§ 5.17 p.m.
§ Lord Howell asked Her Majesty's Government what is the future of the Birmingham hospitals.
§ The noble Lord said: My Lords, I am grateful for this opportunity to raise the question of the future of Birmingham hospitals, a subject shrouded in mystery and accompanied by chaos. I am especially appreciative tonight of the presence of my noble friend Lady Jay who will reply to this debate.
§ Birmingham is an important city. It has some fine hospitals and an excellent medical school at the university. It also has large-scale deprivation among its citizens which imposes great strains upon hospital services. Undoubtedly, it is not receiving fair and adequate funding to meet its needs. My main concern tonight is that there is no overall strategic authority to direct the thinking and decision making that is vital to the future of the service. There is no meaningful public consultation before decisions are taken, or not taken, and there is little involvement of the general practitioner in what planning there is.
The trust system is failing because there is no such overall authority. Trust competes against trust. The purchasing authority, Birmingham Health Authority, controls the funds but does not have the authority for any hospital development programme. A classic example of all this confusion has recently come to my notice and caused me to initiate this debate. I informed my noble friend of the circumstances. I know that she has made inquiries, which I much appreciate. The document that I obtained was a set of minutes of a meeting held on 19th February this year of the Birmingham Health Authority Consultants' Committee which was attended by Mr. Brian Stoten, chairman of the health authority. These include the statement that Mr. Stoten and his colleagues at the authority would be happy to see one or two hospitals in the whole of Birmingham. The implications of such thinking would be calamitous for the whole of Birmingham. It would mean the closure of several hospitals and the services that they provide for the public. I immediately faxed my concern to Mr. Stoten and to my noble friend. Mr. Stoten responded immediately, saying that he had been misquoted and that he had written
to Mr. David Farrer, the chairman of the consultants' committee, pointing out that what they had been discussing was the need to rationalise scarce medical resources and the concentration required for patient tertiary and secondary care services. Mr. Stoten also sent me a copy of the reply that he had received, dated 9th June this year, from Mr. Farrer, saying that after consulting his notes he agreed that their conclusions were that Birmingham required,
One or Two Specialist centres with intermediate hospitals and primary care satellite units"—
and that that unfortunately had been transcribed as "one or two hospitals". However, Mr. Farrer went on to say:
personally, I think that with increasing specialisation and reduction in junior staff hours, there is a high likelihood that only one or two hospitals for Birmingham would be viable for the future".
§ I fully accept those corrections from Mr. Stoten, but there is no doubt that these breathtaking concepts were discussed at that meeting of consultants in his presence. Such thinking could lead to disastrous consequences for the future of the hospital services in Birmingham and this is being conducted without any public awareness or involvement. I have sought this debate to bring the matter to the attention of Birmingham's citizens and I should also like to take this opportunity to comment on some of the proposals which we know to be under consideration.
§ There is general consent among my parliamentary colleagues that the Queen Elizabeth Hospital, our principal teaching hospital, is in a parlous state and needs to be rebuilt. I would give that a very high priority. However, the trust which controls it also controls Selly Oak Hospital, one of our large and essential district hospitals. The trust wants to demolish both hospitals and to rebuild them as one state-of-the-art hospital. One of the trusts's problems is that it cannot find a site big enough to build such a hospital and provide car parking.
§ The cost of such an enormous project would be several hundred million pounds. It seems that the trust, the University Hospitals Trust, hopes that the private finance initiative could produce the money. Ministers have properly made it clear that the number of such schemes would be very limited and I cannot conceive that such a gigantic project would ever get off the ground.
§ I must also make it clear that there would be enormous public opposition to the closure of Selly Oak Hospital, which also includes the recently rebuilt Accident Hospital; nor do I think that any suitable site is available, so it is better to kill off this notion earlier rather than later and concentrate thinking about the rebuilding of the Queen Elizabeth Hospital upon which we can all agree.
