§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Jim Murphy.]9.30 am
§ Mr. Andrew Tyrie (Chichester)
The first point that I want to make to the Under-Secretary of State for Health, the hon. Member for Salford (Ms Hazel Blears), about the impending closure of the King Edward VII hospital is that the campaign to try to save the hospital enjoys cross-party support, as can be seen by the fact that Liberal Democrat and Conservative Members are present for the debate. I have also received many messages from Labour Members and a huge amount of support from people throughout the country. The issue is neither purely local nor party political, but it is extremely grave.
I shall read out one of the several hundred letters that I have received from consultants and general practitioners who practise in the area. It states:I am a Chichester GP. Closing King Edward VII will cost lives. Here's why.The doctor points out that the Portsmouth machines for radiotherapy are not all in good shape:One will be closed from April … Without the one at KE7, they will have 50‥ reduction in capacity. Waiting times for radiotherapy for breast and other cancers are currently 12 weeks at Portsmouth. They will double or more in April if KE7 closes.He notes that the standard waiting time for radiotherapy is four weeks. The letter continues:So West Sussex and Hampshire patients will be terribly at risk, waiting perhaps 6 months to start treatment instead of 4 weeks. Survival at 5 years is related to time of starting treatment.Apparently the bosses at the Strategic Health Authority are saying that the closure will not affect waiting times. They say that existing facilities can absorb the load without increasing delays. They must be wrong.The public will not hear about this"—well, they are hearing about it now—Why? Because the consultants that work in the Portsmouth department have been told they cannot speak to the press. That is terrible.I work in the Orthopaedic department at St Richards, assessing patients before they have their long-awaited hip or knee replacements. I know that the department cannot do more operations per week. There are too many blocks—time available in theatre being the biggest … without the previous use of KE7 for elective orthopaedic surgery, waits are bound to go up—they are already currently around 1 year.I have received hundreds of similar letters.
The King Edward VII will close in three days. Only the national health service can save it. The immediate cause of the hospital's difficulties is the sharp decline in the work given to it by the NHS. It is extraordinary that a hospital of such quality, with spare capacity to provide crucial cardiac, cancer and orthopaedic procedures can be faced with closure at a time when the NHS is 70WH desperate to find places to treat patients. The hospital needs to address some issues for the future, but one point is clear, if the hospital closes in the next few weeks, it will be because the NHS turned off the blood supply.
In the House last week, the Minister said that the NHS was in the business of increasing capacity, not reducing it. The opposite seems about to happen. That will be incomprehensible to my constituents and to those in neighbouring constituencies, many of whose MPs are in the Chamber today to add their support to the campaign to save the hospital.
§ Mr. David Tredinnick (Bosworth)
I have a long association with the county of Sussex. My mother worked in the King Edward VII hospital for many years. My father died there. I know the premises well and I urge the Minister to visit the hospital before the proposed closure and save it. It is set in the rolling Sussex countryside and has wonderful rehabilitation facilities.
Furthermore, is my hon. Friend the Member for Chichester (Mr. Tyrie) aware that, last summer, a friend and I had to queue for five hours for treatment in the accident and emergency department at St. Richard's? It is well known in West Sussex that that hospital is overloaded.
§ Mr. Tyrie
I strongly agree with my hon. Friend's comments. His points are well taken. St. Richard's does a very good job, but it is under enormous strain.
If the NHS closes the King Edward VII, it will be seen to have made a colossal blunder. A sign of the concern about the closure is the fact that 75,000 people signed a petition that was put together in less than a fortnight. Could many issues in British politics at present generate such a response?
In the past few weeks, there has been a miasma of claim and counter-claim in the local, regional and, to some degree, national press about the reason for the closure, so I want to get some basic facts straight. First, is the King Edward VII a private or an NHS hospital? The answer is neither. It is a unique, independent, non-profit-making charitable foundation.
The hospital has a 125-bed capacity and can treat 400 cardiac, 2,000 radiotherapy and 3,000 hip and knee patients per year. It has been treating large numbers of NHS patients since the NHS was created. Since 1948, well over a third of its income and nearly half its patients have been from the NHS. That has been broadly true for the past 10 years, too. No distinction is made between public and private patients in respect of their medical care. The gap between the amount of NHS funding coming to the hospital and the number of patients makes it clear that the charity subsidises NHS work. The Minister frowns, but if she has concerns about that point I shall be happy to give way.
Furthermore, the NHS has benefited from the huge groundswell of local good will for the hospital, which has enabled it to mobilise enormous funds in charitable giving for the benefit of both the public and private sectors. During the past eight years, £10 million has been raised, providing a magnetic resonance imaging scanner, a linear accelerator for radiotherapy and other facilities.
71WH In that respect, King Edward VII is a prototype for what I thought the Government meant by foundation hospitals: hospitals that work closely with, and in, their local communities. Last year, the Secretary of State said that foundation hospitals would bemodelled on co-operative societies and mutual organisations.That is what King Edward VII is.
§ Mr. Francis Maude (Horsham)
Can my hon. Friend confirm that some of the excellent new state-of-the-art facilities at the hospital, especially the radiotherapy units for cancer care, were paid for by the hospital itself, from its own cash flow and voluntary donations? At present, people with cancer have to wait for up to 14 weeks after their diagnosis to start radiotherapy. If the hospital closes, those waiting lists will go up and people will die needlessly.
§ Mr. Tyrie
I agree with my right hon. Friend. Indeed, several of the hundreds of letters that I have received from clinicians and doctors far and wide made the same point. People will die if the hospital closes.
A second area of dispute in the press about the hospital relates to the reasons for its financial difficulties. At present, the hospital has expenditure of about £20 million per annum and income of £17 million. Most of that deficit has opened up in the past couple of years and the lion's share of the accumulated deficit of £8 million is attributable to the gap between those figures. The number of private patients and the income for private work increased slightly in the same period.
Why has the gap between income and expenditure opened up? The answer is unambiguous: the sharp reduction in NHS business. The number of patients being treated has gone down drastically and the amount of cash coming in has also decreased. Since I became MP for the area a little more than five years ago, I have been worried about the hospital's vulnerability to NHS strategic planning. In 1999, I warned that the hospital's long-term future could be jeopardised if the NHS turned off the tap. That is exactly what has happened: contracts have been withdrawn almost without warning.
The NHS line on the hospital's financial problems is that the hospital has been mismanaged. An official spokesman for the NHS described King Edward VII as "a failed hospital". That claim does not bear serious scrutiny. In an immediate sense, the hospital is failing largely because the NHS has ensured that it does so. That is why the official spokesman's description of the hospital as a failure sticks in the gullet of every member of its staff, from receptionists to surgeons.
For a failed hospital, the King Edward VII has done pretty well. In the past five years, it has treated 30,000 in patients and 90,000 out-patients. Its output measures and survival rates for cardiac care are well above those of nearby NHS hospitals, even after adjusting for differences in case mix. In all major areas of care, it is at least as good as the NHS. Readmission rates for unsuccessful procedures are lower than those in the NHS and, above all, staff retention rates are high, which shows that it is a happy place in which to work, with very high morale. That is also reflected in the quality of care.
72WH The King Edward VII is a wonderful place. As a charitable institution, the hospital is a not-for-profit organisation, so one would not expect it to have a large surplus. In any case, if running a deficit is a definition of failure, many NHS hospitals are failures, too.
It is true that the hospital, like many—public and private—must deal with some longer-term issues. It was doing that and, as the liquidator pointed out, it had a good chance of success. It would probably have succeeded if the NHS had not pulled the plug. Some NHS managers have suggested that poor management and nothing else is to blame. Whether or not that is true of the King Edward VII, it is certainly true of much health care in the NHS, which has one or two severe management problems of its own to sort out, as the Secretary of State and others have frequently pointed out.
