HC Deb 17 May 1993 vol 225 cc131-8

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]

11.22 pm
Dr. Joe Hendron (Belfast, West)

I am grateful for the opportunity to initiate an Adjournment debate on the Royal Victoria hospital, which, by any standards, is the finest hospital in western Europe. It was the first hospital in the world to have a cardiac ambulance. Thousands of people in Northern Ireland, and, indeed, in Britain, owe their lives to the expertise and brilliance of the magnificent staff of that hospital. Those people include members of the security forces.

The facilities of the hospital include the accident and emergency unit, which is the very heart of the hospital. They include general medical and general surgical beds and the regional specialties of thoracic surgery, neurosurgery and cardiac surgery.

On Friday 14 May, thousands of people in Belfast marched through the city centre to the headquarters of the Eastern health and social services board. There was a howling wind and it was pouring with rain. Those people came from the Catholic Falls road and the Protestant Shankhill road; Nationalists and Unionists crossed the sectarian divide to bring one message to the Eastern board and the Department—to take their hands off the Royal Victoria hospital, which has served that community so well over the years.

I should like to acknowledge the help that I have received from the NUPE and COHSE trade unions, the representatives of the West Belfast health monitoring committee, the management of the Royal Victoria hospital trust and the medical and general staff of the hospital in making my case for that hospital.

When the hospital management team was preparing to respond to the "Statement of Intent" from the Eastern health and social services board for general (acute) hospital services within that board, the discussion was pre-empted and superseded by recent proposals on purchasing strategy for 1993–94. The board offered the hospital a contract that would result in 1,200 fewer general surgical operations, elective operations, plus 1,500 fewer ear, nose and throat procedures. The prospect of a substantial reduction in elective general surgery and ENT procedure is viewed with great alarm by everyone on the hospital staff.

The medical staff feel that it is most unfortunate that a discussion about the acute hospital services for 1994 and beyond should be rendered so pointless by changes to be introduced in 1993. It is quite bizarre that disciplines with a particular value for undergraduate teaching and research, and hence "star" supplement, should be removed from the hospital. That will lead to a loss of income that will further accelerate the downward spiral on which the hospital now seems set.

The present process of contracting contravenes the DHSS management executive's guiding principles, as set out in a document published in consultation with the boards. That document deals with stability, and states: Contracting should not lead to the disruption and destabilisation of services, nor should it lead to the disruption of education and training. That is exactly what it has done. That document also states: In the first year of contracting, Boards and Units will maintain a steady state"— it is important to stress the use of the words "steady state"— except where changes have been planned and mutually agreed. Where changes in current service patterns are proposed, adequate notice must be given to allow the parties involved to make and manage the adjustments. That is a farce, when one considers the type of contract that the board tried to force on the Royal Victoria hospital recently.

At a recent meeting with the officers of the Eastern board, I asked about consultation. I was told that one cannot consult over every major issue that requires a decision. My goodness, this contract arrangement is the most important decision to be put to the Royal Victoria in my 30 years as a general practitioner in west Belfast.

In its own document, the Eastern board accepts that only three hospitals in its area reach the required standard of clinical effectiveness. It then proceeds to downgrade one of them.

The removal of 1,200 general surgical operations from the Royal Victoria represents one third of the work of general surgeons. They will also be expected to continue to treat complex, major surgical cases referred to them from elsewhere. I am not talking about regional specialities of the hospital, but the work of the general surgeons. They are so experienced that cases are referred to them from other parts of the north of Ireland. They are expected to undertake that work as well as emergency work. That means that in future, if a local doctor refers his patients to the Royal Victoria, those patients will be turned away and sent elsewhere.

One senior surgeon told me that, if he carried out an endoscopy on a patient with stomach cancer, that person would then be sent home and his GP would have to arrange for admission to another hospital. That may lead to a possible delay of one month.

When it comes to trauma, the Royal Victoria is the only hospital with neurology, thoracic surgery, cardiac surgery and burns units. Major trauma also requires a general surgical input. If surgery procedures are run down this year, they will never recover. The Royal Victoria hospital now has fewer than half the beds it had five years ago.

It is important to realise that, at the initial tender for the contract, the Royal Victoria hospital was the cheapest of all the providers, but the Eastern health board held a Dutch auction in reverse, toing and froing between the Royal Victoria, the Ulster and City hospitals, and finished by proposing to withdraw services from the Royal Victoria.

It is hard for the Royal Victoria to come to terms with the fact that, within a few weeks of obtaining trust status, it has been plunged into a deeper and more severe financial crisis than it has previously experienced. Indeed, the future of the hospital's clinical profile is in great jeopardy.

