§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Stringer.]
§ 10.1 pm
§ Mr. John Wilkinson (Ruislip-Northwood)
If I return to a subject on which I addressed the House on the Adjournment before the summer recess in July 2001, a subject on which I have addressed the House during seven previous debates in the past four years—many of them moved by myself—I am genuinely not being personally obsessive. I do so because of the prolonged and agonising sagas that have afflicted Harefield, Mount Vernon and St. Vincent's hospitals, in my constituency. They have caused profound worry to my constituents, and to many thousands of others further afield. There has been the cost of many jobs already, and there will be the cost of many more. Patients in my constituency and for many miles around will be seriously deprived of excellent treatments in hospitals that they have loved and admired.
In my debate on 14 July 1999 on St. Vincent's hospital, I said that the Government's policy of dissuading health authorities from referring national health service patients to "private" hospitals could be fatal to the survival of the small, primarily orthopaedic, hospital of St. Vincent's, Eastcote, which was not private at all but a non-profit making medical charity run for many years by the religious order of the sisters of St. Vincent de Paul.
The Government ignored my warnings. The hospital duly closed, although the policy is at last changed. It is too late to save St. Vincent's, but at least NHS patients are now sent to the excellent private hospital, Bishopswood, on the Mount Vernon hospital site. However, Mount Vernon hospital is now at risk, thanks to the extraordinary way in which it has been treated by the management of the NHS and the Government, who should never allow the perpetuation of Soviet-style bureaucratic central planning which characterises the NHS today.
Soon after the Labour party were returned to power, so-called but frustrated consultation was initiated on the future of the regional burns and plastics unit at Mount Vernon, which the London region wanted to transfer to the new Chelsea and Westminster hospital in inner London.
After the most ferocious controversy, the proposal, which would have undermined the plastics unit and its complementary and supportive work for the regional cancer centre at Mount Vernon, and would have caused the move away from the hospital of the wonderful reconstruction and functional trust medical research charity, was modified in favour of a move to Northwick Park hospital in Harrow, north-west London. I pointed out that Northwick Park hospital was much too far from Mount Vernon for it properly to support the cancer centre. I said that the premises did not exist at Northwick Park hospital and that Northwick Park was already overstretched owing to its high work load as a general hospital.
Although some of the staff of Mount Vernon hospital's burns and plastics unit and that of the RAFT might be able to stay in their existing homes and perhaps keep their children in their present schools, it would be harder for 990 the cancer centre at Mount Vernon to be supported. For staff, patients and their families, commuting to Harrow would be less than ideal. Many of the unit's skilled staff would probably leave.
To date, nothing has actually happened, although the move was due to take place this spring. The uncertainty has been bad for medical morale. Capital investment has been minimal. It has been difficult to maintain operating standards and the throughput of patients in operating procedures. Owing to the lack of investment, the premises are less than ideal. It is also much harder for the RAFT to raise private funds for its vital research.
I believe that London regions would still like our burns and plastics unit from Mount Vernon to go to Chelsea and Westminster hospital, in inner London. West Hertfordshire health authority, which has a big interest, since many patients come from its area and beyond, owing to Mount Vernon's location only a hundred yards from the Hertfordshire border, will probably not wish the burns and plastics unit to move, and certainly will not want it to move to Chelsea and Westminster hospital.
NHS eastern region is conducting a review of cancer services at Mount Vernon. It has identified three options that could have been written by a schoolboy on the back of an envelope in a moment of tedium during a dreary class. They are: to develop the existing cancer centre at Mount Vernon, to transfer services to newly developed facilities at an existing general hospital in Hertfordshire—Hemel Hempstead or Watford—and to construct a purpose-built new hospital on a greenfield site, probably south of St Albans.
On 11 March, an Under-Secretary of State wrote to me:Whichever route is taken, the development of a comprehensive cancer centre will involve the relocation of services from existing hospitals, and for some models the closure of hospitals. An important element of the work has been that the model for the 'ideal' cancer centre in 2010, regardless of location, has been signed up to by the Steering Group and has the support of the National Cancer Director, Professor Mike Richards, as well as clinicians from the cancer centre.In the short and medium term (until 2008) work continues between the local trusts and health authorities to ensure that the cancer service on the Mount Vernon site receives support from other services to ensure that high quality care is maintained.Does that mean that the burns and plastics unit is to stay at Mount Vernon at least until 2008 to support the cancer centre there, as it should? That is what I, at least, would infer from the letter.
