HC Deb 12 November 2003 vol 413 cc93-100WH

11 am

Mr. Julian Brazier (Canterbury)

I am delighted to have the opportunity to raise the issue of the future of the cancer centre at the Kent and Canterbury hospital, and I am delighted to see the Minister in her place. I furnished her with an advance copy of my speech, because I do not want to be adversarial and hope that the debate will be constructive.

The recent review by the independent review panel, on which the Secretary of State ruled in July, was based on proposals in which cancer was confined to an appendix. Those proposals were put forward by the East Kent hospitals trust, which is responsible for all other acute services in east Kent. However, the responsibility for cancer lies with the Maidstone and Tunbridge Wells NHS trust, which was not even a signatory to the proposals.

The rest of the conclusions arrived at by the independent review panel and the Government seem to form the basis of a sensible consultation exercise. Although I oppose all cuts, they have the makings of a working compromise. Unfortunately, no such consultation process has been launched by the Maidstone and Tunbridge Wells trust over the future of the cancer centre. Certain issues connected with cancer were dealt with in the East Kent hospitals trust consultation—breast surgery and haemophilia, for example. At the same time, the Kent and Medway health authority has launched a separate review into interventional radiology.

However, nobody is consulting on the overall issue of cancer treatment in east Kent. In its report, the independent review panel was deeply critical of the poor relationship between management in the Maidstone and Tunbridge Wells trust and the consultants at Canterbury who deliver the service. Those consultants do so in an exemplary fashion, well ahead of the national average.

The cancer consultants have made it clear to me, to Professor James and now to the public that the trust's proposals for cancer services are inconsistent and unsafe. They are also largely unpublished. They follow a model that is untested in the UK, which will worsen access for many of the sickest patients and will throw up a whole mass of anomalies. For example, haematology is to be centralised at the Kent and Canterbury hospital for in-patients, yet all in-patient work for solid cancers is to move to Maidstone. Haematology is at least as complicated when it comes to the treatment and supporting services that it requires as solid cancer treatments.

The partial and incomplete proposals on cancer, provided in the annexe to the original proposals for the future of acute hospitals in east Kent, were sketched on the basis of a large-scale run-down of the Kent and Canterbury hospital. Fortunately, that has now been abandoned for a much better model. The proposals had to take account of the fact that the necessary supporting facilities were likely to disappear. We now know that they will still be in place.

As most of the crucial ancillary facilities are to remain at Canterbury, under the Secretary of State's ruling, there is no reason why the East Kent hospitals trust should not retain its cancer centre. Following the recent review, Maidstone and Tunbridge Wells trust is planning to close in-patient beds for cancer patients at the Kent and Canterbury hospital. It is alleged that those beds will be transferred to Maidstone hospital, so that patients receiving complex cancer treatment will be treated there. That means the loss of the cancer centre at Canterbury. For the first time in more than two generations, east Kent patients will no longer have a cancer centre.

The definition of a cancer centre is very clear. It is a general hospital with medical, surgical, diagnostic and intensive care support, radiotherapy and in and outpatient chemotherapy across the range of complex chemotherapies. Canterbury has been a cancer centre on that definition for more than 50 years.

The loss of the in-patient beds will mean that east Kent will have an out-patient radiotherapy facility operated on an ambulatory model. That model has not been tested anywhere in the United Kingdom, and exists only in America in private medical facilities. Time prevents me from going into detail, but I am happy to discuss that with the Minister afterwards. As it happens, Dr. Coltart has studied the American model and is very familiar with it. It is completely different from the way in which cancer is handled in this country, and trying to impose it on one small area of Britain in this way is outrageous.

No mention is made of who will look after the cancer in-patients in east Kent, but it will not be a cancer specialist. More than 1,000 patients were treated in the Mountbatten five-day in-patient unit and almost 600 inpatients were admitted for a longer duration, amounting to 5,500 bed nights last year. In future, patients are likely to be under general physicians and surgeons with no specialist cancer knowledge, if they have not been sent to Maidstone. It is not always possible to do so. They may come under the care of a physician with an interest in stroke medicine.

Thanet, Dover, and Deal are between 45 and 50 miles from Maidstone hospital. Patients from those areas will therefore be further away from a cancer centre than patients in any other part of England and in most parts of Wales. That loss of access represents a serious deterioration of the service that all east Kent patients have hitherto enjoyed at Canterbury. It seems perverse and distinctly unfair that new centres have been opened or expanded in other parts of the country, such as Truro in Cornwall, Preston in north Lancashire and Bangor in north Wales, yet we are to lose ours.

