House of Commons
Wednesday 22 January 1997
The House met at half-past Nine o'clock
PRAYERS
[Madam Speaker in the Chair]
Intensive Care
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Peter Ainsworth.]
9.34 am
Mr. George Mudie (Leeds, East): I should like to express my thanks and the thanks of thousands of my constituents to you, Madam Speaker, for allowing this debate to take place. The people of Leeds were shocked and angered by the death of my constituent, Mrs. Edna Harrison, and it is a tribute to your sensitivity to hon. Members' constituency problems that you have so quickly permitted the subject to be debated.
I also wish to pay tribute to my local evening paper. The current Secretary of State for Health, his predecessor, now the Secretary of State for National Heritage, and the Minister here today, the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam), are aware that, over a substantial period, the Yorkshire Evening Post has kept the issue of bed shortages in the public domain. As the Minister knows, health provision is largely run by political placemen in the health authorities, who do not see it as being their duty to acquaint the public with the details of local health matters. The public are largely kept in the dark about the true state of the service. That intensive care bed shortages are a matter of public knowledge and concern in Leeds is a sign of how consistently the Yorkshire Evening Post has raised the issue and it deserves the thanks of the people of Leeds for performing that service.
The Minister will be aware that Mrs. Edna Harrison collapsed in her back garden on a quiet Sunday morning two weeks ago. The ambulance arrived at her home and she was rushed to her local hospital, less than one mile away from her terraced home in east Leeds. That hospital is the 1,500-bed St. James's hospital, famed as "Jimmy's" in the Yorkshire Television documentary that has run for some years. It is reputed to be one of the largest, if not the largest, teaching hospitals in western Europe. Despite all that, no intensive care bed could be found for Mrs. Harrison and, four hours later, she was admitted to a Hull hospital over 60 miles from Leeds where, sadly, she died later that week.
Mrs. Harrison's husband and family have shown great dignity and have expressed nothing but praise for the medical staff at both hospitals. I spent some time with Mr. Harrison on Saturday, discussing his wife's sad death. He continues to show great dignity, but he and his family want to know why the long journey to Hull was necessary and why Mrs. Harrison could not have been treated in her local hospital, thereby minimising the
danger of travel. The Minister will accept--as does the working party report to which I shall refer later and which the Minister mentioned in his statement of 6 March--that, for an intensive care patient, travelling is always dangerous. The danger can be minimised, but it should be avoided where possible.
Mr. Harrison and his family would have wanted the danger of travel minimised and they would have wanted Mrs. Harrison to be where they and their friends could have an opportunity to visit her, albeit sadly for the last time before she died. They and I accept the conventional wisdom in various statements by Ministers and health officials about the high cost of intensive care beds and the need not to leave them lying empty. Mrs. Harrison may just have been unlucky as she needed treatment at a time of peak demand, and perhaps it was inconceivable and even unreasonable to expect such a scarce and expensive bed to be available locally.
Time will tell, and that individual case is not the reason for this debate. It may have been a factor, but I have asked for a local inquiry into Mrs. Harrison's death, and Healthcare, the local authority and the St. James's trust--the hospital involved--are conducting one. I am far from happy with the initial details sent to me by the authority, which seems unnecessarily defensive about the whole matter. A fuller and more objective report will no doubt follow.
After our discussion on Saturday, the family and I intend, unless the report is acceptable, to raise a number of other matters. Those include the sheer inconvenience of a family having to travel 60 miles to see a seriously ill mother; the impracticality of the husband finding himself in Hull with no money and being told that he must find his own accommodation and his own way back; and the sadness and distress of the son driving 60 miles having been told that, when he arrived, his mother would be dead. All that, when that family live almost in the shadow of the biggest teaching hospital in western Europe. Those practical problems were compounded by the shabbiness of the accommodation for families staying on the premises because the patient is expected to die, and the fact that other family members and friends could not join in the grieving process as the death occurred 60 miles away in the middle of the week and it was impossible to get the time to leave work and go there.
