February 8, 2006
Nick Hurd introduces a House of Commons debate on the growing health care crisis in west London.
Mr. Nick Hurd (Ruislip-Northwood) (Con): Mr. Taylor, may I be the first to welcome you to the Chair of what I hope will be a constructive debate?
Few things matter more to our constituents than their health and their ability to access high quality care. Things are going wrong in Hillingdon, and the scale of concern is reflected by the presence in this debate of all three Hillingdon MPs. I am pleased to have the opportunity to share some of the problems with the Minister and other Members whose constituency experience may confirm or contradict a sense of growing crisis in west London health care.
North-west London is suffering from two powerful factors that have come into play at the same time. The first is the lack of any credible strategic leadership. With the proposed reorganisation of trusts, it is a problem that may get worse before it gets better. The problem is not just the lack of a strategy, but the failures to listen to patients and local opinion, to back up an opinion with evidence that people can trust, to send consistent signals on which people can rely and to manage competently.
That leads me to the second factor in play; the financial crisis that grips the North West London strategic health authority and the Hillingdon primary care trust, wrestling as they are with some of the largest deficits in the system. I think that at the six-month point, Hillingdon PCT has a deficit of £25 million, although I am happy for the Minister to correct me. The result is a climate of uncertainty and mistrust in an area where people would be the first to admit that they have been relatively lucky over the years. Health funding per capita has been relatively high, if we can trust the official numbers, and residents have had access to some of the best hospitals in the system. We take great pride in living alongside the genius of Sir Magdi Yacoub and the research and surgical teams at Harefield hospital, as they push the boundaries of knowledge and excellence in cardiac care.
Likewise, the local community is deeply committed to the Mount Vernon cancer centre. Some £2 million a year is raised locally for the hospital and on-site charities such as the Paul Strickland scanner centre, the Sir Michael Sobell House hospice and the Lynda Jackson Macmillan centre. They complement the oncology service superbly. For example, the Paul Strickland scanner centre offers patients some of the most sophisticated scanning equipment in the country.
That pride and commitment has been reflected in a long tradition of fighting for what we value. Some 18 years ago, Northwood residents physically occupied for three months the Northwood and Pinner community hospital to prevent it being closed. In the modern age, the tradition is proudly maintained by organisations such as Community Voice and Heart of Harefield, which under the leadership of Jean Brett ran such a tenacious campaign to expose the weaknesses in the case for the Paddington health campus; a campaign for which the village of Harefield and all who care about the hospital should always be grateful.
That determination and commitment is about to be tested again, because we face uncertainty on three fronts: first, the future of Harefield hospital; secondly, the future of Mount Vernon; and thirdly, the fallout from the financial crisis at Hillingdon PCT and the strategic health authority.
I shall start with Harefield, because a key decision is imminent, and there are signs of good sense beginning to prevail, despite what the Minister and colleagues may have read in the Evening Standard last week. Harefield is a recognised centre of excellence as a specialist heart hospital. That was recognised by the right hon. Member for Barrow and Furness (Mr. Hutton), when as a Minister of State at the Department of Health, he acknowledged that
“the hospital has been remarkably successful in its development of heart and lung services and has rightfully earned a reputation as a centre of excellence for that specialist work.”
It is one of the few hospitals in the national health service whose reputation extends beyond our shores. The team remains-it always has been-at the cutting edge of pioneer technologies such as primary angioplasty, which means that patients can receive surgery at Harefield hospital within 25 minutes of a heart attack.
Mr. David Gauke (South-West Hertfordshire) (Con): I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) on obtaining the debate. I entirely agree with his comments about Harefield hospital, and I express my relief that the Paddington basin proposals have ultimately come to nothing.
David Taylor (in the Chair): Order. The hon. Member for Ruislip-Northwood (Mr. Hurd) should be sitting while he gives way to Mr. Gauke.
Mr. Hurd : Thank you, Mr. Taylor.
Mr. Gauke : Is it not remarkable that the Paddington basin proposal reached the stage that it did, with the prospect of it costing taxpayers millions and millions? It had the support of the local hospital trust, strategic health authority and the Department of Health. Was it not the efforts of several hon. Members in this House, including my hon. Friend the Member for Uxbridge (Mr. Randall), who is present today-
David Taylor (in the Chair): Order. Interventions should be brief.
Mr. Hurd : I thank my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) for that intervention. He is right; it was the intervention, not least of Heart of Harefield and colleagues that encouraged the National Audit Office to take such an active interest in the project. As my hon. Friend knows, the NAO will publish a report in the spring that, I think, will throw a harsh spotlight on the management of that project.
