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Mr. Mark Field (Cities of London and Westminster) (Con): It gives me little pleasure to introduce this Adjournment debate, because a dark cloud hangs over the very existence of one of this country's oldest and most respected hospitals, St. Bartholomew's, known affectionately and universally as Barts.
That cloud was thought by all of us who represent constituencies in central and east London to have passed by when eight years ago, the Government announced their strategic medical review of those diverse areas. It has reappeared, however, and it is seemingly blacker than ever.
Just before Christmas, the Department of Health announced that it had commissioned a fundamental review of the Barts and The London NHS Trust private finance initiative on the grounds of affordability and need. For a decade or more, the departments of this most respected hospital have been consistently undermined by political uncertainty. Today, the anxiety levels have become almost unbearable for staff, local residents and countless others throughout the NHS, because of the imminent demise of Barts as a leading London hospital.
It seems scarcely believable that this wonderful hospital, founded as long ago as 1123, and in receipt of its royal charter from Henry VIII in the 1540s, may soon be no more. Once again, however, that seems to be the case.
I take no pride in confessing that it was my party, the Conservative party, who when last in government sought to implement the Tomlinson report. The report was predicated on user figures that applied in the depths of the early 1990s recession, and manifestly have not been borne out by the evidence of the past decade and a half. It is of great regret that my party put in place some of the reforms that have so adversely affected Barts and upset the residential population of not only the City, but the whole of London and much of the UK.
Ms Diane Abbott (Hackney, North and Stoke Newington) (Lab): I am grateful that the hon. Gentleman has been graceful enough to acknowledge the role of previous Governments in casting a shadow over Barts. Does he agree that as well as serving people throughout London, Barts has a particular place in the hearts of east enders? That is why we fought a tremendous struggle against the Tomlinson proposals and why we are so upset that now, at the very last minute, the project seems to be in danger.
Mr. Field : I entirely endorse the words of the hon. Lady. Although the Homerton university hospital is closer to her constituents, Barts none the less predates it by several centuries. The same applies to the Royal London hospital and other hospitals in Newham and beyond.
Emily Thornberry (Islington, South and Finsbury) (Lab): Is the hon. Gentleman aware that despite my constituency's reputation, it is one of the most deprived constituencies in Britain? Bunhill ward, which I have the pleasure of representing, is one of the poorest wards in
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Britain. Its coronary heart disease death rate is 60 per cent. higher than would be expected, and it abuts that hospital.
In the Bunhill, Canonbury and Holloway wards, the death rates from lung cancer are 70 per cent. higher than would be expected. We need an expert hospital that plays a central part in the hearts of my constituents. We were hoping to take advantage of our ability to select which hospital we go toand to select the hospital that has for generations looked after my constituents.
Mr. Field : I thank the hon. Lady for her words of support. I once aspired to represent a part of her constituency when I was a council candidate in Islington some 16 years ago. My candidature was not for as impoverished an area as Bunhill, but in spite of that, the electors were still not going to go for a Conservative candidate.
I hope that this issue is of great interest not only to the Minister but to the Government beyond. It affects me, as a constituency Member of Parliament in the heart of London. As has been rightly said, it affects other parts of the capital, too, because the hospital has a tremendous history.
Bob Spink (Castle Point) (Con): Is my hon. Friend aware that the hospital's patients and staff include my constituents? They are deeply concerned, because in treating cancer and heart disease, the hospital has excellent clinical outcomes. They want to see it go from strength to strength, not damaged.
This debate is about marshalling the forces among parliamentary colleagues, such as those we have heard from in the past few moments, not only to ensure the survival of this hospital but to create a valuable future for the benefit of all Londoners and the many medical professionals who will gain valuable experience within its portals in the years ahead.
In April 2002, I hosted a similar debate on the future of St. Bartholomew's hospital. That debate took place on the day of an announcement by the Government of significant new expenditure on public health care funded by many of the taxpayers who make up the daytime population of the City of London. I shall quote from Hansard part of a reply given by the then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), who was at that time most complimentary about the capability of Barts and adamant that its future was secure as a centre of medical excellence, especially for cardiac and cancer care:
"The minor injuries unit continues to operate at St. Barts . . . and will be retained as part of the new development. There is no prospect of its disappearing."[Official Report, Westminster Hall, 17 April 2002; Vol. 383, c. 238WH.]
