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11.30 am
Mr. Gareth R. Thomas (Harrow, West): I pay tribute to the hon. Member for Southend, West (Mr. Amess) for his work on the Warm Homes and Energy Conservation Bill. However, my view on the NHS plan differs completely from his. I think that it is an excellent document, and that the problems that it addresses are so serious because of the mess that was left to us by the previous Government.
I do not want to address the issues raised in yesterday's NHS plan, but I should like to talk about two important, although perhaps less high profile, health policy issues. The first is wheelchair provision. Quality of life for wheelchair users and their carers is often determined by the make or break issue of whether a high quality wheelchair is provided. As many people will realise, wheelchairs can be the crucial factor in wheelchair users' independence and greater dignity and self-esteem. High quality wheelchairs often also improve their life chances by improving education and employment opportunities.
On 5 March 2000, the Audit Commission published a report highlighting serious problems with NHS and social services equipment provision. I shall concentrate on the report's findings on local provision by the wheelchair service. The report chronicled increasing pressures on equipment services. Demand is rising as the population ages, and expectations are rising thanks to advances in technology and science. The success of community care and the commitment of all parties to helping people to maintain their independence are also increasing demand for equipment services, particularly wheelchairs.
My interest in the issue was sparked by the mother of a young disabled person who came to my surgery and said that a wheelchair was absolutely vital to ensuring her child's full engagement in a school environment. She highlighted the totally unsatisfactory response that she had received from the local wheelchair service. After looking into the matter and examining in detail the conclusions of the Audit Commission report, I realised that, across the country, despite the rolling out by the Department of Health of good practice standards on wheelchair service provision, there is still great inequality in wheelchair provision.
Some NHS trusts offer a wide range of wheelchairs and do not place restrictions on wheelchair type or cost. Other NHS trusts have very tight eligibility criteria and limit wheelchair provision to intensive, permanent wheelchair users. Other trusts restrict the types of wheelchair they provide, although they may make wheelchairs available more widely and not only to intensive, permanent users.
The Audit Commission could find no evidence that the variations in wheelchair provision related to variations in local need. The commission found instead that the problem had more to do with historic patterns of wheelchair provision. The commission also chronicled wide variations in waiting times for assessment of need, receipt of wheelchair, and, in some cases, wheelchair repair.
The commission conducted a survey, at six wheelchair centres, to determine wheelchair users' opinion on the quality of service. It revealed that 40 per cent. of wheelchair users had not been shown how to maintain their wheelchair; 30 per cent. had not been given written information on using their chair; and 25 per cent. did not receive all the equipment that they needed. Perhaps the most telling statistic was that more than 30 per cent. of wheelchair users had not been asked what they wanted in their wheelchair. Another key statistic is that up to one in five wheelchair users have to wait more than two months for their wheelchair to be delivered. It confirmed that wheelchair service standards vary greatly.
It is crucial that the Department of Health should establish as soon as possible minimum core standards for all wheelchair centres. The Department must ensure that
skilled assessment teams are available to provide technical and administrative support to the wheelchair service. There is also a clear need for more investment in wheelchair equipment. In some cases, local health authorities need to reconsider funding for the wheelchair service.The Audit Commission report made two key recommendations: that health authorities review current service standards and urgently introduce quality improvement programmes; and that they introduce systematic reassessment programmes for all wheelchair users.
I know that my right hon. Friend the Secretary of State for Health is deeply concerned about the very stark picture of a second-rate service in some parts of the country, and that an extra £40 million will be made available for the service. Nevertheless, I hope that my hon. Friend the Parliamentary Secretary, Privy Council Office will encourage our hon. Friends in the Department of Health to speed up their response to the Audit Commission report.
I should also like to raise the issue of patients' complaints. When patients make a complaint about the care that they or their relatives have received and the NHS trust decides to convene an independent review panel, they do not always receive clear guidance on the contents of medical files. I raise the issue because of the visit to my surgery by Mr. Alex Eady, of Field End road. He came to see me after his mother, Mrs. Iris Eady, died. He was concerned that she had suffered poor care at the local hospital, that she had not received proper medication and that hospital staff sometimes displayed a negative attitude towards her.
Mr. Eady had a number of meetings with health care professionals at the local hospital. Ultimately, however, he asked for an independent review panel to convene to consider his mother's care in greater detail. The local trust refused the request. I believe that we may need to consider whether NHS trusts should be allowed to make the decision on establishing independent review panels.
Subsequently, Mr. Eady sought to gain access to his mother's files to examine the contents in detail. Although he was successful in that, he lacks the medical expertise necessary to analyse information on the quality of care given to his mother and other information provided by the doctors and nurses who treated her. My staff and I have attempted to secure support for him by working with voluntary and non-governmental organisations such as Inquest, and Action for Victims of Medical Accidents. Thus far, however, we have been unsuccessful. I suggest to Health Ministers, through my hon. Friend the Parliamentary Secretary, that it might be useful to provide community health councils with access to a doctor to examine precisely such cases.