The Surrey and Sussex strategic health authority has an accumulated deficit of £60 million. Which part of the NHS planning process allowed that to happen, with all the related managerial stresses and the shocking implications for waiting times for my constituents? It is deeply regrettable that the NHS primary care trusts, especially the Western Sussex PCT, and the Sussex and Surrey strategic health authority have reacted to the closure by suggesting that their role in it was peripheral—that it was nothing to do with them. A more thorough and frank explanation of the financial constraints that led them to those contracting decisions would have been much better.
Any reasonable assessment of the accounts—I have taken a look at them—will show that the lion's share of the shortfall that triggered the financial crisis and led to the appointment of a provisional liquidator was a consequence of the loss of NHS business. The hospital made repeated attempts to engage the strategic health authorities, PCTs and trust hospitals in discussions but it was largely ignored.
§ Peter Bottomley (Worthing, West)
Some of the hospital staff live in Worthing and we also have a number of NHS patients who have benefited from the hospital. The Government cannot walk away from the issue; they set up the constraints and created chaos in the NHS due to the continual reorganisation of the past five years—tomorrow, they will be advertising for a chairman of the strategic health authority. It is not capacity, cash or the commissioning system that is at fault, but the Government. The problem is in the hands of the Government; it requires action and they should treat it as important.
§ Mr. Tyrie
I agree with my hon. Friend. There is a drive towards decentralization at least that is the current rhetoric—but in fact much of the responsibility for such issues and the authority to deal with them still lies with the Department of Health.
Another allegation is that the hospital lost business because its charges were too high. However, a detailed examination of prices shows that that is not true. If the Minister has been given figures, I warn her that many of them do not bear careful scrutiny. The Western Sussex trust has put out some highly contentious figures—on the cost of cardiac treatment, for example. Some of the more bizarre claims that the trust has put into the press 73WH about the relationship between the PCT and the hospital are not true either. I do not want to delay the debate by going into detail, but I shall refer to one claim about cardiac care. On 14 January, the PCT issued a press release which stated:The PCT had recently negotiated a three year agreement with KEVII for cardiac surgery.A reasonable man might have concluded that a three-year deal had been struck—very good news. However, when I examined the matter in detail I found that no such deal had been struck. Some discussions had taken place, but there was no financial support for a three-year deal for cardiac surgery.
I have also been told privately by PCT management on two occasions that the quality of care in cardiac surgery is lower at King Edward VII than at Southampton. I was surprised to hear that, so I took the trouble to obtain the British Cardiac Society's peer review of the hospital, conducted about a year ago. Unless the Minister challenges me, I shall not go into the detail of the review, but it concludes that the overall level of cardiac care in the hospital is excellent and is higher than in the NHS alternatives available, including Southampton.
The Minister should be wary of taking at face value some of the highly controversial public and private briefing that she has probably been receiving. If she takes a careful look at it and asks some penetrating questions, she will find that things are not quite as they appear.
Of course, no one suggests that life is easy for the PCTs or the STHAs affected. They have been constrained in the amount of business that they can send to the hospital, as my hon. Friend the Member for Worthing, West (Peter Bottomley) pointed out. They have not been given sufficient funds to enable them to take people off waiting lists. Locally, the waiting time for cardiology and cardiac surgery is 12 weeks; for radiotherapy, it is up to 12 weeks and rising; and for orthopaedics, it is 15 months. That compares with national targets published by the Government that the maximum waiting time for elective surgery should fall from 18 to six months by 2005.
§ Mr. James Arbuthnot (North-East Hampshire)
I am listening carefully to my hon. Friend who is making an excellent speech in defence of a superb local hospital. Is not one of the problems that the local area receives only 83 or 84 per cent. of the average health spending per person nationally? It is not an area in which it is cheap to live or to employ people, so we need significantly more funding. That might help to save the hospital.
§ Mr. Tyrie
My right hon. Friend describes a double whammy. First, money has been moved away from the south to other parts of the country. Part of the reason that more hospitals in the north of England have higher star ratings is that they are not under such intense strain as hospitals in the south, as several of the Government's advisers on that issue have recently pointed out. Secondly, costs in the south are much higher than they are in the north. The hospitals are squeezed from both sides.
74WH The targets set for NHS hospitals locally would have been difficult to achieve in any case, but they will be impossible if the King Edward VII is closed. Waiting times will rise further. The claim that things could be otherwise, as the STHA suggests, is ludicrous.
That brings me back to one of my earlier points: at the very time when massive capacity constraints throughout the NHS are leaving patients untreated, the King Edward VII hospital is to be closed. Has the NHS done all that it should have done to keep the hospital's capacity on stream? Regrettably, I think not, although it seems that at one minute to midnight something may be stirring.
What can the Minister do to help? First, as my hon. Friend the Member for Bosworth (Mr. Tredinnick) suggested, she could visit the hospital—before Friday—and see for herself. It is only an hour from her Department by train and it would take her less than three hours to do the journey and see everything that she needs to see. She could then make up her own mind.
Secondly, the Minister could take a look at the huge raft of schemes, some of which are run centrally, that enable the distribution of discretionary finance to help PCTs. For example, can something be done through the access initiative scheme for orthopaedics? Can end-year flexibility be used to bring money forward from the next financial year?
Thirdly, will the Minister bring an end to the absurdity that forces my constituents to be taken abroad for treatment at huge cost when they could be treated up the road at the King Edward VII at less expense to the taxpayer? I have heard grotesque stories about people being lined up to get on coaches to be treated in France after expensive pre-operative investigations at the Nuffield hospital—at £1,000 a throw—for treatment that will cost even more than at the King Edward VII once the travel costs are included. That is absurd and will require considerable justification. The budget is ring-fenced. Will the Minister consider what could be done about the ring-fencing?
§ Mr. Andrew Turner (Isle of Wight)
Does my hon. Friend agree with Dr. Mark Connaughton, the heart specialist at St. Mary's hospital, Newport, who points out that when a patient is treated outside this country, responsibility for their long-term care falls back on the NHS, whereas it would remain the responsibility of the King Edward VII if they were treated there?
§ Mr. Tyrie
My hon. Friend makes an extremely good point. It leads me to reflect more generally that NHS planners have not taken into account the fact that if the hospital closes, the NHS will have responsibility not only for its current NHS patients but for a fair number of its private patients because they may not immediately be able to find alternative care elsewhere, or may decide not to do so.
I was setting out a list of things that the Minister could do. Fourthly, she could bring forward an announcement that the Department will have to make about the need for more cash for Hampshire because the county will face a crisis when it is stripped of the doctors and support staff who will go to the Gulf as part of the contingency planning for a possible Gulf war. There will be an acute shortage in some Hampshire hospitals; Portsmouth will be hit especially hard.
75WH I hope that the Minister will announce that she will release some funds. After all, we are not talking about new money—it will have to be released in any case, as everyone knows—and it will help enormously. The extra capacity in the King Edward VII is already needed, but it will be vital in the event of action, or even preparation for action, in the Gulf.
Fifthly, will the Minister examine carefully the waiting time targets that have been set and consider whether they could be delivered even before the closure of the King Edward VII? Is there a cat in hell's chance of delivering them after it closes? Any reasonable appraisal would conclude that keeping the hospital going for the next year would be extremely important to the NHS in delivering those waiting-time targets and, as I have just suggested, it would cost the NHS little or no extra money. The money would have to be found in any case.
As the Minister knows, the hospital has just offered to carry out 300 cardiac procedures, 2,500 elective surgery procedures, 420 radiotherapy procedures and 1,000 investigative cardiology procedures. All are being offered at the NHS's own reference prices for the coming year—the marker prices that it considers right for work put out to the private sector. Throughout the south, people are waiting desperately for treatment for those conditions. The deal that is being offered could save the hospital and do something to plug that gap.