The strategy encouraged by the board in its "Statement of Intent" document relies wholly on four highly suspect assumptions. The first has to do with population changes. It is assumed that the population of central Belfast will continue to move to outlying areas of the board. The second assumption involves new health care identities and the belief that the Eastern health board population can legitimately be forced into three new catchment areas. Phrases such as "east and west of the Lagan" are used —anyone who knows Northern Ireland has heard of "east and west of the Bann" but not "east and west of the Lagan".

The other assumptions talk about a reduction in services purchased by other boards and a reduction in acute care in west Belfast. The implication is that there will be fewer cases from west Belfast.

The board defines accessibility as giving the best possible access to patients, visitors and staff, geographically and in terms of ready availability and having regard to safety. However, the board fails to define what it means by safety and completely ignores the sectarian geography of Belfast. I do not like using such language, because I am not a sectarian person, but it is a fact of life. To give an example, the people of Poleglass and Twinbrook on the edge of west Belfast will not go to the Lagari Valley hospital, because they look on the Royal Victoria hospital as their hospital.

A number of reports in recent years, including "The Health Divide", the Black report, which dealt with health inequalities, and independent studies in the British Medical Journal, all link unemployment and poverty to ill health. West Belfast has approximately 40 per cent. of the total number of unemployed people in Belfast and 10.7 per cent. of the long-term unemployed in Northern Ireland. North and west Belfast have the highest percentage of low birth weight babies. Of the 12 wards in Northern Ireland rated to have the worst overall health, six are in west Belfast.

We must show that we care about our sick, injured, frail, old and deprived people, whoever they may be and wherever they live. Managers at the Royal Victoria hospital have given the lead by refusing to sign the Eastern health board contract. The chairman of the Royal group of hospitals, Dr. George Quigley, has called for an independent inquiry into the board's proposals for health care provision, and I support that call.

Last Friday, I had a meeting with the Secretary of State about his recent trip to the United States. I accept in good faith the fact that he was genuinely trying to get inward investment into Northern Ireland, although other subjects were also discussed. However, I would say to him and to the Earl of Arran that any attempt to run down the Royal Victorial hospital, which is the major employer in west Belfast and the surrounding area, would make ring hollow any promises made from the United States or projects such as "making Belfast work".

Apparently, there is to be arbitration between the management executive and the board, but the Secretary of State and his Ministers are now directly involved. I hope that common sense will prevail and that the Royal Victoria hospital will be allowed to continue to provide the outstanding service that it has given for so many years.

11.33 am
Mr. John Hume (Foyle)

With the permission of my hon. Friend the Member for Belfast, West (Dr. Hendron), I should also like to question the Minister on this very serious and highly emotional issue. The Royal Victoria hospital is important not only to Belfast but to all the people of Northern Ireland.

At the important level of what could be described as the public health of the people of Northern Ireland in terms of their relationships with each other, the Government are rightly anxious to get both sections of our community working together, especially in their common interests.

Nowhere in Northern Ireland has shown a greater example of that than the Royal Victoria hospital in Belfast and its staff. The staff are drawn almost 50:50 from both sections of our community.

Throughout the past terrible 20 years, and in spite of its location, there has never been a single sectarian incident in the hospital among the staff. In spite of their differences, they have worked solidly to deal with the health of the people who come to them. They have become internationally expert in dealing not only with heart cases, but with many of the illnesses that arise out of the trauma of our violent situation.

The hospital has given an example to the world. Despite the weather in the streets of Belfast last week, all those in the hospital, from the highest consultant to the medical staff, the nurses, the porters and the domestic staff, were together, solidly backed by the people of the Shankhill road and the people of the Falls road. When we get such agreement in Northern Ireland, we surely have a duty to maintain it, especially when it deals with something that is fundamental to us all—the health of our people.

11.36 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Jeremy Hanley)

I am grateful to the hon. Member for Belfast, West (Dr. Hendron) for raising the question of the future of the Royal Victoria hospital in Belfast. As a general practitioner in west Belfast, the hon. Gentleman is an authority on the Royal Victoria and he is respected there, just as he is respected here for that knowledge and dedication.

My colleague Lord Arran, who has responsibility for health and social services matters in Northern Ireland, has asked me to say that he is naturally extremely concerned by the stories that have been circulating about this renowned hospital, which has for a very long time held a pre-eminent position as the premier teaching hospital and centre of medical excellence in Northern Ireland. It is also greatly valued as the general hospital for the people of west Belfast. On his behalf, I welcome this opportunity to make clear the Government's views on the Royal Victoria hospital and on its future role. I hope that they will add to the hon. Gentleman's conversation with the Secretary of State last Friday.

