§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Ainsworth.]10.16 pm
§ Mr. Nirj Joseph Deva (Brentford and Isleworth)
Madam Speaker, thank you for this opportunity—[Interruption.]
§ Mr. Deva
I am grateful for this opportunity to raise an issue affecting the health, care and well-being of a majority of my constituents in Hounslow, Brentford and Isleworth: the future of West Middlesex University hospital. The hospital also serves the constituents of my hon. Friend the Member for Twickenham (Mr. Jessel)—who works very hard on behalf of his constituents, and whom I am pleased to see in the Chamber for this debate—and of the hon. Member for Feltham and Heston (Mr. Keen), who is not here because he is indisposed, although he has sent his apologies.
The West Middlesex University hospital, in Isleworth, is a key acute hospital in west London. It serves a local population of more than 310,000 people and plays a vital role for Heathrow airport, not least in offering speedy access to hospital facilities in emergencies. After much careful planning by the hospital NHS trust, the hospital is now preparing for a major redevelopment, which will allow it to respond to the health care demands of the local community well into the 21st century.
There are always many people involved in such a project, but it is right that I should place on record my congratulations to Mrs. Jane Kelly, the chairman of the trust, and to Mr. John de Braux, the chief executive, on everything that they have done to bring the project to its current state of readiness. They have kept me fully involved in the preparations for the proposal as it has developed, for which I am also very grateful. They were ably supported by members of the NHS trust board and all the staff groups at the hospital—the consultants, the junior doctors, the nurses and the ancillary staff, all of whom are united in their support for the proposal, which bodes well for the future.
Three key features distinguish the project. The first is that the West Middlesex's plans allow for redevelopment with no disruption to existing facilities—which is important for patients to know. Secondly, the project has the merit of delivering improved health care services more efficiently. Thirdly, the proposal's flexibility will permit the hospital to alter its operations according to changing demand. I hope that, as a result of those factors, the Minister will be able to give an assurance that all necessary support will be given to help that vital redevelopment programme to proceed as contracts are drawn up and commitments obtained over the next few months.
A few statistics will help to demonstrate the ever-growing need for the high-level care that the West Middlesex University hospital provides. In 1995–96, the hospital provided care for more than 60,000 accident and emergency attendances, resulting in nearly 15,000 admissions. The accident and emergency unit is one of 774 the busiest in west London. Last year alone, over 7,000 more patients attended the West Middlesex accident and emergency department. The value of the service provided by the accident and emergency department has become all the more apparent because of the rationalisation at other hospitals in the area.
Last year, West Middlesex University hospital cared for more than 124,000 out-patients, as well as 16,000 planned admissions. It has also been caring for the future of the community, delivering more than 2,000 babies—an average of five babies a day. Not only has it delivered the babies, but it has provided what have been recognised as some of the best maternity services in the country. In addition, mental health services, renal dialysis and endoscopy services are all part of the health care provisions on site. In short, the West Middlesex is wholly capable of providing the high-quality health care that is so desperately needed and greatly valued by the community that it serves.
The existing buildings reflect their 19th century origin. All the patient care is provided by a dedicated staff from many dilapidated and outdated buildings, sprawled across a 20-acre site. Originally built for a workhouse and infirmary, many of the buildings are in poor physical condition and are no longer suitable for the provision of acute care to modern standards. The fact that such care is provided from those outdated Victorian buildings speaks volumes for the staff.
There is a backlog of £28 million-worth of maintenance work, which is needed simply to bring the fabric of the building up to modern standards. It would be far better to spend the money on a new hospital, rather than trying to patch up old, out-of-date buildings.
One example of the inconvenience arising from the situation at the most basic level of patient care is that, because of the site layout, critically ill patients requiring admission frequently spend 15 minutes or more in electric ambulances while being transferred to wards, operating theatres or intensive care units. Excellent care is provided by dedicated staff, but everyone could do without such inconveniences.