The family have rightly raised a number of matters that will be referred to the ombudsman. I am sure that, somehow, we shall have the circumstances surrounding Edna Harrison's death properly examined. I was pleased to see that the Minister, in a public statement, expressed his sorrow about it and his determination to ensure that the facts were thoroughly looked at and any lessons learned.
Mr. John Gunnell (Morley and Leeds, South):
Does my hon. Friend know whether an inquiry was made as to whether a bed was available at Leeds general infirmary, which is only two to three miles from Mrs. Harrison's home? I understand that there is a system whereby the nearest bed can be obtained, and perhaps that was in Hull. It seems incredible, however, that with two such large hospitals within such a short distance of that lady's home, she could be found accommodation in neither. Clearly, the travel problems that my hon. Friend describes would not have been the same had she been able to go to Leeds general infirmary.
Mr. Mudie:
I thank my hon. Friend for that intervention. He is aware that, although I shall primarily discuss east Leeds, for which St. James's is the local hospital, all Leeds Members and, because of the regional significance of both hospitals, all Yorkshire Members, know the pressure that is consistently put on intensive care beds at both LGI and Leeds general hospital.
Mr. William O'Brien (Normanton):
I am advised that there are intensive care beds at Dewsbury hospital, but because there is no money to finance their introduction, they are left idle and without function. That should be dealt with also in the Yorkshire region.
Mr. Mudie:
My hon. Friend makes a valid point. Both my hon. Friends remind me of a pertinent fact that deserves examination by the Minister: the two beds that were even nearer but were not even considered. They were at Killingbeck hospital, which has been the subject of an Adjournment debate between two hon. Members present today. Killingbeck hospital is due to close next year and it will be terrible if those beds are not brought into operation simply because of that fact. The explanation is that the beds are ring-fenced for cardiac cases, so no one thought to include them on the register or even inquire whether they were empty. A rumour is going round Leeds that they were empty and available, and they are even nearer to Mrs. Harrison's home than St. James's hospital, so that matter deserves investigation. It would be criminal if bureaucratic ring fencing, however good the reasons for it, excluded Mrs. Harrison from prompt treatment at a hospital that was so close to her home.
Mr. David Hinchliffe (Wakefield):
I have just come down from my office having done a local radio programme involving Mrs. Harrison's brother-in-law. He wanted to make it absolutely clear that the care that she was offered by doctors and nurses was the best in the circumstances, but that the system was wrong, which is the point that my hon. Friend is making. Has he looked at how beds are managed in the Northern and Yorkshire region, in the light of the Government's abolition of the regional health authority? In the past five years, our region has lost more hospital beds--27 per cent.--than anywhere else. The regional health authority's role in planning care was important for the likes of Mrs. Harrison. I should be interested in my hon. Friend's thoughts on that point.
Mr. Mudie:
My hon. Friend makes an important point. The cuts in hospital beds in Yorkshire have been savage. Only last week, my hon. Friend drew the House's attention to an unhappy case and the circumstances surrounding it, at Pinderfields hospital in his constituency. Yorkshire's grave health funding problems and the underlying problem of a lack of intensive care beds become an issue when they culminate in individual cases such as this. Although Mrs. Harrison's death prompted me to raise this matter, the real issue is the fact that the local hospitals' inability to admit her when she desperately needed intensive care treatment was not an isolated incident. Such an incident was predicted, but, as with other events in Leeds, elsewhere in Yorkshire, Warrington and Newcastle, the House was told that it would not happen, as Ministers had listened, learned and taken steps as a result of similar incidents last winter.
I primarily make the case on behalf of my community for an examination of the situation and prompt action in my local hospital. There has been an increase arising from the
March statement--one adult intensive care bed and one paediatric intensive care bed--but at the risk of seeming ungracious and ungrateful, I emphasise that we desperately need more. Whatever the situation elsewhere, Yorkshire and the north-west seem to have problems, as explained so well yesterday by my hon. Friend the Member for Warrington, South (Mr. Hall). When a senior figure in the national health service refuses a Member of Parliament a document on the matter, that must make alarm bells ring throughout the service, if not in the House.
