HC Deb 30 October 2001 vol 373 cc235-42WH 12.58 pm
Mr. Julian Brazier (Canterbury)

I am grateful for the opportunity to hold an Adjournment debate on the future of Kent and Canterbury hospital and on wider acute services in east Kent. I welcome the Minister to her place.

Immediately after the 1997 election, the East Kent health authority brought forward plans to run down Kent and Canterbury hospital so that it would become a nurse-led minor injuries unit, supplemented by a few beds for slow-stream recovery geriatric wards. EKHA, as the authority is normally abbreviated, argued that there was insufficient critical mass for doctor training on the three major sites in its area. It had submitted similar plans under the previous Conservative Government, with children's services as the first area to be considered. The plans were firmly rejected by the then Secretary of State, who insisted that critical mass training requirements for doctors should be met in a different way by a new concept of rotating training across all three sites.

In 1998, after a long and gruelling consultation process, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), ruled on a compromise. It was unsatisfactory, because the most accessible accident and emergency unit in east Kent was lost. Canterbury is the hub of the bus and rail systems of east Kent where 37 per cent. of the population live in villages. To give one small example, the last regular bus service from Whitstable, a town in my constituency, to Margate is about to cease.

The compromise at least guaranteed the future of East Kent's joint cancer centre at the Kent and Canterbury hospital and of a limited cardiac service there, as well as 230 beds. The then Secretary of State wrote to me in December 1998 and September 1999. He asked EKHA to guarantee that on-site consultant anaesthetic, surgical and medical cover would be provided at the Kent and Canterbury hospital during the day, with full on-call cover out of hours, and that consultant medical cover would include cover for the coronary care unit. He announced expenditure of millions of pounds on a new linear accelerator to replace an old one at the cancer centre. That facility is now being installed at the Kent and Canterbury hospital and is a major part of the joint cancer centre shared with Maidstone hospital. That joint centre obtained the country's first cancer charter mark in 1998.

EKHA has continued to argue that, to meet requirements for critical mass, it needs to reconfigure services in Kent. The requirements for reconfiguration were denied in writing from the very beginning by the secretary of the Royal College of Physicians. None the less, the only available route, then and now, has been a private finance initiative programme. That would mean that our local health service would have to bear a heavy and perpetual financial penalty. Due to the sheer scale of the costs involved in the reorganisation, that must affect its ability to deliver capacity. Therefore EKHA logically recognised that a lower bed and nursing capacity would have to be accepted to achieve the reconfiguration of which it dreamed. Since then, for a number of reasons, the position has changed radically and it has become obvious, even to the health authority, that east Kent is suffering from a severe shortage of capacity.

Our local hospitals gained two stars out of three in the recent awards, and I congratulate the hard-working and over-worked clinical and nursing staff who helped to achieve that. None the less, as my postbag continually testifies, waiting times are getting worse despite changes made in the method of recording.

We have just come through summer, which is traditionally less busy than winter, but combined queues in the three accident and emergency units have sometimes totalled as many as 100 people. Behind the appalling statistics are the individual people waiting on trolleys, inevitably, without proper supervision. I could refer to several horrifying individual cases, but time allows me to mention only two.

Earlier this year, Mrs. Connie Jones, a woman of 97, waited two whole nights in casualty before she could be admitted to a proper ward. Much more recently, we had another terrible case. A Whitstable man, Ray Gilson, aged 81, was left in the accident and emergency department while he underwent tests for swelling and pain in his legs. He spent three whole days in the accident and emergency unit, being wheeled backwards and forwards between tests. He was refused a bath, presumably because no one was available to supervise him. His family had to come in and change his pyjamas when they became stained. Sadly, it became clear that he was in the last stages of terminal cancer, but the indignity of his last few days on this earth was so desperate that the family of that seafood shop owner from Whitstable—a much respected figure—scraped together the money to get him out of the Kent and Canterbury and into the private Chaucer hospital where he was able to spend his last few days with some dignity in a proper bed in a proper ward.

Although EKHA, and now the hospital trust, continue to talk the obsessive language of reconfiguration, half the consultants—81 in total—from across the three East Kent acute sites have attended a meeting. They passed a unanimous motion saying that shortage of capacity now threatened clinical standards. Even more amazingly, junior doctors—they have their whole careers ahead of them, so one would not expect them to go public—have almost all signed a letter saying the same thing. In doing so, they have put their careers on the line. In both cases, the concern relates to the shortage of capacity; they were not a call for a reconfiguration.