The Minister knows that plans are well under way for the hospital site to be redeveloped, with modern facilities of exactly the kind that the community needs. Once approval has been given, there is every possibility that a new hospital can be up and running, serving the people of my constituency and those of my hon. Friend the Member for Twickenham and the hon. Member for Feltham and Heston as early as 1999 or 2000.
Approval of the project would provide the community with a new purpose-built hospital. The benefits would be seen in improved patient care, better value for taxpayers' money, much needed increased accident and emergency capacity, improved facilities for coronary and high-dependency care and wards designed to offer high-quality, single-sex accommodation—an issue that has been in the press recently. In short, it would be a flagship national health hospital for the 21st century, with the flexibility needed for expansion.
The West Middlesex University Hospital NHS trust has already shown its foresight and effectiveness by putting into operation privately financed projects that have led to improved patient services. Last September, for example, the West Middlesex announced a ground-breaking arrangement for the provision of hospital pathology 775 services in collaboration with Smith-Kline Beecham. The hospital's new endoscopy unit is another clear example of the management of a privately financed project already in place and working well.
Both projects are ideal models of the way in which the private sector can deliver high-quality services in the public sector, an initiative that has been spearheaded by the Government and is now generally endorsed as the way to the future. Latterly, the idea has even been taken up by some Labour Members.
I note with some concern, however, that my Labour opponent in Brentford and Isleworth still cannot bring herself to support the scheme. She says that she wants a new hospital, but that she is not sure about the private finance initiative. That is an example of her usual fence-sitting; she has nothing to say and no policies, just smiles for the cameras with Tony. If she is waiting for her Labour shadow Chancellor to pay for the development, she and the voters of Brentford and Isleworth will wait for a very long time.
The shadow Chancellor has now accepted the Government's Budget plans, so no more money will be forthcoming. I suggest that my Labour opponent comes off the fence and supports the West Middlesex, its management and staff, all of whom want the private finance initiative project to go ahead. If she found time to visit the West Middlesex University hospital, she could hear that opinion from everyone involved. I do not mean that she should just pop into the hospital to see her Hospital Alert cronies. She could meet the management of the hospital, see the plans for herself and talk to staff groups, none of which she has done so far.
Based on all its experience, the West Middlesex University hospital is extremely confident of its ability to bring about the many benefits that the proposed redevelopment promises. While hands-on patient care will remain exclusively with the national health doctors, nurses and therapists, the consortium will be able to tender for the management and non-clinical functions on site, subject to the normal rules on market testing.
Surplus land will be sold for the development of 350 new homes and all the proceeds will be used to defray the costs of building the new hospital. The West Middlesex University Hospital NHS trust has now completed a careful review of the options for taking the redevelopment forward and it is confident that the £50 million privately financed option will provide significantly greater benefits than those associated with the £11 million Treasury-funded proposal for a partial refit, which was on offer 18 months ago.
It is also agreed that the PFI proposal is considerably better than the only other option, which is to do nothing. Even the do-nothing approach would require considerable expenditure on a backlog of maintenance, just to deliver health care in a safe and acceptable environment. At this point, it is worth stating the obvious; the hospital must develop to survive. It will not be possible for the high standards of care, which everyone rightly expects, to continue in the long term under the present arrangements. Action must be taken if local health care demands are to be met and if services are to improve.
I was grateful to receive in December, as a result of my previous lobbying, a letter from the Minister in which he noted his understanding of the urgency of the situation 776 and the need for new facilities in Brentford and Isleworth, which the project will make possible. The PFI option being pursued by the trust has all the strengths of value for money and risk transfer benefits that one could expect. Discussion on those points is under way with the private finance unit.
The consortium is led by Health Care Development Advisory Ltd., Taylor Woodrow plc and Siemens plc, which have significant experience in PFI projects. The proposal is sound. It will provide better health care and it will give value for taxpayers' money within the framework of accepted public policy.