Ministers have repeatedly said that capacity not cash is the real constraint. They now have an opportunity to demonstrate that. I urge the Minister to encourage acceptance of the deal. I do not urge her to interfere but merely to pick up the phone and say to her senior management team, "Use some common sense."
§ Mr. John McWilliam (in the Chair)
Order. A large number of hon. Members want to speak, so may I ask them to be as brief as possible?
§ Mr. James Arbuthnot (North-East Hampshire)
I shall be extremely brief, Mr. McWilliam.
The long-term problem in our health system is not the quality of its staff, who are superb, nor is it the quality of our hospitals, which are often superb—in the case of the King Edward VII, my constituents have been writing to me in their hundreds to tell me how superb it is. The long-term problem in the national health service is capacity. I am not alone in saying that, the Minister has said it, too.
Closing such an excellent hospital will astonish and anger my constituents, and it ought to astonish and anger the Minister. I ask her to listen very carefully indeed to what is being said in the letters that she has been receiving from my constituents and those of my hon. Friend the Member for Chichester (Mr. Tyrie). I endorse everything that he said.
If the hon. Lady does not take the action to which my hon. Friend referred, she risks being part of the problem, even though she is an extremely hard-working and effective Minister. The NHS runs the risk of being 76WH seen as remote from the people of this country. The Minister should make it plain that we need to deliver on the health system and that means providing this local hospital—King Edward VII—for our constituents. I hope that she will listen to what my hon. Friend said.
§ Sue Doughty (Guildford)
I shall concentrate on how the closure will affect the Royal Surrey county hospital in Guildford. I shall not repeat what has already been said. Instead, I shall set out some of the good things that the management and clinical staff at Guildford have told me about the high quality of care, especially in orthopaedics, at the King Edward VII hospital. When a health care professional says, "If I had to have my hip done, that is where I would want to go", things do not get much better than that.
Some staff work at both Guildford and the King Edward VII, so there is continuity of patient care and a close working relationship. I understand that about 400 orthopaedic cases were expected to be undertaken at the King Edward VII next year. A certain amount of general surgery takes place. Less cardiac surgery is undertaken because there are facilities for that elsewhere. The closure of the King Edward VII will have a bearing on the Royal Surrey county hospital, especially in terms of radiotheraphy.
If the King Edward VII closes, Guildford will take more cases. Is that feasible? Royal Surrey county hospital is a good hospital. It has excellent staff who work desperately hard to try to meet targets. A huge effort is involved. Like everyone else in the south-east, we have massive problems involving national pay scales and a hugely expensive cost of living. These factors work against staff retention. As a result, we are continually investing in recruiting. However, we get there.
The closure of the King Edward VII will have an impact. Local private hospitals are already running near to capacity. In Guildford, fortunately, some people are better off than others and will not wait, or they club together to buy treatment for family members. As a result, we do not have a large amount of spare capacity, even though several private hospitals are immediately local to us.
I was pleased to hear that the strategic health authority is talking to the liquidators to ascertain what can be done. We would want any action taken that would delay or avoid closure to be explored in every way possible. As I have said, closure will have a huge impact.
On cancer care, the closure of the King Edward VII will have an impact on Guildford's performance and its ability to treat many people in Guildford and the surrounding area. I am speaking not only of my constituents but of all people who use the hospital. First, Guildford is unhappy that it takes seven weeks to get somebody into radiotherapy. That period is substantially longer in Portsmouth, and I know that my hon. Friend the Member for Portsmouth, South (Mr. Hancock) will have something to say about the problems in Portsmouth, where the waiting time is about 17 weeks. It should be understood that those patients will be coming to Guildford. That will extend waiting times.
When I spoke to specialists, I was told that the strategic health authority is considering commissioning more linear accelerators. I asked the hospital whether, if 77WH that happened, and the hospital was closed tomorrow, patients would receive treatment. Two linear accelerators are already in commission to deal with the existing work-load, but not the work-load that would accrue as a result of closure of the King Edward VII. Even if orders are in place, that does not solve the problem. If the hospital is closed tomorrow and orders are placed, how long will it take to bring a system on stream? The reality is that it takes about a year. It takes about six months to build a room and to put things in place. The technical commissioning takes a further six months. Technicians undertake detailed and wonderful work to make the equipment work as well as possible.
Ownership has its own costs. The Minister will be aware that it costs about £30,000 a year to keep software up to date and to ensure that the various pieces of technology continue talking to one another if we are to make use of all the brilliant things that the machines can do. Cost of ownership is a factor.
The Minister might suggest that we could run longer hours at the Royal Surrey county hospital. That is something that I have explored. The cost of running longer hours is greater than that of buying more linear accelerators because of the additional costs involved. As the Government and the Minister for Health have regularly reminded the House, linear accelerators need radiographers. There must be that match. Radiographers are like hens' teeth.
It has been argued that if we closed the King Edward VII, a number of staff would be available elsewhere. The reality is that if we ran more linear accelerators to fill the gap, that would take a year, and the available staff would no longer be available. Secondly, available staff who are now at the King Edward VII would not come to Guildford. They live on the south coast and they cannot afford to live in Guildford. We would not get the radiographers or other technical teams.
Our concerns are not only the concerns that have been strongly expressed already. I urge the Government not to let the hospital close on Friday. It should be bought outright, but the Government should consider all the models and all the what-ifs. What will happen to health service provision as a whole in the south-east if the hospital is allowed to close? What will happen to patient care and the high quality of orthopaedic treatment? We are aware of the misery of people waiting for replacement hips, for example. What will happen to those waiting lists? Where will patients go? Where will they get the same high level of aftercare that patients get at the Royal Surrey county hospital when they are sent to Midhurst? When farming out surgery to other hospitals, physical proximity is so important, especially when there are complications.
I add my plea to the Minister to consider a buy-out. An interim rescue package should certainly he considered, until all the questions that we ask today can be answered satisfactorily within the localities that we represent.
§ 10.2 am
§ Mr. Michael Mates (East Hampshire)
I, too, shall be brief. There has not been such an outcry in Hampshire about health since the Government closed Lord Mayor Treloar's hospital in Alton. That hospital was doing excellent work, but in their centralising zeal the 78WH Government decided that it was no longer needed. The hospital concentrated exclusively on elective orthopaedic surgery. That is one of the areas where waiting lists in my part of the world are longer than those for anything else.
As we heard from my hon. Friend the Member for Chichester (Mr. Tyrie), the King Edward VII hospital is doing a marvellous job. This is at a time when the Queen Alexandra hospital in Portsmouth—one of the hospitals graded as failing—was almost coming to a halt on orthopaedic surgery. Disaster was nearly upon us when the situation was saved, to an extent, by the fact that the hospital at Haslar became available. That is where all the orthopaedic surgery is being undertaken now. That has taken place at great expense. As I have said, Lord Mayor Treloar's hospital was closed. It was then found that there was an orthopaedic disaster. That was solved in some nick-of-time way by transferring orthopaedic work to Haslar, at great cost. It seems that the national health service will go through exactly the same process again.
I do not want to talk about all the other excellent specialties because most of our constituents find that the shoe is pinching most when it comes to orthopaedics. They are waiting 15, 18 and 21 months for orthopaedic surgery. Now, we are to reduce capacity. The question is whether we give up capacity now to introduce the reorganisation that the Government say that they want. My argument—it is a simple one—is that we should get capacity right first, reduce waiting lists and ensure that people can get their orthopaedic surgery and cardiac surgery right. If the Minister wants then to reorganise the health service to make it more efficient, that is fine. However, at present it is stretched at every point. To reduce capacity now is nothing short of criminal.
§ 10.4 am
§ Mr. Peter Viggers (Gosport)
We used to hear about joined-up government bringing Departments together. We do not hear so much about it now because I think that we are not getting it. We are debating matters where it is necessary to have joined-up government. The Minister cannot sit back and say that the issue is not directly her responsibility—that the hospital is not directly within the national health service because it is not controlled by the NHS. We need to take an overall approach.
