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4.35 pm
Mr. Michael Mates (East Hampshire): When I intervened on the hon. Member for Dartford (Dr. Stoate)--who had asked, rather plaintively, whether anyone was listening--I said that it was a discourtesy to the House that no Minister from the Department of Health was present. I meant no discourtesy to the Under-Secretary of State for Social Security, the hon. Member for City of York (Mr. Bayley), any more than I mean any discourtesy to the Minister of State, Department of Social Security, the right hon. Member for Birmingham, Perry Barr (Mr. Rooker), but in a debate on the health and social security aspects of the Queen's Speech, surely it is not too much to expect that, out of nine fully paid Ministers, one would be present from each Department so that the Government could at least pretend to be listening to Parliament. Mr. Speaker said that he aimed to ensure that the Executive gave Parliament the respect that it was due. Perhaps, Mr. Deputy Speaker, you could tell him about this unsatisfactory state of affairs.
This is the first time--I think--in about 26 years in the House that I have spoken in a health debate. I do so unashamedly to raise issues of local health, which is in severe crisis in Hampshire. Those who know me are aware that I am not given to telling horror stories or raising unnecessary scares.
The hospital that concerns me is not an old Victorian institution in a run-down inner-city area, but a relatively modern building on the outskirts of Portsmouth.
Queen Alexandra hospital is going through the most desperate crisis of its relatively short life. It has many problems, but I want to concentrate on the orthopaedic department and the ophthalmology department.The problems came to the attention of laymen last July, when a consultant whom I know well turned up to see the seven patients on his list, and the theatre nurse asked him which five patients she should send home because there was sufficient equipment for only two operations. That quickly led to the ceasing of all elective orthopaedic surgery. There has been no such surgery during the past three months, and consultants estimate that there will be none until at least the end of next summer.
The hospital reluctantly took that decision because if it used the orthopaedic instruments for elective surgery, it would not have enough to cope with trauma cases and the accidents that are bound to need treating in a large hospital with a large catchment area of about 600,000 people. That was bad enough, but the hospital could no longer guarantee that it could carry out emergency surgery. That was brought to light when a lady arrived at the hospital four weeks ago with multiple injuries, including a compound fracture of her leg, where the bone was outside the skin. It took the hospital six hours to assemble the right equipment to deal with her injuries.
It was at that point that the consultants felt that they had to tell the trust that it was more dangerous to say that they could cope with trauma surgery than to cancel it altogether. All nine consultant orthopaedic surgeons wrote to the trust to set out their concerns. The letter said:
- Despite stopping elective Orthopaedic surgery we have not seen any improvement in the supply of sterile instruments for trauma. Indeed, the situation has become worse . . . we now feel that patients lives and well being are at serious risk.
The problem in the hospital is the central sterilisation unit, which cannot cope. If the problem had arisen gradually over the past two or three months, the fact that we now face a crisis would be more understandable, but people have known that there was a problem with the unit for the past two years. A report on the matter was commissioned, looked at, then shelved, and now a collapse has occurred.
The problem has several causes: first, there is inadequate steam; secondly, some of the autoclaves broke and were not replaced; and, thirdly, the staffing problem is so dire that it is not possible to put through the amount of equipment that is needed to sustain surgery in the hospital. If that were purely an employment difficulty, it could be addressed, but I have discovered that the problem is that the Portsmouth trust pays the lowest rate of pay in the area: it trains people to work in the washing and sterilisation unit, but the moment they complete their training, they realise that they can earn £2,000 a year more by going 10 miles to Winchester or Southampton, so they up and off.
That is not a fundamental problem with the health service, but one of local management allowing many problems to develop into a crisis. Surgeons tell me that they were being presented with instruments to use in operations that had yesterday's bone and skin still on them, and that is why patients had to be sent home. I am sorry to present the case so graphically, but those are the facts.
A different problem, but one that has the same roots, affects ophthalmology. All intra-ocular surgery has had to be stopped because of the risk of infection. I am told that four or five infections in 2,000 procedures is about par for the course; but when six infections in a row occurred because equipment was not sterile, the procedures had to be stopped altogether.
