§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. David Davis.]11.42 pm
§ Mr. Peter Kilfoyle (Liverpool, Walton)
I was moved to initiate the debate because of the fear that has arisen throughout Liverpool—certainly through the north side of the city—that the Walton centre for neurology and neurosurgery was at real risk because of developments within the Mersey regional health authority. It is a specialist centre and was one of the trusts in the vanguard of the Government's changes to the national health service. When it opted for trust status, it was driven—I choose my words carefully—by the then chairman of the RHA, Sir Donald Wilson.
Hospitals and services within the Mersey region, including the centre in Walton, sought trust status on the basis of promises that there would be funding availability and that flexibility would be given to ensure that the trusts were successful in their own right and in their right as hospitals. However, after they became trusts, the pan-Liverpool review body reported. The body was set up to examine health care provision throughout the area. Tucked away inside one of the consultation documents was the suggestion that neurosciences should be relocated away from the Walton hospital site at the Royal Liverpool hospital in the city centre. That was despite the investment of millions of pounds in the site at Walton. I stress that the centre is highly specialised.
The proposal to relocate the unit also ignored the view expressed in the review body document of 31 July 1989. It said that the neurosurgeons and neurologists were more than happy where they were. The decision seemed to be administratively driven to ease Walton away from that site.
The fate that was dangled before the Walton was a different scenario—a transfer from the Walton site to a new purpose-built unit at Fazackerley hospital. Such a move would have required a massive infusion of cash—a projected cost of about £40 million. That was hardly likely to happen, given that, right next door to the Fazackerely hospital, the Government were committed to wasting £110 million on a new prison. I doubt whether the money would be found to provide the hospital extension that would have been required.
The Walton centre is developing into a centre of excellence. It serves a catchment area of about 3 million people. That includes Merseyside, north Wales, the Isle of Man and west Lancashire. In certain circumstances, it takes cases from much further afield. It provides a high-quality integrated diagnostic and therapeutic service on that site. It has a highly skilled team. It caters particularly for patients with disorders of the nervous system.
If the service is to be successful and effective, it must continue to be an integrated multidisciplinary neurosciences unit. That cannot be the case if the neurosciences unit is fragmented by parts of it being dispersed to district general hospitals. The unit must be developed. The people who run the place want to develop it as a centre for head, neck and spine surgery, neurology and neurological rehabilitation. Thus, the centre is an ideal site for a major trauma centre. It remains under some threat, because 472 saving pounds appears to be more important to some people than saving lives.
We need to put the specialist centre into context. The same pan-Liverpool review body has been a source of contention in many parts of health service provision on Merseyside. Only yesterday, as we heard from my hon. Friend the Member for Liverpool, Garston (Mr. Loyden), we had a visit from the nurses of the north Mersey community trust. As my hon. Friend said, the trust is the first of its type. I believe that it is being watched by bodies around the country to see what happens. It was set up in 1859 by William Rathbone and Florence Nightingale. It is going through what can only be described as a de-skilling exercise, which will lead to a diminution of the services offered to people by the dedicated, skilled nurses who go out into the community.
Broadgreen hospital is to lose its accident and emergency department, as is the Walton site. It has been said that the casualty department of a hospital is literally and metaphorically the doorway through which patients come. It keeps the complimentary and acute services busy.
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
I wish to amplify my hon. Friend's point about Broadgreen hospital. It relates directly to the wider implications of the York review, which refers to the Walton unit. Duncan Nichol, the chief executive of the national health service, visited Mersey regional health authority in December. I wish to quote a section of the document that he produced then. He referred to the main bed reductions that would be made in the Liverpool area. There are several reasons why such bed reductions are being considered. He said:Main bed reductions would need to take place at the Aintree and Broadgreen Trusts … The configuration options for"—what the document described as—
the rump of Broadgreen would then be to merge with the CTC Trust"—the other trust on the Broadgreen site—
or to become an annexe of the Royal".It then referred directly to the neurosciences unit and said:The other provider issue concerned the Aintree Trust moving off the Walton site"—
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
Order. I hesitate to interrupt the hon. Lady, but she is making a speech rather than an intervention.
§ Mr. Kilfoyle
I am grateful to my hon. Friend for pointing out the many uncertainties. If different voices are heard on behalf of the health service, that undermines those people who want to put their faith in a particular site.
