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7 Apr 2003 : Column 93—continued
7.58 pm
Mr. McNulty: With permission, Madam Deputy Speaker, I should like to respond to the debate.
I do not remember saying that I eschewed the notion of consensus, but I am sure that if it was reported twice, I probably did. I should qualify that by saying on most issues. I would certainly hope for consensus on this subject. I know that we are talking about the money resolution, but it would be remiss of me, as alluded to by the hon. Member for Runnymede and Weybridge (Mr. Hammond), if I did not endorse what he said about previous attempts to secure such legislation on both sides of the House. It is by no means a partisan measure and I am more than happy to acknowledge, as I did on Second Reading, the role played by the hon. Member for Solihull (Mr. Taylor), the former hon. Member for Mid-Kent and Faversham and my hon. Friend the Member for Coventry, South (Mr. Cunningham). I look forward, in the nicest possible way, to the hon. Member for Runnymede and Weybridge or his colleagues probing my hon. Friend the Member for Ealing, North (Mr. Pound) in Committee, with all that that entails.
The money resolution, and the cost structure in the impact assessment, have to be seen in the context of a range of other things. It is inappropriate to pooh-pooh advice given in pamphlets—although I am sure that the hon. Member for Runnymede and Weybridge was not doing that. "The right hedge for you: a guide to choosing a garden hedge" was an important piece of work, although it may well be that it should have followed legislation rather than preceding it. Nevertheless, through that sort of advice and information pack, we are trying to work closely with local authorities. There will be guidance on the legislation—it will not simply drop from the sky—and it will include guidance on how local authorities might assess the various issues that may be raised by complainants. That guidance will be widely available. There is a desire for some degree of education and awareness-raising, as well as simply legislation.
Mr. Chope: Will the Government issue draft guidance to be considered at Committee stage?
Mr. McNulty: As I said throughout the stages of the Planning and Compulsory Purchase Bill, I hope that
such draft guidance will be issued. That is the best way of doing things and I will do all that I can to ensure that that happens. I may stretch that guidance to include other things as the Bill goes through both Houses, but I will ensure that it is available at some stage—Committee stage or Report stage—in this place. It will be an important element of scrutiny.The hon. Member for Runnymede and Weybridge—I apologise for nearly saying Runnybridge and Weymede—was right to say that this Bill is not about banning high hedges. The Bill is about putting in place a regulatory framework for mediation. The costs reflect a stand-alone mediation process. With previous legislation, difficulties with costs and effectiveness have arisen. Part of the reason for that has been that measures were tagged on to the criminal trespass regime, the planning regime or other regimes, rather than—
Madam Deputy Speaker: Order. I will treat the Minister in the same way as Back Benchers and ask him to relate his remarks to the additional costs for local authorities.
Mr. McNulty: I will do that, Madam Deputy Speaker. I was going to refer to the costs of a stand-alone system of mediation as opposed to a system attached to the planning or criminal trespass regimes.
The elements that are referred to in the regulatory impact assessment relate to evidence from previous consultations. The 20 per cent. figure for the rate of appeals is higher than the 5 per cent. figure that was used in previous regulatory impact assessments; and it is double the rate of appeals in cases of nuisance—an equally important and troublesome area—and some seven times the rate of appeals in planning applications. I would not describe this as a third-party right of appeal; it is a mediation process, and it takes two plus the mediator to tango, as it were. We have inflated the figure to 20 per cent. rather than using the lower figures because the fact that each party can appeal against the mediation will be reflected in the costs.
Mr. Hammond: I have never seen the Minister dance but the mind boggles at the thought of two plus the mediator tangoing. Will he tell us about the costs of appeals? Will a disincentive to appeal be put in place through the possibility of award of costs against the appellant?
Mr. McNulty: As I said earlier in response to the hon. Member for Christchurch (Mr. Chope), there will be regulations for the fee structure and all the other elements if the Bill is successful. Those regulations will be available in draft form and they will certainly be consulted on before they are presented to the House. One assumes that they will reflect the evidence of cost structures that we already have. Despite protests from hon. Members on both sides of the Chamber, that evidence remains the evidence of the 1999 consultation. The structures will have to include some kind of disincentive to prevent capricious or vexatious appeals after the mediation process.