There is now a growing sense of urgency about the need for a firm commitment and approval for the project to secure the future of the hospital. I know that the Minister will understand the difficulties of planning for the future of health care provision without a clear idea of when that future will be decided. In an atmosphere of uncertainty, any community concerns can be played on by the unscrupulous. The West Middlesex plan may not be the largest or best known of the PFI projects currently under review, but it is exactly the type of project that is designed to deliver the highest standards of health care which the Government have tried to promote. I know that the hospital will greatly welcome the Minister's acknowledgement of the importance of the project and I hope that he will support its development into a finished and approved scheme as soon as possible.
§ Mr. Toby Jessel (Twickenham)
I warmly congratulate my hon. Friend the Member for Brentford and Isleworth (Mr. Deva) on his initiative and success in winning the ballot for tonight's debate on West Middlesex University hospital. He is second to none in his zeal and energy in fighting for all his constituents.
Many of my constituents use the West Middlesex University hospital. It is only one mile from the Twickenham border and is linked by long-established bus routes, so there is a regular flow across health district boundaries from Twickenham, Teddington, the Hamptons and Whitton to the West Middlesex University hospital.
On 21 January, during the debate on the national health service, I intervened in the speech by my right hon. Friend the Secretary of State for Health and asked him tocomment on the private finance initiative in relation to West Middlesex University hospital, which is a matter of eager and enthusiastic interest to my hon. Friend and me.I asked him whether he couldgive us any encouragement on that matter, which is important for our constituents so that the existing, old hospital"—which is 100 years old—"can be replaced". My right hon. Friend replied that I was right to raise my constituents' concerns about the West Middlesex University hospital. He said:it is one of the many schemes that local managers are preparing to meet real local need with health authority support and that the Government are determined to see carried through to projects that modernise the capital stock—that is the buildings—of the health service. I can give him every encouragement that the Government are determined to carry that through."—[Official Report, 21 January 1997; Vol. 288, c. 764.]777 On 5 November 1996, in answer to a parliamentary question, the Under-Secretary of State for Health, my hon. Friend the Member for Orpington (Mr. Horam), who will reply to the debate, told me that:the trust and consortium that are behind the scheme are now meeting twice a week to give it maximum impetus. I hope that it will proceed at full speed."—[Official Report, 5 November 1996; Vol. 285, c. 1029.]The hospital urgently needs replacing. On that, I feel as strongly as my hon. Friend the Member for Brentford and Isleworth, as do my constituents. The hospital comprises a large number of deteriorating buildings spread across too wide an area. It has high medical and academic standards and there is great esprit de corps among the staff, but when the buildings are so old it is more difficult to recruit first-class doctors, nurses and other staff. It is not an attractive building to work in. The problem is exacerbated by the pressure from other parts of west London due to changes at Queen Mary's University hospital, Roehampton and Ashford hospital.
The scheme would produce a brand new national health service hospital on an existing site. It would be built on land owned by the national health service and the building would be leased back to the West Middlesex University Hospital NHS trust for 60 years. The hospital would have to find another lump sum, or perhaps after 60 years the new building would again be out of date and would again have to be replaced.
The scheme would mean that hands-on care for national health service patients remained free at the point of service and it is important that it should go ahead without delay. Any hitch in the negotiations would put the whole scheme in jeopardy. There could even be a hung Parliament after the forthcoming general election. That could lead to uncertainty and perhaps a temporary decline in the economy, which might slow down capital projects. We do not know what might happen. I realise that my hon. Friend cannot give a firm undertaking now, but if the scheme could be contracted within the next few weeks, my constituents and those of my hon. Friend the Member for Brentford and Isleworth would have it in the bag, and that is what we dare to hope for.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)
I am pleased to have the opportunity to respond to the remarks of my hon. Friend the Member for Brentford and Isleworth (Mr. Deva). I congratulate him on securing time to debate the development of the West Middlesex University hospital, which provides crucial services to his constituents. I am aware of his unceasing efforts in pressing the case for improved hospital services in his area. I know that he has left no stone unturned in his efforts to see that West Middlesex University hospital has suitable modern facilities. I know that my hon. Friend the Member for Twickenham (Mr. Jessel) feels equally strongly and has been equally unceasing in his efforts to secure better facilities for his constituents.