I used the metaphor of closing the door. If it is closed, inevitably the acute services will be relocated to those hospitals with accident and emergency provision. If there is no such provision, as sure as night follows day, many of the services currently located at the Walton centre will go. That will be no fault of those trying to do a job there, but because the means to do the job will not be at their disposal.
The logic is inescapable: if the casualty provision is taken away from Walton hospital, it will be difficult for the neurosciences experts there to defend their wish to remain at that site. The ideal of Walton becoming a major trauma 473 centre then becomes a distant dream. A sham exercise is taking place, under the guise of consultation, on accident and emergency provision in the city.
It is strange that, while that consultation is taking place, £1.9 million has been granted to the Royal Liverpool hospital, through the outpost system, to expand its accident and emergency unit. That seems to pre-empt the outcome of any independent consultation. It shows that the regional health authority is determined to have its way, come what may. I fear that we will soon be faced with a fait accompli in accident and emergency provision for the area.
If the health authority's preferred option—No. 2.2.1 —is implemented, on my computation it will mean that about 690 beds will have been lost since the creation of the trust in the area covered by the pan-Liverpool review. It would mean the loss of 34 of the 135 beds that existed at the Walton centre when it originally took trust status.
The accountants who seem increasingly to be in charge of the health service would not think it viable, in terms of numbers, for the centre to continue on that site; yet the centre is an extremely valuable resource—not just its buildings and equipment, but its highly skilled, dedicated, motivated and professional teams of staff.
I am sure that the Minister is aware that the number and range of specialisms at the centre are quite remarkable. It does neurosurgery, spinal surgery, head injuries, intensive care, paediatric neurosurgery, neurology, disability and rehabilitation, pain relief neurophysiology, neuroradiology and neuropathology. The list goes on and on. In addition, the centre is heavily involved in teaching and research, and it has strong links with Liverpool univerity's department of neurosciences. There is also the adjacent Pain Foundation, of which the Minister will be aware, as I understand that it is the only one of its kind in the country, if not in Europe.
The Walton centre has every intention to develop those links. It wants to establish chairs in neurosurgery, pain science and rehabilitation, to add to the new chair that has just been established in neurology. All those welcome and progressive developments are under threat.
Walton is a hospital with strong community links. Everybody in north Liverpool knows it—all have had some dealings with it at some stage. Despite its faults, it has a reputation as a good, caring hospital that clearly identifies with the local community.
The "strategic direction" document for 1993–98, put out by the centre itself, contains four important points about future site options. The first is:We will continue discussions with Aintree Hospitals Trust to reach an understanding of the final disposition of services and the timescale of any changes.That is important because, effectively, there are still two trusts on one site: the Aintree hospital trust and the Walton centre.
The second says:we plan to remain on the Walton site so long as the other specialties remain or can be attracted to this site.Obviously, without those specialties, the site is not viable.
The third point is:The best option is to develop the Walton Centre as a Centre for Head, Neck and Spine Surgery, Neurology and Neurological Rehabilitation. With this combination of specialities it would become an ideal site for a major Trauma Centre.Last but not least, there is a 474need for a separate in depth study of the possible options for the provision of Neurosciences which will clearly include the preferred option for staying on the Walton Site.In the summer of 1991, I visited the hospital to see the opening of the latest state-of-the-art technology—a huge scanner. As an Evertonian, I was pained by the fact that it was opened by Graham Souness; nevertheless, the scanner had cost millions of pounds, which had been paid by public subscription. The working people of Liverpool are renowned for the generosity they show to charitable causes: anyone who knows anything about Alderhey children's hospital knows about the funds that are raised. More important, this instance was undeniable proof of the commitment of the people of Liverpool to the centre, which is very popular and very effective.
§ Mrs. Jane Kennedy
The people of Liverpool may strongly support Walton hospital—as they support Broadgreen—and the trust itself may have plans for its own future that it is seeking to develop. However, Mersey regional health authority clearly has other plans. Over the last five years, three separate documents have been issued, each saying something different. The document issued in December included a third option for the neurosurgical unit.
§ Mr. Kilfoyle
My hon. Friend is absolutely right. Despite all the protestations of the people of Liverpool —even when the trusts were being established—despite the huge number of petitions that were collected and despite united opposition, the regional health authority, under the chairmanship of Sir Donald Wilson, seemed hell bent on using Liverpool and its hospitals as a test bed. I hope to say more about that later.