Hon. Members should bear in mind the fact that costs are calculated in the context of the mediation service actually working. It would be remiss of us to make
calculations assuming a 90 per cent. or 100 per cent. appeal rate. There is also a tripwire because the local authority will not entertain the mediation process unless it is clear that the complainant has exhausted all other means available. There will not be an open house: if someone does not like the leylandii or whatever other kind of hedge next door, they will not be able simply to bung in a complaint to the local authority and expect it to succeed. Things will not work in that way. We intend a stand-alone mediation system.Many of the issues that hon. Members have raised are worthy of further exploration in Committee. Based on the evidence, we believe that the statements in the regulatory impact assessment on costs to local authorities and appeal authorities, and the assumptions in the assessment on the costs of subsequent appeals, are correct. I will not be tempted down the route of a debate on clause 20 on definition and scope. Those issues can and should be investigated further in Committee. That is route, not root, I hasten to add. Any shortfall in our calculations will be covered by the Office of the Deputy Prime Minister under the new burdens principle and through a system that has yet to be determined but which will embrace both elements of the financial regime for local authorities.
I take the point about the difference in the impact on rural and urban authorities, or on urban and suburban authorities. That difference will have to be reflected in any assumptions that are made in the financial regime. However, we are talking about a significant cultural change.
Mr. Chope: I am grateful to the Minister for referring to the different impacts. Will he go further and address the concern of East Dorset district council, which does not receive any formula grant funding at all? How will that council be reimbursed?
Mr. McNulty: We are talking about a money resolution but I cannot be drawn on whether East
Dorset district council receives grant or not, or on what its proportions are in terms of the national non-domestic rate and the rate support grant. That would lead me into money areas that would cause you, Madam Deputy Speaker, quite rightly to pull me up again. I know that "pull me up" is not a very parliamentary term but it was the best that I could think of. However, shortfalls will be covered. Opposition Members do not seem happy with that comment, but it was an attempt to answer the question that they have rightly asked.The thrust of the Bill and the associated money resolution is rooted in evidence. The Bill covers a very important issue and we intend, through consensus—however much it sticks in my throat to say that—to secure its passage through the House with the appropriate costs to the public purse, which will be reflected in the money resolution and the regulatory impact assessment.
- That, for the purposes of any Act resulting from the High Hedges (No. 2) Bill ('the Act'), it is expedient to authorise the payment out of money provided by Parliament of—
(1) any expenses incurred by the Secretary of State in consequence of the Act; and
(2) any increase attributable to the Act in the sums which are payable out of money so provided by virtue of any other Act.
Broadcasting
- That Mr. Brian Jenkins be discharged from the Broadcasting Committee and Jim Sheridan be added.
Standards and Privileges
- That Mr Alan Williams be discharged from the Committee on Standards and Privileges.—[Mr. Jim Murphy.]
Kent and Canterbury Hospital
Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]
8.9 pm
Mr. Julian Brazier (Canterbury): I am delighted to have another opportunity to extol the virtues of a great hospital and its dedicated staff. It saddens me, however, that, after five Adjournment debates, so many years of public outcry and protest and so much evidence, the future role of the Kent and Canterbury hospital should still be in doubt.
It is perhaps worth looking back at the beginning of a long, sorry saga that affects a hospital that has served the local community and, through it specialties, the wider region so outstandingly well. The story started in 1996, shortly after the opening of the new development at Margate—the Queen Elizabeth, the Queen Mother hospital—when the then East Kent health authority, EKHA, made a proposal to run down the children and maternity units at the Kent and Canterbury hospital and focus them on two other sites.
EKHA's argument for that dramatic change was the need for concentration to ensure that training recognition continued with the royal colleges. I should say that no royal college has threatened to remove training recognition at any point from the Kent and Canterbury hospital. At that time, the Kent and Canterbury was by far the most efficient of the seven hospitals in Kent. In 1995, a national league table showed that it was the third most efficient hospital in England.