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): I congratulate the hon. Gentleman on securing this important debate. Does he agree that the key
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question is why the review is happening now, at the eleventh hour, with a cost to the NHS of holding up this development?
Mr. Field : I agree entirely, and the hon. Lady might not appreciate that the Westminster side of my constituency has had a similar problem with the Paddington health campus in relation to St. Mary's, Paddington. Great amounts of money have been spent, as has been well documented, and £100 million will be lost if this private finance initiative project does not go ahead because Skanska has already expended that money, which is ring-fenced from its point of view. As the hon. Lady says, it is inexplicable that a review is taking place at this stage. It makes no sense financially, apart from the other problems to which I referred and shall continue to refer during the rest of my speech.
Barts is internationally renowned for medical excellence. Institutionally, it is equally well-known throughout the nation. I would not mind betting that if we asked people anywhere in the United Kingdom to name a hospital other than their own local general hospital, Barts would be mentioned more than any other. I am afraid to say that it has only been in the 58 years since the nationalised health service came into being that the future of England's oldest hospital has been threatened.
I said at the outset that introducing this debate gives me no pleasure. After five years of representing the Cities of London and Westminster constituency, I am completely at a loss to understand, just as the hon. Member for Hackney, South and Shoreditch (Meg Hillier) was a moment ago, the Government's strategy for the provision of health care in central and east London. Judging from my own postbag and discussions with the many health professionals in my constituency, others share that incomprehension.
In a letter published in the Evening Standard last week, Alistair Wilson, the accident and emergency clinical director of the Barts and The London NHS Trust, put the case on the broken promises to Barts and the London succinctly. He highlighted the crucial capacity offered by the two hospitals during the 7 July bombings last year. One of those bombings took place on the edge of my constituency, by Aldgate tube station. He also wrote about the expectations of what Barts and the London will do when the next terrorist strike occurswe pray to God that that will not happen any time soonor indeed during the London Olympics in six years' time.
The nation is united in its support for Barts as a hospital and as a national treasure. Last week, I met Professor Charles Hinds, who spent his entire medical career at Barts, to discuss the critical importance of the PFI project to the future of the hospital. Without PFI, Barts probably has no future as a medical institution. There has already been huge investment in the new breast cancer centre in the west wing of Barts, which was predicated on the fully-fledged PFI taking place. Without the revenue from a cardiac and cancer care centre at Barts, the entire business case for the PFI, and the work of the Royal London in relation to cancer and heart care, seems to fail.
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Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to my hon. Friend for giving way; he has been generous with his time. Does he agree that following a discussion I had last night with five very senior consultants from the Barts and The London NHS Trust, it seems increasingly clear that the demand for cancer and cardiac care and major trauma at the trust is undeniable? The question that the Treasury raised at the last minute concerns the affordability of the scheme. Does he also agreeI hope that the Minister will respond directly to this pointthat the worst value-for-money outcome for the NHS would be for the project not to proceed at this stage? Major penalties of up to £100 million would be incurred if the project had not proceeded by 31 January, as intended.
Mr. Field : I entirely agree with my hon. Friend. Clearly, there is a financial case, but, none the less, as he has rightly pointed out, even that begins to fall when the facts of the matter are put into place. He also touched on demand. Demand is very prevalent in the parts of London that I represent and that are represented by the three hon. Ladies who have spoken and the hon. Member for Leyton and Wanstead (Harry Cohen), who has not. It is estimated that there will be some 300,000 new residents in the Thames Gateway and a further 100,000 in Tower Hamlets. That is based on the Government's figures for population increase in the east of London. At a time of such planned population increase and with the average age of many local residents rising substantially, the decision to put Barts under threat seems short-sighted in the extreme.
