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Kent and Canterbury Hospital
Motion made, and Question proposed, That this House do now adjourn.—[Angela Smith.]
7.10 pm
Mr. Julian Brazier (Canterbury): I am grateful for the opportunity to raise once again the future of Kent and Canterbury hospital and of acute health services in east Kent. I am also grateful to my hon. Friends, including my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson) and the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt), for coming to support me here.
Since my last Adjournment debate, four formal options have been put forward and the consultation period has just closed. The crisis in our hospitals has worsened. I believe that all four options put out to consultation are dangerous, and that the formulation of those options—the process before consultation—was hopelessly flawed.
Time restricts me to describing just four factors this evening. The first is the failure of East Kent health authority and the East Kent Hospitals Trust to relate the issue of capacity to that of affordability. The second is their failure to include cancer. The third is the lack of support for, and consultation with, the medical and nursing staff, and the fourth is the issue of access.
Let us start with capacity and cost. Last year, 81 consultants—almost half of those in all three sites in east Kent—supported a motion stating that the quality of patient care was being undermined by a shortage of capacity. More than four fifths of junior doctors across the three sites signed a letter making a similar point. Since then the position has worsened. Individual cases, such as those of 97-year-old Connie Jones and 82-year-old Arnhem veteran Bill Holman, both of whom were left for two nights on trolleys in our accident and emergency unit, are sad examples of the worsening crisis. The queues outside the casualty departments at all three east Kent hospitals continue to grow. On some nights recently, we have had as many as 50 trolleys in the Kent and Canterbury hospital casualty department. Colin Baker, the distinguished ITN war correspondent making a programme for Trevor MacDonald, said that the situation was as bad as a Balkan battle zone. He should know; he was wounded in one.
Elective surgery has been disrupted to the extent that operating theatres are under-utilised due to a lack of beds. I shall give one example from the many. Yesterday I received a pitiful letter from a constituent who has had her hysterectomy operation—needed because of desperate bleeding—cancelled for the fourth time. Surely the most important issue for the consultation should have been to show how the revenue costs of each capital option would allow room for the extra beds that we so desperately need. Instead, all the options have been presented without any capital costing. There are no financial figures. Instead, the management continue to promise that their plans will allow for 175 extra beds. Asked about funding, they simply say that that is a matter for their political masters.
It will come as no surprise to you, Mr. Deputy Speaker, or to the lady Minister, whom I welcome to her place, to hear that it is not my job to defend a Labour Government. It would, however, place an unreasonable demand on any Minister of any Government if the management were simply to say that they were going to engage in a
programme of colossal capital spending—with all the revenue implications that that entails—and that the funding consequences were a matter for Ministers.Estimates for a less radical option A—the so-called Dobson option—have risen from £102 million to £150 million. The average overrun for larger private finance initiatives has been about 30 per cent., which would raise £150 million to £200 million. However, that would fall a long way short of the cost of the most radical option, option D. A typical annual PFI costs about 10 per cent. At a time when the south eastern NHS budget is desperately overstretched, can such a burden be afforded, even without adding any of the extra beds that we desperately need now?
My second point is that the cancer centre has not been included in the consultation process, although the document includes an appendix on cancer and Professor James, the director of cancer services in Kent, appeared at all the consultation meetings. He said again and again that he was determined to keep a full cancer centre in East Kent. He further told us that all three oncologists at Kent and Canterbury hospital—he referred to them by name—fully supported him and the plans in the document. Above all, he stressed that, with an oncologist post vacant, they could keep the oncology centre going with its new linear accelerator only if a positive atmosphere was generated to attract new blood to Canterbury, and we all agreed on that last point.
Unfortunately, the truth is that two of the three consultants to whom Professor James referred had already put their vehement opposition to the proposals in writing in public letters some weeks before, and the Minister has those letters. They pointed out the clinical dangers in the approach. I understand that the third oncologist has now denounced Professor James for misleading the public about her views.
The national cancer director, following a visit to the Canterbury oncology centre, has also refused to endorse the concept. He said in his letter only that "It might work". In fact, the text rules out keeping a cancer centre under two of the four options, and even says:
- "For the longer term it is not possible to guarantee the continuous medical support . . . that is required for safe inpatient radiotherapy and chemotherapy services in Canterbury."
The third issue is the exclusion of so many doctors and nursing staff in the formulation of the four options. No proposal is likely to work unless those that have to deliver it feel committed to the outcome. Obviously, that does not mean total consensus. However, everyone must feel that they had the opportunity to put their point of view, and a reasonably large majority of the doctors and nurses involved must agree with the broad outline of the outcome.
Mr. McNee is a urology consultant who is based not at the Kent and Canterbury but in Ashford. He said:
- "I am extremely angry about the consultation document. I first came across it at 11th January 02. My clinical director Robert Insali had not seen it until I showed him. . . . At no point has there been any discussion with the body of urology consultants."
The pattern among consultants is repeated among the junior doctors. All three East Kent branches of the Royal College of Nursing, Canterbury, Thanet and south eastern, have come out against the proposals in a joint document, which states that
- "the RCN believes that the proposals could fundamentally undermine future quality of care for patients in East Kent, particularly older people".
Is this the way to treat dedicated professionals? They are the very people who will have to deliver the quality health care that we need in East Kent in the future. Is that the way options should be formulated?
Finally, I turn to the question of access. Canterbury is the centre of east Kent, the hub of the bus and rail system. Canterbury and Faversham GPs belong to by far the largest primary care group in east Kent. They have voiced their opposition to the proposals in the strongest possible way. Both Dover and Shepway district councils faxed their replies to me this afternoon, rejecting all four options. One council calls for an independent review, and the other uses similar language. I understand that all the councils in Kent, apart from Ashford, have demanded that the cancer centre be kept in east Kent, and in practice that has to mean that it be kept at Canterbury.
The independent hon. Member for Wyre Forest (Dr. Taylor) has asked me to pass on to the House his apologies, as his broken arm prevents him from attending this debate. He is organising a rally for 25 March to get new thinking into emergency provision, based on ideas from the Royal College of Physicians. I hope that Ministers will listen to him.
In summary, the formulation of the proposals is deeply flawed. Many of the crucial people—the doctors and nurses who have to deliver the services—appear not to have been consulted. The cancer centre was excluded from the process, and its needs were pushed in a cowardly and unsound manner into the back of the document. Issues of access were simply glossed over.
Above all, the desperate and growing capacity crisis has been simply ignored. A fig leaf of nominal extra beds has been produced, while the authors of the proposals have ducked away from considering whether the proposals will allow us to fund even the existing number of beds, let alone some extra beds.
When the proposals come before the Minister and the Secretary of State, I urge that they be sent back to East Kent health authority, which will dissolve at the end of the month. I hope that the Minister will ask its successor authority, the new Kent and Medway strategic health authority, to start again with properly formulated proposals based on consultation with the doctors and nurses who will have to implement them.
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