House of Commons Hansard Debates for 8 Jun 1993

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I am anxious that the Minister appreciates that four years ago, a decision was taken and was challenged at the time. That decision, depending on one's standpoint, had a certain validity. It involved centralised neurosurgery and cardio-thoracics at the LGI at a cost, for the first phase, of about £75 million. The Ministry accepted the plan and pencilled in the money. Today, four years later, half the plan has unravelled, because public hostility has been dropped and towards the other half the same level of public hostility exists or, at least, is uncommitted.

Where does that leave the Minister? If he does not think it interesting enough to have a closer look, the Chief Secretary to the Treasury should. I appeal to the Minister to take time to consider the background. The new development will produce only 20 cardio-thoracic beds and no additional operating facilities. Is that worth£70 million? I suggest he takes another look at the plan. To give him time to undertake that review and to give the consultations the credibility that they sadly lack, I urge him to instruct the LGI not to sign a commitment to the contract on the new building. The LGI knows the implications of the review, and fears it. Two hours before I rose to speak tonight, I was approached by a senior member of the LGI and urged not to suggest that in this Chamber. The LGI knows that it is in a building programme under false pretences. While I understand its need, I shall not be party--and I hope the Minister will not be party--to it getting a refurbished hospital at the cost of Pinderfields and Killingbeck hospitals. If the Minister gives himself the necessary breathing space, he will find the facts to be as I have outlined them. He may find that there are other, and cheaper, ways of delivering the stated objectives. He may find the other Leeds hospitals indulging in some fresh thinking. He will end up achieving a victory over medical politics and empire-building. He will certainly gain the eternal gratitude of the people of Leeds.

11.12 pm

Mr. William O'Brien (Normanton) : I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on having raised on the Adjournment the significant and important issue of the future of Killingbeck hospital. As he explained, because of empire-building at Leeds general infirmary, services at Pinderfields are in danger. Indeed, the whole future of Pinderfields is in doubt.

The neurosurgical department at Pinderfields is among the most efficient in the Yorkshire region. There are at present only three such facilities--in Hull, at Pinderfields and in the LGI. If the programme set a few months ago is allowed to proceed, the neurosurgical department at Pinderfields could be lost.

Tremendous opposition was expressed when a consultative document was issued. So highly valued are the Pinderfields services by communities some distance from the hospital that the document was withdrawn. One reason for that was that it had not been costed. So when people started asking questions about cost comparisons, no answers were forthcoming from the regional health office, and the document had to be withdrawn.

Because of the stupidity of the regional health authority, a group of people were brought together to analyse the objections put to the original consultation exercise. The resulting committee is due to report back in the near future. The committee refused to meet the

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chairman of the Wakefield community health council to hear the views of that council on the neurosurgical department at Pinderfields. Now we await the report.

I ask the Minister to insist on further consultations arising out of the complaints submitted for the first consultation document. Failing that, I join my hon. Friend in saying that there has been maladministration here. If it had taken place in local government, these people would have been charged with maladministration. As it is, they may be in this case. Anyway, there must be more consultations after the report by the review committee. I ask the Minister to afford that opportunity to the people who use the neurosurgical department at Pinderfields.

If the department is withdrawn from Pinderfields, the young disabled unit which forms part of it will be in danger. It is the only unit of its kind in West Yorkshire. It would be quite wrong to let such a facility disappear. Since 1 April this year, when community care was introduced, there has been a greater need for such a unit in the neurosurgical department to afford respite care for those with neurosurgical problems.

From the point of view of communications, nowhere is better placed than Pinderfields. From the M1 or the M62, people can be transported to the hospital buildings within minutes. The helicopter pad is first-class. If there are any better facilities in West Yorkshire, I would like the Minister to tell us about them. The car parking at Pinderfields is first- rate too. Only a few weeks ago I went to St. James's, where parking is, to say the least, traumatic. No such problem exists at Pinderfields.

There is a great deal to be said for maintaining the neurosurgical department at Pinderfields, and I ask the Minister to consider what I have said.

11.18 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I have almost lost my voice, but I shall attempt to muddle through.

I was glad to hear the hon. Member for Leeds, East (Mr. Mudie), who has initiated a debate on a number of important topics. I am pleased to see his colleagues in their places, and to see my hon. Friend the Member for Leeds, North-East (Mr. Kirkhope), who takes a strong interest in this matter.

The hon. Gentleman and the hon. Member for Normanton (Mr. O'Brien) have made some serious allegations against local management, and have repeatedly questioned their motives and competence. Let me give my version of the history of the proposals.

Cardio-thoracic services are currently provided at two sites in Leeds, Killingbeck and the LGI. In 1988, the regional health authority commissioned a review of cardio-thoracic services and associated cardiology from the York health economics consortium. The review concluded that cardio -thoracic services should be concentrated on two sites--one unit in East and the other in West Yorkshire. There was a wide-ranging discussion on the outcome of the review, involving consultant surgeons, cardiologists and health authorities in the region.

In early 1990, St. James's, the LGI and Seacroft were invited to submit proposals for a new West Yorkshire cardio-thoracic unit to be developed on their sites.