§ The City Hospital which I know very well is also contemplating rebuilding. This would cost another £150 million of private finance money. Having regard to the statement of Ministers, I do not think this has any chance. In this case, I believe it to be unnecessary. City Hospital does magnificent work among the most disadvantaged neighbourhoods. It needs modernisation; some £50 million would work wonders. But any 1112 thoughts of closure, such as the thinking of the consultants' committee suggests, and which I have raised in this Chamber on a previous occasion, would be met with public outrage.
§ Ten years ago Sir James Ackers, the then chairman of the regional health authority, declared its policy for Birmingham to be for four district general hospitals—City, Selly Oak, Heartlands, and Good Hope. He was right. The only criteria has to be the service such hospitals provide for the public.
§ The geographical make-up of Birmingham's population demands these four hospitals. The demands upon their medical and acute beds is overwhelming, as I know from personal experience. In spite of all the day surgery and technological advances, there are no empty beds in those four hospitals. At peak times, there is overflowing and chronic shortage. The Birmingham public will believe that anyone contemplating the closure of any of those four acute hospitals has taken leave of his senses.
§ In his Budget speech the Chancellor drew attention to the financial savings that can be made by a merger of trust administrations. I believe that one simple authority for Birmingham hospitals could produce such savings and provide the strategical authority the city needs. In its absence some trusts are contemplating a merger of administrations, such as between the City Hospital and Sandwell. This would save money and is understandably probably welcome, provided it is absolutely clear that West Bromwich and Sandwell need their hospital and that the west side of Birmingham needs the City Hospital. I hope that my noble friend can give me concrete assurances upon those considerations.
§ The trust administrations of the Queen Elizabeth Hospital and Selly Oak Hospital are already merged, as are those of Heartlands and Solihull. There is no doubt that substantial savings could be made by merging the administrations of City Hospital and Sandwell. So far as Good Hope Hospital is concerned, its natural population extends into Warwickshire and Staffordshire, a population of some 400,000 and growing. There is room for further administrative economy if Good Hope assumed responsibility for the community hospitals of Tamworth and Lichfield which would be a sensible development.
§ At the moment we have 11 trusts in Birmingham, which shows the expensive nonsense which my noble friends have inherited. These have to be drastically reduced. As I have indicated, I prefer one single strategic authority for Birmingham with four centres of management based on the Queen Elizabeth Hospital and the four general hospitals.
§ Finally, this leads to the one and only priority consideration: how can our hospitals best serve the needs and the convenience of the Birmingham public? There is not much support for the concept of a mega-hospital, even if enough land and financial resources were available, which they are not, so we need to rationalise our hospital services at the acute general hospitals that we now have established.1113
§ An example of what can be achieved can be seen from the astonishing figures that I have been given this week for the Heartlands and Solihull Hospitals, which are now administered by one trust. Solihull Hospital is now taking 23,000 more patients than a year ago. Heartlands is up by 55,000. Incidentally, their accident and emergency admissions are up 12 per cent. Last week when I inquired—mid-summer—they had the same patient load as they normally expect in mid-winter. The other Birmingham hospitals are subject to similar pressures. Every bed is full, illustrating the absurdity of any further district hospital closures.
§ City Hospital and Sandwell have scope for some very sensible rationalisation, especially in the departments of vascular surgery and cardiology.
§ Birmingham has some great strengths which need to be built upon. These are high quality hospitals, an excellent university and a fine medical school which must be urgently expanded. Sadly, as I stated, the main teaching hospital is totally sub-standard and must be rebuilt.
§ An example of the world standard research being undertaken at the university, about which I have personal knowledge, is the Institute of Cancer Research which now has a staff of seven professors and 200 researchers in residence. Professors David Kerr and Alan Rickinson are working as a team to develop new cancer treatments from an understanding of the science underlying causes of cancer. They are leading the world in terms of gene therapy, using viruses to treat cancer.
§ Birmingham has the largest liver transplant team in Europe, led by Professor Paul McMaster, and is considered an international centre of excellence. Birmingham is also developing a team for neuroscience, bringing together surgeons, physicians and scientists to combat neurological illness.
