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Health Services (West London)

2.30 pm

Mr. Nick Hurd (Ruislip-Northwood) (Con): Mr. Taylor, may I be the first to welcome you to the Chair of what I hope will be a constructive debate?

Few things matter more to our constituents than their health and their ability to access high quality care. Things are going wrong in Hillingdon, and the scale of concern is reflected by the presence in this debate of all three Hillingdon MPs. I am pleased to have the opportunity to share some of the problems with the Minister and other Members whose constituency experience may confirm or contradict a sense of growing crisis in west London health care.

North-west London is suffering from two powerful factors that have come into play at the same time. The first is the lack of any credible strategic leadership. With the proposed reorganisation of trusts, it is a problem that may get worse before it gets better. The problem is not just the lack of a strategy, but the failures to listen to patients and local opinion, to back up an opinion with evidence that people can trust, to send consistent signals on which people can rely and to manage competently.

That leads me to the second factor in play—the financial crisis that grips the North West London strategic health authority and the Hillingdon primary care trust, wrestling as they are with some of the largest deficits in the system. I think that at the six-month point, Hillingdon PCT has a deficit of £25 million, although I am happy for the Minister to correct me. The result is a climate of uncertainty and mistrust in an area where people would be the first to admit that they have been relatively lucky over the years. Health funding per capita has been relatively high, if we can trust the official numbers, and residents have had access to some of the best hospitals in the system. We take great pride in living alongside the genius of Sir Magdi Yacoub and the research and surgical teams at Harefield hospital, as they push the boundaries of knowledge and excellence in cardiac care.

Likewise, the local community is deeply committed to the Mount Vernon cancer centre. Some £2 million a year is raised locally for the hospital and on-site charities such as the Paul Strickland scanner centre, the Sir Michael Sobell House hospice and the Lynda Jackson Macmillan centre. They complement the oncology service superbly. For example, the Paul Strickland scanner centre offers patients some of the most sophisticated scanning equipment in the country.

That pride and commitment have been reflected in a long tradition of fighting for what we value. Some 18 years ago, Northwood residents physically occupied for three months the Northwood and Pinner community hospital to prevent it from being closed. In the modern age, the tradition is proudly maintained by organisations such as Community Voice and Heart of Harefield, which under the leadership of Jean Brett ran such a tenacious campaign to expose the weaknesses in the case for the Paddington health campus—a campaign for which the village of Harefield and all who care about the hospital should always be grateful.

That determination and commitment are about to be tested again, because we face uncertainty on three fronts: first, the future of Harefield hospital; secondly,
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the future of Mount Vernon; and thirdly, the fallout from the financial crisis at Hillingdon PCT and the strategic health authority.

I shall start with Harefield, because a key decision is imminent, and there are signs of good sense beginning to prevail, despite what the Minister and colleagues may have read in the Evening Standard last week. Harefield is a recognised centre of excellence as a specialist heart hospital. That was recognised by the right hon. Member for Barrow and Furness (Mr. Hutton), when as a Minister of State at the Department of Health, he acknowledged that

It is one of the few hospitals in the national health service whose reputation extends beyond our shores. The team remains—it always has been—at the cutting edge of pioneer technologies such as primary angioplasty, which means that patients can receive surgery at Harefield hospital within 25 minutes of a heart attack.

Mr. David Gauke (South-West Hertfordshire) (Con): I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) on obtaining the debate. I   entirely agree with his comments about Harefield hospital, and I express my relief that the Paddington basin proposals have ultimately come to nothing.

David Taylor (in the Chair): Order. The hon. Member for Ruislip-Northwood (Mr. Hurd) should be sitting while he gives way to Mr. Gauke.

Mr. Hurd : Thank you, Mr. Taylor.

Mr. Gauke : Is it not remarkable that the Paddington basin proposal reached the stage that it did, with the prospect of it costing taxpayers millions and millions? It had the support of the local hospital trust, strategic health authority and the Department of Health. Was it not the efforts of several hon. Members in this House, including my hon. Friend the Member for Uxbridge (Mr. Randall), who is present today—

David Taylor (in the Chair): Order. Interventions should be brief.