I shall let my colleagues make the case for their areas. Apart from the common problem of growing debts and underfunding, the matter should be judged in the light of local circumstances. I am content for the situation in Leeds to be judged on its merits.
The House may not need reminding of last winter. We in Yorkshire witnessed a number of horrifying incidents, culminating in the death of a young child who had been driven through a snowstorm from Manchester. We witnessed the spectacle of a retired policeman being touted round a dozen hospitals in Yorkshire before being flown 60 miles to Scarborough, where he died before he could be admitted. We heard senior, well-respected consultants in Leeds speak of a crisis.
I want to get across to the Minister a point that the Secretary of State seems not to take on board, especially in respect of Leeds and Yorkshire: throughout the year, the two city hospitals in Leeds regularly--not just seasonally--turn away patients. Yesterday I was at St. James's hospital and saw the book of refusals, in which there was not a blank page. Certainly the situation gets worse in winter, but the two consultants responsible for managing intensive care beds at the two major hospitals in Leeds have consistently said that it is not a seasonal problem. It may be exacerbated seasonally, but it is a regular problem. They made that statement last winter, when once again they had to turn away seriously ill patients because they had no spare intensive care beds.
So serious was the position in Yorkshire and elsewhere that after last winter the Secretary of State was obliged to make a statement in the House in March. Last week, sadly, he refused to do so when similar incidents were being reported this winter. On 6 March he stated:
Sadly, we continue to experience problems in Leeds and Yorkshire. I have raised the tragic case of Mrs. Harrison. The week that she died, Dr. Mark Bellamy of St. James's hospital commented:
A Leeds consultant and British Medical Association representative commented after the death of Mrs. Harrison:
It is accepted that last winter there was a shortage of intensive care beds. The Minister took steps in good faith to overcome it, but the signs are that the problems continue. As it is a matter of life and death, the Secretary of State should act urgently. Yesterday, during the health debate, he attacked my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), claiming that all that my hon. Friend did was
I hope that the Minister will consider the following points. First, he underestimates the regular demand for intensive care beds in cities such as Leeds. The consultant at St. James's hospital is a sober, responsible, committed person who weekly faces the task of turning away seriously ill people.
I thank the Minister for the two additional beds that were made available after the March statement. However, the ward has 13 beds, but 18 bays. I do not understand why it seems to be impossible for health officials to sit with the consultant responsible for the service, examine the records, determine the true level of demand and make provision accordingly. It seems that Ministry officials would prefer not to ask the question, because they do not want to know the answer. They fear that the reply may not suit them.
I understand the cost implications, but if that is the reason for the failure to ask questions when lives are at stake, that is unacceptable. As part of the discussions arising from the Minister's March statement, Andrew Cohen made a number of requests. Apart from the additional one paediatric and one adult intensive care bed, nothing else has arrived.
The Minister should understand and make allowances for the effect on demand when intensive care beds are located in a hospital with many regional facilities. I am told that my constituents in east Leeds gain from having so many specialties or centres of excellence at St. James's hospital. However, the Minister knows that those specialties make regular demands on intensive care beds. When someone such as Mrs. Harrison collapses, she must compete for a bed with patients who have been moved to intensive care from other departments within the hospital. Dr. Cohen must decide whether to stop an operation or deal with the inevitable emergency that will result from denying new patients intensive care beds. He advocates separating dedicated intensive care beds from general intensive care beds at Leeds general infirmary and St. James's hospital, and that proposal should be considered.