That the team at Harefield hospital achieves what it does is all the more remarkable given the fabric of the antiquated buildings in which it works. That centre of excellence would have been destroyed by the Paddington health campus project, not least because the staff made it clear that they would not move. That ill-starred project fell over because no credible business case was ever made after six years and £14 million of consultant fees.
The independent review pointed out that the cost was
“dwarfed by the opportunity cost to the nation as a whole, due to building inflation over the long duration of the project.”
The same review pointed out that if appropriate risk management processes had been in place, the project would have been halted or terminated on at least six occasions between September 2002 and the end of 2004. The review made 43 separate recommendations about how those projects should be managed in the future.
Sir John Bourn, the Comptroller and Auditor General, noted in a letter to me that the report
“provides a catalogue of missed opportunities; inadequate programme management and fundamental weaknesses.”
As a result of requests from myself and three other colleagues, including my hon. Friend the Member for South-West Hertfordshire, Sir John has decided to make a value for money study into the collapse of the Paddington health campus, which will be available in the spring.
Mr. Gauke : Very briefly, many of the problems that came to light were because of the hard-working Heart of Harefield campaigners, as my hon. Friend has mentioned. I put on record in particular the tremendous work done by Mrs. Jean Brett, a constituent of mine, who made great efforts to reveal the weaknesses in the business proposals for the Paddington basin project.
Mr. Hurd : I thank my hon. Friend for that intervention, with which I completely concur.
The Comptroller and Auditor General in the meantime has written to the Department recommending that it take the independent review very seriously and publicly respond to it. May I press the Minister therefore to clarify whether it is the intention of the Department to respond publicly to the independent review, and, if so, when and how?
The Paddington campus is now important only in terms of the lessons to be learned from it. It is time to move on, not least because its collapse has left a strategic void just at a time of uncertainty about short-term leadership in west London health. Royal Brompton and Harefield NHS Trust is stepping up to the plate. The new chief executive, Bob Bell, deserves great credit for his vigorous response to Paddington and the subsequent clinical governance review of Harefield hospital, a response that has the support of local stakeholders and clinical staff.
The message is that, basically, the review is clear that clinical outcomes at Harefield are “satisfactory”. What is done at Harefield on bed and bench cannot be replicated elsewhere in the short term. The trust needs two sites. Primary angioplasty, for example, is an increasingly valuable local service requiring cardiac surgery, which in turn feeds into the need for transplant capability.
The review rightly points out the inadequacies of the hospital’s infrastructure. The trust believes that that can be fixed in the medium term by spending some £20 million, which it believes it can afford to raise off its own strong balance sheet as a result of its competence in managing its own affairs, thereby making no call on NHS funds. It believes that it can fix the clinical isolation argument by specialist recruitment and the formalisation of agreements with local hospitals.
The message seems to be, “Let’s get on with it in the interests of patients and medical advancement.” It has a powerful logic that needs to be worked up into a credible business plan, and it seems to reflect a view that it is time for a more practical approach, taking medium-term decisions based on what we know, rather than pursuing grand, long-term visions supported by insufficient clinical data. It is time to back the competent rather than the incompetent. It would be disappointing if that logical initiative fell foul of financial crisis management or power-play in the NHS.
I shall close my comments on Harefield by simply asking the Minister to confirm that the Department has no objection in principle to the concept of specialist hospitals, as long as they have the support of senior clinical staff and a robust business plan.
Moving down the road, the story of Mount Vernon hospital has parallels. Again, it is an acknowledged centre of excellence that has achieved great things for 40 years despite its poor fabric of buildings. Again, the hospital enjoys wide support throughout the community. During a bitter public consultation, 75,000 people signed a petition protesting at the proposal to close the cancer centre in 2003. Again, I am referring to a hospital that has to live with uncertainty about its long-term future. It suffers from a persistent lack of commitment from the centre and fragmented ownership, with four separate trusts being involved in service provision and commissioning. Again, I am talking about a hospital that is threatened by the latest vogue of medical opinion that the future does not lie in smaller, specialist hospitals, although there is no evidence that patients have been disadvantaged.
We should remind ourselves of the wisdom of Nietzsche, who wrote
“whichever interpretation prevails at a given time is a function of power and not truth.”Those are wise words. The reality is that we do not know how we will be treating cancer in 10 years’ time, but we know that, when the Mount Vernon cancer centre is moved to Hatfield in 2013, as is the current plan, about one million people will lose their cancer centre.
Mr. John Randall (Uxbridge) (Con): Can my hon. Friend confirm that, as we speak, the site for the proposed hospital at Hatfield has still not been identified, so not even the planning process can be started?