The proposals for that partial run-down were firmly rejected by the then Secretary of State, my right hon. Friend the Member for Charnwood (Mr. Dorrell), who insisted on a more imaginative approach, whereby the three main sites—Canterbury, Ashford and Margate—carried out joint training. Immediately after the 1997 general election, however, EKHA leapt into a process of fervid activity and within a matter of months, in December, came up with an ill-founded proposal to reduce Kent and Canterbury hospital to a day centre with one solitary ward of geriatric beds.
Battle was joined in earnest. A campaigning organisation—Concern for Health in East Kent—was established, drawing support from prominent figures, including all three political parties locally, and I cannot pay it strong enough tribute to the battle that it has fought. EKHA modified its proposals and decided instead to keep roughly half the hospital, but to close the accident and emergency unit and remove almost all the specialist facilities.
The proposals were put to the then Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). He modified the EKHA proposals yet again, insisting, in particular, that coronary care should be retained at Kent and Canterbury hospital and pledging that it would remain a joint cancer centre with Maidstone. Indeed, that joint centre underpins the cancer outstations at the other five main hospitals in Kent.
After that, EKHA decided that the proposals were unworkable and began the consultation process all over again—jointly this time with the newly created East
Kent hospitals trust. There was another long, bitter round of campaigning, with CHEK leading the way again. Astonishingly, EKHA brushed aside the all the proposals on which it had consulted and introduced an unheard of fifth proposal for a diagnostic and treatment centre at Kent and Canterbury hospital, but it still proposed to focus the accident and emergency units on the other two hospitals, leaving only a minor injuries unit to deal with accidents at Canterbury, while keeping a sizeable bed capacity to cover elective care.Cancer was left out of the document and confined only to an uncosted annexe, and the trust responsible for delivering cancer care at Kent and Canterbury hospital was not even a signatory to the document. For some months, that proposal has now been with the Department of Health, where Ministers are, no doubt, rightly giving it very thorough scrutiny. I am delighted to see the Minister in her place to respond to this debate, as we have exchanged views on a number of occasions. Indeed, last July, the Secretary of State received a delegation of MPs and specialists, led by me, to discuss the proposals.
Fortunately, things have moved on. With the demise of EKHA and the much more open and straightforward approach of the new Kent and Medway health authority, the impetus for change appears to have altered. Since our meeting with the Secretary of State, two important developments have taken place—one national, the other local.
At national level, the Government have published the White Paper, "Keeping the NHS Local—a New Direction of Travel", which represents a reversal of the trend towards ever larger centres and emphasises the importance of access. I welcome the document, which applies directly to our own case. Let me quote two of three core principles; I shall return to the third in a moment. First, it demands a
- "focus on redesign, not relocate".
- "take a whole systems view . . . to exploit the contribution of different hospitals, primary and intermediate and . . . social care providers".
At local level, the parallel development, which is also welcome, is that the East Kent hospitals trust has introduced some interim proposals that represent an important step forward in two respects. First, that document effectively recognises the stark reality that the health authority will not get the money—figures of £100 million, £200 million and even £300 million have been bandied about—required for that sort of radical proposal. As a result, it seeks to build on existing arrangements, rather than on greenfielding. Secondly,
there has been a genuine attempt to engage with medical staff in a way that did not happen in earlier proposals, although that process has been uneven.None the less, even those interim proposals suffer from several severe faults. First, the costings are completely unrealistic, and I confess to having a background in corporate finance. For example, the actual removals cost for each facility is listed at £5,000—less than Pickfords charge for moving the contents of a large house. The building estimates, too, bear no resemblance to reality. In combination, the building cost budgeted—about £15 million—probably amounts to less than the actual cost of relocating one or two of the departments.
The truth is that NHS capital projects have tended to overrun massively, and the most recent in east Kent—the Queen Elizabeth, the Queen Mother project—was no exception. This project would certainly be no exception even on those provisional costings. The net saving for option 3, which would involve the largest move away from Kent and Canterbury hospital and is the only one fully financially assessed, amounts to only £3 million a year. In practice, given the vast underestimate in capital costs and the interest charges inevitably associated, that option would almost certainly worsen the already dire financial position in east Kent, rather than improve it.
