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1.17 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I congratulate the hon. Member for Southwark and Bermondsey (Mr. Hughes) on his success in securing the debate. I am delighted to have the opportunity to respond. As always, he spoke knowledgeably and eloquently about health services for his constituents. I can assure him that the Government are equally concerned that the best possible health services are available to the people of south-east London.
The reorganisation of services at Guy's and St. Thomas's trust has generated strong feelings locally, and fears for the future of Guy's hospital. I recognised those concerns in the hon. Gentleman's speech. The debate provides me with the opportunity to explain to hon. Members the reasons why the changes are necessary, and the significant benefits to health care provision that they will bring. I hope that I shall be able to assure the hon. Gentleman that Guy's has an important and exciting future in the provision of local health care, medical education and research.
I should also refer to the King's College London Bill, as the hon. Gentleman did, which my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) brought to the House for its Second Reading
on 24 June. The Bill is designed to bring about the merger of King's College hospital and the united medical and dental school. Although independent of the health service changes at Guy's hospital, the merger and the health service changes reinforce each other. There are close working partnerships between the NHS and London university, to ensure that plans are co-ordinated and achieve a coherent, consistent and properly managed change.
During the earlier debate, the hon. Member for Southwark and Bermondsey and others made various points, some of which the hon. Gentleman repeated today. I particularly noted what he said about the need for a sufficient number of in-patient beds to provide appropriate work experience for students, and about the undesirability of unnecessary travelling around south-east London. As I have said, there will be at least 112 beds in the new Guy's hospital, and a certain amount of travelling will be inevitable regardless of the configuration, because Cornwall house--which will be part of the development--and King's College, St Thomas's and Guy's are all at different sites. I noted the hon. Gentleman's general points, however, and I shall do my best to ensure that Ministers respond to what he and others said.
The changes agreed for Guy's and St Thomas's were decided on against a background of changing patient needs. The aim is to develop the service to enable it to respond to those needs, and to rising expectations and medical advances. Guy's and St Thomas's between them are larger than is necessary to provide the services required by residents, and the specialist service for which some patients travel further. The split-site arrangement is both inefficient and detrimental to good patient care, notwithstanding the dedication and hard work of the trust's medical and nursing staff, to which, like the hon. Member for Southwark and Bermondsey, I pay tribute. The two hospitals are little more than a mile apart, and both are accessible from the surrounding area.
The trust considered a range of options for amalgamating services to create stronger single departments, avoiding unnecessary duplication and freeing space for medical education and research. The agreed changes build on the best features of the two hospitals. The division of services between the hospitals has been chosen because it concentrates medical staff and facilities related to accident and emergency services in one hospital, which is the arrangement preferred by doctors. In-patient and specialist services are to be consolidated on the St Thomas's site, and Guy's hospital is to be developed at the leading edge of future medical technology and service delivery as a major centre for planned patient care, offering a comprehensive range of high-quality diagnostic and treatment services for patients who generally do not require an overnight stay.
Essentially, Guy's will remain a major hospital site, focusing on planned care services. Those will include a range of out-patient, day-care and elective in-patient surgical services, centred in the new Guy's phase 3 development. The decision to use St Thomas's rather than Guy's as the site for the accident and emergency hospital was made for a number of reasons; the hon. Gentleman will be familiar with the arguments. The local population served by the A and E department at St Thomas's is half
as large again as that served by Guy's, and twice as large during the working day. It is also easier for ambulances to get to, and there has recently been a major extension to it.
Incidentally, as the hon. Gentleman may know, St. Thomas's started off on the site of London Bridge station, and Guy's developed next to it. Originally, the two hospitals were close together.
Overall, we believe that the changes yield the most efficient and clinically coherent balance of services between the Guy's and St Thomas's sites. They give Guy's an exciting future as both a community-style hospital and a world-class centre at the forefront of new developments in medical education and research. Guy's will continue to be a substantial provider of health care. The ambulatory care centre will include a day-case surgery and other single-day treatments, a development centre for minimally invasive therapy including endoscopy, a wide range of out-patient clinics, a new diagnostic centre and a minor injuries unit. As I said earlier, the centre for planned surgery will contain some 112 beds, operating theatres and other facilities.
I noted what the hon. Gentleman said about the distribution of specialties between the two sites, but obviously the intention is to achieve what the Government and, I hope, clinicians regard as the most sensible arrangement for specialties. Moreover, by giving Guy's that framework of care, we are putting it at the leading edge not only of medical research and technology--I hope that the combination will achieve that--but of the developing area of day-case surgery, which is expanding far more rapidly than the traditional services. I think that that opportunity is very important.
The dental hospital and school at Guy's will continue to provide services for the local population, and also specialist services for patients from further afield. The unification of the medical schools, and the co-location of teaching and research facilities with clinical services on the Guy's site, will bring benefits to both patients and education and research. Obviously, the changes cannot happen overnight; accident and emergency services will remain at Guy's until building developments at St. Thomas's are completed, as will cancer and kidney treatment.
In all, the developments at Guy's will mean no change for about 80 per cent. of visits by patients who currently look to Guy's. Clearly the hospital has a future, and we believe that it is a very exciting future.
The hon. Gentleman asked a number of questions about the Guy's phase 3 development. There were two aspects to his concern--the future use of phase 3 in the light of service reconfigurations, and the management of phase 3 as a construction project. The phase 3 development was designed with out-patient services and research very much in mind, and under the plans it will be used substantially in line with its design. It will be seen as particularly well suited to the future role of Guy's hospital in providing a one-stop patient service, focused on out-patients and day-case patients, enabling diagnosis and decisions about treatment to be accomplished in a single visit.
The trust estimates that 75 per cent. of the space involved in phase 3 will be used as originally intended. That includes the united medical and dental school. The use of the remainder, and any other space on the Guy's site not taken by the university, is a matter for the trust:
it must decide how the space that it retains can best be used. Trusts own and are fully responsible for the capital assets transferred to them, and bearing the cost and responsibility of ownership is a powerful incentive for them to make the best use of those assets.
Mr. Simon Hughes:
Can the Minister assure me that, as far as he is aware, it is 100 per cent. certain that the space that he described as not designated for a specific use will continue to be used for health service provision?
Mr. Horam:
I repeat that 75 per cent. of the phase 3 space will be used as originally intended.
Let me bring the hon. Gentleman up to date on the construction of phase 3, as far as I am able. As he said, there have been a number of problems, but they are being dealt with as expeditiously as possible. The trust is negotiating an alternative commercial settlement, which will require the approval of the NHS chief executive and the agreement of the Treasury. That settlement is linked with proposed amendments to the fabric of Guy's phase 3 to reflect the change in the use of the building since its original design, and will also deal with other problems along the way. The contract will be separate from, but linked to, the commercial settlement.
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