§ In fact, the Queen Elizabeth Hospital is a referral pathway, not just for Birmingham but for the region and the country. Its standard of excellence cannot be tied to just one district general hospital. That hospital, Selly Oak, should have the same relationship with it as do the Heartlands, the City, Good Hope and other hospitals in the region.
§ Birmingham requires leadership—a strategic authority to make and implement decisions. I know that health action zones—I hope I have their title right—are being created to deal with such situations. I ask my noble friend whether we can please have one created for Birmingham. As a leading administrator said to me very recently—this week in fact—Birmingham has spent so long arguing about what should be done that nothing has been done. It is time for a change, which is why my noble friend sits on the Front Bench carrying all our hopes and good will.
§ 5.32 p.m.
§ Baroness Cumberlege
My Lords, perhaps I may say how very pleased I am to be in the Chamber this evening, not least to pay tribute to the noble Lord, Lord Howell. Your Lordships will be aware of the immense contribution which the noble Lord has made as a 1114 distinguished and effective Member of Her Majesty's Government. If my memory serves me right, he was given the unenviable position as Minister for the elements and to the joy of the general public, he only had to say, "Let there be rain", and there was, and there was an end to the drought; and when we were heavily snowbound, he only had to say, "Let there be a thaw", and there was. As someone who comes from a farming community, I have to say that we were greatly indebted.
But more seriously, the noble Lord did and continues to do an immense amount of good in promoting sport. Locally, he has probably done more than almost any other individual to promote Birmingham. Marrying those two together, I think I can say that the vast majority of us shared his acute disappointment when his sophisticated and energetic bid for the Olympic Games suddenly failed. This evening, in his customary forthright manner, we have heard in this debate his determination that the NHS in its turn should not fail his proud city and its people.
On 6th December 1994 we had a debate with a very similar title, but the situation today is not the same; it is altogether different. In that debate, your Lordships recognised the recent, very unhappy past of the South Birmingham Health Authority and its unresolved deficits. We also recognise the interest and investigation undertaken by the Public Accounts Committee and the department's reply. But that was in 1994 and so much has happened since then.
At one time there used to be five health authorities for Birmingham guided and steered by a regional health authority. The regional health authority was abolished and the five authorities reduced to one. The new, or rather newish, Birmingham Health Authority, is the largest in England and its purpose, among other things is to give strategic direction in consultation with the local people.
It also has a duty to live within its means, and I should like to congratulate it on achieving that. That is no mean feat when there have been so many changes with which to contend and it had to start its work from such crumbling foundations. It had to eradicate a £23 million deficit in three years. That is a huge achievement and I believe that there are lessons here for other large cities in the United Kingdom.
However, Birmingham has not achieved all this by standing still. On the contrary, it has taken some brave decisions, not least in moving the children's services into the old general hospital. Before long these paediatric services will be in place, at a cost of £25 million, and will be in a position to lead the country. Even the great and marvellous Great Ormond Street hospital, with which I know the Minister's mother was closely involved over many years, will need to look out.
The excellence of some of the other clinical services is also unquestioned. The noble Lord has mentioned some of those. The liver, renal and cardiac services have not only a national but an international reputation, and that is without going into the many areas of research and development, for which Birmingham is world famed, and again the noble Lord has mentioned that this 1115 evening. If anyone has any doubts about the delivery of service, then the recent publication of the performance league tables can leave them in no doubt. I am sure that the noble Lord, Lord Howell, whose very life has been gripped by league tables, must have been thrilled to read the headline in the Birmingham Post: "Best Hospitals in England".
I recognise the noble Lord's fears for the City Hospital. I do not know the detail of the next strategy about to be published, but I would be surprised if, for example, the available places for training medical students, which we know are very important in keeping up standards, were to be reduced. There is a 500 increase in the planned numbers of medical students and they will need clinical experience. Where better to have that than in the City Hospital in Solihull and other local hospitals, albeit the nature of some of the clinical specialist and other services will be changing. That is right and proper if we are to meet the ever-increasing demands of the population and the new developments in technical medical advances.