I was talking about the generosity of Liverpudlians to causes such as the Walton hospital. I hope that the Minister will reciprocate by giving an unequivocal commitment that the Walton centre will remain where it is, and substantially as it is. We all recognise that change is inevitable, but I have given my reasons for hoping that the Minister will make such a commitment.
As my hon. Friend the Member for Liverpool, Broadgreen (Mrs. Kennedy) suggested a moment ago, there has been a recurrent theme in the Mersey region—the theme of health care being used as a test bed for the latest cost-cutting exercise devised by those who are motivated by cost saving rather than life saving. I do not like to say that, but it is the only conclusion that I can reach.
What is perhaps unique about the Walton centre is that, having followed the line of Sir Donald Wilson and Tory ideologues who forced through these so-called reforms, the trust is now discovering that the idea that it—the trust —was the way forward for the centre is not all that it seemed at the time. The blunt truth is that the money for further developments has run out: it is not there on the scale that is required for rationalisation of the kind that was planned—for example, the transfer to the Fazackerley site.
The health authority is looking for ever more ways of cutting costs, without proper regard to patient care of the need to keep specialist units together in the only way that will ensure their viability. Tonight, the Minister should consider—it is an important point for him politically—not only the opposition that he would naturally expect from Labour Members but the concerns of those who believed the Government and their promises and involved 475 themselves in trusts. Will the Minister tell us whether those people are now as dispensable as many of the health facilities on Merseyside appear to be?
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I am glad to have a chance to respond to the hon. Member for Liverpool, Walton (Mr. Kilfoyle) in this debate on the future of the Walton centre for neurology and neurosurgery.
The centre has been an NHS trust since April 1992. It is situated in the grounds of Walton hospital, and for many years has provided a service to patients from all 10 districts in Mersey region, as well as Clwyd and Gwynedd in north Wales, parts of west Lancashire and the Isle of Man. The total population it serves is about 3 million. It is recognised as a centre of excellence, as the hon. Gentleman said, and it enjoys a first-class reputation in the local community and beyond for neurosurgery, pain relief and neurology services.
I was pleased to visit the centre last October and to open the excellent new operating theatre suite—I am afraid that I am not a footballer—which was hugely impressive. It had been refurbished with the addition of a fourth operating theatre and a new five-bed recovery suite. I saw a presentation of the centre's fully integrated computer system, which is the first of its kind in the country.
Waiting times in the centre are extremely encouraging. No one is waiting more than 12 months for treatment. The new scanner, which, as the hon. Gentleman said, was opened 12 months ago at a cost of £1.4 million, is being used with great success. Other encouraging developments include the refurbishment of the centre's out-patient facilities and the appointment of two new consultants. The centre received recognition from the NHS Management Executive for meeting its financial duties and is reporting an encouraging financial outturn.
Why are we having this debate? I well understand the hon. Member's concern about the future of the centre, stemming immediately from the recent review of hospital services in Liverpool conducted by the York Health Economics Consortium. The hon. Member is aware that the York study was set up to see how the recommendations of the "Pan-Liverpool" report could be developed and implemented. "Pan-Liverpool" made a number of recommendations, including the future of acute services and neurosciences.
The York review must be viewed against the background in Liverpool of a population that has declined by more than 8 per cent. in the past 10 years up to 1991, the fact that Liverpool health authority is a loser under weighted capitation funding; changes to clinical practice that affect everywhere—not only Liverpool—moves to more day-case surgery; development of so-called keyhole techniques; and other developments that involve fewer days having to be spent in bed.
A key conclusion of the York study was that, due to the factors that I have just mentioned and others, fewer people in Liverpool will need to stay in hospital, and that those who stay will do so for a shorter time and will benefit from non-invasive techniques and improved rehabilitation. This suggests that the health care of the future will be much less dependent on hospital beds and much more community-focused.
476 The study recommended that the city would be best served by two district general hospitals based at the Royal Liverpool and Aintree hospital trusts, supported by facilities at Broadgreen.
I have already said that "Pan-Liverpool" made recommendations on neurosciences. The clear recommendation was that services should be moved to Fazackerley, part of the Aintree trust. Although the regional health authority welcomed the general direction of service development proposed in "Pan-Liverpool", no further action has been taken on the recommendation. That is how we stand today.