Professor James has repeatedly said off the record that the east Kent cancer department is too small. A comparison of new patient referrals with other centres is revealing: Canterbury had 2,200, whereas Colchester had 2,100, Ipswich had 1,500 and Dundee 1,200. No one suggests closing any of those and centring them elsewhere. I should like to give two genuine case histories to illustrate how patient care will be damaged by these changes.

Mrs A comes from Folkestone. She has had breast cancer, which has spread to the bones. For two years, this has been controlled by tablet treatment. In the past two weeks she has had increasing pain and has been feeling very unwell. She was seen urgently by the cancer specialist in the Kent and Canterbury hospital. Her cancer had progressed causing high calcium levels in the blood, which was making her feel very ill. She was admitted immediately from the clinic, started on appropriate specialist treatment and within 48 hours began chemotherapy to control her cancer. Throughout her admission, she was under the care of a consultant oncologist and his specialist team.

If there had been no cancer centre at Canterbury—if the proposals outlined in the letters that I have received from the Minister's colleagues in the Department had been implemented—she could have been seen in the clinic by the consultant cancer specialist, but would have been admitted to Maidstone hospital for specialist treatment. The cancer specialist would visit the Kent and Canterbury for one or two days a week, so there would have been a delay in her seeing him and receiving chemotherapy. One alternative would have been for her to be admitted to the Kent and Canterbury hospital's on-call medical team, but they are not skilled in dealing with oncological emergencies.

The second case involves Mr. B, who is 58 and lives in Ramsgate. His wife is unwell with diabetes and he has been her main carer. Recently he was found to have cancer of the throat, which requires six or seven weeks of daily radiotherapy and chemotherapy. That treatment makes his throat extremely sore, making him feel unwell. Are we really asking him to make the 110-mile round trip every day? Of course not. He will have to stay in Maidstone hospital for seven weeks as an inpatient in order to complete the treatment. It is short of beds. His wife has to rely on friends to take her to visit her husband in hospital, which she can manage only once a week.

It would normally be possible to have that treatment as an out-patient of the Kent and Canterbury hospital on a daily basis—it is close enough for the round trip, being one third of the distance. With the closure of inpatient facilities for cancer patients at the Kent and Canterbury hospital, the Government are closing a cancer centre. Let us be clear about that. That is unprecedented, unjust and will worsen access for the poorest residents of east Kent, which, unlike the rest of south-east England, is home to large poor communities. The decision is perverse, particularly as cancer centres have been expanded in other parts of the country.

With the reconfiguration of Kent and Canterbury hospital, there is no reason for beds to transfer to Maidstone other than to fulfil the empire-building desires of Professor James, whose relationship with the consultants at Canterbury is so bad that even the independent review panel knows of it. Having dealt with him during the consultation, I understand that. It would be perfectly possible to have a centralised haematology and oncology in-patient cancer unit at Canterbury with the supporting services that are to be kept under the otherwise sensible settlement for the rest of the hospital.

Professor James recently said that he wished cancer treatment to be localised as close to patients' homes as possible. The plans to move in-patients and complex treatment would seem to have the opposite effect. One of the great successes of the national health service—of which the Government claim to be so much in favour and into which they pour more and more money to precious little effect—is bringing good quality care as close to the patient as possible. This plan reverses that principle.

I suspect that NHS planners wish to uncouple cancer services from the Kent and Canterbury hospital. We have a new linear accelerator, but when that and the other one come to the end of their lives, I imagine that the cancer service will slowly fade over the next five years as staff retire. I doubt that the radiotherapy machines will be replaced again. It will then be easier to close the remaining cancer services at the Kent and Canterbury hospital.

I have just heard that there is a plan to move the little centre of excellence for treating gynaecological cancer at Queen Elizabeth the Queen Mother hospital from Margate to Maidstone—my source is a leak from the minutes of the trust, which I believe to be true. Gradually, all specialist cancer work is moving to Maidstone, which is deeply inaccessible to people in much of east Kent. The political objectives for tomorrow's health care will be achieved, but at the cost of the patients of east Kent. I urge the minister to do what has already been done by the Secretary of State for the rest of the east Kent hospital trust's services—apart from cancer.

The Department should do a proper review of cancer services and talk to the consultants. They have played no role in the angry campaigning about the rest of the hospital. They are deeply professional, as are the rest of the consultants at the hospital, but they have kept their heads down and worked hard at their subject, assuming that all would come right. They have had enough. They have made it absolutely clear that this is a line in the sand; they will not go along with a manifestly half-baked attempt to impose on east Kent what is not the American model but a copy of something that Professor James claims is the American model. It is completely untested in England. I am most grateful to Dr Stewart Coltart for providing most of the briefing for this speech. I know one of his two colleagues extremely well and his views are the same, and I have a letter from the other colleague, from which it is clear that they all take the same view.