There is no need for us to shake our heads; we need to get together and put the wheels of this PFI back on the rails. I am cheered by the fact that so many Government Members are present today. I understand that they will be making their feelings plain to the Prime Minister in a meeting later tonight with the right hon. Member for Holborn and St. Pancras (Frank Dobson), who was the very Minister who announced the saving of Barts in 1998. I am under no illusions. As an Opposition Member of Parliament there is only so much that I can do. Perhaps I can raise the profile of the issue, but, ultimately, it is for Government Back Benchers to have their say. I hope that it will be clear to the Minister that there is a unity of purpose among all of us who represent this vibrant part of the capital.
The operation of the PFI is causing great grief. It may be expensive, but it is the only funding option in town for our hospitals today. The failure of this PFI in health care, alongside the recent breakdown in the major development in St. Mary's hospital, Paddington, may prove the thin end of the wedge. Other contracts, such as the one operating at the Queen Elizabeth hospital in Woolwich, will bring trepidation to those who are relying on the future success of PFI programmes nationwide for their health care.
In my previous debate in 2002, I made the point to the then Minister that we must have an eye on the decades to come rather than simply on the past. I appreciate that one could talk about the historic importance of Barts, going back almost 900 years, but if we look at the future, even in the past four years the Government have developed quite detailed plans to build many more homes in the Thames Gateway, especially for key
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workers who will be servicing central London day by day. Obviously, we have also won the Olympics bid in the past seven months. Whatever increase finally occurs, the east end of London, as one of the poorest communities in Englandit is the poorer areas where the highest rates of heart disease and cancer occur, as the hon. Member for Islington, South and Finsbury (Emily Thornberry) pointed outdeserves more investment in medical care, not less. It is painful to report the Government's intention to turn their back on the population of the east end of London.
The case for redeveloping Barts and all its services has been made a long time ago and it is now a matter of the Government finding the money and letting that project blossom. Some people may wish to talk up the importance of cardiac and cancer care at Barts, but I want to talk about maintaining the viability of all the hospital's current operations and their importance both locally and nationally.
Four years ago, in the light of the attacks in New York and Washington on 11 September 2001, I challenged a Health Minister on what would happen should a major terrorist incident occur in the City and the important role that Barts and the London would undoubtedly play in the care of the injured. Tragically, such an event came to pass on 7 July last year. I should like to quote again from Alastair Wilson's letter. He said:
"On 7 July thirty major incident trained doctors and paramedics were transported to the sites of the explosions; trauma teams were assembled from all over the Trust to treat the awful shrapnel injuries and amputations caused by the bombswe drew on all our expertise, including our cancer and cardiac colleagues from Bart's many of whom work also at the Royal London because of their interest in trauma care".
Those same people now feel desperately let down by a Government who only seven months ago were happy to bathe in the public's approval of our front-line health care professionals by stressing how their investment had led to such capability in the face of those terrible terrorist incidents. Alastair Wilson's words, and those of his colleagues, speak far more eloquently than anything that I can manage about the importance of Barts and the Royal London acting in concert.
After decades of under-investment in local medical infrastructure, I believe that the people who live and work in the City and the east end of London deserve the centres of clinical excellence and medical care that they were promised. We will all continue fighting to ensure that we achieve them in the years ahead.
Ms Diane Abbott (Hackney, North and Stoke Newington) (Lab): It was eight years ago that the people of the east end and Londoners generally fought a tremendous struggle to save Barts hospital. The proposals then came from a Conservative Government, and we were proud that a Labour Minister for Health was able to announce that he would save Barts. It is therefore with deep sadness that I rise to contemplate yet another threat to the future and viability of Barts and the Royal London.
To remind hon. Members who were not here eight years ago, the argument then, in the light of the Tomlinson review, was that there was too much medical
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provision in London: it was over-resourced with hospitals and health care, and that that was why Barts had to close. It is sad indeed to have to revisit those arguments. However, as colleagues will remind the Chamber, there are pockets of poverty in inner London as bad as anywhere in Britain.