However, I well understand concerns about the future. I have said already that a fundamental part of the Liverpool health authority's proposals is the development of Aintree hospital trust as one of the two centres for the city's acute centres. Allied to that, Aintree has had to consider its configuration.
The first stage of implementation, in the shape of major capital investment in a new £7 million accident and emergency unit at Fazackerley, is already under way. The new unit is due to open in summer 1994 and will provide one of the most modern and the third largest A and E departments in the country. The trust plans to transfer all in-patient acute services to the Fazackerley site over approximately the next three years, with out-patient services, day surgery and diagnostic services remaining on the Walton site to provide continuing access for the local community.
Clearly, as the hon. Gentleman recognises, the proposed changes on the Walton site of the Aintree trust may have consequences for the Walton centre for neurology and neurosurgery. The future location of the centre can be determined only by the demands of the service. I am sure that the Walton centre is correct in approaching the "problem" as an opportunity. The trust board is aiming to retain the Walton site as the preferred option. As I said, there is clear evidence of the significant progress that the centre has made since being established as a second wave trust. The centre has strong links with the university of Liverpool, the Pain Foundation and many voluntary agencies which assist it in carrying out its work throughout the region.
As I said, the future location of the Walton centre must be determined by the demands of the service. Some patients treated at the centre require the skills of other specialties in addition to those of the centre. Co-operation is more successful when staff are on the same site. The centre plans to remain on the Walton site as long as the other specialties necessary remain on, or can be attracted to, the site, thus monitoring the well established patterns of co-operation of clinicians and support services.
Another factor that needs to be taken into account in a transfer off site is the cost in both revenue and capital terms. The cost may be considerable. The current purpose-built accommodation was built in 1972 and is in good condition. Recent improvements have been the completion of an upgrading of the new theatre facility to provide a fourth theatre and a new recovery suite. They are strong arguments for retaining the site.
However, I cannot give the hon. Gentleman the commitment he seeks, that there will be no changes. I must emphasise, however, that decisions have not yet been taken. "Pan-Liverpool" remains the definitive statement of 477 Mersey's policy, and the region intends to revisit the specific recommendations when other developments become clear.
Let me emphasise that any change will be purchaser-driven. In other words, it is about patients and a perception by the purchaser of the needs of patients, not about institutions. We have faced the same problem in many large cities, including London where, recently, well established and well loved institutions, which have been in existence for many years, have become vulnerable because of changes in population and clinical practice. It may become necessary to take very difficult decisions based on two things.
First, such a decision would have to be based on the fact that, as a result of the separation of the purchaser and provider, purchasers have the obligation to purchase provision in line with the needs of a specific population —no more, no less. If they do more than that, other parts of the NHS must, by definition, make sacrifices.
It is a difficult balance to strike. Difficult decisions have had to be made in London. I myself have recently been involved in difficult decisions involving well loved and well established hospitals in Birmingham, and there is a similar situation in south Manchester. It is a feature of the large conurbations of this country that historical factors have often resulted in over-provision and duplication of services, which cannot but have an effect on the rest of the NHS.
478 As I have said, we have to find out, from the point of view of the purchaser—
§ Mr. Kilfoyle
Does the Minister see the distinction between the Walton centre and the type of hospital that he is talking about? I have explained, and the hon. Gentleman is fully aware, that the catchment area of the specialist unit is far wider than the urban areas of Liverpool, and includes north Wales, the Isle of Man, west Lancashire and the whole of Merseyside. So the catchment area does not fluctuate a great deal.
Will the hon. Gentleman also deal in more detail with the withdrawal of other acute services from the site? What does that mean for the future of the Walton centre?
§ Mr. Sackville
We are not talking about the future of the centre as an entity. It is a centre of excellence; it is needed; it will be provided. We are talking about the knock-on effect of changes to acute services in the Liverpool area. There are various possibilities, as I have said, and the decisions have not been made, and cannot be made at this stage.
I can only tell the hon. Gentleman that the value of the centre is well recognised, and that it provides an excellent service. Its future must be decided in tandem with changes that may be made to acute services in Liverpool, but the hon. Gentleman need not doubt that the centre will remain, and will continue to serve the people of the north-west of England in the excellent way in which it has done since 1972.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes past Twelve o'clock.