§ Ms Estelle Morris (Birmingham, Yardley)
I am pleased to have the opportunity in this short Adjournment debate to bring to the Floor of the House an issue that is tremendously important to the residents of Solihull and east Birmingham.
First, may I give the House a little history? After decades of campaigning and fund-raising—much by local organisations—the new Solihull district hospital opened in August 1994, at a cost of about £35 million. In the following 12 months, it was twice turned down for trust status and it now has a deficit of £7.8 million a year hanging over it.
Following an auditor's report by Price Waterhouse, a consultation document on the future of the hospital has been drawn up by Solihull health authority. That consultation ends this Friday.
The solution favoured by the health authority is to merge Solihull district hospital with Birmingham Heartlands hospital in east Birmingham, under the Heartlands management. Neither I nor anyone else concerned about the future of health care in Solihull and east Birmingham pretends that things can go on as they are—£7.8 million is a massive deficit and something has to be done. But neither can anyone underestimate the anger and sadness among people that things should ever have been allowed to get into this position.
The new Solihull general hospital not only gives local people good local hospital care but is an important part of their community. There has been a hospital in Solihull for years, but everyone united around the new building. Its construction was a goal that everyone shared. The hospital is a source of civic pride, and rightly so. Its doctors and nurses are highly respected, its new facilities greatly admired and its independence is valued.
At a time when health care is too often judged on a profit and loss account, none of us should ever forget that that sense of civic pride and local worth is to be valued and preserved.
There is a real question about how a new hospital has managed to run up such a large debt in such a short space of time. I ask the Minister to consider three questions, which seem to be at the root of the hospital's difficulties. Why was the estimated cost of running the new hospital so wide of the mark? Why did the hospital management fail to bill health authorities for care carried out? Why was the estimate of the number of patients that would be repatriated from other local hospitals so badly over-estimated?
Solihull hospital has suffered from both poor management and lack of support from the regional health authority. Frankly, it was foolhardy to proceed on the basis that 20,000 patients would be repatriated from Heartlands hospital, when it was only estimating 14,000. Indeed, had repatriation from Heartlands and the south Birmingham acute unit run at the rate forecast, those two hospitals would probably have found themselves in financial difficulty. It was unforgivable that the information system at the new hospital was so poor that some purchasers were not billed for care given.
992 Solihull hospital was planned in an era of planned hospital provision. When it opened, it was into the era of the national health service internal market. No one, but no one, seems to have done anything to help the hospital to make that difficult transition.
If the management system had been better, the hospital had been offered price support when its planned activity level was reached and the regional health authority had helped with the pressures associated with the opening of the new accident and emergency department, as had been discussed, it might have been a different story.
As it was, the new hospital seemed never to stand a chance. Those who work there and those whose health care it was planned to meet were let down by poor management, bad planning and the lack of apparent will to make the hospital the success that it deserved to be.
I do not think I use too strong a term when I say that local people feel betrayed. Many of the problems facing the hospital should and could have been foreseen. The people of Solihull and east Birmingham have paid the price for poor management and planning.
Whatever our feelings, however, we know that we must look to the future. The public are offered two choices. Either the hospital merges with Heartlands, or it closes. If it merges, there will be reduced accident and emergency facilities, in-patient admissions and some reduced paediatric care. Some children's services will no longer be available at the Solihull hospital. What a choice—in fact, no choice at all.
The feeling against both those options is overwhelming. From Solihull hospital consultants to patient support groups, from parish councils such as Bickenhill to the Solihull borough council, the options seem to carry no support. The community health council in Solihull does not support them, nor does the council in east Birmingham. People accept the need to deal with the crisis, but they feel strongly that other solutions ought to be considered.
The final decision is likely to land on the Minister's desk. When he comes to that decision, I ask him to consider the following. First, many of the recommendations of Price Waterhouse, which would reduce the deficit, could be implemented if Solihull hospital remained independent—there is wide agreement that those savings amount to £4 million, which is half the current yearly deficit.
Secondly, it was unreasonable to expect the repatriation of patients from neighbouring hospitals to occur within a six-month period. That is not to say that it will not happen and that contracts cannot increase, but it needs to be targeted over a long and more realistic period and financial support has to be offered to the hospital while that transition is made.
Thirdly, the regional health authority should support the new hospital while it is carrying the high capital costs for the new building. Fourthly, the hospital needs an efficient management system, so that it can bill accurately and give management the information it needs.