Cancer has been excluded, presumably because it is the responsibility of another trust. It is, however, dependent on 28 other facilities provided in the Kent and Canterbury hospital, so it must be brought into the picture.
The most important weakness of all, in my view, goes back to the original flawed proposals for children's and maternity services in 1996. More than a third of the population of east Kent live in villages. Many rely on buses to Canterbury, or on volunteer drivers, many of whom are elderly and, while willing to give their time generously, are understandably willing to drive only so far. Hardly a single village in east Kent has decent access to Margate. One or two provide access by public transport, but most are a long way away.
My right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) pointed out in a speech that many villages that, as the crow flies, are closer to Ashford than they are to Canterbury have decent bus access only to Canterbury. In fact, the vast majority of villages provide the best access to Canterbury on buses. Canterbury is the hub of the east Kent bus system. Moreover, there are two railway stations, one on each of the two main railways lines through east Kent. A number of small coastal towns also have much better access to Canterbury—Whitstable, which I represent, Herne Bay and Faversham. I am delighted to see my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson), who I hope will say a few words later. He has been a stalwart supporter of the campaign.
The number of patients who cannot reach hospitals by buses or volunteer drivers would inevitably increase greatly, even with the interim options; yet the heavy extra cost to the ambulance service, which is already overstretched, seems to have been ignored, perhaps
because it comes from a different budget. The price in lost access to the family and friends of patients cannot be costed—but it will be paid, in terms of a lower recovery rate for patients whose loved ones cannot get to their beds. The truth is that, for roughly half the population of east Kent, Canterbury is by far the most accessible of the three sites.Further problems arise from the consideration of individual service configurations. I do not want to go into detail, but I will say something about accident and emergency services, which are most important and which have simply not been thought through. As I have said, Canterbury is at the centre of east Kent, and Margate is inaccessible. The interim accident and emergency proposals for Margate, however, are flawed in principle. What sort of A and E centre would have no facio-maxillary, no vascular surgery, no ear, nose and throat services and no eye facilities? If that is what is proposed for Margate A and E, surely it is not viable in the long run. Who would want to work in an accident and emergency system that was supposed to provide a full service with consultants, but whose structure was so incomplete?
In fact, the interim proposals leave east Kent with only one real, long-term A and E centre, at Ashford. Ashford is an important place and is expanding, but it also happens to be the only place in east Kent with excellent road access to another A and E service—at the huge hospital at Maidstone, just 15 minutes up the motorway. It is surely ridiculous to propose that east Kent's main A and E facility should be at Ashford, the only east Kent population centre with really good access to west Kent's premier A and E centre.
Two weeks ago there was a multi-car pile-up at Brenley Corner in the morning fog. Mercifully, there were few injuries, largely because of the extraordinary bravery of a crane driver who risked his own life to avoid the crash. Had it not been for his heroism, there would probably have been many serious casualties. That is the view of the ambulance service; it is not just my view.
Where would those people have been sent? Getting to Ashford would have meant a long, slow journey down a tiny country lane. Had Canterbury lost its A and E centre, would the ambulance crews have ended up picking and choosing according to category? Would those with minor injuries have been taken to Canterbury—by far the closest destination—while those with facio-maxillary, vascular, ENT or eye injuries were sent to Ashford, the least accessible point, down the little winding country lane? The rest, presumably, would have gone to Thanet.
It is worth considering overstretch, which has featured so much in the national press. Last year, sadly, east Kent repeatedly made the national news with stories of people in their eighties and nineties waiting for two or even three nights for a proper bed in A and E. Blind statistics hide the individual humiliations and tragedies of people such as Connie Jones, who, in her nineties, waited two days for a bed, and octogenarian Ray Gilson. His family, who have owned a little seafood shop on the Whitstable waterfront for many years, in desperation scraped together the money to get him into the Chaucer private hospital so that he could spend his last few days in some sort of dignity rather than hanging on without a bed in A and E.