Taking a slide rule or a tape measure to the number of hospitals within the M25 and arguing that London is overprovided misses other factors, such as the high number of refugees with endemic health problems and the logistical problems in London. It is easy to take a ruler and stretch it across a map from Stoke Newington to the Royal London hospital and ask, "Why do these people need Barts when they can go somewhere else in London?" People should try joining a mother with a push chair and a couple of children on the three buses that it takes to get from parts of my constituency to the Royal London to understand how ludicrous that position is. Eight years ago we fought with Ministers about that slide-rule, accountants' approach to medical care. That approach did not consider the need and the endemic problemsincluding the understating of the population in London by the census and other statisticians, and the poor housingyet, on the basis of accountancy rules, said that we had too much health care. However, we are now revisiting the issue.
As I said, Barts is not the closest hospital to my constituency. However, although Homerton hospital has an excellent reputation and is one of the leading hospitals in London, Barts has a special place in the hearts of Londoners, not only because it has been there for so long but because of the high standard of care that Londoners, particularly in the east end, have grown accustomed to receiving there.
Emily Thornberry : Taking the slide-rule approach to consider the future of Barts for a moment, does my hon. Friend appreciate that the current price of the cardiac and cancer care services that Barts provides for the east end and north of London is some £16 million? If Barts were redeveloped under the private finance initiative, that would be £20 millionan additional £4 million. To uncouple Barts from the London PFI would not make a dramatic difference, given the amount of money that we are using in any event. I would suggest that we need not turn our back on the PFI, even under the slide-rule test.
Ms Abbott : I am grateful to my hon. Friend for making that point. Even under the rules of cold-hearted accountants, it does not make sense to decouple the development at Barts from the bigger PFI, which includes the Royal London.
Meg Hillier : Given that north-west London has five hospitals specialising in heart problems, does my hon. Friend agree that it is right that my constituents and hers should also have access to a good heart hospital in the east end?
Ms Abbott : That is right, but I do not want to take the argument forward on the basis of comparison, because that is what got us into trouble in the Tomlinson review. I want to take the argument forward on the basis of
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need, and the need for the services that Barts produces is real and quantifiable. Barts commands a special affection in the hearts of Londoners. They were promised that it would be saved and that they would have world-class cardiac facilities on that site. I cannot believe that my Government intend to go back on that promise now. If, at the last minute, there is an attempt to decouple the Barts part of the PFI from the general redevelopment of London, that will cost the taxpayer money. Skanska, the approved developer, could walk away with £100 million in compensation. What sense does that make?
I understand from Ministers that they are asking for the review at the last minute because the decision was made four years ago and things have changed in four years. Let me tell them that there are not fewer people; there are not fewer ill people nor are there fewer people suffering from heart disease and cancer in my constituency than there were four years ago. What do they believe has become so much better about health outcomes in the east end that they can justify throwing away £100 million of taxpayers' money on compensation to a developer at the last minute?
Miss Anne Begg (in the Chair): Order. I remind the hon. Lady that this is a half-hour debate and we have to allow the Minister time to reply. She already has less than 10 minutes to do so. If the hon. Lady can wind up her remarks now, I should be most grateful.
The review of the Barts and The London PFI at this late stage makes no financial sense. It makes no health care sense. It makes no political sense. I can assure the Minister that the issue goes beyond party loyalties, and that all concerned and involved MPs in London will unite to fight the latest threat to Barts.
The Minister of State, Department of Health (Jane Kennedy) : It is a pleasure to be debating this subject. I congratulate the hon. Member for Cities of London and Westminster (Mr. Field) on securing the debate about the future of Barts. I accept that it is a subject of worry not only to his constituents but, as demonstrated by the presence here of his hon. Friends and my hon. Friends, clearly one of great interest to them. I have been following the debate in the local media, too. I acknowledge up front the role played by Barts and the Royal London in the emergency that faced London last year. No one who watched those events without the great sadness and horror that we all shared could have anything other than admiration for the way in which the staff responded in the circumstances.
I also say up front that there are no plans to close St. Bartholomew's hospital. Barts is renowned internationally for its medical and nursing excellence. It was founded in 1123, well before the creation of the NHS. Today, it provides a range of specialities from a 388-bed facility.