The Government gripped the rest of the situation in east Kent and, although I am not happy with all aspects of the conclusions—I am against any cuts in east Kent—at least a workable compromise has been established and the rest of the hospital service is working towards it. I urge the Minister to have the cancer proposals properly considered by an outside body, and to try to work towards a similar compromise in that area.

11.14 am
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate the hon. Member for Canterbury (Mr. Brazier) on what is the third debate that he has secured on the subject, the previous one being in April. Cancer services are obviously and understandably of great concern to east Kent residents, and the Kent cancer network provides cancer services for 1.8 million people. The two main sites are at the Kent and Canterbury hospital and Maidstone hospital, which see about 6,000 new patients a year. In the Kent cancer network, waiting times and performance have improved, and we want that to continue. Therefore, I want to make it clear that there is no doubt about the important role that the Kent and Canterbury hospital plays as a base for providing cancer services, and there are no plans to close it. That commitment has been made time and again, but I would like to reiterate it in light of the hon. Gentleman's remarks.

The vision and the long-term strategy for cancer services were developed in 1998 during the original consultation on the future of health services in east Kent. Following that consultation, the former Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), confirmed: Specialist cancer services at Canterbury have a firm future". That remains the case.

In 2001, a consultation contained a clear statement on the role of the hospital in the Kent cancer network, and the provision of cancer services was given careful consideration by the independent reconfiguration panel in its investigation. Its recommendation was that the Kent cancer plan is in the interests of local people and patients, and should continue to be implemented through the Kent cancer network.

I shall now address the hon. Gentleman's points on the independent review panel's report and the consultation. Having been thoroughly examined in court, both points he raised were rejected during a judicial review process last year, and it would be difficult for me to disagree with the court.

Mr. Brazier

The court did not produce a medical ruling; all it said was that the hospital trust had not broken the law. I am sure that the Minister has read the original document and the incredibly sketchy, conditional and vaguely written appendix on cancer. She must realise that it is not a proper representation. The independent review panel says that the relationship between Professor James and the consultants at Canterbury is so bad that it is damaging to patients' interests. Unless we get a grip of the situation at Canterbury—it cannot be gripped only from one end—the rosy picture that she described will not continue.

Miss Johnson

The hon. Gentleman made a point about the nature of the consultation, and I will discuss the model in more detail in a moment. However, the Maidstone and Tunbridge Wells NHS trust was fully involved in contributing to the consultation document, and the process behind the document has been tested by judicial review.

The original public consultation set out the long-term strategy, and in 2001 there was consultation on modernising hospital services, which I have already mentioned. Since then, there has been no change in the proposals for the provision of cancer services in Kent. The independent reconfiguration panel considered the cancer centre, and recommended that the Kent cancer plan is in the interests of local people and patients, and should continue to be implemented through the Kent cancer network. Primary care trusts in Kent are consulting on interventional radiology, along with renal and vascular services, but that is because all other aspects of cancer services have already been the subject of consultation and have been agreed.

The model supports and fits in with the national cancer plan. The plans for the location of specific services are necessitated by the need to improve the five-year survival rates for people with cancer. I am glad that the hon. Gentleman said that the health service in Kent was doing well on those fronts, but I am sure he would like improved survival rates, as we all would. The national cancer plan makes it clear that specialist work must be delivered from fewer places. Patients with more common cancers will still receive care at a local hospital. The proposed ambulatory model has already been tested, and is the model by which the majority of patients starting primary treatment for common cancers receive care. The 10 oncologists at Maidstone and Tunbridge Wells supported that model, and the national cancer director also gave his support to the model at a meeting in May 2002, which I think the hon. Member for Canterbury attended.

A review of other cancer centres across the country points to less than 5 per cent. of patients requiring admission as an in-patient. New cancer treatments mean that, increasingly, radiotherapy and chemotherapy are given on an out-patient basis. The model of care reflects that trend, while recognising that from time to time unwell patients need in-patient treatment. Consistent support needs to be available throughout east Kent from non-cancer services, as well as from specialist cancer nurses.

Mr. Brazier

The Minister made two statements. First, she said that the ambulatory model has been tested elsewhere. Leaving aside the general points, where has that model been tested in the United Kingdom? At every meeting, including that with the national cancer director, the only example given, apart from the experiment that was abandoned in Cornwall, was of the private sector in the United States of America. Can the Minister tell us the location of the health authority involved?