Mercifully, this year the overstretch has been greatly reduced, partly through some innovative changes in the hospital, for which the hospital must take due credit, partly because of extra money that the Government have provided and partly because of a considerable shifting of the burden on to our community hospitals, which hitherto have provided an excellent service, yet find themselves increasingly struggling to meet the extra challenges placed on them by the acute hospitals—challenges that they are not equipped to face. I have never had a complaint about the Whitstable and Tankerton hospital, until the past year or so, when there has been a drip-feed of people saying that it is overcrowded and overstretched. Interestingly, there are also signs of over-administration under the new arrangements.
The worst case that I have received in the past 12 months involves the Queen Victoria hospital, the cottage hospital in Herne Bay, and the interface between the Queen Victoria hospital and the Kent and Canterbury. I do not wish to go into the details of the case here, save to mention that my constituent, Mrs. Florence Jones, a 73-year-old suffering from dementia, twice fell over while she was at the Queen Victoria hospital awaiting an operation at the Kent and Canterbury because she was not escorted to the lavatory, and on the second occasion she broke her wrist. She suffered a multiple fracture. She was left for three days, apparently without fluids, and has, sadly, died. Her son and daughter brought the case to me.
The extent to which inappropriate problems are being pushed on to our community hospitals, and the extent to which the interface is not working, are partly demonstrated by the administrative muddles in the paperwork in that case as it went to and fro, but, worst of all, by the fact that Mrs. Farnham, Mrs. Jones's daughter, virtually had a stand-up fight in A and E to prevent her mother from being transferred back to the Queen Victoria from A and E overnight, when her operation was delayed until the following morning.
I do not want to criticise any medical or nursing staff at the Kent and Canterbury. They are desperately overstretched. So many former patients have had so many words of praise for them over the years, right up to the present time. However, we must recognise that we are still desperately short of capacity, and any proposals for capital expansion must take full account of the fact that, with our huge financial overrun, we cannot afford a further debt burden and the interest charges that that would bring.
We must also recognise that Canterbury is not just the most accessible site in Kent, and the one with the concentration of regional specialties, but remains the main centre for surgery in east Kent. I have a graph of surgical operations at the main hospitals in east Kent over the most recent 12 months. Of the in-patient cases—the major surgery cases—Canterbury carried out more surgery than the William Harvey hospital in Ashford in every month of the past 12, save one. In some months it carried out as much as a third more than the William Harvey.
Compared with the Queen Elizabeth, the Queen Mother hospital in Margate, the disparity is much greater. In the two most recent months for which figures are available, January and February this year, the Kent and Canterbury carried out 1,466 in-patient operations,
almost double the 802 achieved by the Queen Elizabeth, the Queen Mother hospital in Margate, yet it is Kent and Canterbury hospital that is threatened.I am anxious that this should be a constructive exchange, and I welcome the willingness of Ministers to discuss the problem. I particularly welcome the fact that the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), has been down to see for herself. Her Government's new framework is based on looking at services as a whole and—I quote again—"redesigning, and not relocating". It is time to realise that Canterbury is by far the most accessible point in east Kent. It has the hospital with the greatest success in recruiting medical staff—a hospital that continues to remain the premier surgical facility and is the centre for all east Kent's regional specialties.
I do not think that anybody still thinks that the proposal that theoretically remains before the Secretary of State will ever fly, not least for cost reasons. It is time to bring to an end this five-year saga of proposal and counter-proposal, and to all the misery that that has brought to our overworked staff at the hospital. We need to build on what we have in our three acute hospitals in east Kent and focus on reinforcing strength—and by far the strongest hospital is the Kent and Canterbury.
The good things that can be picked out of the trust's interim proposals should be picked out, including ideas for consolidating one or two services at individual hospitals where that can be done without compromising interlocking dependencies. Any change must be implemented in a way that leaves our acute health facilities available where patients can best get to them without saddling our local budget with the heavy interest charges that come from huge capital spending.
In the words of the third guiding principle of "Keeping the NHS Local", options for change should be developed
- "with people, not for them, starting from the patient experience"
- "working with staff to find new ways of delivering services."
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