Another issue that I should like to raise before the recess was brought to my attention by Mr. Bustin of 14 Wyvenhoe road, in my constituency. He highlighted the sell-off by Prudential of Egg shares, which could be bought only on the internet. If services become internet-exclusive, there is a real danger of exclusion for constituents such as Mr. Bustin, who do not have or do not want access to the internet. They are in danger of suffering if services or business operate only on the internet.
Prudential claimed that that method of trading shares reduced the costs to those who wanted to buy shares, but as my constituent highlighted to me, there is an element of discrimination against those who do not have access to a computer, or those who live in parts of the countryside where there is no cyber cafe or library with internet access. There is potential for some form of exclusion if we are not careful.
The last issue about which I wanted to speak was the story of the Tower colliery in south Wales. Not every hon. Member is as lucky as I am in having Welsh roots. However, many hon. Members, especially Labour Members, know the story of the Tower colliery and of the campaign to save it. That campaign was led in part by my hon. Friend the Member for Cynon Valley (Ann Clwyd). Those of us with an interest in mining communities, such as my hon. Friend the Parliamentary Secretary, or with roots in the Co-operative movement, are proud of the Tower colliery.
The story has been made into an opera, which was performed throughout Wales and, on several occasions, in Europe. My hon. Friend the Member for Cynon Valley tells me that it will shortly be made into a film. However, the opera has not been widely performed in England. The Arts Council of England turned down the application for support to help the company tour. I hope that my hon. Friend the Parliamentary Secretary will take issue with the urban peasants at the Arts Council of England and urge them to review their decision.
I hope that my hon. Friend the Parliamentary Secretary and other hon. Members have an excellent summer recess.
11.42 am
Mr. John Wilkinson (Ruislip-Northwood): I associate myself at the outset with the memorable remarks of the hon. Member for Tooting (Mr. Cox), who paid the warmest tribute to Madam Speaker at the beginning of our proceedings, after prayers. I am delighted that, in addition to her responsibility in chairing the September conference of the Commonwealth Parliamentary Association--an organisation which we hold in the highest regard--she will take time during the recess to visit the Baltic states and Ukraine. Those countries have regained their freedom and enjoy independence, which they did not have in the bad old days of the Soviet Union.
The Adjournment procedure provides an invaluable opportunity for me to consider the future of
- Harefield hospital--one of the best-known heart hospitals in the national health service. I am grateful for the opportunity to describe the high regard in which we hold its services.
Coronary heart disease is the most common cause of premature death in the United Kingdom. It accounts for about a quarter of deaths under the age of 65 and is on the increase.
In 1997-98 in England, 389 heart and lung transplants were performed, of which around a quarter were undertaken at Harefield . . . This year, NHS providers in England will receive a total of £349 million for spending on research. The Royal Brompton and Harefield NHS trust is the health service's pre-eminent provider of research into cardiac and respiratory diseases and is receiving £20 million--just under 6 per cent. of that total.
Many people are aware that, under the inspirational leadership of Professor Sir Magdi Yacoub, Harefield hospital has become a world leader in heart and lung transplantation. It has the largest transplant programme in Europe . . . and has accumulated experience over the past two decades that is second to none, not just in this country or in Europe, but in the world. Since its programme was set up in the early 1980s, Harefield has completed well over 2,000 transplants.
- I pay tribute to Sir Magdi and the whole team at Harefield, who have helped so many people over so many years to live a rich and fulfilling life.
Harefield not only provides top-quality medical care, but makes a major contribution to world-class research into cardiac disease through its links with the Imperial college school of medicine. The research output of the cardiac and respiratory sciences department at Imperial has been recognised in successive assessments by the Higher Education Funding Council for England as of the highest international quality. Some 20 per cent. of the UK's research output in cardiac and respiratory diseases is completed at Imperial and its associated NHS hospitals. Perhaps even more impressively, two thirds of top-quality research citations in the UK are generated by the same department.--[Official Report, 2 December 1998; Vol. 321, c. 1020-21.]
The Secretary of State and the Government now wish to close the hospital. I am delighted that my hon. Friends the Members for Beaconsfield (Mr. Grieve) and for Uxbridge (Mr. Randall) are on the Opposition Front Bench this morning. From their local experience, they fully appreciate the enormous merits of Harefield hospital, which is an incomparable national institution of international repute. Unless the Government have a change of heart, it will close shortly.
A three-month consultation period on the proposals outlined in the document "Modernising Specialist Acute Hospital Services in West London" began on 13 July. It is therefore opportune that we have the debate this morning. When we return in the autumn, only three weeks of the consultation period will be left, and the vagaries of the ballot system mean that I cannot be certain of securing an Adjournment debate in those remaining weeks.