In our heart of hearts most of us resent change, and never more so than when it is a local and much loved hospital which in our eyes is providing a first-class service. But some changes are inevitable. The merger of the Solihull and Heartlands Hospitals is a case in point. Indeed, it was where the Royal Colleges felt unable to accredit for teaching purposes unless there was a better quality of clinical experience for the medical students.
But mergers do not necessarily mean demolition. I should be very surprised if there were a suggestion that Solihull, with its spanking new A and E department were to be demolished. No doubt the Minister will be able to reassure us about that this evening.
I believe also that there is a limit to the numbers of tertiary centres which can be sustained if we are to maintain or, indeed, improve the quality of care which today is complex, sophisticated and enormously successful. With a population which increasingly seeks redress through the courts, care must be given to ensure that health professionals have the equipment, access to diagnostic testing and access to the skills and expertise among other areas which we know they need in order to provide a first-class service. But we cannot begin to provide everything for everyone in every hospital.
Tonight the noble Lord made a plea for a single strategic authority. A week or so ago, I think, I heard him suggest that Birmingham needs an exercise similar to that performed by Sir Bernard Tomlinson for London or an expert panel similar to the one just set up by the Government under the leadership of the distinguished former president of the Royal College of Physicians, Sir Leslie Turnberg.
My Lords, I am grateful for the way in which the noble Baroness is dealing with this matter. But I made no suggestion that Birmingham should have anything comparable with the Tomlinson Report. It may need it but I doubt it. I certainly have not suggested it.
§ Baroness Cumberlege
My Lords, I stand corrected. I have misunderstood the noble Lord. It was a debate on a Starred Question which we had about 10 days ago. However, I shall have to re-read Hansard.
I am grateful that the noble Lord does not believe that we need something similar to London. I believe that we already have a strategic authority in place in Birmingham. When we look back to the regional health authorities and their abolition, a few of their functions were transferred to the centre but many more were transferred to the new health authorities. Of course, Birmingham, which has a single health authority—indeed, the largest in England—has shown that it does have a grasp, a management grip, to provide not only the ability to control finances but also to procure some first-class services and also to encourage education and research. It has the capability to provide a strategic approach.
If we look back to the history of Birmingham, it will be seen that in the 1980s we had a strategy entitled, "Building a Healthy Birmingham" and that, in the 1990s, it was "Looking Forward" and later, "Moving Ahead". We look forward in the autumn to seeing another strategic document. I am sure that it is necessary because it is being done, but I hope that it is the last one for some time because I believe that the health service has earned itself a reputation of suffering paralysis by analysis. I fear that this may be another case in point, if we go on just providing strategies rather than action.
Finally, I should like to tell the noble Lord, Lord Howell, that I am aware that he is the recipient of the Olympic Order. I hope that he, in turn, will be able to award a similar distinction to the health services in the proud city of Birmingham, for, although they probably have more work to do, I do believe that they are probably Olympic winners.
§ 5.41 p.m.
§ The Minister of State, Department of Health (Baroness Jay of Paddington)
My Lords, I am very glad to have the opportunity to reply to my noble friend's Question about the future of the Birmingham hospitals. I should like to thank the noble Baroness, Lady Cumberlege, for her contribution to the debate which was of course extremely authoritative. As so often, my noble friend has drawn attention to a major issue in this important city which he has represented so ably in both Houses of Parliament over many years. I should like to thank him in this context for his courtesy in discussing the debate with me and letting me know what points he planned to raise.
Naturally I share my noble friend's frustration about the recent lack of strategy in organising and developing healthcare. That has been one of the most destructive outcomes of the National Health Service internal market and is one of the main reasons why this Government will replace it. It has led to the kinds of local administrative excesses which my noble friend vividly described in Birmingham and in many other places.
Birmingham has, nonetheless, a well-deserved reputation for improving its health services, as the noble Baroness described, and has a reputation for outstanding 1117 medical science. My noble friend rightly mentioned some of the distinguished people who have contributed to that reputation. In the past few weeks, I have had the personal benefit of some extremely useful advice from people like Professor David Kerr, who has been enormously helpful in the Government's new initiatives on cancer.
