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12.48 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on his success in securing this debate. I appreciate the importance of this topic to his constituents, for many of whom St. Vincent's is a much-loved and respected local hospital.
I do not believe that there is any connection between the Government's success in getting under way the PFI hospital-building programme--the largest ever in the history of the national health service--and the future of St. Vincent's. Nor do I believe that the connections made by the hon. Gentleman between other policies and what is happening at the hospital will stand examination.
St. Vincent's hospital, which is under the pastoral care of the Sisters of Charity of St. Vincent de Paul, has a long history of serving the community and the public at large.
Beginning in the early l900s, it later began to provide surgery and treatment and in 1925 it expanded further to include facilities for girls as well as boys. The advent of the second world war meant a further change of direction, with services being provided for adults or casualties of the war as part of the emergency medical service. The hospital has continued to develop services over the years.
This debate provides me with an opportunity to pay tribute to the work of such charitable organisations. In the past, and in the present day, they have proven to be beneficial for their communities. I, too, wish to pay tribute to all those who have worked, or are working, at St. Vincent's hospital. It is clear that local people have benefited greatly from their endeavours over the years and the hospital has been, and continues to be, an important provider of local health services. It currently has a reputation for providing an excellent physiotherapy and rehabilitation service, and I am aware that local NHS patients have been very happy with the care and treatment they have received at St. Vincent's hospital.
The House will be aware, of course, that St. Vincent's hospital is a hospital outside the NHS and it might be helpful to set out several aspects of the relationship between the NHS and the private and voluntary sectors. Under the new arrangements for commissioning health services, general practitioners and consultants retain the clinical freedom to refer patients for the most appropriate treatment, and we would not have it any other way. However, it is still the case that health authorities, GPs and NHS trusts should explore the scope to make maximum cost-effective use of local NHS capacity before contemplating recourse to independent sector hospital provision.
When care is none the less commissioned from private hospitals, the reasons must be reported to the regional office of the NHS Executive. That was set out, as the hon. Member for Ruislip-Northwood said, in the planning and priorities guidance for 1998-99, which was issued to the health service in September 1997. The same applies to any hospital outside the NHS, be it a charitable organisation such as St. Vincent's or a voluntary sector provider of health care services.
It is clear that NHS facilities should be utilised where available and contracts with voluntary and private health care providers will be subject to the same standards of quality and effectiveness as NHS service agreements. The NHS has a responsibility to place its contracts with, and to commission, the voluntary and private sector only when it is most cost effective to do so after ensuring that the quality of services provided meets NHS standards. However, we accept that people should be free to choose private health care if they wish.
Ministers' relationship with the NHS is different from our relationship with the private and voluntary sector. We manage the NHS: we regulate the non-NHS sector. There is quite a difference. We have recently brought forward for consultation proposals for the regulation of the private and voluntary health care sectors.
The decision to commission services provided by voluntary and private health care providers is a local one and it will continue to be made locally and in the interests of patients. It is not the case that decisions are taken irrespective of local needs or circumstances. Indeed, two local health authorities currently have service agreements with St. Vincent's hospital. The local health authority of
the hon. Member for Ruislip-Northwood--Hillingdon--has a service agreement with St. Vincent's hospital for physiotherapy and for rehabilitation services. That service agreement covers 8,200 physiotherapy contacts and a rehabilitation service for 12 long-stay residents as well as on-demand respite care. Hillingdon health authority and primary care groups will invest more than £730,000 at St. Vincent's in 1999-2000. The health authority and local primary care groups are of the view that St. Vincent's provides excellent physiotherapy and rehabilitation services and that that investment decision, made locally, ensures that cost-effective, high-quality services are available to Hillingdon residents.
Brent and Harrow health authority and the five primary care groups in Brent and Harrow also have a service agreement with St. Vincent's hospital for physiotherapy services. That covers 3,500 treatments for local patients and means that more than £56,000 is being invested in St. Vincent's. That reflects the high regard with which the physiotherapy service is viewed by many Brent and Harrow GPs and by patients in the area. So far as I can establish on the information available to me, the transition from GP fundholding to primary care groups has had no impact on the utilisation of physiotherapy services by the doctors in the two local health authority areas.
It is true that St. Vincent's used to provide a variety of other services. It used to provide orthopaedic services for both NHS and other patients. It no longer does so following a hospital board decision, taken in summer 1998, to cease offering orthopaedic surgery as one of the hospital's services. The hon. Member for Ruislip- Northwood suggested that that was a reflection of the priorities guidance to which I referred earlier. My understanding is that the hospital was experiencing difficulty in maintaining surgical facilities to modern standards, given the prohibitive cost. That was certainly an important factor in the decision. However, as the hon. Gentleman said, a wide range of services is offered at St. Vincent's, including facilities for younger chronically disabled, post-operative rehabilitation, respite care, physiotherapy, and radiography.
Given that health authorities and primary care groups have a responsibility to ensure that they make the best use of the public money that they receive, Hillingdon and Brent and Harrow health authorities and PCGs have decided that it is more cost-effective and appropriate in terms of ensuring that their populations receive the highest quality of care to look to St. Vincent's hospital to provide physiotherapy and rehabilitation services. I must reiterate, however, that those decisions are made locally. I am sure the hon. Member will appreciate that it would be unfair for Ministers to get involved in such decision making. We want health authorities and primary care groups to have responsibility for local decisions because of their expert knowledge of the health care needs of the
local population. Our responsibility as Ministers lies in setting the strategic direction of the NHS, not in deciding which local service is most appropriate.
We are determined to ensure that the NHS in London provides Londoners with top-quality care. That is why better GP premises are being provided, new hospitals are being built, and more resources are being invested in mental health and community services. We also have a London region of the NHS looking at the capital's health needs Londonwide and providing Londonwide plans for improvement. A document, titled "The modernisation plan for the NHS in London 1999-2002", sets out what is planned for the next three years and beyond. So we have targets in place and we need to ensure that they are delivered
The key objectives of the Government policies for health and social services are longer, healthier lives; a reduction in inequalities in health and health care; and an NHS which is modern, dependable and there when it is needed. We want to focus on improving the health of all Londoners, including addressing cultural, social and ethnic diversity, and we want to work effectively with others to reduce inequalities in health. We also want to ensure that all Londoners have fast and convenient access to quality local services and that London continues to lead the way nationally and internationally.
I wish to make it clear to the hon. Member for Ruislip-Northwood that I understand that there are no plans to disinvest from the services that are currently provided at St. Vincent's hospital. I understand that that on its own may not be sufficient to secure its future, and I understand why that is a cause of concern. If the St. Vincent's board were to decide not to offer the services any longer, the local health authorities and primary care groups would need to consider how to ensure that people requiring those services were treated. That would, as I have said, be a local decision.
The Hillingdon health authority, local GPs and patients share the concern about the future of St. Vincent's. Hillingdon health authority has been in regular contact with the hospital, and discussions have been held to try to find a solution for the problems facing St. Vincent's. The hospital is seen as an integral part of the local health economy along with local NHS providers, and the health authority is encouraging St. Vincent's to look at what opportunities may exist locally and has entered into discussions with local social services on how to take that forward.
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