There is a solution, which I was hoping to put directly to a Health Minister--I hope someone will read my speech and respond. Some years ago, it was thought right to centralise all sterilisation, but that was before the introduction of laser surgery and the development of micro-instruments. Now, such highly sensitive instruments are chucked into the central sterilisation unit along with the hammers and chisels used by orthopaedic surgeons, and they come out bent and damaged. The simple answer is to let the laser surgery department have its own small sterilisation unit, and it will then be able to get on with its work. Currently, its instruments come back not only unsterile, but damaged, and therefore have to be replaced.
The crisis is a symptom of problems of management. If hon. Members are surprised to learn that there are management problems in the hospital, they should not be. There has been no chief executive for the past six months: the former chief executive left and the newly appointed chief executive does not start until next March. The result is paralysis. I have no doubt that the acting chief executive is doing his best, but he cannot make strategic decisions ahead of the arrival of a new boss, so he is confined merely to putting his fingers into all the holes of the dam.
The net result is that, for three days now, Queen Alexandra hospital, Portsmouth has not been able to offer trauma facilities; if there had been a major accident, the victims would have had to be dispersed to other hospitals. The hospital now accepts trauma patients on a day-by-day basis, which is to say that, twice a day, the duty consultant has to go and see whether there is sufficient sterile equipment to cope with the expected number of trauma patients; if there is not, ambulance services have to be told to take patients to other hospitals in Winchester, Southampton or Chichester.
That is the current state of affairs, so when the Prime Minister warns that there might be a crisis this winter, my response is to tell him that there is a crisis in our part of the world, right now. All it needs is winter and a night of freezing fog and black ice and major accidents to cause the accident and emergency service for 1 million people, many of them my constituents, to grind to a halt. I am sorry to have to put it all so starkly, but I believe that the public and Ministers need to know what goes on down at the end of the line.
Everybody has been doing their best to get around the crisis. Much elective orthopaedic surgery is now being carried out 10 miles away at Haslar hospital, which is under threat of closure. It was an excellent Royal Naval hospital, but the services have no further use for it, so the
Government and local health management think that it should be closed. However, Haslar now takes 10 per cent. of all orthopaedic procedures formerly carried out at Queen Alexandra hospital, and it has opened an extra ward of 16 beds; meanwhile, a 16-bed ward has been closed at Queen Alexandra, not because of the crisis, but because it cannot recruit the nurses needed to man the beds. What an amazingly topsy-turvy state of affairs.My greatest complaint and the reason that I believe that Ministers, rather than anyone else, must act is that there is no strategic plan for my part of the world. I have told the House about Queen Alexandra hospital and Haslar hospital; now, I shall tell the House about a third hospital in the ring--Lord Mayor Treloar hospital, which is a specialist orthopaedic hospital. Only four or five years ago, £5 million was spent upgrading the theatres, but, for the past three years, the facility has stood empty because the local health authority thinks that it is surplus to requirements and wants to close it. In fact, it is not that the health authority wants to close it, but that the hospital occupies land on which 150 houses can be built which is the main factor in determining its fate. The health authority thinks that it can make some money out of selling the site.
What I mean when I say that there is no strategic plan is that we have one district general hospital in crisis over orthopaedics, another hospital under threat of closure trying to do something to plug the gap, and a third, which has had all its theatres upgraded, standing empty because someone somewhere in the system wants to make money by selling the land on which it stands for development.
It should be plain to the simplest layman that if the work of the three hospitals could be co-ordinated, we could have the district general hospital back to doing its proper job, we could have orthopaedics properly organised so that elective orthopaedic operations could be carried out and trauma cases could be coped with. We could have a sensible and comprehensive policy.
I am not clear who it would be who would organise the co-ordination. I have been to almost everybody. I asked the Prime Minister a question about Lord Mayor Treloar's hospital in the summer, and he promised to look at the matter. The issue went all the way down the chain and up the chain, and we were told that the decision had been taken to close it. Somebody should be examining the strategic way in which we deliver the health service. I know that every Government, including the previous Conservative Government and the present Government, want to do their best for everybody's health. However, I have drawn attention to a situation where resources are being wasted, money is being badly spent, management is not present, hospitals have been closing, waiting lists are growing and almost nothing is happening.
It takes somebody, as did the Under-Secretary, to put a bomb under the issue. The hon. Lady managed to get many things moving. She now needs to be re-armed and to examine the entire management system so that someone will say, "What is going on here makes no sense, let us rationalise and produce a better service for the people who live in the south of England."
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