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Mr. Peter Viggers (Gosport): This short debate allows me to raise an issue in which I have long taken an interest in the House. I spoke on defence medical services when we had six military hospitals. I expressed concern and alarm when, under the previous Government, that number was reduced to three, as I did when "Defence Cost Study 15" decided that there should be only one military hospital, the Royal Hospital Haslar in my constituency.
I wish now to articulate the anger and distress caused not just in my constituency and the locality but to all who have an interest in defence medical services and in defence generally by the fact that the Government chose to announce that the Royal Hospital Haslar would close, as they originally said, not before 2002. That crass and incompetent decision had to be reversed almost immediately when the Government realised that it would be impossible to close the hospital without finding alternative medical care in the locality, and that the proposed expansion--through a PFI bid--of the Queen Alexandra hospital, Cosham could not be completed in less than five to seven years.
For those reasons, almost immediately after the initial statement that Haslar would not close before 2002, an announcement had to be made that it would stay open for five to seven years. That original decision caused such consternation that almost irreparable damage has been done to defence medical services--I say "almost" because I believe that there is a way ahead and I hope that the Minister will take note of it.
This is not a simple plea against a hospital closure or for hospital development. I listened to the end of the debate that was instituted by the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt), talking about his local hospital. Haslar is the local hospital in my constituency. This is a more important, national issue, because Haslar is a military hospital. As one would expect, the United States has many military hospitals. France has 15, but the United Kingdom has only one, which is Haslar. It was selected under "Defence Cost Study 15" to be the single military hospital. The plan was never fully implemented. It was to expand Haslar from 180 beds to 350 or 320. If it had been implemented, we would have had strong medical services. It was not implemented, and the number of beds remains at about 180. As a result, a great deal of damage has been done to defence medical services and to medical care in the locality.
The special feature of Haslar is that the throughput of patients, to provide sufficient throughput for the practice of doctors and nurses and other medical staff, needs to be both civilian and military. To that extent, Haslar is unique. Military staff have front-line duties that may need priority from time to time; to that extent, too, Haslar is unique. The medical staff who are training and practising there must be accredited by the royal colleges, who have strict rules about the amount of training that is required of trainee doctors and the maintenance of training by existing doctors. That imposes a breadth of experience and training on all at Haslar and in other hospitals and, to some extent, a requirement for split-site working to which the royal
If there is a cadre--a corps--of individuals whose first responsibility is in the front line of battle and they are taken from their civilian milieu, it will obviously be necessary to have a reserve somewhere in the United Kingdom. We knew that it would be difficult to cope with defence medical services. There is no satisfactory accountant's answer, no cost-efficient response: we must have a reserve of doctors and nurses.
Those who saw the decision in "Defence Cost Study 15" in 1995 that the Royal Air Force hospital at Wroughton and the Cambridge hospital at Aldershot were to be closed, may reluctantly have decided that their future careers lay in the Gosport area of south Hampshire. When they, their families and children moved to south Hampshire, although they may have been reluctant initially, they found it an agreeable place to live and would not willingly move again to Birmingham. The Government's proposal to establish a centre for defence medicine in Birmingham will not be popular. The Government--who have no Defence Minister who has served in the armed forces--have misread the motivation of defence medical services.
Recruitment has turned up a little in the past year or two. That is not surprising, because the armed forces give excellent training to trainee doctors and good pay during training; the way of life is attractive and the experience varied and exciting. One can imagine why many younger people find it attractive to join defence medical services for their training during their first 10 or 15 years of medical experience. When fully qualified, however--at consultant level--their motivation is different. They no longer wish to be deployed at short notice to the Falkland islands or to Kosovo and on return to be told that they are going back again. No; they need to be retained by a different motivation. They want greater stability, they want to be sure that their career plans are working their way through and they want to be fully and sensibly employed for the skill that they have. If, as is happening now, they are more frequently deployed overseas because of shortages, that will make them less willing to remain in the armed forces. They will not be retained by the Ministry of Defence hospital units.
These units, previously at Derriford, Frimley and Peterborough--now at Northallerton--do provide the medical experience and the training that doctors require. I would not fault them on that. What they do not provide is the ethos, the services' camaraderie--the reasons why people join defence medical services rather than qualify in the national health service as civilians.
I have raised this issue previously with Ministers and responsible individuals in the MOD and they say that they are satisfied with MOD hospital units. They must be talking to people other than those whom the Select Committee on Defence talked to when it visited Frimley and Peterborough. During our visits we were told, by all those to whom we spoke--every single service man and woman--that the MOD hospital units were
Mr. Viggers : I see that my hon. Friend agrees with that point. He has visited MOD hospital units and has visited the Royal Hospital Haslar with me, and has taken a keen interest in the subject. I am grateful to him for his interest, and for the fact that he is present to show support for my submission today.
