§ Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Arbuthnot.]
§ 11 pm
§ Mr. George Mudie (Leeds, East)
I am grateful for the opportunity to draw the attention of the Under-Secretary of State for Health to matters relating to the proposed centralisation at the Leeds general infirmary of the cardio-thoracic facilities of Killingbeck hospital and the subsequent disposal of that hospital site. Although I shall also touch on the parallel proposal to centralise the neurosurgical work currently undertaken at Pinderfields hospital in Wakefield, my hon. Friend the Member for Normanton (Mr. O'Brien), will seek to catch your eye, Mr. Deputy Speaker, to deal with that in greater detail.
I wish to draw a number of matters to the attention of the Minister and, in particular, to ask him to intervene. I must underline the widespread unhappiness felt in Leeds and the surrounding areas about the proposals to relocate the excellent work carried out at Killingbeck hospital at Leeds general infirmary. That hospital has been long established and is secure in the affection of the Leeds people. Excellent work is carried out in its cardio-thoracic and respiratory units by their completely dedicated staff.
More than 900,000 heart operations are carried out at the hospital, and some involve tremendous work on children. The hospital's reputation is worldwide, it conducts first-class research and could continue to provide that superb service to the wider community for a fraction of the capital sum that has been expended so generously by the Government to the LGI.
Killingbeck's location is unique because it is surrounded by park land and has excellent road links with all of Yorkshire. It is a source of puzzlement to all in West Yorkshire that those benefits have been disregarded in the rush to centralise services in a city centre site, in a multi-storey block at that. Time and time again, lay and medical staff of the hospital stress the recuperative value of its surroundings.
It is of vital interest to consider the history of the closure proposals, which appeared in the 1980s, when a regional review was conducted. That review eventually led to a report, as yet unpublished, that suggested that the thoracic facilities of Killingbeck and the neurosurgical facilities of Pinderfields might be centralised at LGI.
The unpublished report was hotly disputed by the medical staff at Killingbeck hospital. It was not then a unanimous view and, until recently, the argument in favour of centralisation bringing patient benefits was severely challenged. However, it was and has always been accepted that more money had to be spent, and that both buildings, the LGI and Killingbeck, suffer from problems of age. There is a great difference between spending modest but sensible sums and the amount being advanced in respect of the LGI.
When, in 1989, the unpublished report suggested centralising the LGI services, the proposal was warmly welcomed by the LGI, as it meant securing much-needed capital investment in the aging hospital. The proposed centralisation gave the hospital a golden opportunity. The decision to go ahead with the proposal was taken in 1989, and work on a £4 million multi-storey car park started last year, as the Minister is aware.
257 However, as with most things in life, nothing stands still. The Pinderfields hospital's proposed move was put out to public consultation a year ago, met with unanimous opposition and was hurriedly withdrawn. The inevitable committee was established, and is still deliberating to this day. Killingbeck relocation and closure proposals were released for consultation 10 days ago, and are programmed to run for three months.
A decision taken in 1989, which committed more than £75 million of public money, has been overtaken by events. One major user—Pinderfields—has serious doubts, and the second user is in the early stages of consultation and the opposition is just as fierce. Some issues relating to the credibility of the consultation need airing and answering.
There is deep disquiet in Leeds over the status of the consultation. First, why is the Minister allowing the LGI to go ahead with a £70 million new block, built with the stated aim of centralising both cardio-thoracic and neurosurgical work when, as I stand here in the Chamber, neither proposal has completed its consultation period?
Secondly, why is the Minister allowing a contract to be signed for the new building when it is clear that Pinderfields will not permit the neurosurgical work to come to Leeds? If the Minister replies that the work will come to Leeds even though the proposal faced total opposition, what validity does consultation have?
The third and most important reason for concern relates to the consultation and an open public debate on the value of centralising the services. How can the people of Leeds feel confident in the consultation process when, from 1 April this year, the LGI has been managing the Killingbeck site? Does the Minister know that, only days ago, the LGI reinstated a whistleblower, but only after strenuous efforts had been made by my hon. Friend the Member for Leeds, Central (Mr. Fatchett)?
That behaviour is hardly the sign of a benevolent management. Does the Minister feel that, on the basis of such behaviour, staff will be inclined to participate in an, open debate on the key medical aspects of the exercise? I believe that public airing of the medical arguments is impossible, as staff are only too well aware that their future careers rest with the LGI.
Fourthly, how can the people of Leeds have faith in the consultation process when, the day after the consultation paper was released, the Yorkshire Evening Post revealed secret plans prepared by Touche Ross at the instruction of a developer which disclosed details of a multi-millionpound development, including a private health centre, a luxury hotel and a shopping complex on the Killingbeck site?