In central southern England, we have serious health sector problems. For example, there are money problems. The Portsmouth hospital trust is running at a deficit, and the plan by which the chief executive has awarded a franchise to the hospital does not tackle where the money will come from to rectify the situation. We face a capacity problem. It is not possible to lose any facilities within the NHS or within allied health services without that leading to serious damage to local residents.
My hon. Friend the Member for Chichester (Mr. Tyrie) did not refer to the fact that he is supported this morning by 14 Members from the area that is concerned. Nearly all of those representing central southern England are present to express their profound concern that the Government have not so far taken action in joined-up government to rectify the possible loss of the superb facilities at the King Edward VII hospital.
79WH I shall quote from a constituent who wrote to me a couple of days ago. He has had surgery at the King Edward VII hospital on five occasions. He writes:It is beyond belief that this excellent hospital, which has served both NHS and private patients for many years, should be allowed to close. Meanwhile the Portsmouth area is saddled with a zero-rated establishment where ambulances have to wait for hours outside the hospital entrance because beds cannot be found for emergency cases.The loss of any hospital facilities in our area will worsen a situation that I have already described as dire. I plead with the Minister to listen to my hon. Friend the Member for Chichester and respond to his requests.
§ 10.6 am
§ Mr. Mike Hancock (Portsmouth, South)
I congratulate the hon. Member for Chichester (Mr. Tyrie) on initiating the debate. I support much of what he said and in particular, his five questions to the Minister. It is vital that those questions are answered. He invited the Minister to visit the King Edward VII hospital. If she sees the facilities that are there, there is a real possibility that even at this late stage she will be minded to do all that is in her power to keep the hospital open.
Hon. Members have talked about the King Edward VII as a local hospital. In fact, it goes way beyond that, as is made clear by the presence of so many hon. Members this morning. I believe that we are all speaking up for the people who would like to be present this morning. I refer to those who have been fortunate enough to be treated at the hospital and to consultants who have been prevented from taking part in the debate. One or two of them have been courageous enough to take on their bosses and to speak out on behalf of their patients, and how right they were to do so. I am sure that many other people have spoken to those present about their fears of what will happen.
The record speaks for itself. The hon. Member for Chichester spoke of being cautious about costings. Indeed, those bear close examination. They are far from the costings that have been reflected by some who have tried to do down the King Edward VII hospital on that basis. Costings must be balanced against the care that is provided, along with skill and treatment.
I have received about 20 or 30 letters in the past week or so from constituents who have been treated at the King Edward VII hospital. I shall mention two. Mr Damen lives in the heart of Portsmouth. He writes:I believe I have to complain to you about the proposed closure of the K. E. VII hospital. What on earth are they trying to do—bring the whole national health service to a standstill? I was treated there … a short time ago and found it to be a superb hospital with staff and nursing to match.He writes that he went therebecause the Q.A. couldn't cope with the work load. Yesterday I had to take my wife—this was to another hospital that was out of area—because Q.A." —that is in Portsmouth—was full up".Apparently it was unable to deal with her problems. 80WH I have a letter from another constituent, Mrs. Edwards, who knows the hospital well. She talks about the shameful way in which the issue has degenerated into the threat of imminent closure of a facility that so many have used.
The figures speak for themselves. Nearly 30,000 patients in the NHS have been treated at the hospital in the past 10 years. It has planned for what it can do in future. In the current year alone, more than 1,000 seriously ill patients have been offered care. I come from Portsmouth and I know the position only too well. We are facing a crisis because we failed as a hospital, despite the best efforts of the staff and management. Despite having had three chief executives in two years. we have a failing hospital. It is being held together now by the support of the Ministry of Defence staff who are working there. Many of them will leave, if they have not already done so, during the next few weeks. That is a serious problem and I have written to the Secretary of State about it. I have yet to receive assurances from the Secretaries of State for Health and for Defence about their proposals for filling the gaps.
It is unacceptable to wait 16 weeks for radiotherapy in any circumstances. To remove the facility will mean that my constituents and other people living in the Greater Portsmouth area will wait even longer. It is unacceptable that more has not been done. We should not be having the debate three days before closure. The hospital is far too important to the health service generally in the area. When the Minister replies, I hope that she will set out a well thought-out solution that will be a guarantee for my constituents and for many thousands of others who will not benefit if the hospital closes. If she is not to save the hospital, they will need to know where they will be treated. They will need to know also how long it will be before they are treated.
§ Mr. Howard Flight (Arundel and South Downs)
I, too, congratulate my hon. friend the Member for Chichester (Mr. Tyrie) on securing the debate, albeit at the last hour. The representation in Westminster Hall makes it clear that the issue is important for the hundred of thousands of citizens that hon. Members present represent. It is also, I suggest, an important test for the Government. Candidly, are they in earnest and are they to be trusted in organising and working with the voluntary sector to make available the capacity that is necessary to reduce waiting lists and to deliver national health service care?
I greatly respect the Minister's competence and integrity. However, I urge her independently to examine the data. It is apparent to several of us that behind the scenes many in the NHS have seen the failure of the HCA International deal as being quite convenient in leading to the closure of the King Edward VII hospital, and in terms of longer-term plans and views about it. For example, we were told that it cost 38 per cent. more to have cardiac care at that hospital than at Southampton. The figures are matters of fact—£8,153 and £9,485. That is 16 per cent. more for the operation. The Minister will find how the spin was placed. The King Edward VII kept people in slightly longer, with the health authority's approval. That resulted in increased costs, which were presented as the cost of the treatment.
81WH I urge the Minister to look for herself and to test the data. This is something more than just a terrible thing that has suddenly happened. My hon. Friend told the story in pretty full detail but some points should be stressed. There is a capacity issue. There is major scope for primary care trusts to use the King Edward VII facilities to reduce waiting lists. The Minister knows—we have been in correspondence for the past year—that the waiting list for radiotherapy is serious. It is approaching 14 weeks. Southampton has a one-year wait for diagnostic cardiac catheter investigation. The waiting list for coronary artery bypass grafts is causing significant and unnecessary mortality. Brighton is at capacity. As the Minister will know, it has been sending patients to the King Edward VII because of that. There is generally about a three-week wait at Portsmouth. With the possibility of war in Iraq, the immediate situation will become serious in Hampshire.
The King Edward VII hospital could perform 400 to 500 open heart operations a year. It could undertake 600 to 700 anaplastics and 1,000 diagnostic cardiac catheters. It is not often pointed out that it is the centre of the crucial Macmillan unit, which looks after many older people and others who are suffering from cancer.
It is crucial to buy time to investigate how the hospital's future could be resolved. The Minister will be aware that various proposals have been presented in the past few days. It is clear that they cannot be assessed by the liquidator within three days. Local MPs, doctors, councillors and, indeed, the entire community, have pointed out to the powers in the NHS in the area that time can be bought. The work can be done. Waiting lists are long and, candidly, if those involved stood back, the stories told would be believed. We hear about intentions behind the scenes. The local community would not forgive the NHS for many years.
There is the power at least to buy time to ascertain whether arrangements can be made to save the hospital in the long term. Those arrangements may be radical. They may involve turning the existing building into a nursing home. We are drastically short of beds in that sector. A smaller purpose-built hospital could be constructed. It is clear that there is a need for the capacity that has been provided.
Again, I ask the Minister carefully to check the claims that have been made by the NHS in the area about the ability to make up capacity. The advice of those in the other hospitals is that the claims do not stand up to examination. As I outlined, waiting lists are already higher by far than in other parts of the country. The hospital treats 30,000 patients a year, 12,500 of whom are NHS patients. It is not only an NHS issue—if the facility is lost, many private patients are likely to put on the NHS. That will increase costs and usage, as many doctors in my part of the world have said.