If doctors are not going to be retained by the MOD hospital units, are they going to be retained through the attractions of the centre for defence medicine at Birmingham? There were high hopes for the centre for defence medicine; we thought that it would provide the clear, leading light to guide medical defence services.
Then we discovered that initially, the centre for defence medicine would be a ward of 32 beds. That will not be the compass that will lead defence medical services out of its present difficulties. I recognise that the centre for defence medicine, as it is based in the University Hospital Birmingham NHS trust, is intended to provide an academic link to the defence medical services and give them an intellectual edge--that is attractive. A 32-bed unit will not be an incentive for individual consultants to remain in defence medical services. They will not be retained by the University Hospital Birmingham NHS trust.
What is happening in defence medical services at the moment? A week ago, the permanent under-secretary at the Ministry of Defence appeared before the Select Committee on Defence. He admitted that defence medical services were arguably the area of greatest concern to the MOD at the moment--as they should be. I am certain that when the Minister responds to this speech, he will say that recruitment is going better than it has for a few years. That is true for junior doctors, but the crucial question is, how many deployable consultants are there in the key areas? The key areas, which the services must excel at if they are to have proper medical cover, are anaesthesia, general medicine and general and orthopaedic surgery.
What are the numbers? The requirement for anaesthetists is 120 and the MOD has 29: a 76 per cent. shortfall. The requirement for general physicians is 51. We have 19: a 45 per cent. shortfall. The requirement for general surgeons is 44. We have 18: a 52 per cent. shortfall. The requirement for orthopaedic surgeons is 28. We have 8: a 71 per cent. shortfall.
There are even worse statistics. For accident and emergency, which one might think is one of the prime requirements for the Ministry of Defence armed forces, the requirement is for 23 consultants, and we have three: a shortfall of 87 per cent. The situation is critical, facing collapse. What is it doing to those serving in the armed forces?
We have more deeply worrying numbers. The number of personnel in the Army who are downgraded for more than a month is 9,144, which is 9.5 per cent. of establishment. The Army is of course also 5,000 under strength, so it is 14,000 people short of full fitness. The comparable figures for medically downgraded personnel in the Royal Navy and the Royal Air Force are around 2,500 and 3,796 respectively.
Those are critical figures, and the Minister cannot be complacent. He cannot say, in the face of such a shortfall of doctors and nurses, and the danger to the armed forces' health, that there is no problem that he should address. Perhaps as a result of a parliamentary question that I tabled about the fitness of service personnel, there seems to have been a desperate attempt to rectify the situation by sending service men to private hospitals. In response, the Minister told me that he could not give details of those arrangements, as they are commercially confidential. If he cannot tell me anything about the arrangements, I will tell him.
The Ministry of Defence is being charged £95 for a consultation at a private hospital, and if that leads to an operation, the Ministry buys that specific item without medical back-up. In other words, if a soldier, sailor or airman goes to a consultation, the doctor advises tonsillectomy and the operation is authorised in a private hospital, the patient will of course get the tonsillectomy and come out. There is no aftercare or general care through the private arrangements that have been made by the Ministry of Defence. Should anything go wrong, the patient will have to have aftercare elsewhere.
Let me take an example. A service man had a varicose veins operation in a private hospital that went wrong. There was no follow-up and he developed sepsis and pulmonary emboli. He had to be admitted to Haslar hospital as an in-patient. There are other examples. Patients have been sent privately for magnetic resonance imaging scans, for ear, nose and throat surgery and for general surgery, when in each of those cases there is virtually no waiting time at Haslar hospital and it would have been possible to perform the operations there. Obviously, all is not well.
I have said little about the civilian need for Haslar hospital, and I am conscious that the Minister is responsible for the Ministry of Defence medical services, not civilian medical care. However, I will say that Gosport, although a peninsula with a tidal flow of traffic, is fully accessible for most of the day, and Haslar is available to those outside the Gosport peninsula. It is intended that the Queen Alexandra hospital will be rebuilt, as I mentioned, under a private finance initiative. However, the Queen Alexandra hospital has had problems recently with its sterilisation plant and for some weeks it was not possible to carry out cold surgery there at all. It has also had management problems. It has unfortunately lost its chief executive and its chairman in the last year.
Much has been done at Haslar to rectify the situation from a civilian and a military point of view. There is at Haslar an accident treatment centre, which seems to be working well. The health authority has agreed a plan whereby the number of out-patients seen at Haslar will be increased from 55,000 to 60,000 a year. May I put it to the Minister that we have a way ahead? I recognise that the Ministry of Defence has signed an agreement with Birmingham to create a centre for defence medicine at the University Hospital Birmingham NHS trust. That is a mouse of an agreement, providing only 32 beds, but I would be seeking to push water uphill if I tried to persuade the Minister to go back on that agreement, which I believe is not being put in hand.