Secondly, the Minister said that the consultants at the Maidstone and Tunbridge Wells NHS trust supported the model, which Roger James claimed in a letter. However, three of the consultants—a third of the total—work in Canterbury and they are vehemently opposed to it, as they made clear after Roger James wrote the letter. Will the Minister put the record straight?

Miss Johnson

My advice is that 10 oncologists supported the model. If the hon. Gentleman has a different view, it is obviously difficult for us to square the matter during this debate.

Many cancer services are provided on a similar, if not exactly the same, model. The hon. Gentleman asked what other places were involved, and I shall be happy to write to him after the debate. As he knows, if patients require in-patient care, it will be provided in Maidstone.

On the closure of the cancer centre and the hon. Gentleman's allegation that east Kent patients will no longer have a cancer centre, as I said, there is no doubt about the important role of the Kent and Canterbury hospital as a base for providing cancer services and there are no plans to close it. The Kent and Canterbury hospital has a firm future. Under the newly developed hospitals reconfiguration plan, the hospital gains a number of acute services and will remain viable as an acute site, able to support a successful local emergency centre. There will also be other developments, including a new child health ambulatory centre, a paediatric assessment unit and a centralised aseptic unit. All those service improvements have been backed by £7 million of extra investment at the hospital.

It has been stated that the east Kent cancer department is small. I am grateful to the hon. Gentleman for sharing that information with me, but I do not recognise the figures that he used. However, if he tells me his source, I will ask my officials to look into the matter.

The hon. Gentleman said that the centre of excellence for treating gynaecological cancer was being moved from the Queen Elizabeth the Queen Mother hospital in Margate to Maidstone. Such statements worry families and communities. There are no plans to move the service from Margate. Indeed, external reviewers have praised the service at Margate for its high standards. Although the hon. Gentleman located the source for his comments, I am advised that there is no reason for such a statement.

The Department is not in a position to commission a proper co-ordinated review because the IRP looked into the issue fully and its recommendation is clear: the Kent cancer plan is in the interests of local people and patients and should continue to be implemented through the Kent cancer network. Although the Department will continue to work with the strategic health authority rigorously to manage the performance of the local delivery plan, the responsibility for taking the work forward now rests with the local national health service.

There is a clear model for cancer services in east Kent. There is a substantial work programme, which will deliver real benefits to patients and mean that the majority of cancer patients receive their cancer care as close to their homes as possible. There has been thorough consultation, much debate and an independent review of the proposals, and it is now time to deliver the changes so that local people can benefit from a high-quality and modernised service.

I also want to comment on the hon. Gentleman's remarks about the controversy among staff. When people disagree locally it is unconstructive for the future of local services. It is important that people come together to support the service developments that are taking place. I do not want to get involved in the local controversy or comment on the rightness either way, but it is important that people come together to support local communities. I am sure that he would want that, too.

Under the plans for east Kent, there will be much greater use of all local hospitals for routine cancer treatment. Radiotherapy and chemotherapy will continue to be provided at the Kent and Canterbury hospital. The hon. Gentleman mentioned in-patient issues. Increasingly, few patients receiving radiotherapy or chemotherapy will be in-patients, and only a few will require in-patient stays. The model that is being used recognises that.

The hon. Gentleman referred to rarer forms of cancer and patients having to be referred to specialist centres in London and Maidstone, and I want to touch on what the IRP said about that in its report. Everyone to whom the panel talked agreed it was right for the rarer forms of cancer to be treated in specialist centres in London and Maidstone, in accordance with national guidance. We obviously want people to get better treatment and live longer, and it is often important that patients with some of the rarer cancers receive treatment in specialist centres, which see more of those cases and are better geared to give the best possible treatment.

Cancer services have been kick-started after decades of neglect and under-investment, and are now moving forward. There are still problems, but progress is well under way.

Mr. Brazier

The fact remains that in a country that has a massive shortage of oncologists—my sister-in-law is an oncologist—plans cannot work if those who are supposed to implement them have no confidence in them. All three of the consultants based in Canterbury have made it clear that that is how they feel.

Miss Johnson

The hon. Gentleman and I are left trading oncologists—his three for my 10, as it were—and I can only reiterate my previous point.

Three years after the start of the national cancer plan, it is delivering faster treatment, higher standards and a better patient experience. In east Kent, there is a clear model for cancer services and a substantial work programme that will deliver real benefits to patients and mean that the majority of cancer patients receive their cancer care as close to their homes as possible and, in many cases, in their local hospital. There has already been thorough consultation, and it is now time to deliver the changes so that local people can benefit from a high-quality, modernised service.

11.28 am

Sitting suspended until Two o'clock.