The King Edward VII hospital has been a voluntary sector partnership, it has been almost a prototype for much of what the Government are thinking about. It worked extremely well until two years ago. There have been management problems and we are all aware of many issues, but the crucial issue to affect finances has been reduced NHS usage. I think that some of that was deliberate. There should have been negotiations on price and other matters.
82WH We are interested not in debating the past, but in getting the data right. We desperately urge the Minister to give the hospital sufficient time to work out a solution. If the hospital goes in three days' time, the Minister will not be forgiven.
§ Mr. Nick Gibb (Bognor Regis and Littlehampton)
I start by congratulating my hon. Friend the Member for Chichester (Mr. Tyrie) on securing the debate. This is likely to be the most important day in the 54-year history of King Edward VII hospital.
The hospital is in my hon. Friend's constituency, but its importance spreads way beyond the bounds of Midhurst and Chichester to all parts of West Sussex and parts of Hampshire and Surrey. It is a vital hospital for many of my constituents. Over the years, it has treated many thousands of people from the Bognor Regis area for cancer, heart problems, back complaints and orthopaedic surgery.
As my hon. Friend the Member for Arundel and South Downs (Mr. Flight) said, about 12,500 national health service patients a year are treated at the hospital. It has always been an NHS provider. About half its patients come from the NHS. Hundred of my constituents who have written to me on the issue are astonished that at a time when the NHS is short of capacity, a hospital that has capacity in cardiac, cancer, orthopaedic and ophthalmic procedures could be closed.
National health service spokesmen say that the costs of the KE VII are too high. However, the hospital says that it will charge the prevailing NHS rates for any secure bulk contracts. NHS spokesmen hint at quality issues, but they provide no evidence other than citing the current NHS orthodoxy that only very large-scale hospitals provide the throughput of patients that is sufficient to provide quality. That is not the experience of my constituents who have been patients at Midhurst.
The very reason for the volume of anger at the proposed closure—it is an anger that has surprised many—is that the hospital provides a higher quality of medical care than that people have experienced at other NHS hospitals. It is not only the fact that it is tiny and intimate that elicits that response; it is the medical care itself that is the key factor behind many people's support for Midhurst.
On Friday, a friend of mine in Bognor Regis told me of her experience of the hospital. Ten years ago she found a lump, she went to her GP who said that because it was causing pain it could not possibly be malignant. She insisted on being referred to a consultant and because she had BUPA cover, she went to the King Edward VII. Tests there proved that the lump was malignant and she was treated straight away. Ten years later, another lump was discovered. She went back to her consultant at Midhurst, who took five biopsy samples—four from the lump itself and one from the area adjacent to it. Normal NHS procedure, I understand, is to take biopsies just from the lump. None of the four samples taken from the lump proved malignant, but the sample taken next to the lump was malignant and she was then treated. Had my friend not gone to the King Edward VII 10 years ago and again more recently, she would not be alive now.
83WH I have received a huge number of letters from constituents with similar stories to tell, pointing out that the quality of clinical care is higher at the King Edward VII than at other hospitals. When I hear intimations from NHS civil servants that there are quality issues at the King Edward VII, I do not believe them. When that is coupled with their claims about costs, with which my hon. Friend the Member for Chichester successfully dealt, I come to the conclusion that I cannot trust anything that is said by the NHS on the issue. I urge the Minister to take the same approach.
Officials are far from being infallible. As a Minister, it is always tempting to take the advice of officials, particularly in such a technically difficult area as health care, but officials do get things wrong, especially with regard to the NHS. For example, the Tomlinson report published in 1992 called for a reduction in hospital capacity in London. The report concluded:There is likely to be a significant fall in the requirement for inpatient beds in the inner London hospitals … Closures and mergers will be necessary.Last Monday, I went round the newly acquired London Heart hospital. I also toured the 20-storey new-build hospital in the Euston road, and a new hospital is being built at Barts. So NHS advice now is to increase capacity in London.
Advice has changed. When I put that to the director of policy and planning at the Department of Health, he said that the advice 10 years ago was probably wrong, but that civil servants have moved on. The NHS has its fads, which are in vogue and then go out of vogue again. The current fad in the NHS is "large is beautiful"—the belief that a certain minimum but large number of patients being treated at a particular hospital is needed for it to be regarded as being of a sufficient standard. There is obviously some truth in that. The experience gained by performing 1,000 bypass operations a year must be better than the experience from just five. But is the experience from 400 operations a year so much worse than the experience from 800? Surely there are diminishing returns to clinical excellence as the numbers increase to very high figures. Clearly, there is a balance to be struck.
The public believe that in addition to the large general hospitals, there should also be some smaller, friendlier hospitals that can give more tailored care and attention to patients. In a debate such as this, where the public view is clear, but contradicts the view of the health professionals, whose views should prevail in a democracy? I believe that in this case, the public view should prevail, particularly where the costs and comparisons are far from clear and there is no evidence of a diminution in quality as a result of the smaller scale.
I shall quote from a couple of letters from constituents, as other hon. Members have done. One constituent from Aldwick in Bognor Regis wrote:I did the Ambulance Car Service for approximately five years when I retired in the 80s and know only too well how the NHS patients travelling to King Edward VII for treatment felt about this particular hospital. Every one of them expressed views that they were in safe hands compared with other hospitals, and were consequently uplifted by this knowledge.84WH Another constituent from Bognor wrote:Many, many people have had the facilities of this hospital made available to them … The Macmillan Unit has cared for many cancer patients, giving peace and constant 1st class service to the terminally ill patients".Finally, a letter from a constituent in Shripney, Bognor Regis stated:Unfortunately, in June 1999, I was diagnosed as having acute prostate cancer. This entailed daily radiotherapy treatment for a period of seven weeks and it was carried out at the King Edward VII hospital. During this very traumatic time I received wonderful care and attention from the staff of a dedicated unit where emphasis was upon accuracy and careful attention to detail. Without any shadow of doubt I would not have been here to write to you today had it not been for the excellence and efficiency of the specialist doctors and radiography staff at the King Edward VII hospital.I urge the Minister to read the letters that she is receiving on the matter, to take her own counsel, talk to the hospital administration, and not, like so many of her predecessors, to fall into the trap of following officials' advice at great political cost, only to find five years down the line that that advice has proved to be wrong.
§ Mr. Andrew Turner (Isle of Wight)
I shall not detain the Chamber for long. Hon. Members can read for themselves comments I made in my Adjournment debate last week. I am sure that the Minister has done so. I welcome her to her place. I know that she is an honest and decent Minister, and she has helped me with constituency matters in the past. It was noticeable that the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), was unable to complete his speech last week in the Adjournment debate. When I asked what he had intended to say, I was told by the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), in a written answer that she would reply to me as soon as possible.
The most dangerous aspect of the entire debate is the reasons given for the withdrawal of contracts from the King Edward VII hospital. Some have been withdrawn on costs grounds, and they have been dealt with by my hon. Friend the Member for Arundel and South Downs (Mr. Flight). Some have been withdrawn on throughput grounds, which have been described by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb). Some have been withdrawn on the basis of slithy imputations about quality issues, which hospital administrators are not willing to put on the record. If officials have something to say, let them say it in public, rather than make such imputations, which support the decisions that they have taken, but which they are not prepared to put on the record.
There has been a somersault in the Government's approach to the private sector over the past six years. I understand that. When the right hon. Member for Holborn and St. Pancras (Mr. Dobson) was Secretary of State for Health he had a different approach to the private sector from that which the Government now take, and I welcome their change on that. However, I must point out that the heart doctor in my constituency, who is an NHS professional, is clear that no problem would stop a doctor referring patients to the King Edward VII.
I have spoken to my strategic health authority chairman on the matter. He warned me that Ministers were taking a hard line: it is not up to the NHS to bail 85WH out a failing private hospital. That is the line that he has been given by the Department of Health. I do not know what idiot behind the scenes dreamed up that line, but it is a singularly inappropriate response to a hospital that has given 54 years of wonderful service to the national health service.