How can the public have confidence and feel that their views will be taken into account when a director of health care, a member of the consulting body, admitted last week in a radio programme that the health care body had already had discussions and—the impertinence of it—had even had disagreements over the proceeds from the sale of the Killingbeck site? Remember, that body has been issuing the consultation documents. How can the Minister defend the validity of the consultations when a consultant at Killingbeck hospital was quoted by The Yorkshire Evening Post as saying:Public consultation will be nothing more than a cosmetic exercise"?258 I am anxious that the Minister appreciates that four years ago, a decision was taken and was challenged at the time. That decision, depending on one's standpoint, had a certain validity. It involved centralised neurosurgery and cardio-thoracics at the LGI at a cost, for the first phase, of about £75 million. The Ministry accepted the plan and pencilled in the money. Today, four years later, half the plan has unravelled, because public hostility has been dropped and towards the other half the same level of public hostility exists or, at least, is uncommitted.
Where does that leave the Minister? If he does not think it interesting enough to have a closer look, the Chief Secretary to the Treasury should. I appeal to the Minister to take time to consider the background. The new development will produce only 20 cardio-thoracic beds and no additional operating facilities. Is that worth £70 million? I suggest he takes another look at the plan.
To give him time to undertake that review and to give the consultations the credibility that they sadly lack, I urge him to instruct the LGI not to sign a commitment to the contract on the new building. The LGI knows the implications of the review, and fears it. Two hours before I rose to speak tonight, I was approached by a senior member of the LGI and urged not to suggest that in this Chamber. The LGI knows that it is in a building programme under false pretences. While I understand its need, I shall not be party—and I hope the Minister will not be party—to it getting a refurbished hospital at the cost of Pinderfields and Killingbeck hospitals.
If the Minister gives himself the necessary breathing space, he will find the facts to be as I have outlined them. He may find that there are other, and cheaper, ways of delivering the stated objectives. He may find the other Leeds hospitals indulging in some fresh thinking. He will end up achieving a victory over medical politics and empire-building. He will certainly gain the eternal gratitude of the people of Leeds.
§ Mr. William O'Brien (Normanton)
I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on having raised on the Adjournment the significant and important issue of the future of Killingbeck hospital. As he explained, because of empire-building at Leeds general infirmary, services at Pinderfields are in danger. Indeed, the whole future of Pinderfields is in doubt.
The neurosurgical department at Pinderfields is among the most efficient in the Yorkshire region. There are at present only three such facilities—in Hull, at Pinderfields and in the LGI. If the programme set a few months ago is allowed to proceed, the neurosurgical department at Pinderfields could be lost.
Tremendous opposition was expressed when a consultative document was issued. So highly valued are the Pinderfields services by communities some distance from the hospital that the document was withdrawn. One reason for that was that it had not been costed. So when people started asking questions about cost comparisons, no answers were forthcoming from the regional health office, and the document had to be withdrawn.
Because of the stupidity of the regional health authority, a group of people were brought together to analyse the objections put to the original consultation exercise. The resulting committee is due to report back in the near future. The committee refused to meet the 259 chairman of the Wakefield community health council to hear the views of that council on the neurosurgical department at Pinderfields. Now we await the report.
I ask the Minister to insist on further consultations arising out of the complaints submitted for the first consultation document. Failing that, I join my hon. Friend in saying that there has been maladministration here. If it had taken place in local government, these people would have been charged with maladministration. As it is, they may be in this case. Anyway, there must be more consultations after the report by the review committee. I ask the Minister to afford that opportunity to the people who use the neurosurgical department at Pinderfields.
If the department is withdrawn from Pinderfields, the young disabled unit which forms part of it will be in danger. It is the only unit of its kind in West Yorkshire. It would be quite wrong to let such a facility disappear. Since 1 April this year, when community care was introduced, there has been a greater need for such a unit in the neurosurgical department to afford respite care for those with neurosurgical problems.
From the point of view of communications, nowhere is better placed than Pinderfields. From the M1 or the M62, people can be transported to the hospital buildings within minutes. The helicopter pad is first-class. If there are any better facilities in West Yorkshire, I would like the Minister to tell us about them. The car parking at Pinderfields is first-rate too. Only a few weeks ago I went to St. James's, where parking is, to say the least, traumatic. No such problem exists at Pinderfields.
There is a great deal to be said for maintaining the neurosurgical department at Pinderfields, and I ask the Minister to consider what I have said.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I have almost lost my voice, but I shall attempt to muddle through.
I was glad to hear the hon. Member for Leeds, East. (Mr. Mudie), who has initiated a debate on a number of important topics. I am pleased to see his colleagues in their places, and to see my hon. Friend the Member for Leeds. North-East (Mr. Kirkhope), who takes a strong interest in this matter.
The hon. Gentleman and the hon. Member for Normanton (Mr. O'Brien) have made some serious allegations against local management, and have repeatedly questioned their motives and competence. Let me give my version of the history of the proposals.
Cardio-thoracic services are currently provided at two sites in Leeds, Killingbeck and the LGI. In 1988, the regional health authority commissioned a review of cardio-thoracic services and associated cardiology from the York health economics consortium. The review concluded that cardio-thoracic services should be concentrated on two sites—one unit in East and the other in West Yorkshire. There was a wide-ranging discussion on the outcome of the review, involving consultant surgeons, cardiologists and health authorities in the region.