Today in Birmingham the health authority and the health service managers are also, as the noble Baroness, Lady Cumberlege, described, achieving good results after a very rocky period—results which have been achieved by some innovative action. Birmingham now enjoys some of the lowest waiting times for operations in any city in the country. At University Hospital, which is the largest hospital in the region, no patients have been on the waiting-list for treatment for longer than nine months. I am sure that my noble friend is extremely pleased to acknowledge that performance.
The noble Baroness, Lady Cumberlege, mentioned the impressive performance on the basis of the standards of the league tables, the most recent of which were published just last week. As noble Lords will know, the Government have been critical of the limitations of those league tables and we shall in future introduce measurements of clinical quality, as well as financial and management targets, into the assessments of NHS performance because we feel that they are more relevant to most of the people who use health services. Nonetheless, I am glad to have this opportunity to congratulate Birmingham's hospitals on the great improvement in local standards on the performance measurements which the league tables, as they stand at present, show.
In looking at the particular circumstances of individual hospitals, perhaps I may just recap on the present position. As my noble friend explained and as the noble Baroness, Lady Cumberlege, said, there are four general hospital trusts in Birmingham; namely, City Hospital in Dudley Road, Good Hope Hospital in Sutton Coldfield, Birmingham Heartlands Hospital in the east of the city (which is merged with Solihull Hospital) and University Hospital Birmingham NHS Trust (which combines the Selly Oak and Queen Elizabeth Hospitals). There are also four specialist hospitals: Birmingham Children's Hospital, Birmingham Dental Hospital, Birmingham Women's Hospital and the Royal Orthopaedic Hospital. As well as serving Britain's second city, Birmingham's hospitals are indeed a centre of excellence for the whole of the West Midlands region.
As the noble Baroness, Lady Cumberlege, mentioned, the most recent organisational plan for Birmingham was published three years ago. It recognised the rapid advances in medicine, such as day case surgery, and new technologies which allow patients to leave hospital more quickly after treatment. But that plan confirmed the need for all of these hospitals, while recommending changes in the pattern of services that they offer. As we know, medical techniques continue to develop year on year, and that plan set in train a series of discussions 1118 about the development of individual clinical specialties. Birmingham Health Authority needs to take that into account in planning its services of the future.
On an earlier occasion—and I believe that this was the one to which the noble Baroness, Lady Cumberlege, was referring—my noble friend raised the question of a fresh look at the overall picture of service provision. At that time, in response to an oral question, I did say to my noble friend that obviously the Government will be looking closely at the outcomes of the short-term review of London hospitals that Professor Lesley Turnburg and his expert colleagues are conducting this summer. It was that form of inquiry which I believe my noble friend was anxious to see replicated in Birmingham.
I am happy to confirm today that if we do feel that that is a successful method of reviewing services, it could well be used in developing a strategic approach in other places like Birmingham. I should like to take this opportunity to take note of my noble friend's suggestion about Birmingham becoming a health action zone. That is certainly an idea that I shall take back to my right honourable friend the Secretary of State for Health.
Apart from the distribution of services, the other issue which needs to be faced in Birmingham—and again both speakers referred to this—is the physical state of the hospitals. I am sure that I do not need to elaborate on this to my noble friend, but Birmingham hospitals still have many buildings which are in a very poor condition or unsuitable for modern clinical practice and the situation needs remedying. In recent years Birmingham has reduced the number of small outdated hospitals and concentrated services on the four acute trusts that I mentioned. I am sure that my noble friend is familiar with this, but the old Midland Eye Hospital and Birmingham's skin hospitals have closed, with the services being transferred to City Hospital. Moreover, there have been some new buildings on other Birmingham hospital sites. Indeed, the noble Baroness, Lady Cumberlege, referred to some of them.