EKHA's response has been a new public consultation document, suggesting five options. Time precludes me from evaluating each singly, so I will just say that they range from option one, keeping the status quo—which EKHA effectively rubbished in its initial announcement—through to the Secretary of State's plan, which is now called option two. Option five, at the other extreme, is a reversion to the original 1997 plans to close the whole hospital apart from a nurse-led minor injuries unit, out-patient services and a few recuperation beds.

The halfway house on which the previous Secretary of State decided would have been very expensive, costing more than £100 million even by EKHA's estimates—and it seriously underestimated the cost of its last big private finance initiative. One can only imagine the colossal cost of the reorganisation proposed under option five. Yet that appears to be EKHA's favoured choice. It would mean not only the loss of the accident and emergency unit, which proved so vital during the flooding when roads in both directions were blocked, but the loss of the beds and the coronary unit promised us by the Secretary of State. Perhaps most seriously, it would result in abandoning the necessary support for the cancer centre. Some cancer services would, of course, be able to continue, but services for the most dangerous cancers—those requiring more complex chemotherapy and radiotherapy—would be lost to East Kent completely if option five went through.

I believe that all east Kent MPs strongly oppose that option. The hon. Member for South Thanet (Dr. Ladyman) has suggested that the loss of those services from east Kent would be unacceptable to him and I know that my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson) will say something on the subject in a moment. Yet, incredibly, although at least one of the proposed options involves abandoning those services and would result in our walking away from the new linear accelerator that is just being completed, the options have been framed without any mention of cancer at all. Apparently, that is to be dealt with in a separate plan.

I want to give the Minister plenty of time to respond, so I will end by asking three simple questions. First, were the former Secretary of State's pledges to the people of east Kent worth anything to my constituents? Secondly, does the Minister accept that, even if substantial extra sums were made available, the addition of a gigantic financial burden to our current health budget—a PFI on such a scale must result in that—will lead to a lower capacity than could otherwise be afforded? Thirdly, does she accept that any move away from the status quo must mean a loss of access for people in Canterbury, Whitstable and Faversham and for those in villages who make up more than a third of the population of east Kent?

I urge the Minister to tell EKHA that it should reconsider it proposals. It should examine how it can increase the capacity of our already overstretched system, and not get involved in empire building through expensive reconfigurations.

1.9 pm

Hugh Robertson (Faversham and Mid-Kent)

I should like to add some brief comments to the excellent speech made by my hon. Friend the Member for Canterbury (Mr. Brazier).

My concern about the Kent and Canterbury hospital stems from three factors: I was born there; my parents, now retired, live in Canterbury; and the hospital has been the dominant issue in my postbag in the four months since my election. The matter affects approximately 20,000 of my constituents, so the extent of local anger should not be underestimated. There is anger that the hospital is being downgraded at a time when the public perceive that more money is going into the national health service. There is also massive local anger about the decision to row back from the commitments given by a previous Secretary of State. My hon. Friend has also alluded to the capacity concerns that many of us share.

Canterbury is a cathedral city. It has a large and growing student population and it is also an extremely popular retirement venue. In anybody's figures, the population in Canterbury and its surrounding areas can only rise over the next 10 to 15 years. In short, it is the dominant population centre in east Kent, and it needs its own hospital in the current configuration. I therefore support totally my hon. Friend's efforts.

1.11 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing a debate on a matter of great concern to him, to other Members of Parliament and, crucially, to his constituents. For many years, the hon. Gentleman has been a fervent supporter of his local hospitals. He, like the people of Canterbury, is eager to secure the best quality health services that any community expects. At the outset, I assure him that the Government share common ground with him. We are committed to providing a high-quality NHS for everyone, wherever they may live.

As the hon. Gentleman said, the provision of hospital services in east Kent has been the subject of much debate in the House and the local community. I am pleased that this debate gives me an opportunity to outline some of the changes that have taken place since the issue was last debated. I shall also try to outline some future plans for the development of services both specifically at the Kent and Canterbury hospital and generally in east Kent.

As the hon. Gentleman said, the former Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), originally made the decision on changes to the area's hospital services in December 1998. He also set out the conditions on which the changes should be based. The reasons why he made that decision have previously been debated by the hon. Gentleman, and I do not propose to go into them now. The chosen option for reconfiguring acute services, which was endorsed by my right hon. Friend, was right at the time that it was taken. However, we are three years on and we have seen the introduction of a whole agenda for clinical governance. We must therefore reconsider whether that configuration would still be able to meet present-day needs. I shall speak about the detailed options later.