It is important to get some vital facts on the record. First, the document's proposals are more orientated to building up the Paddington basin site, through new developments, and economically and socially regenerating that part of west London, than to addressing the future of cardiothoracic medicine in this country. The study's remit is far too narrow. I acknowledge that the specialist advice was given by the West London partnership forum. Perhaps it is therefore understandable, to some extent, that its vision should be so limited. However, we do not need to have limited vision. We should try to ensure that Harefield hospital, which the Secretary of State acknowledged as pre-eminent in its field, should continue and go from strength to strength.
The consultation document makes proposals for other specialist services with which I can readily concur. It suggests concentrating renal services at Hammersmith hospital and the movement to and concentration of paediatric services at St. Mary's hospital, Paddington. It also proposes two cardiac and thoracic centres for west London, and I do not demur. What is wrong is that both should be concentrated in inner London. We need one unit in inner London, at Paddington, and one in outer London--one must call it that, although I prefer "rural Middlesex"--at Harefield.
Harefield takes its patients primarily from outside London. Only 10 per cent. come from Hillingdon--the borough in which it is located--although 90 per cent. of patients in the borough with heart, chest and lung problems are referred to Harefield. The hospital is vital to
us locally, both clinically and for employment in the village and that area of my constituency. There is no other comparable employment. The hospital is at the heart of the village economically and contributes greatly to its spirit.Harefield's catchment area is wide; patients come from the whole of this country and from abroad. Earlier this week, I visited a patient who had received a transplant, without which he would certainly have died. His condition had degenerated and he was helicoptered from the south coast back to Harefield. He has been there for more than two months and, I am glad to say, is recovering well. Patients cannot be helicoptered into Paddington as they can be to the rural location of Harefield.
The patient's devoted wife has been at his bedside during the two months. She can stay in the hospital for £20 a night. She eats in the canteen. Those possibilities would not exist in central London--in Paddington.
The correct model is not necessarily to incorporate a specialist centre in a large general hospital. That is the model which the Government are pursuing, and I am happy for it to be set up at Paddington as they desire. However, at Harefield, not only is the most sophisticated treatment available--including heart-lung transplants--but there is a range of other services, such as angioplasty, bypass surgery and out-patient treatment.
The fact that the hospital offers the whole gamut of heart-lung treatments is its strength. This could be the model for the future. The Government should not put all their eggs in the general-hospital, central-London basket. They should build on the strength of Harefield and ensure that it has a real future.
Furthermore, Harefield has always benefited from private sector finance. In the NHS plan announced yesterday, with much fine rhetoric from the Prime Minister, the Government had something to say about that. The conclusion to the chapter dealing with changes in the relationship between the NHS and the private sector states:
- A closer working relationship between the NHS and the private and voluntary sector will be mutually beneficial. By putting the relationship on a new footing NHS patients will benefit. It will, in particular, contribute to winning the war on waiting for treatment in the NHS.
Since the consultations on specialist hospital services in west London began, the financial background has changed dramatically, not least because of the expenditure review announced by the Chancellor, but also because of the NHS plan. On investment in coronary heart disease, chapter 14 states:
- We shall be investing an extra £230 million a year in heart disease services by 2003/04. There will also be an extra £120 million of capital funding from the Treasury Capital Modernisation Fund over the two years to March 2002, to expand capacity and modernise services.
Paragraph 14.23 of the NHS plan states:
- The National Service Framework pledged an expansion of 3,000 extra heart operations in the two years to March 2002 at a cost of £50 million. We shall now boost this with a further £10 million in the current year backed by £120 million over two years from the Treasury Capital Modernisation Fund, to support more rapid expansion of existing services and begin the development of new cardiac centres. This will enable the NHS to achieve the 3,000 target ahead of time, and to bring on stream at least a further 3,000 operations on top of this by 2003.
- Decades of underinvestment in coronary heart disease services will come to an end.
- The Coronary Heart Disease Partnership Programme, starting in October 2000--
- will work with a group of cardiac networks across the country to streamline the delivery of high quality, patient-centred care and--
- get the most out of existing capacity.
I shall end my remarks as I began, with a short quote from the debate on 2 December 1998. The debate needs to be reread by anyone studying the issue. I said:
- Harefield hospital's situation in rural green belt, at the nodal point of the M1, M25, M40, M4 and M3 motorway network, near to Heathrow and Luton airports, with its very own helicopter pad, ample space, surrounding quiet countryside, clean air and cheaper housing, is surely the right one to make it the right place for the country's premier cardiothoracic transplant centre, now and well into the century that is to come.
Developers, PFI financiers and the great and good committee men may have other ideas, but I simply pray that Our Lady of Harefield--whose image in glass glorifies a window in the hospital chapel--and of the parish church dedicated in her name may bring advent wisdom to Ministers and allow the work of the healing of hearts to continue in the village where England's first and only Pope, Nicholas Breakspear--Adrian IV--was born.--[Official Report, 2 December 1998; Vol. 321, c. 1019-20.]
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