The trouble with NHS planning is that the best all too easily becomes the enemy of the good. Mrs. Rosie Varley and her review team from eastern region, to her credit and on her initiative, presented a progress report to local MPs at two meetings at the House of Commons in the summer and the autumn of last year. All Members, regardless of party—except one "dissentient" on the second occasion—said that Mount Vernon was the ideal location for their constituents' cancer treatment, and praised the quality of the care that they received there.
The cancer research institute, known as the Gray laboratory at Mount Vernon, has made eminent submissions in favour of keeping the cancer centre at Mount Vernon—submissions which do not seem to have received the attention they deserve from the review team. I have had to bring them to the attention of the Secretary of State.
991 People have become totally cynical about decision making in the NHS. Their experience tells them that decisions are made behind closed doors at a high level in advance, that specialist reviews are designed to build up usually specious arguments to justify those decisions, and that the conclusions are then presented to the public for so-called consultations which are in practice a charade, as they are a dialogue of the deaf with NHS officials who are reluctant to change their predetermined policy.
That was our experience with the Government's proclaimed intention, which is an official intention, for Harefield hospital, probably the most famous cardiothoracic hospital in Britain, which has done more heart transplants than any in the world. Following a Government diktat, its in-patient services are due to move by 2006 to a new hospital in Paddington, as yet unbuilt. Its out-patient services are due to move to extra facilities, as yet unconstructed, at Watford and Hemel Hempstead hospitals. Rumour has it that land has been set aside beside Hemel Hempstead hospital in hopeful anticipation.
Those of us who care for Harefield's future—I am glad to see the hon. Member for Hayes and Harlington (John McDonnell) in the Chamber, because he has been a staunch supporter of its work—believe that, despite Her Majesty's Government determination to sell much of the Harefield site for a science park, their policy is expensive and fatally flawed, and will cost infinitely more than enhancement of Harefield's facilities in its excellent location—in fact, well over £100 million more.
By contrast, Hammersmith hospital's inner London cardiac facilities are to be built up. The cost is modest, as it is building up an existing unit: the cost is £13 million. Harefield, however, which is in outer London and serves a vast catchment area throughout the south of England, is ignored in favour of a new hospital at Paddington in one of the most inaccessible, polluted, congested and overdeveloped parts of inner London—indeed, it is on the edge of the Mayor's motor congestion tax zone.
It is not surprising that Westminster City council has not granted the necessary planning permission. It believes that there was an excess of proposed retail developments on the intended medical campus. The council is also unimpressed, as is anyone else who knows the situation, by the lack of parking spaces on the proposed site. Families could only easily visit their relatives and park there after staff had gone home in the evening. Paddington basin is to be the single biggest urban development in London since docklands, bringing 30,000 additional jobs to the capital—hardly the oasis of calm and pure air which cardiothoracic patients need in abundance and currently enjoy in full measure at Harefield.
The heart of the Harefield campaign, under the indomitable leadership of Jean Brett and her many friends and associates, whose efforts I salute, is convinced that, before 2006, Her Majesty's Treasury will realise that the cost-effective solution of building up existing centres for specialist excellence, such as those at Harefield for cardiothoracics and those at Mount Vernon for cancer, burns and plastics, is much better value for money and a wiser investment of public funds than grandiose projects such as the Paddington basin.
The new cancer centre in Hertfordshire also sounds like a grandiose project, as it is going to be an "ideal" cancer centre, possibly even on a greenfield site, which has not of course been revealed by Hertfordshire county council. 992 No one knows exactly where it is, although notional journey times have been measured to it. From those notional journey times, we secured from the review team the admission that it had picked a site somewhere south of St. Albans.
The wishes of patients and their families should count in the NHS, but they seem not to do so at present. Even the representations to the Secretary of State of the former chairman of Harefield and Royal Brompton NHS trust, Sir Geoffrey Errington, were ignored. That fine public servant stressed the benefits of complementarity of heart research and treatment on the Harefield site.
I hope that the Secretary of State will grant Sir Geoffrey the interview that he requested, and which he fully deserves. The trouble is that Kensington, Chelsea and Westminster health authority was the lead health authority in the public consultation, and it had a blatant vested interest as a member of the development partnership for Paddington basin, even before the consultation began. As a consequence, the outcome was predictable. It prejudiced the decision-making process, and it merits much further examination, perhaps in terms of its permissibility under the Human Rights Act 1998. The health authority, like the Government, ignored all petitions, debates and representations.