As well as the need to meet the clinical governance agenda, I am well aware that the hon. Gentleman and other hon. Members have raised concerns about the increasing pressure placed on the capacity of the local health economy as the demands for hospital services grow in that area. I should like to outline the progress that has been made since the original decision was taken. There has been significant extra investment at the Kent and Canterbury hospital. We have expanded renal inpatient beds at the hospital and the surgical ward block, and we have refurbished a day-surgery area. A purpose-built unit for the health care of older people has also been completed. It includes two rehabilitation wards, a stroke unit, a therapy centre and a day hospital. Elderly care services have been transferred from Nunnery Field hospital to a new elderly care facility, and a new daycare recovery unit has been opened. There also plans to open a new cataract centre at Canterbury in the next few months. Despite all that investment, I acknowledge that the local health economy is still under pressure and that local people are concerned about the future of their hospital.

A key plank in the development of services is the major capital investment—the hon. Gentleman referred to this—in the Queen Elizabeth Queen Mother hospital, the William Harvey hospital and the Kent and Canterbury hospital. To achieve that aim, the East Kent Hospitals NHS trust submitted a strategic outline case for investment, which was approved in February. However, in the next stage of developing that business case, it became clear that were other ways in which to try to achieve the overall objective of providing first-class health services for the people of Kent and that those options should be reassessed. A rigorous reappraisal of the original endorsed option has taken into account the standards for current clinical work and the requirements for developing new hospital facilities.

However, I should like to take this opportunity to tell local people that there is no question mark over the future of Kent and Canterbury hospital. There are no proposals to abolish it or to prevent it from functioning; instead, we are reappraising the balance and mix of services that ought to be provided throughout the health community in trying to ensure that people have access to high-quality care. None the less, I acknowledge that physical and geographical access is an issue. It is always very difficult to decide on such matters, and to balance local people's need for access with the need for quality, accreditation and sufficient throughput of work to maintain clinical standards.

In reappraising the options, we have tried to ensure the involvement of front-line staff. Indeed, clinicians' support for some of the options has been an issue for many years. As the hon. Gentleman said, there are four options, all of which are based on the principle that there will be two main centres at Margate and Ashford, but a mix of services at Canterbury. Option one is the former Secretary of State's endorsed option; option two is to have an elective service at Canterbury; option three is to develop Canterbury as a community hospital; option four—perhaps the most substantial of those currently proposed—is for Canterbury to have an acute medical unit, a critical care unit, elective orthopaedics and a day surgery.

Mr. Brazier

Have the Government and the East Kent health authority abandoned the status quo—which was option one—in the past few days? As I understand it, such an option is a legal requirement in any private finance initiative submission.

Ms Blears

As far as I am aware, the options that are being developed are those that I have outlined. Of course, we have yet to begin a formal consultation process. If a further option emerges, I shall inform the hon. Gentleman. However, according to my information, the four options to which I referred are being developed.

I want to make it clear that none of the proposed options means that the Kent and Canterbury hospital will lose its ability to deal with emergency cases—an issue that I know has been of great local concern. There will be a full accident and emergency service on the Kent and Canterbury site until the William Harvey hospital and the Queen Elizabeth Queen Mother hospital are able fully to accommodate patients from Canterbury. Under each of the four options that I outlined, a unit would remain on the Kent and Canterbury site. I understand that it will continue to treat between 70 and 80 per cent. of the patients that it sees. The impression has been given that a minor injuries unit will see only a minority of the cases that must currently be dealt with, but the reverse is true: it will deal with the majority of such cases.

As I understand it, there will be a three-month period of public consultation, so I cannot comment further on any of the options. However, I am sure that they will be the subject of intense debate in the local community.

The hon. Gentleman raised the issue of how the proposals will interact with cancer services. That is an extremely important point, and I can reassure him that proposals for public consultation on the options for the future of services in Canterbury will not be published until it is clear how they will relate to cancer services. I agree with him that we do not want consultation on one set of services to proceed in isolation. In developing services, we must fully take into account their clinical implications for the cancer services that are available at the Kent and Canterbury hospital. We have responsibilities in accordance with the national cancer plan to ensure that people in Canterbury have access to good, high-quality cancer services, but we must ensure that the proposals are not seen in isolation, and do not have a detrimental effect on developing cancer services for local people.

Mr. Brazier

That does not quite answer my question. Will there be consultation on the implications for cancer services, or will they simply be listed? At least one of the options, certainly the minimum option, means losing the cancer centre in Canterbury and probably in east Kent. It would be extraordinary if the Government consulted on that issue at the same time as the rest of the package.