I have listened carefully to the points made by my hon. Friend the Member for Brentford and Isleworth. I know very well the inadequacies of the buildings that form the West Middlesex University hospital. Both my hon. Friends made that fair point very strongly. I can understand local concerns to ensure that everything possible is done to bring to fruition proposals for a new hospital development.
778 The provision of health care buildings well suited to the delivery of modern health care and their upkeep and maintenance is a major undertaking. The national health service capital building programme is the largest of its kind in the world. More than 750 schemes, each costing more than £1 million, have been completed over the past 10 years. This year, about £1 billion of taxpayers' money will be spent on modernising and improving health buildings and about £500 million will be spent on maintenance. Further projects are at various stages of planning, design and construction.
As my hon. Friend the Member for Brentford and Isleworth will be aware, the proposed redevelopment of West Middlesex University hospital is one of a number of capital schemes being tested for the private finance initiative in the NHS. I am pleased to note that the number of schemes exploring PFI possibilities are increasing. One hundred and fifty schemes, with a total capital value of approximately £2 billion, are testing private finance options at the moment. Those include 22 major schemes worth more than £10 million each. To date, 71 projects have been approved, with a capital value of £626 million. Of those, 43 schemes, of a total capital value of £317 million, have passed contract signature stage.
By vigorously pursuing PFI options that represent value for money, not only can more capital assets be made available, but the NHS can devote more resources to patient care. With the private sector being responsible for providing buildings, the NHS is free to make clinical decisions that are in the best interests of patients.
I am sorry to hear that the Labour opponent of my hon. Friend the Member for Brentford and Isleworth appears to be opposed to the development. My hon. Friend is entirely right to say that the PFI is the way in which to make progress in providing modern health care facilities. As he says, the comparable public sector scheme was smaller and less comprehensive than the scheme now in front of us. As he is well aware, the amount of available public sector finance is strictly limited.
The PFI enables a good scheme, such as the one for West Middlesex University hospital, to jump outside the queue for limited public sector finance and be judged on its merits, and thereby bring to fruition all the hopes of the clinicians and people of Brentford and Isleworth and Twickenham much more quickly than would otherwise be possible. That point seems to be missed by so many Opposition Members, who cavil and whinge about PFI projects.
Despite operating from relatively poor buildings, West Middlesex University Hospital NHS trust provides a full range of excellent health services to the considerable credit of the 1,200 or so doctors, nurses and other staff employed by the trust. The trust provided about 160,000 patient treatments in 1995–96, and my hon. Friend the Member for Brentford and Isleworth will be pleased to know that waiting times have reduced substantially. No one has had to wait more than 18 months for an operation and the total number of patients waiting has dropped from 3,641 in September 1995 to 2,693 in September 1996. More evidence of good performance is to be found in the NHS performance tables. [Interruption.]
§ Mr. Jim Cousins (Newcastle upon Tyne, Central)
On a point of order, Mr. Deputy Speaker. I too have an interest in the West Middlesex University hospital. 779 I am trying to follow the Minister's arguments extremely closely, but I am being distracted considerably by a private conversation in the corner of the Chamber. I wonder whether you could bring that to the attention of the hon. Member for Colne Valley (Mr. Riddick).
§ Mr. Deputy Speaker (Sir Geoffrey Lofthouse)
I am sure that the hon. Member's point has been noted.
§ Mr. Horam
The hospital achieved a significant improvement in the percentage of patients seen within 30 minutes of an out-patient appointment time. I wholly agree with my hon. Friends the Members for Brentford and Isleworth and for Twickenham when they say that first-class medicine is being conducted in what are clearly out-of-date facilities. There is no doubt that something must be done to improve them.