In early 1990, St. James's, the LGI and Seacroft were invited to submit proposals for a new West Yorkshire cardio-thoracic unit to be developed on their sites.
260 Following an option appraisal of all three bids, it was proposed to centralise cardio-thoracic services for West Yorkshire at new facilities to be built at the LGI.
As a consequence, the regional health authority examined ways in which the facilities at the LGI could be improved. As the cardio-thoracic facilities in both Killingbeck and the LGI are housed in fairly elderly buildings, it was recognised that they would have to be replaced at some point. Killingbeck is about 90 years old, and a recent survey of the estate estimated that a substantial sum needed to be spent on bringing it up to scratch. This led to a proposal to construct a purpose-built cardio-thoracic unit as part of the first phase of the redevelopment at the LGI. The proposals for that phase —to redevelop the site and provide modern facilities and better patient care, at a cost of some £72 million—were approved by my Department in July 1992.
That approval is an approval in principle, for a very good reason. It is an approval of the principle of a capital development, and is given only after careful consideration. It does not carry with it approval of any consequential changes that may require consultation. The approval was not conditional on the closure of Killingbeck hospital, and there has never been any question that Leeds Healthcare, or anyone else, can move cardio-thoracic services from Killingbeck to the LGI without full public consultation. The business case for the redevelopment of the LGI is not dependent on the centralisation of these services.
As the hon. Member for Leeds, East pointed out, Killingbeck is now a directly managed unit, and is part of the district health authority, Leeds Healthcare. So that Leeds Healthcare could carry out its primary function of commissioning the best possible care for the people of Leeds, it asked the LGI to manage Killingbeck on an agency basis. The LGI is responsible to the district health authority for the day-to-day running of Killingbeck; it has no power to make major changes or to sell assets. There is no secret back-door merger. The staff at Killingbeck are, of course, still employed by Leeds Healthcare, and have been kept informed about the changes and the reasons for them.
Following the various proposals to centralise cardiothoracic services, the next stage was for Leeds Healthcare itself carefully to examine the proposals for the location of the centre. It is for purchasers to decide what health care is needed, and how it should be provided. The aim of Leeds Healthcare, as the lead purchaser, is to secure the best possible patient care—within available resources—for the people of Leeds and West Yorkshire.
Naturally, the views of clinicians and other staff at the LGI and Killingbeck were taken into account when the proposals were put together. The outcome of the discussions was the consultation document that has recently been circulated to a large number of medical bodies, to Members of Parliament and to health and local authorities, voluntary groups and trusts, as well as to the media. The purpose of the document is to invite public discussion of the proposals, and to invite organisations and members of the public to write in with their comments.
There may be some surprise at the fact that Leeds Healthcare is consulting so early on proposals that could not take place before 1996. However, purchasers in supporting the Leeds general infirmary development have to consider what impact the development would have on their requirements for Killingbeck's services. For its part, the LGI needs to know that purchaser's support can be 261 translated into action. That could not happen if, as a result of consultation, purchasers were prevented from moving services from Killingbeck. It is also important that patients and staff know where they stand and that uncertainty is ended. All that indicated an early consultation exercise.
At the end of the consultation period, Leeds Healthcare will consider the proposal in the light of the responses made during the consultation period. That will be not a rubber stamp but a serious re-examination of the proposals. Health authorities are well aware that proposals referred to Ministers are scrutinised very closely and no health authority worth its salt will want a reputation among Ministers as an author of half-baked schemes. However, if the proposals were opposed by the local community health council—we must not assume that it will disagree—and the health authority still wished to proceed, the case would be referred to the regional health authority. If the RHA wished to proceed, the matter would automatically come before Ministers.
Neither I nor my right hon. Friend the Secretary of State have considered the merits of these proposals. However, I can assure the hon. Gentleman that, when Ministers receive proposals from any health authority to close any hospital, they do not go through on the nod. Before we take any decision, we want to be sure that the correct consultation procedures have been followed. We will take into account what other services are available, and we will listen to the views of staff, who have been instrumental in giving cardio-thoracic surgery and 262 cardiology the reputation that they have in Leeds. The most important criterion on which the proposals will be judged is that they are in the best interests of patients. We all want to be sure that the proposals will provide the best clinical care with the available resources.
I have listened carefully to the points made by the hon. Members for Leeds, East and for Normanton, and I understand the strong feelings that these proposals awake in local people. I have heard the hon. Member for Leeds, East express doubts about the validity of the new development and on consultation, on which I should like particularly to reassure him.
§ Mr. William O'Brien
Obviously, the Minister does not have information on the question that I asked about neurosurgery. However, will he ensure that there will be further consultation on the report that will be submitted to the regional health authority from the group set up to examine the responses of those who objected to the earlier consultation document, which was withdrawn because it has not been costed?
§ Mr. Sackville
I can say only that all representations will be fully considered. As a result of this debate, I am fully aware of the strength of feeling that exists about both proposals—[Interruption.] As I have said, all representations will be fully- considered. No action will be taken unless Ministers are satisfied that it is in the full interests of the people of Leeds and West Yorkshire.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Eleven o'clock.