If those things were done even now, local people feel that Solihull could retain an independent hospital. I urge the Minister strongly to give serious consideration to their wishes. If it is thought that past errors cannot be rectified and if the hospital cannot remain independent, I ask him to consider the alternatives that were not included in the "Difficult Choices" document.
993 Above all, I ask that any changes allow Solihull hospital to keep its 24-hour accident and emergency service. The pressure on Birmingham accident and emergency departments, including Heartlands, from the closure of the general hospital is immense. It is not so long since Birmingham Members of Parliament were telling the Minister of the crisis in hospital queues in Birmingham accident and emergency departments. The closure of any further accident and emergency facilities could jeopardise the progress that has been made in the past 12 months.
Only last week, the community grieved over the death of a 15-year-old schoolboy, Jamie Hoccom, from meningitis. He was taken to Solihull hospital and had to be transferred. I do not suggest that that had any effect on his care. I merely point out that, in an emergency, minutes matter.
There are alternatives, yet no work seems to have been done on developing them. The option that is being put to the public is not a merger, but a takeover. People fear that Solihull hospital will become an outpost and a subsidiary, not an equal partner. They worry that, if financial problems arise at Heartlands, Solihull hospital's services will be cut. Closure or takeover is not what people want; independence or partnership is what they ask for.
The campaign run by the people of Solihull and east Birmingham to secure their hospital has been tremendous. The leadership of Solihull borough council and its hospital sub-committee, to which I pay tribute, the campaigning zeal shown, in particular, by the Solihull News and the Solihull Times and the commitment of staff and patients earns them the right to have the future of their hospital considered at the highest level.
I hope that the Minister will respond this afternoon to the concerns that suggest to the people of Solihull and east Birmingham the existence of a hospital system in crisis. I look forward to hearing what the Minister has to say.
§ 2.9 pm
§ Mr. Iain Mills (Meriden)
I assure the hon. Member for Birmingham, Hodge Hill (Mr. Davis) that I shall not cut into his time. I know that we all share a strong anxiety and I shall be brief.
I hope that the Minister will not mind if I say how strongly my constituents feel about this matter. I represent Meriden, the county constituency or rural part of Solihull borough. The merger poses particular difficulties for my constituents because villages such as Knowle, Dorridge, Meriden, Balsall Common and, even further afield, Cheswick Green, Earlswood and Dickens' Heath are so remote from Birmingham Heartlands hospital that it is inconceivable how transport could be arranged from them.
The demographic profile of Solihull borough, including Meriden, shows that there are many older people who are living longer, who need more hospital care and who do not have cars. It is difficult to imagine how their transport to Birmingham Heartlands could be arranged. This is a matter of enormous importance not only to Solihull council—I share the view of the hon. Member for Birmingham, Yardley (Ms Morris) of the leadership it has given—but to the consultants. There is a united view that a merger with Birmingham Heartlands would not be beneficial.
994 Closure of the hospital is inconceivable, as, with Stafford and elsewhere, it was the flagship of the Government's building programme in the midlands. To consider closing it because of a £7.8 million deficit would defy belief.
My hon. Friend the Minister has stated—and I welcome it—that after the detailed consultation with local people, including my constituents,no decision has been made about the level and type of services provided at Solihull Hospital. This will only be done when the residents of Solihull and those in the surrounding areas have had the opportunity to express their views. The Health Commission will then consider carefully all proposals to ensure local services are provided in the best possible way.Will my hon. Friend the Minister be more specific in his response about what role the Health Commission plays, what powers it has and what thoughts can be communicated to it by Solihull council, local Members of Parliament and others who are concerned about the matter?
My hon. Friend continues:If it is thought that a merger is the best way of providing those services, there would then be a further full public consultation.Will he expand on that and tell us in some detail how it would work and what we can do to ensure that we get the right message?
I mentioned transport. I emphasise what the hon. Member for Yardley said about the importance of accident and emergency. We have provided a flagship facility for Solihull residents. The loss of a full and proper service—and I do not accept this suggestion—and its replacement by some sort of 20-hour attendance system would require assurances that the service was full and proper and could cope with a real emergency.
I am concerned about the children's ward, although I understand the problem of staffing and obtaining doctors. I will conclude to allow my colleagues to speak. To judge from the mailbag at my advice bureaux over the past few months and in every other way, this has been the key issue affecting the rural part of Solihull, which is my constituency of Meriden.
