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Kent and Sussex Hospital
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Clelland.]
10 pm
Mr. Archie Norman (Tunbridge Wells): I am grateful for this opportunity to raise the question of the West Kent and East Sussex NHS trust private finance initiative. I am also grateful for the attention of the Minister on this serious matter.
My purpose in calling for this Adjournment debate is to raise the extremely serious position of the future capital funding of the trust. The hospital, which is spread between two sites in my Tunbridge Wells constituency--one in Pembury and one in the centre of Tunbridge Wells--serves the surrounding area of Tonbridge, Sevenoaks, East Sussex and Kent, down to the south coast. Until the PFI review in June, the trust was working with its partners on a substantial proposal for rebuilding the hospital on a single site.
I want to be clear that my purpose tonight is not simply a case of constituency special pleading. Indeed, I do not advocate that we should immediately fund the PFI in Tunbridge Wells; nor is it ready to be funded. Rather, there appears to be an acute need in this case, which may be illustrative of other NHS trusts, for proper forward planning and a better long-term framework to enable the trust management to move forward and plan for the future investment that is urgently needed.
The effect of the cancellation of the PFI proposal is not just to abort any future capital work, but to plunge the whole hospital into a state of relative uncertainty, which obviously has an effect on the morale of clinicians and staff. That problem now needs to be addressed.
The hospital's position is untenable in the long term. The trust delivers a good standard of clinical service, but that is despite, not because of, the state of the facilities, which is extremely poor. We rely on the energy, good will, hard work and dedication of the doctors, nurses and management to overcome the impoverished state of our facilities.
The hospital suffers from being split between two sites, both of which are old and have been developed piecemeal over the years. The first site at Pembury was, ironically, originally built as a workhouse in the 1890s. It consists of long, Florence Nightingale-style wards with 24 to 28 beds, an open-plan format, limited privacy and inadequate medical support facilities. For example, oxygen is not piped into the facilities.
Many of the support and related facilities at Pembury are housed in wooden huts. The operating theatres were designed as a twin operating suite some 30 to 40 years ago. The Pembury site includes all the major radiology facilities as well as obstetrics, paediatrics, gynaecology and care for the elderly. The net result is that, every time a patient needs radiology or similar treatment, he has to be transferred between the two sites.
The Kent and Sussex site is in the heart of a very congested part of Tunbridge Wells. It was built around the site of an old tuberculosis hospital, and has been developed higgledy-piggledy over the years. It is poorly laid out. It contains the main accident and emergency facilities for the entire area and is therefore crucial not just for my constituency, but for the surrounding areas.
The effect of the dual site operation is to make the hospital more expensive to run, and also to hinder patient care. One can imagine that transferring patients in poor condition between hospitals, which can take half an hour or so, does not make any sense from a clinical point of view. It is expensive, and it is an unnecessary burden on the staff.
The general standard of the buildings is wholly inadequate for this day and age. On an aerial photograph, it looks like an industrial site. Shed-style buildings, wooden huts and warehouse roofing are simply not an acceptable standard for a modern hospital. Despite this, the staff manage, but it is important to note that there is an estimated £30 million backlog of capital maintenance, which is required to bring the facilities up to what are regarded as acceptable standards today.
Hon. Members will be aware that the capital maintenance allocation is related to turnover, not the state of the buildings. As a result, unless something is done, I fear that the situation at Kent and Sussex can only get worse.
Furthermore, the poor quality of the wards means that the trust is unable to provide patients with the privacy and dignity that they expect today. My constituents continually complain about the inadequate state of the wards and the fact that we have dual-sex wards with no privacy. Tunbridge Wells is--like it or not--the long-term location for accident and emergency and acute facilities. There is no alternative. The nearest hospital, in Maidstone, is far too far away to meet any standards of performance and service delivery on emergency facilities for constituents, particularly those living to the south.
The case for long-term investment, therefore, is very sound by any standards. There is simply no alternative. In my judgment, the PFI proposal should have been allowed to proceed to a state where it could have received mature consideration. It has, however, been turned down, but on technical grounds, not on grounds that can be weighed up as an economic case. In the long term, it will have to be revived.