There are three areas with which the hospital deals: cardiac care, for which, I am pleased to say, some new arrangements are in place, but people have to wait more than six months to go to Brighton, which is causing bed blocking in my hospital, St. Mary's; radiography, for which there is no plan in place to deal with the relevant patients if the King Edward VII closes—one of my constituents had to wait 16 weeks for radiography at Southampton; and finally, orthopaedics, for which the local hospital thinks it can find the extra capacity, but it will be hit when 20 per cent. of the staff at Portsmouth go to war. The case is clear—the Minister must act, and act swiftly.
§ Virginia Bottomley (South-West Surrey)
My constituents are devastated by the possible threat of the closure of the the King Edward VII. For almost 19 years, the most dedicated and committed staff at King Edward VII have provided a quality of care second to none. It is not just a matter of clinical issues; it is a matter of the values and ethos associated with the hospital, which are hard to replicate elsewhere. In an area where there is a shortage of staff, miraculously and wonderfully the King Edward VII recruits, retains and provides a resource for the national health service locally.
Local general practitioners are already under enormous pressure because the waiting times are some of the worst in the country. For far too long, we have had a huge proportion waiting more than a year. As the Minister knows well, we are caught in a pincer. The cost of living is so high, but because local people are healthy they are deemed not to be worthy of financial support for health care delivery. It is unacceptable that there should be so much public squalor amid private affluence. However, that is a separate debate, which the Minister and I have had on many occasions.
The King Edward VII has sought to follow the Government's agenda. It has tried to achieve a creative partnership. A much-loved, long-standing voluntary hospital has developed a partnership with HCA International in the commercial sector. It is not only local people who are devastated and deeply distressed and who are sending letters in a volume that I have not known for many years—the wider health community is watching. The Government said that they believed in partnerships, and that they had no hostility towards the independent and the commercial sector. If it emerges that it is impossible for an independent provider to form such a partnership—an innovative solution—many will take to heart that example and think that the additional effort and cost of arranging contracts with the NHS is too difficult. When push comes to shove, the whole relationship will implode.
86WH The last time the Minister came to my constituency, she did so to turn the sod for the much sought-after Farnham community hospital. I have every confidence that somehow the Minister will be the bearer of good news to us today. I very much hope so.
§ Mr. McWilliam (in the Chair)
Order. Before I call the winding-up speeches, I congratulate all the. Members who have taken part in the debate this morning. I think it is some kind of record.
§ Dr. Evan Harris (Oxford, West and Abingdon)
All of us owe a debt of gratitude to the hon. Member for Chichester (Mr. Tyrie) for securing the debate and for the open, cross-party, cross-constituency and cross-county way in which he has pursued the issue. As has been said, he and the cause have been rewarded by the turnout today—14 right hon. and hon. Members from the area who are concerned about their hospital. That shows Adjournment debates and Westminster Hall at their best.
The Government have claimed that it is not part of the job of the NHS or the taxpayer through the NHS to subsidise, as they put it, a private or charitable or voluntary hospital by paying above the rate that can be obtained in the NHS, elsewhere in the private or voluntary sectors or abroad. In that narrow sense, on principle, the Government are correct, but I very much doubt that that is what pertains in the present case. If it does pertain, the Government must present evidence that it would effectively be a subsidy if non-value-for-money services for NHS contracts continued to be placed at the hospital.
It is very much the job of the NHS to safeguard capacity where it is needed. It is clear from what has been said and from all the evidence we see around us that capacity is needed in the NHS, and that such capacity is needed locally. If the hospital closes, the doctors and nurses will not necessarily transfer into NHS employment in the area, so it is unlikely that any capacity could be saved, despite the fact that there may be staff shortages that limit capacity in the area. There must be a fit. As my hon. Friend the Member for Guildford (Sue Doughty) said, if there is no fit, people will simply leave the NHS or leave the area. That would be a disaster, especially given the threat of the loss of staff to troop deployment or war in the Iraq theatre.
It would be sensible for the NHS to find the means to acquire the hospital as an NHS hospital, with a view to using its entire capacity for NHS patients. Arguably, some private work could remain, equivalent to NHS pay beds, although there is a separate debate to be had about that. Given that capacity is so short in the NHS, that would seem a sensible investment to preserve capacity, even before one considers the need to preserve existing services. As the Minister knows, the NHS acquired the London Heart hospital in that way. Indeed, that was one of the early announcements that she made in her post. That was about 12 months ago, and the National Audit Office published a positive report on the finances, so the model exists.
The key question is whether the strategic health authority has the ability and the means to acquire the hospital, or whether it requires central Government 87WH approval. One hon. Member suggested that the Government could not interfere in the matter. It would be an historic moment for this Government if they did not seek to interfere in local issues, especially strategic issues.
I should like to see the hospital used to increase NHS capacity, which is a top priority. I have heard that the hospital may need extensive structural repair, mainly to its roof, but that would surely be cheaper than the cost of a new-build diagnostic and treatment centre. Such a "cold" hospital is exactly the sort of facility whose growth the Government want to promote. It is curious that the NHS has allegedly chosen not to make a long-term commitment to send work to the hospital. Such a commitment was said to be required by HCA International in seeking to buy it. The NHS decision may be due to a shortage of revenue, such that the commissioners cannot commit to buying capacity outside the NHS in the medium to long term. Unfortunately, in the pursuit of short-term targets, health economies in the NHS tend to look no further ahead than the next quarter. That is a problem when we are trying to create partnerships with the private sector.
If there is a quality problem—that seems unlikely, given the testimony that we have heard—the NHS should be open about those concerns, rather than allowing them to be raised by rumours, which are impossible to check out. If the problem is one of throughput, we need to think more widely than length of bed stay. It is known that the shorter the bed stay, the greater the possibility of readmission acutely, which would create pressures elsewhere. If local purchasers are buying capacity outside the area or even abroad, they might argue that the prices offered by the King Edward VII are not competitive. The Government have always claimed that treatment abroad compares favourably with private sector contract prices, although that says more about private sector prices for spot contacts than about the cost of overseas treatments.
If local purchasers are buying capacity elsewhere, the Government may be right to say that there should not be long-term subsidy for non-value-for-money prices, but I do not think that that is the case in this instance. I fear that, because of their fragmentation, the small purchasers involved in the modern NHS—primary care trusts—fail to see the strategic effect of withdrawing contracts. The strategic health authority and central Government have a role to play. The Government should start publishing the prices that are obtained by the NHS abroad and in the private sector, rather than hiding behind the cloak of commercial confidentiality; otherwise people will not understand why contracts are being placed where they are being placed.
§ Peter Bottomley
Hon. Members on all sides will welcome the hon. Gentleman's comments. Will he add that West Sussex and West Surrey—two of the three health authorities with the longest waiting times in the country—are not the place to start running an experiment?
§ Dr. Harris
Quite so. I entirely agree.
It has been alleged that the NHS has deliberately manoeuvred the hospital into non-viability by withholding a commitment to long-term contracts, even 88WH where they would be value for money, in order to place the NHS in a position to buy the hospital cheaply. That would be unfair practice, and if there is any evidence of that it needs to be provided and the Minister needs to give assurances. There is a case for the Audit Commission to investigate how the present situation has come about, as it may well happen elsewhere. We need action from the Government, but in the short term, and certainly before Friday, we need answers.
§ Tim Loughton (East Worthing and Shoreham)
I shall be brief, in order to give the Minister time to respond to many of the points that have been made. First, we should put on record our congratulations and thanks to my hon. Friend the Member for Chichester (Mr. Tyrie), not just for bringing the issue to the Chamber today and raising it in the House but for the active part that he has played in the campaign with the local community and the health professionals to make sure that the issue is decided at the highest level. I speak today wearing two hats—as a shadow Health Minister and as a West Sussex MP whose constituents will be greatly affected by the decision if the worst comes to the worst for the King Edward VII.