§ Mr. Terry Davis (Birmingham, Hodge Hill)
I congratulate my hon. Friend the Member for Birmingham, Yardley (Ms Morris) on securing this debate so that we can discuss the future of Solihull hospital before the end of the consultation period. As she explained, the hospital caters not only for Solihull but for some of our constituents in Yardley and Hodge Hill who are referred there by their general practitioners, especially by GP fundholders. The one doctor in my constituency who has told me that he uses Solihull hospital was the first—and, I think, is still the biggest—fundholder in my constituency.
It is ironic that Solihull hospital is faced with closure or takeover as a direct result of the internal market imposed on the health service by the Government. That is the blunt fact. We are told that the catchment area—I know that the phrase is out of date because of the changes in the health service, but it is a phrase used by management of Heartlands hospital—of Solihull hospital is too small. However, it is no different from what it was when the hospital was originally planned. Provision should have been made for proper funding but, because of the workings of the internal market, it is not going to 995 get the custom—we have to use such phrases now—that it needs to be financially viable. It is a matter of money. It is not a matter of what will provide the best health service for the people of Solihull and east Birmingham.
To be fair to the management of Birmingham Heartlands hospital, they tell me that it was not their idea that they should take over Solihull hospital. They were approached by the regional health authority and asked if they would save Solihull hospital. What the RHA really asked was for the management of Heartlands hospital to save the Government's face. The reasons for the problems in Solihull have nothing to do with the care provided by doctors or nurses and everything to do with the internal market.
What is now proposed by Solihull health authority is that there should be, in the words of the Heartlands management, again one hospital on two sites. I am concerned about the effect of that on those of my constituents who look to Solihull hospital for their care. I am even more concerned about the overwhelming majority of my constituents who look for their care to Birmingham Heartlands hospital. With the closure of the general hospital in Birmingham, almost all my constituents have come into the catchment area of Heartlands hospital.
Although the proposals have not been spelled out yet, some people in east Birmingham will be told that they must go to Solihull hospital. They will be told by the management of the combined hospital that they must go to Solihull for operations that would previously have been undertaken at Heartlands hospital. We have not yet been told which operations will be involved.
Similarly, some people in Solihull will be told that they must go to Heartlands hospital—there will be no choice in the so-called internal market—for their operations. That is bound to mean greater pressure on services at Heartlands, especially on emergency services, which, in turn, will mean a deterioration in service for my constituents who live in its catchment area and who depend on its services.
We are told by the management of Heartlands hospital that the specialists there will provide cover for what is described as an outpost at Solihull. I make no apology for using that word, because it is the word used by the management of Heartlands hospital. That is how they conceive of the Solihull site: an outpost to be covered by consultants currently working at Heartlands. If consultants are covering an outpost several miles away, it follows that they will not be giving all the time that they presently give to my constituents served by Heartlands. That is a deterioration in the service enjoyed by my constituents.
My hon. Friend the Member for Yardley asked why we could not have a partnership between the hospitals. I accept that there are problems in departments, such as paediatrics, which face difficult decisions. Those problems could be met by a partnership between the two hospitals, but we are told that this cannot be done. We are told, with specific reference to the paediatric speciality—the children's ward to which the hon. Member for Meriden (Mr. Mills) referred—that a partnership arrangement would spread resources too thinly. Why would a partnership, but not a merger, spread resources too thinly? That does not make clinical sense. The same situation would apply to both.
We put that point to the management of the Heartlands hospital and were told that, because of the consultants, they had to take over Solihull and have one hospital on 996 two sites instead of a partnership to provide the expertise needed by Solihull. In fact, we were told that the consultants would refuse to provide cover for Solihull unless it were a merged takeover hospital. The management of Birmingham Heartlands hospital said that they could insist that consultants provide cover only by giving them an instruction to do so—and they could give that instruction only if they were allowed to take over Solihull so that it became one hospital on two sites. If that is true, it is a deplorable comment on the state of the national health service in both east Birmingham and Solihull.
§ The Minister for Health (Mr. Gerald Malone)
I am glad of the opportunity to respond to such an important debate, and I thank hon. Members for expressing their views in a forthright manner. I also acknowledge the presence on the Front Bench beside me of my hon. Friend the Member for Solihull (Mr. Taylor), who has campaigned vigorously on the issue. Although he may be obliged to remain silent, I assure the House that he has not been silent in pressing the hospital's case in his constituency. He has also arranged a number of meetings with me, and led a delegation from the local newspaper, the Solihull News, when a petition was presented to me.
The hon. Member for Birmingham, Yardley (Ms Morris) has an interest in the hospital because, although it is slightly outwith the boundaries of her constituency, many of her constituents use it as well as Birmingham Heartlands NHS trust. I am aware—from what I have read in the press, and from what hon. Members have said and written to me—of the intense local debate in Solihull about the future provision of health services in general, and about the hospital in particular. Although those issues are intertwined, they are nevertheless separate issues and must not be confused.