I begin, therefore, by making it absolutely clear that the hospital will continue in each of the capacities mentioned. There is no question of the Royal Victoria losing either of them, let alone of its closing, or of a conspiracy to bring it to its knees by a series of cuts in its services. On the contrary, we wish to develop the benefit of the enormous capital investment in the past in the hospital and in the associated hospitals in the group which make up the Royal group of hospitals.

For example, over the past five years, some £13 million has been spent on a variety of schemes on the Royal group of hospitals site. Current major building schemes on the RGH site under construction or about to start amount to some £18 million. The schemes include new laboratories, a new mortuary, an extension to the dental hospital and further redevelopment of the Royal Belfast hospital for sick children. Only recently, my colleague Lord Arran opened a new magnetic resonance imaging unit at the Royal, the very latest in high-tech diagnostic equipment and the only one in Northern Ireland.

Within the past two years, new cardiac surgery theatres have been built, and a new cardiac catheterisation unit and cardiac intensive care beds have been provided. Over the past five years, Government have spent some £13 million on major schemes alone and are now spending or plan to spend a further £18 million. I can assure the hon. Gentleman and his right hon. Friend the Member for Foyle (Mr. Hume) that there is no intention of allowing those enormous investments to go to waste.

I want to put it firmly on the record that the future of the Royal group is secure. The hon. Member for Belfast, West, of all people, will, with his expert medical knowledge to which I have alluded, recognise that advances in medical and surgical research and practice justify and demand changes in the provision of hospital services if full advantage of them is to be gained. Any examination of the history of the RVH will reveal that it has evolved very successfully over the years to meet the demands made upon it and to embrace the newest medical and technological developments. I have every confidence that it will continue to do that.

The Government have introduced an internal market into the health and personal social services in Northern Ireland reflecting what has happened here in Great Britain. That means that the health and social services boards and some GPs have become purchasers of services and that hospitals, such as the Royal group of hospitals trust, which I am pleased to have helped establish, have become largely autonomous providers which are expected to respond to the requirements of their purchasers and to compete among themselves to secure contracts.

The Government expect boards and GP fundholders to use the contracting process and the spur of competition to tackle inefficiencies. That should improve the quality of services and develop new services. The RGH trust, like every other provider, will be expected to participate fully in this process and to adapt as necessary to meet the requirements of its purchasers.

I should like if I may to say a few words about the position of the Eastern health and social services board, which, as the Royal's principal purchaser, can be expected to have a considerable degree of influence over the future direction of the Royal. I am aware that the chairman of the Eastern board made it clear last week that the board envisages a continuing and important role for the Royal, and we naturally welcome that.

As the hon. Member for Belfast, West if fully aware, the board has proposed a number of changes to the pattern of hospital services in its area, and those are set out in its "Statement of Purchasing Intent for Acute Hospital Services". The closing date for comments on that was 14 May. I know that the hon. Gentleman, along with many others, has made his views fully known to the board, and indeed in person to my right hon. and learned Friend the Secretary of State for Northern Ireland.

My noble Friend Lord Arran has made it clear that he does not intend to comment at this stage on the merits or otherwise of the board's proposals. After all, the board will need to weigh the very many responses which it has received, and to reach its own conclusions about the future direction of acute hospital services in the Eastern area as part of its remit. However, I know that the board is fully aware that its conclusions must come to the Minister responsible for health and social services for his endorsement before they can be reflected in the board's future purchasing intentions.

My noble Friend will want in particular to be satisfied that Queen's university will continue to be able to discharge its clinical teaching and research responsibilities satisfactorily and that the very specialised regional medical services, provided almost entirely in the two Belfast teaching hospitals, will be properly safeguarded.

I am aware, from what the hon. Gentleman has said, that a matter of more immediate alarm and concern is the board's proposals for the purchase of services from the Royal in 1993–94. I hope what I have said about the security of the Royal's future will go far to dispel that concern.

The board has a duty, however, to ensure that the money available to it is spent in a way that secures the maximum provision of services of the high quality that is needed and expected. That must be beyond question. Unnecessary expenditure is money wasted that could be spent on more operations, improved facilities for patients, and on scanners, drugs, hospital amenities and anything that could benefit patients in Northern Ireland.

While mentioning patients, I must stress that the reason for our reforms—remembering that any money saved in our health reforms is ploughed back into patient care—is to benefit patients. As far as we are concerned, patients are the most important people in the provision of a national health service.