Mr. Hurd : I thank my hon. Friend for that intervention. He is right that there is tremendous uncertainty about the future of Hatfield, which only compounds the sense of uncertainty and frustration in my constituency about the future of the Mount Vernon cancer centre.
As I said, one million people will lose their cancer centre if it moves. The issue crosses borders. The strategic health authority has rejected the option of a walk-in radiotherapy centre at Mount Vernon to replace the oncology centre. It awaits the outcome of yet another review, the access and capacity review. It is expected to send a stark message to cancer patients in Hillingdon and Harrow that, if they suffer from cancer and require regular radio therapy and chemotherapy, they must travel to either Hammersmith or Hatfield.
The Minister should be aware such a choice is unacceptable for Hillingdon residents. Recently, I chaired a meeting with local stakeholders and it confirmed that view. The intrepid reporters of the Ruislip & Northwood Gazette have timed the journeys. To either facility, it is a one-way journey time of between 45 minutes and 90 minutes. Last year, my father-in-law died of cancer. He required regular chemotherapy. It would have been unthinkable for us to accept regular journey times of that length on his behalf. It would have exhausted him. I am sure that the Minister would apply the same standards for her family.
If matters are not okay for us, why should they be okay for the one million people for whom Mount Vernon is today the most convenient location? Apart from a trail of broken promises, what most upsets local people is the deafness of the centre to their arguments, and a growing feeling that the matter concerns cost reduction rather than patient convenience and care. I emphasise that, on the SHA’s own figure, the demand for cancer services is expected to grow by 50 per cent. between now and 2013. The travel times to Hammersmith and Hatfield are unacceptable. The cancer tsar himself admits that we have a shortage of radiotherapy capacity in this country. Calculations by Community Voice involving 2001 data from the national cancer services analysis team make a strong numerical case for at least three cancer centres in north-west London.
Will the Minister consider seriously the option of an additional cancer centre in outer north-west London by 2013? It could be a satellite facility, spoke-linked to the hub. It could be free-standing. It should include chemotherapy, radiotherapy with oncologists and cancer beds on site treating palliative patients, but not necessarily all cancers. Where can it be located? The infrastructure is in place at Mount Vernon. The hospital enjoys superb community support. There is no hard clinical evidence to argue that patients are disadvantaged at Mount Vernon. If there were such evidence, why would the Department be sanctioning the £20 million investment that is going into the site now? During public consultation, the community will express profound anger if that option were not evaluated seriously.
If there is a better site than Mount Vernon, the community wants to receive a signal that the hospital has a long-term future that is relevant to the community, which gives it so much support. A growing voice asks, “Why not look harder at the opportunity to develop co-operation with another neglected and valuable site down the road, Harefield hospital?”
The final worry concerns the fall out from the general state of financial crisis in our local health institutions. Hillingdon primary care trust causes the greatest concern. All three hon. Members who represent the Hillingdon area recently met the temporary chief executive. It is hard to pin down the truth of what has happened. The special factor concerns the impact of Heathrow, and we should be grateful if the Minister received representations on the matter. However, there is a strong suggestion of overtrading over time and inadequate flows of information.
Can the Minister enlighten us on the current deficit because the numbers seem to swing around? Can she explain the Department’s view on what it considers to be the major drivers of the problem and why it was not controlled earlier? Given that outside help has been called in, will the right hon. Lady say when a recovery plan is likely to be proposed and what degree of consultation there will be? Residents are already beginning to feel the fallout. Much valued services have been cut, such as homeopathy, specialist orthodontics, therapy in the community and, most shamefully, therapy in specialist schools.
Mr. Stephen O’Brien (Eddisbury) (Con): My hon. Friend made an important request to the Minister about the current level of deficit. I hope that she will have the opportunity to gain that information during the debate. Some of the remarks that I have contemplated making depend a little on where we currently stand in respect of the deficit. If the information is in the Room, it would be helpful if it were introduced in the debate earlier rather than when the right hon. Lady makes her final remarks.
Mr. Hurd : I thank my hon. Friend for that intervention. Is the Minister in a position to give us an update?
The Minister of State, Department of Health (Jane Kennedy) : I do not have the information in my immediate briefing, but I am looking for inspiration.
Mr. Hurd : I hope that the Minister’s inspiration is fast in arriving.
It is felt that worse is to come because the trust is fiddling at the margin of the problem, the cumulative deficit. Two questions spring to mind. First, are Hillingdon residents now to suffer as a result of managerial incompetence? Are the Government sending out a firm message that trusts have to trade their way out of the problem or is there scope to discuss some restructuring of the historic debt if the books are balanced in the current year? Can a primary care trust in such a condition really handle the new responsibilities being devolved by the Government?