A contract has been signed between the Ministry of Defence and the Portsmouth Hospitals NHS trust to provide a Ministry of Defence hospital unit in south Hampshire. It is needed because of the large number of service personnel in that area.
However, the private finance initiative at Queen Alexandra hospital at Cosham is not likely to go ahead with the military element. There are already problems with the PFI bid at the hospital. There are also planning issues, which may be insuperable. There will certainly be considerable hostility from the local authority over the full PFI bid if it includes the military element. I have already mentioned the management issues and problems at the Portsmouth Hospitals NHS trust and Queen Alexandra hospital.
I maintain that the only way to retain defence medical staff is to provide them with a focus of service interest. They will need that if they are to get the two 200-bed hospital ships in due course. Where better to place that massive commitment--which would imply a significant swing in favour of ship-provided hospital care--and moor those hospital ships than the Portsmouth area? From where should they be supported but Haslar?
I press the Minister to say that he would not object to the MOD hospital unit's remaining at Haslar after the national health service takes over management responsibility for clinical services on 2 April 2001. There is no other way to provide the framework for the defence medical services--their spirit, loyalty, spiritual home and centre. The MODHUs will not provide it; nor will Birmingham. Without it, the decline in the number of doctors and nurses will continue. It would take 25 years to get the defence medical services in proper order again. I said to a senior individual who is responsible in this area that it would take 25 years to rectify the damage, and he smiled thinly and said, "Well, perhaps 15." This is a serious problem, and I urge the Minister to take note of it and respond.
The Parliamentary Under-Secretary of State for Defence (Dr. Lewis Moonie) : I congratulate the hon. Member for Gosport (Mr. Viggers) on securing this debate on the important subject of defence medical services. As the House recognises, he continues to take a close interest in defence medical matters. He has been particularly assiduous in pressing the interests of his constituents, who are concerned about our plans to close the Royal Hospital Haslar.
I reiterate my previous assurances that Haslar will not close until our new Ministry of Defence hospital unit opens at the Queen Alexandra hospital, Cosham. The Portsmouth Hospitals NHS trust plans to develop that hospital on a private finance initiative basis. The timing of the final closure of Haslar and the opening of the new MOD hospital unit therefore depends on the progress made on the redevelopment project. The hon. Gentleman can be assured that we are working closely with both local and central NHS authorities to ensure the appropriate provision of health care services in the Gosport area during the transition to the new arrangements.
I am pleased to say that our plans for close integration with the Portsmouth Hospitals NHS trust are progressing satisfactorily. As part of the plans, the trust will take over the management of clinical services on 1 April this year. The arrangements will be similar to those in our existing Ministry of Defence hospital units, with military personnel integrated with NHS staff. However, we will remain responsible for the infrastructure and support of the Haslar site. As in any other MODHU, the Portsmouth Hospitals NHS trust will pay my Department for service personnel employed in the trust, and we will in turn pay the trust for treating service patients.
We have also reached agreement with the Department of Health on the transfer of funding to compensate for the costs that the health authority will incur during the transitional period for NHS patients who were hitherto treated at Haslar at no cost.
The hon. Member for Gosport expressed concern that current manpower shortages in the defence medical services will affect our ability to meet staffing commitments at Haslar and at the new centre for defence medicine that we are establishing in Birmingham. I can assure him that manpower plans for that centre take account of other medical manpower commitments, and any moves of staff from Haslar will occur only on a carefully planned basis. Our plans for the centre also assume a gradual growth over a number of years in which we expect overall staff levels in the defence medical services to improve. He referred to the provision of a ward in Birmingham as part of a Ministry of Defence hospital unit. In the long term, I anticipate that unit growing substantially. The initial provision is just that: a means of getting the unit started and having our own particular unit attached to the hospital in Birmingham. Over seven to 10 years, the MODHU component in Birmingham would increase in line with the number of staff.
The hon. Member for Gosport rightly expressed concern about the current personnel shortages, to which I have frequently referred in debates over the past year. He doubts our ability to achieve improvements. With hindsight, the cuts made during "Defence Cost Study 15" were obviously too severe, and morale in the defence medical services undoubtedly suffered as a consequence. When consultants are lost, it takes a long time to train replacements. We have given a high priority to trying to restore the operational capability of the defence medical services. The strategic defence review provided for extra money over the four years to 2002 for additional medical manpower and equipment. Our plans for the procurement of medical equipment are on target. Making good manpower shortfalls is much more difficult, because it takes time to train the personnel--eight to 10 years for a doctor to qualify as a consultant.