In conclusion, the stories of the St. Vincent's, Mount Vernon and Harefield hospitals, as I have recounted them tonight, demonstrate all that is worst in the NHS today. Staff work nobly, often against a background of total uncertainty and inexplicable bureaucratic power-plays. Patients and local residents love their local specialist hospitals, and they are appalled. No notice seems to be taken of their views, and the taxpayer pays more for decisions that cannot be justified logically. It is time to put matters right, and I hope that the Government will do so as far as Harefield and Mount Vernon hospitals are concerned.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
First, I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on securing this debate about the future of specialist hospital services in north-west London. It gives me a chance to set out the work under way in relation to Harefield hospital and the Paddington basin complex.
The scheme will cost £360 million, and will bring together the NHS and the Imperial college school of medicine in a development that will be a centre for clinical excellence, innovation, teaching and research. It also represents a unique opportunity to establish hospital design at the forefront of a massive urban development.
Tonight's debate also gives us a chance to discuss the provision of some specialist services in north-west London, as well as the options for change being developed for Mount Vernon hospital cancer services. Although it is inevitable that I shall have to rehearse some of the arguments behind the options being developed in relation to services such as cancer services at Mount Vernon hospital, it is important that I do not prejudge the future consultation. I hope that the hon. Member for Ruislip-Northwood will understand that, given that the proposals are still very much under development and that public consultation has yet to commence, I am not in a position tonight to engage in a detailed debate about some of the matters that will arise out of that consultation process.
993 The hon. Gentleman has raised in this House the future of Harefield hospital on many occasions on behalf of his constituents. I think that we all know that, under the inspirational clinical leadership of Professor Sir Magdi Yacoub, Harefield hospital has been remarkably successful in its development of heart and lung services. It has also become a centre where research and development is an integral part of the work to improve life expectancy and the quality of life for those with serious cardiothoracic conditions. I would like to take this opportunity to acknowledge that specialist care of the type that has been pioneered at Harefield will continue to form a crucial part of the overall network of services provided for people with coronary heart disease.
The Department of Health confirmed last October that it intended to move ahead with plans to develop a new hospital complex at Paddington. That development will bring together three world-class hospitals and include cutting-edge research facilities. The £360 million Paddington basin scheme will offer specialist services for children, with heart and lung patients being concentrated on one site in Paddington. That will bring together the strength of the Royal Brompton, St Mary's and Harefield hospitals. Specialist kidney services, including transplants, will be developed at Hammersmith.
The Paddington health complex will be a centre for clinical excellence, innovation, teaching and research, and it will form part of a major urban regeneration scheme. We should not underestimate the strength of the project being developed.
The hon. Gentleman referred to the objections of the community health councils to the proposals. Those have been considered by Ministers, and a full response was given by my right hon. Friend the Minister of State, Department of Health. He was satisfied at that stage that the conditions associated with the decision and the undertakings about further work to be done will address many of the issues raised during the consultation process.
The hon. Gentleman has expressed concern in the past that the option of investing at Harefield was not given sufficient attention during the consultation process. In fact, I can confirm that the option of a centre at Harefield hospital was included in the consultation. It considered the option of developing an independent specialist centre at Harefield hospital. It acknowledged Harefield hospital's national reputation as well as the strong doubts about the ability of a single specialty hospital to continue in relative isolation. I acknowledge that proposals and decisions of that nature are difficult for local communities. There are tensions involved in bringing together services so that they can provide excellence within a setting of other specialties rather than continuing to develop in a fairly isolated situation. Sometimes those issues are finely balanced and raise tremendous concerns in local communities.
The argument presented was that Harefield, being several miles from local general hospitals with accident and emergency departments, would not be in a position to draw on support from the wider range of specialties that are found at such hospitals and that the only way to achieve these benefits would be to build a completely new major general hospital on the Harefield site. Such a proposal would seriously threaten the viability of two 994 existing hospitals—Hillingdon and Northwick Park. The options that were shortlisted were considered more robust because, if implemented, they would make use of existing major teaching hospitals rather than requiring the creation of a new one at the expense and probable demise of two other local general hospitals.
The hon. Gentleman referred to the staff concerns about whether they will be able to transfer to the new complex at the Paddington basin. Staff recruitment and retention, particularly in this part of the country, are challenging matters for the national health service. Every NHS trust has to carry out a survey of all its staff to see how it can improve recruitment and retention, provide flexible working hours and child care facilities and ensure that when we attract the best staff into the NHS, we keep them there.
I confirm that the trust is developing plans to ensure that all staff will see a career path and options for their future that will mean that they want to continue to play a part in the provision of health services in the area. The new Royal Brompton and Harefield NHS trust will open on the Paddington basin complex in 2007, so we have a lengthy period in which to prepare and ensure that staff receive proper reassurance about their future.