The PFI was for £65 million to create 400 beds, which compares favourably with other PFIs that have been allowed to proceed. I believe that I am right in saying that the PFI for Dartford was for £120 million to create the same number of beds. The capital efficiency of the proposal was therefore very good. The revenue efficiency is also good, as there would be obvious revenue savings from consolidating a dual site.
Important landholdings would be released as a result of the PFI, because we currently occupy large acreages which are capable of being used for housing, or other uses. The economics of the proposal to rebuild the hospital on a single site is by any standards outstanding.
Why was the PFI turned down? First, it did not meet the criteria, apart from anything else, for readiness--a fact of life, but not a reason, surely, for kicking it into touch indefinitely. Secondly, the service requirement was not sufficiently strongly demonstrated, because the surrounding population are reasonably healthy--but unless we can sustain the quality of service that we have managed in the past, they are unlikely to remain so. The hospital is a centre of excellence today, and deserves our support to remain so. If we are not prepared to invest in it, it will not remain so. Surely the Government's policy for the NHS is not to level down standards but to increase standards everywhere.
My fear is that, if a coherent investment plan is not developed, in the future there will be an obvious impact on morale--which there has been already--and a risk that our top physicians will migrate elsewhere. There is a risk that standards of care will deteriorate and it will not be possible to maintain and meet minimum standards of cleanliness, hygiene and clinical care.
There is also a risk to the economics, because, unless we have a plan, the temptation will be to invest in one site or another at the cost of meeting the long-term objectives. In other words, the costs will be wasted, because in the long term we want to consolidate on a single site. Today, it is simply not possible to ignore the deteriorating state of our buildings.
The Minister of State said in July:
I fear, however, that, by selecting certain PFIs to go ahead and kicking the rest into touch, we may have deferred any sensible long-term planning for hospital building, particularly in this case. We have moved out of one gridlock into, potentially, another. Meanwhile, the hospital management are in a Catch-22 situation. They have been told not to invest in further developing the PFI proposal, so that has been shelved, and no more work can be done on developing the right proposal for the future of Tunbridge Wells.
I am also aware that the Minister said in July that it was
We fully recognise that health service expenditure must be prioritised, and that some schemes must be selected to go ahead. That is not the issue; the issue is what happens to schemes when there is an acute need for redevelopment, but they have been booted into the long grass for the time being.
The Government made a great commitment to the health service in their election manifesto. In the past few years, they have been highly critical of the last Government's record on health, and have made much play of the need to improve facilities and reduce waiting lists--which in Tunbridge Wells, incidentally, are in serious danger of lengthening again this winter; but that is another subject.
Now is the time to reassure hospitals such as the Kent and Sussex about their long-term future. That is really all we are looking for--a plan for the long term. That means
not a stop-go on PFI schemes, but a coherent framework in which to plan, and some understanding of how schemes will be run and of the wherewithal to fund them and bring them to a state in which we can advocate them and make a proposal to the Government.
In short, I am asking the Minister to reassure us that he will look favourably on future plans for the redevelopment of the NHS trust, and to ensure that, in the months ahead, the trust is provided with clear guidance on the type of capital expenditure programme that will be allowed to enable single-site relocation in the long term.
In other words, are we to invest in both sites, or can we start concentrating on a single site in the knowledge that in the future a scheme will be supported? I also seek the Minister's reassurance that the NHS trust will be allowed to incur the expenditure necessary in the future to get a proposal into the state in which it can receive his blessing.
"Today the Government is unlocking the PFI gridlock in the NHS".
In June, he said:
"I wanted to be the Minister that got hospitals built, not the Minister that only promised them."
Those are sentiments that I am sure we all share.
"not the end of the road"
for the schemes that had been turned down, but it is unclear today what can be done to revive them. According to a letter sent to me on 29 July, it was the intention to
"prioritise all future major acute sector projects according to the key criteria of health service needs."
The point about needs is that it is not just a question of today's needs; it is a question of future needs and future trends. We are talking about a long-term building project, and we are considering not what happens today, but what should happen in five or 10 years' time. The NHS trust needs to know that in order to prioritise what it does with its expected investment now. Currently, it is being left in the dark.
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