Jane Kennedy : After the interventions that have been made, I have only a few minutes in which to respond to
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the debate. It is important that I reply to the points that have been made. If my hon. Friend will forgive me, I shall press on.
I have been asked to explain why we are in such a situation. For many years, it has been widely acknowledged that there is a need to develop the facilities that are provided through the hospitals. Much of the estate is old and generally in poor condition. It was not designed to support 21st century health care and it is in need of modernisation. I acknowledge that, and I hope that it will be accepted that the Government acknowledge it, too. Departments at Barts and the Royal London are not co-located for efficiency. The buildings do not lend themselves to the implementation of modern models of care. There is a need for new facilities in that part of London.
A scheme of such a size or complexity has not been undertaken by the NHS before. It provides a total of 1,248 beds across two sites. When complete, it will be Britain's biggest new hospital. Therefore, it is right and proper for us to undertake greater scrutiny when the proposals are of such magnitude. We will soon be publishing a White Paper on the future of health care services in the community. We have been listening to what the public tell us about how they want to move some services from hospitals out into local communities wherever it is safe and economic to do so. People want personalised services that are built around their needs.
People tell us that they want more services delivered away from hospitals and closer to them in communities. For that reason, the local NHS in this case was asked to commission the independent review that is ongoing of the proposed redevelopment of Bart's. That is not intended to be a long review or to add costs in the way described; I know that fears exist about the implications of it for the overall scheme. We genuinely want to ensure that we have the right balance of services in north-east London before making a commitment that will last for 42 years, which the health service in London will be expected to meet and which will expand cardiac and cancer services. I hope that the hon. Members for Cities of London and Westminster and for South Cambridgeshire (Mr. Lansley) agree that that is a sensible step to take. Any new proposal must offer the best value for money and be affordable by the health economy.
When the business case was submitted to officials, there were still a number of outstanding commercial issues to resolve. That is not intended as a criticism of the trust or of those engaged in drawing up the bid: it is perfectly normal to have outstanding issues at this stage of the process. However, because a scheme of this size
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and complexity has never been undertaken in the NHS before, it has taken longer than normal, and longer than we would have wanted, to resolve the outstanding issues satisfactorily and to finalise the review of the business case.
Part of that process has resulted in our request to the strategic health authority further to demonstrate the need to expand cardiac and cancer services at Bart's. North East London SHA has therefore commissioned an urgent review to ensure that the NHS in east London has the right hospital capacity to meet the needs not only of east Londoners, but of those in the City of London, who have an interest too. There have been significant reductions in waiting lists in recent years, and a great deal of money has been expended. It would be reckless to go ahead without that proper scrutiny. I hope that those who are debating with me this afternoon agree that we should all be prepared to accept that hospital and community services will, from time to time, need to change if we are to continue to fulfil patients' needs, improve services and meet patients' aspirations as I have described.
Jane Kennedy : If the hon. Gentleman will forgive me, I will not. I would welcome representations from him and his hon. Friends after the debate, but in the few moments that I have left now, I want to reiterate that services should not remain static for ever, but should reflect advances in technology and clinical practice. Throughout the transitional phasethe closing phases of this PFI processstaff involved in the scheme and those who have continued to provide health care to patients have worked tirelessly. I have been taking an active interest in the project, and it is important that I, not with ministerial responsibility for the PFI process but with responsibility for London services, acknowledge how tirelessly the staff engaged in the project have been working. I pay tribute to all those who contribute to the excellent work of these hospitals.
I assure the hon. Member for Cities of London and Westminster that officials are working closely with North East London SHA and the trust to arrive quickly at the best solution for the local health economy. I appreciate the anxiety and interest shown by those who have participated in this debate, and by those who wanted to participate and to whom I have been a little mean. The hon. Member for Cities of London and Westminster was far more gracious in giving way than I have been able to be; it would be my normal practice to give way. However, I have listened to what has been said today and I am reading what is being said by staff at the hospital through the pages of the local press. We are working closely with all concerned to resolve the issue as quickly as possible with the best outcome not only for east Londoners, who are close to my heart, but for everyone who has an interest in the services that these hospitals provide.
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