but, since the beginning of the year, 770 posts have gone at the South Birmingham Acute Unit. The vast majority have been administrative and clerical but some have been from the nursing and medical grades. Only 14 of those redundancies in total have so far been compulsory with the majority achieved through freezing of vacancies and voluntary early retirement.

Decisions on what posts should go is a matter for local managers, who must take account of local needs and the reductions in workload. It is certainly not the case that patients' lives are being put at risk because of those reductions. Posts go because the work is no longer there.

To help those whose jobs have been affected, South Birmingham Acute Unit has set up a staff commission which has been notified of some 400 nursing vacancies since June. In addition, there are plans to retrain about 60 acute nurses to work as community and practice nurses, reflecting the move towards greater care in the community.

Both noble Lords raised the question of waiting lists. The West Midlands Regional Health Authority is unique in that it has set all hospitals within the region a target of guaranteeing all patients who were on West Midlands waiting lists as at 1st July 1994 the offer of treatment by 31st March 1995—a maximum waiting time for treatment of no more than nine months. An additional £10 million region-wide has been made available to achieve that. South Birmingham is signed up to this target but to achieve it means an additional work load. I should explain to the noble Lord, Lord Rea, that that is a short-term initiative, over and above the normal workload. It will not be of a long duration once the backlog has been cleared. Therefore, it is a good idea to use other facilities in order to accommodate that increased workload.

The noble Lord mentioned the situation concerning the cancellation of operations. That is an area of great anxiety, which needs careful management. In that authority, the level of cancelled operations is high. That is partly attributable to the fact that the South Birmingham Acute Unit is heavily involved with treating emergencies and many cancelled operations are a direct result of unexpected surges in the emergency workload. That is particularly true of the cardiac services.

The noble Lord mentioned also intensive care beds. Currently in South Birmingham there are 25 intensive care beds but a further four will be opened in January 1995. Also, a new cardiac bed is due to be opened early next year. I hope that that will relieve the situation.

In his Question the noble Lord, Lord Howell, asked what action is proposed to ensure that South Birmingham provides adequate hospital services for patients. I have already outlined what is planned for the future, but let me also mention very briefly the excellent services already provided: the Birmingham Children's Hospital provides first-class patient care not only to the local community, but to patients elsewhere in the UK and overseas. Its expertise includes craniofacial surgery, oncology, cochlear implants, liver programme including liver and small bowel transplants, cardiac services; the Royal Orthopaedic Hospital, a single specialty orthopaedic hospital where outcome measures compare favourably with world standards; a women's hospital providing excellent maternity facilities and gynaecological care; strong community and mental health support from the local community and mental health trusts. Perhaps the most significant is the South Birmingham Acute Unit which offers one of the widest range of specialist leading edge services in the country including: one of the largest and most extensive transplant programmes in Europe; a quick and early diagnosis facility for the early detection of cancer; a major injuries intensive care unit for burns and trauma patients; one of the top national comprehensive cardiac programmes in the country; a direct access service for GPs to the day surgery programme; the most extensive renal programme in Europe; and a urology department which was a finalist in the national Hospital Doctor of the Year Awards for this year. Add those services to the planned £70 million plus investment in services in South Birmingham over the next four years and I believe that your Lordships will agree that that shows considerable commitment to providing excellent hospital services to the people of Birmingham in the future. Sadly, therefore, I cannot accede to the noble Lord's request for an inquiry.

Lord Rea

My Lords, before the noble Baroness sits down, in her reply she said that the reason for the smaller income of the unit was that fewer patients were being referred to Birmingham for treatment and presumably for operations. How is it then that the number on the waiting list has been increasing?

Baroness Cumberlege

My Lords, I believe that I explained that it is to do with all the changes that are taking place: the need to close beds to refurbish some of the other units; and some of the moves that are taking place concerning the children's hospital and other developments.

Lord Howell

My Lords, the Minister said that she is not able to accede to my request for an inquiry; and I am sad about that. But will she assure the House that she and her ministerial colleagues will maintain a continuous interest in the affairs of those hospitals until the service provided meets the satisfaction of the Members of Parliament and the people of Birmingham?

Baroness Cumberlege

My Lords, I willingly give an undertaking to the noble Lord that we shall keep a very close eye on South Birmingham. The situation needs improvement and I shall give a personal commitment to that.