Ms Blears

The proposals for the consultation will not be published until it is clear how they relate to cancer services. I cannot confirm that there will be a joint consultation on the services, but I take the hon. Gentleman's point about the minimum option. I make it clear to people in east Kent that I will urge the health authority to ensure that, if the proposals have implications for cancer services, it will not simply be a matter of including them and ticking a box. No decisions will be taken that could have a knock-on effect on cancer services from which it would be impossible to recover. We need to get the balance right.

The hon. Gentleman mentioned capacity, which is an underlying issue in the area. In April 1999, there were 1,627 acute beds in east Kent, and the number has increased slightly to 1,633 in 2000 and to 1,642 at present. I accept that the increase in the number of acute beds is slow, but it is going up. I acknowledge that services are under pressure, so it is crucial that the beds inquiry continues to monitor the number of beds available in the east Kent area. I am pleased that a new service, the east Kent bed bureau, is monitoring bed occupancy in the area, and that will result in a more efficient and effective use of the existing capacity. I do not say that it is an entire solution but, in many cases, bed usage is not maximised because people do not have up-to-date, online information on the beds that are available in each hospital at a particular time. We are gradually developing more sophisticated systems to monitor bed occupancy in the NHS to ensure that the maximum use is made of the beds in the system.

Every hospital now has a medical acute assessment unit, and community assessment and rehabilitation teams, day hospitals and crisis outreach teams help to reduce the pressure on accident and emergency departments by supporting people, especially elderly people, in their own homes, thus avoiding emergency admissions when possible. A key plank of our strategy for hospitals is to support people at home and another is to tackle the important matter of delayed discharges, which is essential if we are to maximise hospitals' capacity.

I am pleased that the announcement of extra money to deal with delayed discharges will affect capacity in east Kent, not just this winter and for the next 12 months but for the next few years. We will put in £100 million this year and £200 million in the following two years and that money will have a real impact. Kent county council has been allocated an extra £2.1 million from the extra funds to try to ensure that people do not linger in hospital when they no longer need to be there. If people stay in hospital when they do not need to, other people cannot be treated, and it is bad for their health. Once people no longer need acute medical care, they should be either in intermediate care or supported by domiciliary care packages in their own homes so that they can maintain their independence. Putting all the measures in place will be essential in ensuring, as far as possible, that we relieve the pressure on the health economy in east Kent.

I acknowledge that staff in all the area's hospitals work incredibly hard and do their best to ensure that patients get the highest quality care and that we do not see repeats of the terrible incidents of the past. I am pleased to say that the trust has not reported any cancelled urgent operations in the past three months, and that is a tribute to its management and working systems. As the hon. Member for Canterbury said, the trust was awarded two stars, and it is delivering on its targets on many of the indicators that we monitor. It is important to say that, because I do not want to create the impression that there is an on-going crisis in the hospitals. They are doing a fine job in providing a high standard of care to local people.

I am concerned about the length of time that it has taken to reach a resolution on many issues in east Kent. Uncertainty for staff and the public can affect morale and recruitment, and does not ensure that people perceive their health services to be prospering and growing in the local community. Whichever option is decided on after consultation, the overriding concern must be that patients are treated in a safe environment and in facilities that are fit for the 21st century.

Mr. Brazier

Given that the decision may mean the abandonment of the former Secretary of State's pledges, is the Minister willing to commit the Government, rather than EKHA, to making it? Will she assure me that, if EKHA were to choose an option that involved abandoning even the minimal pledges made by the then Secretary of State three years ago, EKHA alone would not be allowed to make the decision and that it would require the new Secretary of State's approval?

Ms Blears

As I have said to the hon. Gentleman, the decision made then was the right one at the right time for the circumstances. Time has moved on and we have a new clinical Government agenda. It is right that further options are considered. He will know that there is a process through which every option must go, and that involves it being drawn up, public consultation involving the whole of the local community and, if there is not agreement, submission to Ministers for consideration. That is why it would be inappropriate for me to comment further on those options. If there is no local resolution, a central decision will be taken.

The modernisation of services in the area will go ahead. I acknowledge that there have been some problems and that they are a sign of the need to invest in new, modernised services for local people. That is exactly what we intend to do. I accept that there have been problems in the transition, but we have not simply stood still and not made progress. I have set out today the investments that have been made in Kent and Canterbury hospital for new surgery units and rehabilitation facilities. People in Canterbury and all east Kent have a right to expect to be able to rely on the best national health service facilities for themselves and their community. Consultation on the options will undoubtedly take place in the next few months, and hon. Members will have the opportunity to make further representations. I know that they will do their utmost to represent the views of local people and to ensure that we are thoroughly informed when we come to deciding on the crucial issue of the future of health care in the area.