Many of my colleagues have made pertinent points, which I shall not repeat in detail. My hon. Friend the Member for Chichester dispelled some of the myths about costing and quality issues at the King Edward VII. I hope that the Minister has taken them on board. The situation is dire, and the debate could not have been more timely. This time next week, the hospital may no longer be looking after patients—one of the largest independent charity hospitals in the country may have been closed.
We should think not only about the 70,000 in-patients the hospital has looked after in the past 10 years, and the 180,000 out-patients it has treated, half of whom were NHS patients, but about the 90,000 in-patients it could look after in the next 10 years, the 180,000 out-patients and the 2,000 radiotherapy patients per year it is capable, willing and eager to handle in the crucial years ahead. We should consider the 422 happy, dedicated and professional staff who work in the hospital, as I saw for myself when I visited the week before last.
More than 50 per cent. of the hospital's patients in most years have been NHS patients, whom it has treated in real partnership with no barriers. It is a model of the way in which private, not-for-profit and NHS providers can work together in harmony for the good of patients, which is the ultimate aim. All that will be lost in that hospital's centenary year, after the 100 years during which it provided an excellent service to the people of Sussex, Hampshire, Surrey and beyond.
I shall make four quick points. First, if it ain't bust, don't fix it. The hospital is not bust. We heard today that the quality of the care offered there is second to none. It is doing a good job. It is not a failing hospital. It is not an NHS hospital that has just been awarded zero-star status, which would be cause for concern. If it has not been doing a good job, why has the NHS awarded it so many contracts in the past and, by all accounts, received 100 per cent. satisfaction?
The King Edward VII is a not-for-profit hospital. It has not produced surpluses because it has reinvested all its money in state-of-the-art equipment so that it can 89WH continue to offer its patients the best treatment and service, which are not available in other parts of the country or the county. That equipment has been made available to NHS patients without any of the investment or depreciation costs that the NHS would have had to take into account if it were NHS equipment. That contrasts with other local hospitals, which have benefited from large increases in investment in the NHS, which we all know about. They have also benefited from a share of the £93 million from the new opportunities fund, which has paid for much of the cancer equipment in NHS hospitals. Obviously, that has not happened at the King Edward VII. The ParseNet scores for quality of care at the King Edward VII show that it is second to none.
Secondly, it would be against Government policy if the hospital went down the tubes. We need a multiplicity -of providers. The Government acknowledge that in their policy. We have serious problems with capacity. The Government have negotiated a concordat with the private sector. We wish that well; it is the way things will be in the future. There is a good example in Scotland, where the Scottish Assembly recently negotiated a £4 million initiative to clear the backlog of people waiting for hip and knee operations. All the spare orthopaedic capacity in the private sector has been booked over the next six months at discounted rates, and 500 patients who have been waiting up to a year will benefit from that arrangement. Why can we not make a similar arrangement with the King Edward VII and other hospitals?
My third point relates to patients being sent overseas. It is absurd and obscene that my constituents and those of many of my hon. Friends present today are sent off to Germany and France—and if anything goes wrong, the residual liability will come back to the UK, as my hon. Friend the Member for Isle of Wight (Mr. Turner) pointed out—at a cost that we do not know, because our repeated requests have failed to produce the costings. The same patients could have been sent up the road to the King Edward VII and treated quickly.
The fourth point concerns the waiting list impact. Most people seem to think that there will not be an impact on other hospitals. Of course there will. There is no more depressing sight than cardiac equipment, angioplasty machines and linear machines lying idle for more than half the week, when our constituents queue for weeks, months and years to gain access to that treatment. King Edward VII radiotherapy referrals are usually seen within two weeks. That contrasts with the Queen Alexandra hospital in Portsmouth, where the wait is currently 10 to 12 weeks, and we have heard from other sources about waits of 14 weeks. We know that there are problems with the machines at that hospital and waiting times will get worse in future. That is a zero-star hospital which was rated as under-achieving for two-week cancer waits, under-achieving on cancelled operations and under-achieving on financial management.
The Brighton hospital, at the other end of Sussex, has long waits for the radiotherapy department and 20 per cent. vacancies for radiographers. As my colleagues have argued, people will die if those desperately needed facilities are not available in a few weeks or months. In orthopaedics, which as we all know is especially crucial in Sussex because of the elderly population, at the 90WH Southampton, Portsmouth and Royal Surrey hospitals, there are typically 372-day waits—more then 12 months—for a hip replacement, and 443-day waits for knee replacements. Those patients could be seen within weeks at the King Edward VII.
Those hospitals are improving and they are doing a good job in difficult circumstances, but they need help, and they need it now. That help will not be there next week unless the Minister does something today. The impact on capacity elsewhere in the area will be immense. We are told that capacity will improve by 2005 with the extra investment in Southampton, but we need that capacity now. Is it not absurd to build new capacity at large cost, some years hence, which could be much more expensive than supporting the existing capacity? This really is an urgent case.
We are not looking for a handout. This is not about a handout or bailing out a private hospital. We are not even looking for investment. All that we want is for contracts to continue as they have done. All that the King Edward VII hospital wants to do is to continue to offer operations and conduct the business that it is there to do, for private and NHS patients. That is all it is asking for. If the recent offer that has just been placed on the table, which does not involve comparative costs with the NHS—in fact, those comparative costs are very similar in normal circumstances—involves doing the work at the NHS reference cost, there can be no question about cost, just as there is no question about the quality of the service offered.
In these final minutes of the eleventh hour, the Minister has the power to intervene. It is in her interests to do so, and it is also in the interests of the NHS, the King Edward VII hospital, all its staff and the patients it serves. As my hon. Friend the Member for Chichester said, this will be a win-win situation if she will just take the simple step of giving the hospital a breathing space so that it can continue for the benefit of its patients. This is basic common sense, and I hope that the Minister will continue to show today the characteristic common sense that she has shown in the past.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
The strength of feeling on this matter is illustrated by the number of hon. Members in the Chamber today, and they have made some interesting and passionate contributions to the debate. Clearly the hospital is held in great regard in the community, and I would like to thank the hon. Member for Chichester (Mr. Tyrie) for securing the debate because it gives me a chance to put my response on the record and to answer most of the questions put by hon. Members. I shall certainly do my best to do so.
There has been a lot of misinformation and speculation in the media and the community over the last few weeks as a result of the events that have occurred at the hospital, and I want to try to give the community some reassurance about the future of its health services, because that, for me, is the important matter in this debate. Clearly, we need to ensure that high-quality services are available for NHS patients, wherever they live, and I am concerned that there is a great deal of wild speculation in the press at the moment. We must try to get this issue into perspective.
91WH The hon. Member for Chichester set out the history of the hospital. It is a charitable hospital—neither an NHS facility nor a private facility. It is in that third sector that the hon. Gentleman rightly suggests the Government want to promote and to work with to develop more interesting and innovative partnerships. It employs 420 staff and currently has 41 patients, although it has the capacity to treat 150. It is not owned by the NHS, but we should recognise that it has a long history of good partnership working with the NHS. NHS patients have traditionally made up about 30 per cent. of the hospital's income, not 50 per cent., as has been suggested. A substantial proportion of its patients are NHS patients, none the less.
Until fairly recently, the hospital has provided routine surgery, cardiology treatment, cardiothoracic surgery and radiotherapy and oncology care to a mix of private and NHS patients. The Macmillan centre at the hospital has been mentioned, and it has clearly been of great value in providing terminal and palliative care to patients. There are 10 primary care trusts in West Sussex, Hampshire, the Isle of Wight and Surrey that regularly send patients to the hospital, spending a total of between £4.5million and just over £6 million at the hospital each year over the last five years.