I now refer to the scheme itself. My hon. Friend the Member for Brentford and Isleworth made a point in passing about the excellent maternity facilities at West Middlesex, and referred to the fact that five babies a day are born at the hospital. He and my hon. Friend the Member for Twickenham know that there will be a transfer of maternity and children's services from Ashford hospital to West Middlesex and St Peter's hospitals. This will lead to an increase—more than five babies a day will now be born—in the number of patients referred to the West Middlesex University hospital.
The additional demands on the hospital in terms of a rise in accident and emergency attendances—an increase of 13 per cent. in 1995—and bed-blocking problems has created pressure on the hospital infrastructure, particularly on in-patient admissions. The proposed redevelopment will address these issues, as well as the problems with the existing hospital. It is important not only from the point of view of existing facilities, but in terms of the future demands on the hospital to which we will move new facilities.
The West Middlesex University hospital comprises a large number of deteriorating buildings—some over 100 years old—spread across a wide area. Some of the buildings are no longer suitable for the provision of acute care to modern standards. As a result of the dispersed nature of the hospital, the trust has to use—as my hon. Friend the Member for Brentford and Isleworth said—electrically powered vehicles to transport patients across the site. That is astonishing in the modern age.
The planned redevelopment represents a rationalisation of an extremely inefficient acute site. The scheme originally proposed in the outline business case was a small redevelopment of the surgical and accident and emergency specialties which was constrained by the availability of public funding. This scheme was given outline approval by North Thames regional health authority in 1994.
The Treasury-funded scheme is being tested against a more extensive private finance initiative proposal. The private finance partner has put forward an innovative, although much more capital-intensive, scheme involving 780 the rationalisation of a much greater proportion of the trust's estate. It involves the development of three separate health care buildings to provide ambulatory care, medical in-patient facilities and surgical in-patient facilities. The Marjorie Warren unit built in the 1960s would be the only existing building to remain on the site. The PFI proposal is the preferred option of the trust board.
The PFI option allows for greater efficiencies in the use of both clinical and non-clinical manpower which were not envisaged in the original outline business case. The key features of the scheme are: a new NHS hospital on the existing site; a new accident and emergency department, with increased capacity and room for expansion if necessary; a flexible design, allowing bed numbers to rise or fall according to need—this is very important in looking at the planning of modern health care facilities, and flexibility is built into the scheme; one central entrance; and the fact that it will be built on NHS land and leased back to the hospital for up to 60 years.
The scheme also provides opportunities to reduce further the trust's revenue spend year on year, which will be invested in health provision elsewhere in the health authority's area. At this point in time—before analysis of the full business case has taken place and before further negotiations between the trust and the consortia have occurred—it is difficult, as my hon. Friend the Member for Twickenham acknowledged, to be precise in relation to a figure. However, the results are expected to be worthwhile. The health authority supports the principle of the scheme.
The trust has tested for PFI and has chosen a Taylor Woodrow-led consortium as its preferred partner. The trust is now working with Taylor Woodrow to deliver a final draft of the full business case and detailed contracts to North Thames regional office, although there are a number of contractual issues still outstanding. A draft business case has been submitted to the regional office in the last few days. This represents the first opportunity the regional office will have to examine the privately financed proposal in detail in terms of value for money and affordability to the NHS.
My hon. Friend the Member for Brentford and Isleworth said that he wanted me to assure him that the Government would give all necessary support to the scheme, and I can do so. There will be no delay in examining the scheme, and we will give it the attention that it requires to allow it to proceed as fast as it can. He knows that there is a lot of work to be done and that our contractual negotiations have to be completed. We must see the full business case, and the consortiums and the trust have to come forward with a scheme that the health authority can afford. All these hurdles have to be jumped, but I can assure him that we shall give it all the support necessary. The scheme is making good progress, and I will do all that I can to ensure that the excellent progress continues in the interest of providing good health care in modern facilities to the people of Brentford, Isleworth and the surrounding area.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes to Eleven o'clock.