Staff have raised issues such as help with transport, financial incentives, accommodation, career opportunities and working environment. An action plan for all those issues is being developed by the trust to make sure that measures are in place to address the concerns about accommodation, transport and travel in the area.
In his response to the community health councils, my right hon. Friend the Minister of State emphasised the importance of drawing a line under any uncertainty or confusion that patients or staff might feel. There is investment in the Harefield site while we are waiting for the development of the Paddington basin. More than £4 million is being put into a patient services centre and £1 million into pathology services on the site.
We have also made available £2.5 million to the Harefield Research Foundation for the further development of the heart sciences centre on that site. The centre will remain on the hospital site beyond the transfer of clinical services to Paddington. The second phase of the centre is under construction. That presents an opportunity for the development of a science park built on the success of the heart sciences centre. A feasibility study was commissioned last year and a draft report is being assessed. It appears that there is a market for a science park in the area, but further work is required in collaboration with the Imperial College of Science, Technology and Medicine. The two trusts are developing a full business case for the Paddington basin scheme which, as I said, should be completed by 2007. That will safeguard all the excellent research and clinical work that is going on and will provide services that are fit for the 21st century.
§ Mr. Gareth R. Thomas (Harrow, West)
On uncertainty, does my hon. Friend realise that there has been considerable concern about the future of specialist services in north-west London ever since the accident and emergency unit at Mount Vernon hospital was shut in 1996? Does she realise that the profound concern expressed by the hon. Member for Ruislip-Northwood (Mr. Wilkinson) about the future of cancer services at 995 Mount Vernon is shared by my constituents? Will she ensure that the consultation process currently under way and the considerations by her Department take into account the concerns of my constituents in Harrow as well as those of the hon. Gentleman?
§ Ms Blears
My hon. Friend and the hon. Member for Ruislip-Northwood have referred to the uncertainty of local people. Any period of change and uncertainty in the NHS causes great distress to local people. That is partly because they value their services enormously—that great attachment to the NHS makes us realise how central its services are to local communities. It is vital that patients and the public be fully involved in all the consultation processes. The hon. Gentleman said that the voice of patients and of the public is not heard so we must consult the public creatively and innovatively rather than simply going through a formal process.
It is important to get to the heart of the concerns of local people. We want to provide modern, 21st-century services of a much higher standard than those that existed previously. It is essential to take the public with us on that journey. My hon. Friend the Member for Harrow, West (Mr. Thomas) made the point extremely well.
A large number of reviews of Mount Vernon hospital have failed to deliver a long-term solution. It is essential to clarify the long-term future of the whole cancer network so that decisions about medium and long-term investment can be made sensibly.
The Mount Vernon cancer review started in February 2001 and an interim report was published in September. Feedback has been received on the three options for developing the cancer centre: at Mount Vernon; at a greenfield site; or at an upgraded district general hospital in Hertfordshire. A detailed site survey was conducted at Mount Vernon and the other district general hospitals under consideration to identify their condition and capacity for further development. A further survey of public and car transport has been undertaken. Access to those services is a key issue for local people.
§ John McDonnell (Hayes and Harlington)
In our area we almost feel consultatively abused at present—we have been reviewed and consulted so often. The test of any 996 review or consultation is whether anyone is listening. In relation to the latest review, the community is unanimous—across the political spectrum of all the MPs representing the area—in opposing the move. I hope that this time someone will actually listen.
§ Ms Blears
My hon. Friend makes an important point. No matter how good the consultation process, the proof of its success is that people not only listen but act on the points made by local communities. In this review, the issues were closely investigated and that will continue—especially as regards people's concerns about access to services. In the past such concerns have not always weighed as heavily as the clinical issues. My hon. Friend is right.
§ Mr. John Randall (Uxbridge)
The hon. Lady referred to the importance of these services to local communities. Does not she consider that that is one of the paramount reasons for retaining such services in those communities?
§ Ms Blears
As I said to the hon. Member for Ruislip-Northwood earlier, decisions about the reconfiguration of services are always beset with tension. We have to try to achieve the right balance between specialisation—to provide an excellent quality of service—and access for people close to their homes.
We have to listen to all the parties involved to ensure that people have the high quality services that they rightly demand and expect and that those services are accessible to as many local people as possible. That balance is difficult to find but we should not shy away from entering the debate.
The model being developed for cancer services is the right one. It brings together diagnosis, surgical treatment and oncology and has been widely endorsed in the interim report. I understand the concerns of the hon. Member for Ruislip-Northwood about the future of the cancer centre, and I shall ensure that the consultation is rigorous and takes into account the views of local people in deciding the way forward for those services that are so important to the constituents of all the hon. Members who have spoken this evening.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Ten o'clock.