What is happening with the trust and health authority regarding the provision of high-dependency beds? The Minister appreciates the vital role that those bodies play, both physically and financially, in providing a valuable safety net. However, the health authority and the trust have taken no action to increase the number of high-dependency beds at St. James's hospital--in fact, all eight high-dependency beds are dedicated to the other specialties. In March, the Secretary of State and the professional working group said that such beds play a vital part in health strategy. When patients are admitted to hospital, staff usually determine the availability of intensive care beds with a view to moving patients to a high-dependency unit. That is not possible at St. James's hospital and we must ask why.
The Secretary of State requested discussion, consensus and transparency between intensive care beds, high-dependency beds and the other specialties, but nothing has happened. The trust and health authority have used the Government's money to provide only two extra beds. Is the Minister aware of that fact? Is he monitoring the situation? If so, what is he doing about it; and, if not, why not, as it was a vital part of the 6 March statement?
Does the Minister agree that there is something slightly obscene about forcing seriously ill patients to criss-cross the country in search of intensive care beds? I accept that, if patients require specialty treatment that is available only in Birmingham, it is common sense to transfer them to that hospital. However, seriously ill patients should not be expected to criss-cross the country in search of treatment. Surely specified geographical areas, such as west Yorkshire and south Yorkshire, could combine and squeeze out enough money to provide an agreed safety net, so that we do not see ghoulish transfers of seriously ill patients to hospitals 60, 80 or 100 miles away. It is acceptable for my constituents to travel to Bradford, but not to Bridlington.
"I told the House earlier this year that I would undertake to ensure that we learn the proper lessons from the general pressure on the emergency services this winter. I shall set out to the House this afternoon the steps that I am taking to ensure that that happens."--[Official Report, 6 March 1996; Vol. 273, c. 356.]
In three brief paragraphs, he dealt with the intensive care beds crisis. He relied largely on the report of a professional working group that examined best practice in the use of intensive care, to which I shall return. With his Commons performance on 6 March, the Secretary of State drew a line in the sand. He accepted that there were lessons to be learned from last winter, he outlined his solutions and the inference was clear: this winter, we would not expect a rerun of the unhappy experiences of last winter.
"We are sailing extremely close to the wind and sooner or later we are going to come unstuck."
22 Jan 1997 : Column 877
The same week, the following examples occurred: a Leeds patient faced a possible trip to Birmingham or London; Leeds patients were sent to Grimsby, more than 80 miles away; patients were sent from Airedale to Stoke; Bradford patients were sent to Doncaster; and Newcastle patients were sent 100 miles to Edinburgh. In the week that Mrs. Harrison of Leeds died in Hull, a 71-year-old male pensioner was sent from Hull to Leeds for an intensive care bed and died a few days later. Those patients were not sent to a particular centre of excellence because of their specific complaints--they were shipped around because of bed shortages.
"There are many more incidents which are not reported in the media. The fact that it is going on is very worrying."
A Leeds consultant, Dr. Mark Darowski, was quoted as saying:
"Mr. Dorrell has not learnt the lessons of last winter."
Dr. Andrew Cohen, the St. James's intensive care manager with whom I spent some time yesterday, said:
"Resources are stretched to the absolute limit. The strain has been caused by the increase of illness we always see in winter and the only way we are going to avoid this sort of problem is if there is an increase in intensive care beds. There is a chronic shortage across the region and the country as a whole."
Dr. Andrew Bodenham, intensive care manager at Leeds general infirmary, stated:
"We are just playing musical chairs all the time."
I do not think that he meant to be humorous when speaking about seriously ill people.
"to parade a few individual cases that are supported by incomplete facts, to make a half-researched charge about the Government's record, wave a shroud, repeat the mantra that Labour will abolish the internal market and base metal will be transformed into gold."--[Official Report, 21 January 1997; Vol. 288, c. 755-56.]
I have not waved any shrouds. Without getting angry, I have tried to express the anger felt in Leeds. I have not used political comments. I have used comments from doctors who have the unhappy task of deciding who is to have an intensive care bed and who is to go on the dangerous search for a bed elsewhere.
| Next Section
| Index | Home Page |