Dentistry is of particular concern. I accept that that is not the direct responsibility of the Minister, but I should be grateful if she took on board some specific concerns that may be reflected in other constituencies. First, I am led to believe that the Hillingdon PCT dental budget allocation contains a shortfall of £453,000. I should be grateful for her confirmation in writing about whether that is the case and what the Department of Health intends to do about it at this late hour.
Secondly, there is alarming anecdotal evidence about the intentions of local dentists to quit the national health service, due principally to inadequate funding, but also to uncertainty about whether children and exempt adult only contracts are being offered. Thirdly, it is a symptom of Hillingdon PCT’s apparent difficulty in managing the process that no decisions will be taken on the matter before 22 February, six days before dentists are required to make a decision on signature. Fourthly, I perceive cash-flow risks for the PCT arising from the new contracts.
I am worried about the flow of incentives. At the moment, I understand from local dentists that they are incentivised to send in data on treatments because that is how they gain access to NHS funds. However, under the new system, dentists will be sending in data only in order to allow the system to check how they are performing against contract and to calculate what needs to be deducted from their next gross payment from the PCT. If that is so-I stand ready to be corrected-where is the incentive to send in data on a timely basis? If there were no incentive, does that not carry a cash-flow risk for a PCT that is required to fund the contracted gross monthly revenue until an adjustment is agreed?
We are also worried that any money eventually recovered from inefficient or demotivated dentists will flow back to the Department of Health and be lost to Hillingdon. Is that the Minister’s understanding of the position? Even if dentists submit timely returns, I detect significant IT risk arising from the fact that apparently every practice will be required to upgrade its software. A recent article in BDA News dated 2 February confirms that
“Both the major dental IT suppliers agree that it will be difficult, if not impossible, to upgrade every practice before the new contract comes into effect.”
Is the Minister aware of how many local practices have upgraded their systems in anticipation of the new contract? Does she accept the seriousness of this IT risk in terms of potential system chaos, and also in terms of compounding the PCT cash-flow risks?
As I mentioned, Hillingdon PCT is not the only concern. Redevelopment of Hillingdon hospital was two years in the planning. That is urgently needed to improve the fabric of a hospital that has suffered from persistent problems with hospital cleanliness, but the redevelopment has been called in. The community waits anxiously for smoke signals to emerge from the Department of Health. Can the Minister confirm when we can expect some clarity of intention in respect of that development?
On a smaller scale, the proposed redevelopment of the Northwood and Pinner community hospital has been frozen. Back at Mount Vernon, the plastics and burns service collapsed last week, following a number of consultant resignations. In his letter of explanation, the chief executive of West Hertfordshire Hospitals NHS Trust says:
“Over time it has become increasingly difficult to maintain the fabric of the buildings to a standard that is acceptable. Staff have become frustrated with the inability of the NHS collectively to resolve these issues.”
I have tried to throw a spotlight on to what is happening in the part of outer west London that I represent.
Jane Kennedy : In respect of the question that was asked of me, the Committee might be interested to learn that Hillingdon PCT’s deficit in the year 2004–05 was £13,470,000. For the current year, the six-month figure is £25,657,000. That is a significant deficit.
Mr. Hurd : I am grateful to the Minister for coming back to me with that data, which confirms the figures I gave earlier.
As I said, I have tried to throw a spotlight on what is happening in the part of outer west London that I represent. I sincerely hope it is not typical, although I note the comments of my hon. Friend the Member for Hammersmith and Fulham (Mr. Hands)-he cannot be with us as, ironically, our party leader is visiting Charing Cross hospital with him as we speak-who wanted to raise the ongoing huge deficit at Hammersmith Hospitals NHS Trust, which is currently running at £37 million, the second largest in England. My hon. Friend tells me that the effect of that is the axing of 200 beds in the trust, 300 redundancies and thousands of operations being postponed. Therefore, it is clear that the situation in Hammersmith at least is also very serious.
I hope that the Minister will respond to my questions and be able to reassure me that the future of health services in my constituency and the London borough of Hillingdon is not as bleak as it appears to be. Labour came to power singing, “Things can only get better.” All I can do is quote to the Minister from the front page of today’s Ruislip & Northwood Gazette; the headline of an article on dentists deserting the NHS is, “You’re Having a Laugh!”
David Taylor (in the Chair): Four Back Benchers are seeking to catch my eye, and about 37 minutes remain before I intend to call the Front-Bench speakers. If that fact is reflected on, we will get to hear from more Members.