Those changes have clearly led to improvements; for example, in the upgraded accident and emergency facilities to which the noble Baroness referred. Next spring will see the transfer of Birmingham Children's Hospital to the substantially refurbished General Hospital site in the city centre. Another example is the concentration of cancer services at a centre of excellence at the Queen Elizabeth site of University Hospital, which will enable full advantage to be taken of the collaborative research facilities at the university.
However, despite this and other investments which have taken place, it is striking—and I am sure that my noble friend knows this very well—that the newest of Birmingham's major hospitals actually opened before the last war. My noble friend will indeed know better than I do that investment in Birmingham hospitals is needed, for, as my noble friend and I agree firmly, there needs to be a proper strategic context to plan such investments.
Birmingham is faced with having to meet the constantly changing challenges of medical science in buildings which are often old and in need of heavy maintenance. Consequently, Birmingham Health 1119 Authority is now seeking views from all stakeholders in the various communities and health services in the city about how it can improve access to services and improve the quality of such services. The health authority wishes to use the process to help it to plan the future direction of hospitals and indeed of hospital development.
I know that that is the main point of my noble friend's concern. I should like to make it absolutely clear that there really is no predetermined view of how those services will change. Bryan Stoten, the chairman of the health authority, to whom my noble friend referred, has said that his authority is committed to working collaboratively to plan strategic change in Birmingham. I know that my noble friend has been worried that Mr. Stoten has a secret agenda for change and, as he said in his speech, that he may have been conducting planning meetings behind closed doors. I reassure my noble friend that I have personally spoken to Mr. Stoten about this matter on several occasions, most recently yesterday evening. I am convinced that he intends there to be an open discussion about the future. There seems to have been some genuine confusion about the status and the content of the meeting in February to which my noble friend referred.
I also wish to emphasise to my noble friend the Government's overall determination to improve openness in the National Health Service. We feel strongly that there must be transparency about decision-making in this vast public service, and proper public consultation, before decisions are finalised. I hope that my noble friend will have been encouraged by the recent announcement of my right honourable friend the Secretary of State that in future hospital trusts must hold their meetings in public. This is an important change which, I hope he will accept, supports our aim of general openness.
I refer to a few of the proposals in Birmingham which are known and already in the public domain. The noble Lord will know that University Hospital Birmingham NHS Trust announced last autumn a series of interdisciplinary clinical service reviews across the trust. In the interim report about six months ago the doctors came out strongly in favour of combining the services 1120 of Selly Oak and Queen Elizabeth hospitals on one site. At the same time City Hospital has begun work on its own site development plan, with a focus on the services required by the people of Birmingham in the next century. Unfortunately, this work was not at a sufficiently advanced stage to have been included in the recent strategic review of PFI schemes undertaken by the Government.
I recognise, of course, that the noble Lord has a particular personal interest in the proposed modernisation of City Hospital, having long been a good friend and a champion of the hospital. I thank him for raising those anxieties here. I look forward to visiting City Hospital again at the beginning of September and seeing the situation for myself. I believe that the eventual reprovision of City Hospital should result in an enhanced service for the residents of Birmingham, taking advantage of improvements in day surgery and shorter lengths of stay. It is too early to answer some of the specific points, for example, how many beds will be required at the new hospital, and how working practices may change. That will be clear only when plans have progressed further, but I can assure my noble friend that the future of City Hospital will be subject to full public discussion and consultation. As a start, my honourable friend in another place, the Minister of State at the Department of Health, Mr. Milburn, is meeting Members of Parliament from Birmingham before the end of this parliamentary Session to discuss these questions and the next stage of the plans.
Everyone with an interest in seeing improved healthcare in Birmingham, including local residents—I stress that—will have the opportunity to contribute to the debate. Any final decision on the future size and shape of the new City Hospital and University Hospital in Birmingham and the other two acute trusts will take careful note of the responses during the consultations and the work currently under way in the trusts. I am sure that my noble friend will continue to contribute vigorously to the discussions and to the consultations. I again thank him for raising these issues in your Lordships' House.
§ House adjourned at eight minutes before six o'clock.