I value greatly, as does Lord Arran, the excellent service provided by doctors, nurses and all those who work in ancillary services in our hospitals. We take pride in the quality of health in Northern Ireland. As the hon. Gentleman said, it is second to none. The patients do and must come first. Therefore, we must ensure that their needs are answered. That is why the board must look carefully at relative costs when considering future contracts. The board has reached agreement with all the other providers, but at present there is disagreement with the Royal group and the City hospital as to the board's proposals.

The hon. Gentleman set out the nature of those proposals. Their purpose is to secure the delivery of general surgery and ENT treatment as the lowest available cost but with no decline in standards. The proposals derive from the respective costings offered by the Royal and the City hospital and from no hidden agenda of any sort.

The Management Executive of the Department of Health and Social Services has been asked to resolve the issue. It will aim to do that as quickly as possible, in consultation with both parties. It will, of course, wish to take into account the reliability of the costings offered by both the Royal and the City hospital, but it will wish to consider a number of other factors, including the implications of the proposed transfer of admissions for teaching and specialised regional services.

Both Lord Arran and my right hon. and learned Friend the Secretary of State are well aware of the concerns that many have raised about the impact of any reductions in services at the Royal, both on the accessibility of hospital services for the population of west and north Belfast and the unemployment level there. The unemployment level in west Belfast is already extremely high. Lord Arran has asked me to say that he will ensure that those areas are examined most carefully both in seeking a resolution of the contract issue between the eastern board and the Royal in 1993–94 and assessing the board's longer-term proposals for the Royal.

Hospitals do not exist in total isolation from the communities that they serve. Hospitals are part of the community. Therefore, the provision of services in west Belfast is an important contribution to the economy of that area. That point is admitted, and will be taken into account by my noble Friend when he takes his consideration of these issues later.

I know that Lord Arran has been concerned that a good deal of the negotiation process between the board and the Royal has been exposed to the media and that that has caused widespread concern in the public at large about the future of the Royal and their access to services. Both he and I regard this as most regrettable. I would ask those who have chosen to go public in that way—while doubtless for the best of motives—to consider carefully whether that is serving the best interests of the public and patients.

Mr. Hume

When the Minister talks about people going public and dealing with the best interests of the patients, he must realise that he is talking about the senior consultants, the medical staff, the nursing staff and the entire staff of the hospital, who have provided the outstanding service to which he referred. Last week, they went public in a powerful way. If they are deeply concerned about this matter, is it any wonder that the rest of us are concerned?

Mr. Hanley

What I said still stands. I have no wish on earth to believe that the doctors, the nurses or any of those involved in the ancillary services have anything other than the interests of patients at heart. I said that they had done What they did for understandable reasons.

But they are in a process of negotiation. I do not believe that making the matter public has created the right atmosphere within which sensible decisions can necessarily be taken. It increases worry and tension.

Mr. Kevin McNamara (Kingston upon Hull, North)

Will the Minister give way?

Mr. Hanley

No. I am coming to the end now, and I want to complete my speech.

To go public during the contracting process is undesirable.

Mr. McNamara

What about the public interest?

Mr. Hanley

The hon. Gentleman mentions the public interest. I am answering the public interest. I hope that the debate tonight helps to answer the public interest and assure the people not only of Belfast but of Northern Ireland that the future of the Royal Victoria hospital is secure.

There have been calls from some quarters for the Department of Health and Social Services to set aside the board's strategic planning process for hospital services and carry out a regional overview. My colleague Lord Arran has rejected that, on the grounds that boards are expected to plan their services within regional guidelines issued by the Department. That is what the Eastern board is required to do, and exactly what it is doing. I am sure that we can resolve the issues in the coming weeks.

The Royal Victoria hospital is, as the hon. Member for Belfast, West said, pre-eminent in its field. I spent many months when I was the Minister with responsibility for health and social services dealing with the Royal and its on-going problems and trying to secure the service for the future. I believe that that future is secure, as I have said several times this evening, but no hospital can stand still and say that, because it exists, it should therefore be funded. It has to justify its existence and improve its service to the public in terms of the medicine that it provides, the new techniques which are available and the added expectations of the public.

In the national health service, we provide neither a job protection scheme nor furniture warehouses. We provide places where skills will meet the needs of patients. Therefore, the hospital will succeed into the future, and the funding that the Government have provided for Northern Ireland will continue to increase. I believe that the future of the Royal Victoria hospital is secure for patients. I hope that the negotiations in the coming few weeks will prove that that is so. I am grateful to the hon. Member for Belfast, West for the contribution that he has made tonight, which I am sure is an important part of that debate.

Question put and agreed to.

Adjourned accordingly at eight minutes to Twelve midnight.