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Following an option appraisal of all three bids, it was proposed to centralise cardio-thoracic services for West Yorkshire at new facilities to be built at the LGI.

As a consequence, the regional health authority examined ways in which the facilities at the LGI could be improved. As the cardio-thoracic facilities in both Killingbeck and the LGI are housed in fairly elderly buildings, it was recognised that they would have to be replaced at some point. Killingbeck is about 90 years old, and a recent survey of the estate estimated that a substantial sum needed to be spent on bringing it up to scratch. This led to a proposal to construct a purpose-built cardio- thoracic unit as part of the first phase of the redevelopment at the LGI. The proposals for that phase--to redevelop the site and provide modern facilities and better patient care, at a cost of some £72 million-- were approved by my Department in July 1992.

That approval is an approval in principle, for a very good reason. It is an approval of the principle of a capital development, and is given only after careful consideration. It does not carry with it approval of any consequential changes that may require consultation. The approval was not conditional on the closure of Killingbeck hospital, and there has never been any question that Leeds Healthcare, or anyone else, can move cardio- thoracic services from Killingbeck to the LGI without full public consultation. The business case for the redevelopment of the LGI is not dependent on the centralisation of these services.

As the hon. Member for Leeds, East pointed out, Killingbeck is now a directly managed unit, and is part of the district health authority, Leeds Healthcare. So that Leeds Healthcare could carry out its primary function of commissioning the best possible care for the people of Leeds, it asked the LGI to manage Killingbeck on an agency basis. The LGI is responsible to the district health authority for the day-to-day running of Killingbeck ; it has no power to make major changes or to sell assets. There is no secret back-door merger. The staff at Killingbeck are, of course, still employed by Leeds Healthcare, and have been kept informed about the changes and the reasons for them.

Following the various proposals to centralise cardio-thoracic services, the next stage was for Leeds Healthcare itself carefully to examine the proposals for the location of the centre. It is for purchasers to decide what health care is needed, and how it should be provided. The aim of Leeds Healthcare, as the lead purchaser, is to secure the best possible patient care--within available resources--for the people of Leeds and West Yorkshire.

Naturally, the views of clinicians and other staff at the LGI and Killingbeck were taken into account when the proposals were put together. The outcome of the discussions was the consultation document that has recently been circulated to a large number of medical bodies, to Members of Parliament and to health and local authorities, voluntary groups and trusts, as well as to the media. The purpose of the document is to invite public discussion of the proposals, and to invite organisations and members of the public to write in with their comments.

There may be some surprise at the fact that Leeds Healthcare is consulting so early on proposals that could not take place before 1996. However, purchasers in supporting the Leeds general infirmary development have to consider what impact the development would have on their requirements for Killingbeck's services. For its part, the LGI needs to know that purchaser's support can be

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translated into action. That could not happen if, as a result of consultation, purchasers were prevented from moving services from Killingbeck. It is also important that patients and staff know where they stand and that uncertainty is ended. All that indicated an early consultation exercise.

At the end of the consultation period, Leeds Healthcare will consider the proposal in the light of the responses made during the consultation period. That will be not a rubber stamp but a serious re-examination of the proposals. Health authorities are well aware that proposals referred to Ministers are scrutinised very closely and no health authority worth its salt will want a reputation among Ministers as an author of half-baked schemes. However, if the proposals were opposed by the local community health council--we must not assume that it will disagree--and the health authority still wished to proceed, the case would be referred to the regional health authority. If the RHA wished to proceed, the matter would automatically come before Ministers.

Neither I nor my right hon. Friend the Secretary of State have considered the merits of these proposals. However, I can assure the hon. Gentleman that, when Ministers receive proposals from any health authority to close any hospital, they do not go through on the nod. Before we take any decision, we want to be sure that the correct consultation procedures have been followed. We will take into account what other services are available, and we will listen to the views of staff, who have been instrumental in giving cardio-thoracic surgery and

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cardiology the reputation that they have in Leeds. The most important criterion on which the proposals will be judged is that they are in the best interests of patients. We all want to be sure that the proposals will provide the best clinical care with the available resources.

I have listened carefully to the points made by the hon. Members for Leeds, East and for Normanton, and I understand the strong feelings that these proposals awake in local people. I have heard the hon. Member for Leeds, East express doubts about the validity of the new development and on consultation, on which I should like particularly to reassure him.

Mr. William O'Brien : Obviously, the Minister does not have information on the question that I asked about neurosurgery. However, will he ensure that there will be further consultation on the report that will be submitted to the regional health authority from the group set up to examine the responses of those who objected to the earlier consultation document, which was withdrawn because it has not been costed?

Mr. Sackville : I can say only that all representations will be fully considered. As a result of this debate, I am fully aware of the strength of feeling that exists about both proposals-- [Interruption.] As I have said, all representations will be fully considered. No action will be taken unless Ministers are satisfied that it is in the full interests of the people of Leeds and West Yorkshire.

Question put and agreed to.

Adjourned accordingly at twenty-eight minutes past Eleven o'clock.

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