In her opening remarks, the hon. Member for Yardley seemed to suggest a predicated merger of Solihull and Birmingham Heartlands. That is not the case. The matters that are currently out for consultation relate solely to the local health authority's future proposals for the purchasing and structure of health care for the people of Solihull. Of course, any purchasing decisions will bear on the future of Solihull hospital, but it would be wrong to misunderstand the position. It is not inevitable that a merger will follow. I hope that the House will understand that, and that the public debate will be conducted in that knowledge.
We await the conclusion of public consultation and the steps that will follow. It would not be helpful for either the people of Solihull or those working in the hospital to assume that future directions are written in stone; much remains to be decided. Any proposal for merger of the two hospitals would be separate, and would have to be submitted for further consultation.
§ Ms Estelle Morris
I acknowledge that there would be further consultation in the event of a merger. However, the exercise is aimed at reversing a £7.8 million deficit, and the only financial proposals that have been advanced so far depend on such a merger. If someone somewhere has a different set of figures presenting other options, the people of Solihull would be delighted to see them.
§ Mr. Malone
Hon. Members will be pleased to hear that I do not intend to anticipate what the consultation 997 will reveal. Announcements will be made in due course, and if the matter arrives on the desks of Ministers they will view it with an open mind. I hope that my assurance will be accepted by the hon. Lady, her hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) and my hon. Friends who have an interest in the matter.
I understand that, in the heat of public debate, it is more difficult to tease out the various strands—to identify where consultation on one suggestion ends and the possibility of another proposal may well begin. It is my purpose, however, to reassure the hon. Lady and the people of Solihull that nothing can be said to be a foregone conclusion.
The consultation document proposes that, in some instances, services that have been provided at Solihull hospital will in future be purchased from other hospitals in the area, notably Birmingham Heartlands NHS trust. That proposal makes the fairly common assumption that an ultimate merger may well be suggested. As I have said, public consultation on the plans continues, and I shall not pre-empt the outcome.
I can, however, give some idea of the timetable. The consultation period is due to end on 27 October; the health authority will then consider the responses that it has received. I believe that the outcome will be discussed at a public meeting of the authority on 10 November.
Although my hon. Friend the Member for Meriden (Mr. Mills) did not raise the point in the debate, he has spoken to me before—along with my hon. Friend the Member for Solihull—and has asked me whether I would be prepared to meet a delegation from Solihull metropolitan borough council to discuss the future provision of health services in the town. I should be happy to meet such a delegation and listen to its views, once the current public consultation is complete but before any final decision is made. I hope that my hon. Friends will take that as an earnest of my good intentions, and of my understanding that this is a serious public issue.
The hon. Member for Yardley set out the background rather well. We are clearly not where we expected, and would like, to be. The financial problems facing Solihull hospital are extremely difficult. The hon. Lady asked three questions about what had happened and the implications of those events. I understand that a survey has been carried out by Price Waterhouse, and the health authority's external auditors have also been asked to investigate the position immediately; their findings are being examined very carefully. I do not wish to predict 998 what Solihull health authority's audit committee will say, but it is considering the findings and is expected to report its recommendations to the authority by early next year.
That, too, is a separate matter. I do not suggest that those investigations will have any particular relevance, other than in examining the past. As the hon. Lady said, we need to look to the hospital's future.
During the investigation of the problems, things have not been standing still. The health authority, which is managerially responsible for Solihull hospital, has replaced the previous management team with an experienced team of managers whose task is to ensure the continuation of the day-to-day management of the hospital, and the provision of a good local service for the people of Solihull.
Let me tell my hon. Friend the Member for Meriden that there is no question of there being an overall shortage of funds in the area. Over the past five years, there has been a 6.7 per cent. real terms increase in Solihull health authority's budget allocation from West Midlands regional health authority. The problem lies in the unexpected outcome of developments in the hospital itself. I understand the serious concern about what appear from the Price Waterhouse report—which has been published—to be serious misunderstandings about the hospital's position both before and during the period of its application for trust status. I assure the House that I take that very seriously. We shall await with interest the outcome of the consultation process and read with great interest what the health authority's auditors say, because that must be examined.
Finally, I assure the House that it is our concern that the people of Solihull have the best possible health service, to which they are entitled. The debate has been extremely useful in illuminating the issues, and I thank all hon. Members for their contributions.
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, pursuant to Order [19 December].