I have had a look at the figures: in 2000–2001, those trusts spent £4.85 million: the year before that, they spent £5 million. This year, up to December, the hospital has received £3.35 million from the NHS, which—if the expenditure had carried on, and if we had not got into the difficulties that we have—would have been the equivalent to an annual figure of £4.5 million. That is comparable to the expenditure in 1999–2000 and in 2000–2001. There has not, therefore, been a huge slashing of NHS funding. I want to put it on the record that the NHS is perfectly prepared to continue with that level of funding to the hospital. Last year, there was a different order of funding—I think it was £6.3 million. One of the main reasons for that was that last year there was a much higher level of waiting list initiative projects right across the NHS—not just in that region—but, in terms of the underlying funding, there has been no huge slashing of NHS contracts. The hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) said that the NHS was closing this facility. The NHS is not closing this facility; it is not an NHS facility. We are perfectly prepared to carry on with the current level of funding and we are actively engaged in discussions with the hospital almost as I speak.
§ Mr. Tyrie
I suggested to the Minister that it might be advisable for her not to quote figures that she had been given by her officials without having checked them extremely carefully. It is not correct to say that NHS contract levels are broadly similar, in cash terms, to the levels of previous years. I have the figures in front of me. As early as 1998–99, the hospital had contracts to the value of almost £6.3 million. If we look at the run of the last five years, health cost inflation must of course be taken into account. Any reasonable assessment of the contracts over the last five years before the current year would show a fall of about one third in the level of 92WH contracts going to this hospital, resulting directly in the shortfall of cash that it has at its disposal. That is also the conclusion of the provisional liquidator.
§ Ms Blears
The hon. Gentleman and I can trade figures—he has the figures for the last five years, as do I—but the point I want to make is that there has been a variation in funding for this hospital over the last five years. In the year following the year that he has just cited, the funding was down to £4.85 million. So, we can trade those figures, but it is important to recognise that in April last year the management team at the hospital advised the Isle of Wight PCT that costs were to rise by about 20 per cent. That was a significant event, and, on that basis, the Isle of Wight PCT reviewed its cardiac requirements and decided to cancel its contract with the hospital because the costs were going up by that amount. It decided to commission those services from an alternative service provider.
All Members will recognise that it is the responsibility of the NHS, through the primary care trusts and the strategic health authority, to ensure that we get best value from the investment of public money. In April last year, the King Edward VII hospital told one of its main purchasers that it was going to put up its costs by 20 per cent. A decision was therefore made by that purchaser. We are trying to devolve power to the local communities that have the information on the ground, and this one decided that it could purchase care for its NHS patients from an alternative service provider. That is how we have arrived at the situation we are in today.
For the last three years, the hospital's expenditure has exceeded its income, and that remains the position, so this is not simply a matter of what has happened in relation to the NHS contracts. This has been a long-standing issue. All hon. Members will know that the hospital recently held discussions with HCA International, a large American health care provider, but they did not produce a positive outcome. Nevertheless, NHS officials at strategic health authority level and the director of health and social care of the southern region are now engaged in discussions with the liquidator, to see what steps can be taken to secure provision for NHS patients. Clearly, those negotiations are commercially sensitive. I understand that, as late as last night, the hospital put forward new proposals, and they will be considered extremely seriously by the NHS because we are determined to ensure that we can provide good continuity of care and increased capacity.
I am on record as saying many times that the NHS is facing not a financial difficulty but a capacity difficulty, and that is quite true. We are increasing capacity, as the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) acknowledged when he went on a visit with the Public Accounts Committee to look at the heart hospital and the other new hospitals being built in London. We are undertaking the biggest hospital building programme ever seen in this country and making the biggest investment in the NHS since 1950. Most primary care trusts are getting a real-terms increase of 30 per cent. over the next three years, so capacity is increasing and we are determined to have those negotiations and to ensure that we do not lose out on capacity. That must be balanced, however, with getting a good financial deal for the public investment that we are making. 93WH I referred a moment ago to the heart hospital. The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that the National Audit Office had said that project represented a good deal in terms of spending public money. We are getting a good facility and increasing capacity. At every stage, I am committed to our spending public money in a way that will get a good return for the patients whom we all represent.
§ Mr. Oaten
The Minister has confirmed that negotiations were taking place up until last night. Given the short time scales involved, will she give a commitment today that the NHS will put in place a package of temporary funding, so that the King Edward VII hospital does not have to close next week and there can be more time for those discussions to continue, rather than working to the time scale that means that the hospital will close next week?
§ Ms Blears
Officials and the Department are actively engaged in those discussions, but we are not able to give the simple guarantee that was requested of us at the meeting just before Christmas, which was that we should pick up the bill, whatever the cost. We are not in a position to do that, and I do not think that any responsible Members would expect us to do it. I can, however, give the hon. Gentleman the reassurance that we are actively engaged in those discussions.
I want briefly to respond to the points made by the hon. Member for Arundel and South Downs (Mr. Flight). I was a little surprised by his contribution. He raised concerns about the figures. He knows how important it is to get value for money, but he is on record as saying that he thinks we could cut NHS expenditure by 20 per cent. That is an important point to make, and I am very surprised that the hon. Gentleman made the comments that he did. I think that he would acknowledge that it is important to get the very best value out of public expenditure.
§ Tim Loughton
I want to put the record straight. At no point has my hon. Friend the Member for Arundel and South Downs commented to any extent on any cuts in NHS spending, so let us get that clear. If the Minister is so concerned about value for money—a subject on which we all agree—and if there are no quality issues involved, what possible justification can there be, when the hospital has yesterday made this winter sale offer of a large quantity of much-needed contracts at the NHS reference price, for the Minister's turning it down? For whose benefit would she do that?
§ Ms Blears
As I have just said, I think that the offer was put on the table last night. The Department of Health and the strategic health authority have been in discussions with the hospital since before Christmas. 94WH The offer will obviously need to be examined properly. Hon. Members have urged me not to take figures at face value, and to drill down and find out exactly what they will mean for the NHS. That is exactly what we will do, to ensure that we get best value.
The right hon. Member for South-West Surrey (Virginia Bottomley) talked about the dreadful waiting times in her constituency, and I acknowledge that they are still far too long. I have to say, however, that they were much longer under her stewardship, when, in many cases, people were waiting up to 30 months for heart care.
§ Ms Blears
No, I have only two minutes left.
The right hon. Lady also made the point about funding this area on the basis of need. We have had discussions about trying to tackle health inequality and ensuring that the formulae are accurate. I understand the stresses and strains that exist in the south of the country, in terms of high living costs, wages and the need to recruit and retain staff. That is a significant issue for us, but we must balance it with targeting our funds towards the areas of greatest need, where health inequalities still scar the country and are of great concern to the Government. The right hon. Lady made a better point about partnership, and, as I have said, the Government are anxious to pursue that issue, both with the independent sector and the not-for-profit sector, which the King Edward VII hospital is in.
§ Mr. Tyrie
The Minister has descended into making spurious and, in some respects, cheap party political points. Will she, in the final few seconds available to her, address the question whether, if the hospital is able to offer a deal at the marker prices—the reference prices—that the NHS itself thinks are correct and good value for money, and if there are no quality issues at stake, there should, in principle, be a deal to be struck?
§ Ms Blears
I have tried to emphasise that the Government are committed to increasing capacity and to providing good services for NHS patients. We will examine with rigour whatever proposals are put forward to us, to ensure that we get the best deal for the people who fund the NHS—the taxpayers—and the people who use it. It is this Government who will provide good stewardship of the NHS and who have decided to put in massive investment to ensure that the services can grow and that we get capacity into the system. We are absolutely determined not to let down the people of these communities who rely on these important services, but it is also right that we should take a rigorous approach to ensuring that we get the very best value from the investment that we make.