Levels of recruitment into training are satisfactory. The number of medical cadetships and nurse training places has increased, and we are making progress in meeting the higher figures. The medium to long-term outlook is happier than at this time last year. However, to make a significant impact on manning levels in the short term, we need to recruit more direct-entry, qualified medical personnel, particularly doctors. Recruitment of such personnel has proved difficult in the past, and we are undertaking a considerable amount of work to identify and deal with the barriers that have previously limited our success in that area. We shall shortly be able to put in place arrangements that will encourage already trained and qualified staff to join the defence medical services, and so contribute directly and quickly to easing manning pressures. I shall keep the hon. Member for Gosport and the House informed of progress in that area.
We also recognise the need to improve the retention of experienced medical personnel if we are to achieve a significant improvement in manning levels. We are still losing more people than we would wish through early retirement, although the situation is better than a few years ago. We are, therefore, also undertaking work on a range of measures to improve the retention of staff.
The centre for defence medicine will play an important part in attracting and retaining personnel in the defence medical services. I am pleased to say that this project, which is a core element of our strategy for the defence medical services and which will include academic, teaching and clinical roles, is going very well. We are on track to open the centre formally on 2 April. Many defence medical personnel have shown a keen interest in serving at the centre. The first group were posted there last September. They have been warmly welcomed by their civilian colleagues, and are enjoying working there. By the time of the formal opening on 2 April, some 80 of our people will be serving at the centre, with one ward managed exclusively by military personnel. The centre will then, as I said, build up progressively, especially in its academic and teaching roles, to its full strength over a period of five to 10 years. I believe that it offers exciting prospects as a professional focus for the defence medical services and a facility for promoting excellence in military medicine.
The hon. Member for Gosport rightly referred to the importance of fostering a military ethos among defence medical services personnel and the part that that plays in sustaining high morale in the service. It is especially important that those serving at MODHUs should have access to military facilities and be able to participate in military training and exercises. That also applies to those who will be serving at the centre for defence medicine. I assure him that every effort is made to ensure that personnel at our units are released for military training, exercises and adventurous training whenever possible and that they have access to facilities at local military units, all of which helps to foster a military ethos.
We are working on plans for the development of separate domestic accommodation for military personnel at the new MODHU in Portsmouth, and at the centre for defence medicine. That accommodation will include the usual service mess facilities, which will help military personnel maintain their distinctive identity.
Having visited Derriford and Northallerton in the past six to eight months, my experience, having spoken to medical colleagues about their experiences, is different from that of the hon. Member for Gosport. There is no doubt that teething troubles were experienced when the units were first set up, but I believe that those troubles have been largely overcome. Certainly at Northallerton, the experience gained from the units set up earlier seems to have paid dividends, and staff seem to have adjusted quickly to conditions there, which differ from the conditions where they were formerly. However, we shall keep a close eye on the matter, because it is important to maintain high morale and a military ethos among the staff serving there.
The hon. Member for Gosport also said that, as a result of manpower shortages in the defence medical services, service patients are now waiting longer for treatment. He referred to two aspects; the number of medically downgraded personnel and our use of private facilities in trying to reduce treatment. I am a wee bit sorry to be criticised for taking an initiative that I thought would help. Not many options are available in the short term to make dramatic inroads on waiting lists, and I believe that we have shown an imaginative attitude towards the problem. If the hon. Gentleman wants to bring any individual cases to my attention, I promise him that they will be carefully investigated to find out whether more can be done than is being done at present.
Although we are worried about the downgrading of personnel, it covers a wide range of circumstances. Many--indeed most--such personnel can be deployed on military operations, although not necessarily in the front line. A considerable amount of work is being done to improve our understanding of the cause of downgrading and on the action that can be taken to ameliorate the circumstances. Numbers awaiting medical treatment are only part of the problem. They include personnel who are permanently medically downgraded and have been retained in the armed forces with limited employability because we feel an obligation to people who have given us sterling service in the past.
I am happy to say, in passing, that I have experienced at first hand what is being done in Edinburgh for recruits who become injured. Many acute downgradings are due to skeletal injuries sustained during training. I am cautious about what I say, because it is only too easy to make dramatic claims for medical advances that are not borne out in the long term. However, the initial impression seems to be that the extent of medical downgrading and the length of time for which people are downgraded are dramatically reduced through early interventions such as intensive physiotherapy and access to consultant treatment. I hope that we shall be able to generalise on that experience in the rest of the services over the next year or two to ensure that people who suffer injuries to their knees, ankles or backs return to service as quickly as possible.
The debate has shown once again the importance that hon. Members, and in particular the hon. Member for Gosport, rightly attach to the defence medical services. Before concluding, I reiterate the Government's commitment to restoring the capability of such services. It is essential that the armed forces have the level of medical support that they need on deployed operations. Despite the current manpower shortages, defence medical services continue to meet their operational commitments. Those whom I have met have impressed me with their motivation and professionalism; that applies to reservists, as well as full-time staff. Morale is generally good, although people are anxious about numbers, just as we are. Personnel are beginning to see that there are grounds for optimism about the future of the defence medical services.