Mr. Hurd : I thank my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) for that intervention. He is right; it was the intervention, not least of Heart of Harefield and colleagues, that encouraged the National Audit Office to take such an active interest in the project. As my hon. Friend knows, the NAO will publish a report in the spring that, I think, will throw a harsh spotlight on the management of that project.

That the team at Harefield hospital achieves what it does is all the more remarkable given the fabric of the antiquated buildings in which it works. That centre of    excellence would have been destroyed by the Paddington health campus project, not least because the staff made it clear that they would not move. That ill-starred project fell over because no credible business case was ever made after six years and £14 million of consultant fees.
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The independent review pointed out that the cost was

The same review pointed out that if appropriate risk management processes had been in place, the project would have been halted or terminated on at least six occasions between September 2002 and the end of 2004. The review made 43 separate recommendations about how such projects should be managed in the future.

Sir John Bourn, the Comptroller and Auditor General, noted in a letter to me that the report

As a result of requests from me and three other colleagues, including my hon. Friend the Member for South-West Hertfordshire, Sir John has decided to make a value-for-money study of the collapse of the Paddington health campus, which will be available in the spring.

Mr. Gauke : Very briefly, many problems came to light because of the hard-working Heart of Harefield campaigners, as my hon. Friend has mentioned. I put on record in particular the tremendous work done by Mrs. Jean Brett, a constituent of mine, who made great efforts to reveal the weaknesses in the business proposals for the Paddington basin project.

Mr. Hurd : I thank my hon. Friend for that intervention, with which I completely concur.

The Comptroller and Auditor General in the meantime has written to the Department recommending that it take the independent review very seriously and publicly respond to it. May I press the Minister therefore to clarify whether it is the intention of the Department to respond publicly to the independent review, and, if so, when and how?

The Paddington campus is now important only in terms of the lessons to be learned from it. It is time to move on, not least because its collapse has left a strategic void just at a time of uncertainty over short-term leadership in west London health. Royal Brompton and Harefield NHS Trust is stepping up to the plate. The new chief executive, Bob Bell, deserves great credit for his vigorous response to Paddington and the subsequent clinical governance review of Harefield hospital—a response that has the support of local stakeholders and clinical staff.

The message is that, basically, the review is clear that clinical outcomes at Harefield are "satisfactory". What is done at Harefield on bed and bench cannot be replicated elsewhere in the short term. The trust needs two sites. Primary angioplasty, for example, is an increasingly valuable local service requiring cardiac surgery, which in turn feeds into the need for transplant capability.

The review rightly points out the inadequacies of the hospital's infrastructure. The trust believes that that can be fixed in the medium term by spending some £20 million, which it believes it can afford to raise off its own strong balance sheet as a result of its competence in managing its own affairs, thereby making no call on NHS funds. It believes that it can fix the clinical isolation argument by specialist recruitment and the formalisation of agreements with local hospitals.
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The message seems to be, "Let's get on with it in the interests of patients and medical advancement." It has a powerful logic that needs to be worked up into a credible business plan, and it seems to reflect a view that it is time for a more practical approach, taking medium-term decisions based on what we know, rather than pursuing grand, long-term visions supported by insufficient clinical data. It is time to back the competent rather than the incompetent. It would be disappointing if that logical initiative fell foul of financial crisis management or power-play in the NHS.

I shall close my comments on Harefield by simply asking the Minister to confirm that the Department has no objection in principle to the concept of specialist hospitals, as long as they have the support of senior clinical staff and a robust business plan.

Moving down the road, the story of Mount Vernon hospital has parallels. Again, it is an acknowledged centre of excellence that has achieved great things for 40 years despite its poor fabric of buildings. Again, the    hospital enjoys wide support throughout the community. During a bitter public consultation, 75,000    people signed a petition protesting at the proposal to close the cancer centre in 2003. Again, I am referring to a hospital that has to live with uncertainty about its long-term future. It suffers from a persistent lack of commitment from the centre and fragmented ownership, with four separate trusts being involved in service provision and commissioning. Again, I am talking about a hospital that is threatened by the latest vogue of medical opinion that the future does not lie in smaller, specialist hospitals, although there is no evidence that patients have been disadvantaged.

We should remind ourselves of the wisdom of Nietzsche, who wrote

Those are wise words. The reality is that we do not know how we will be treating cancer in 10 years' time, but we know that, when the Mount Vernon cancer centre is moved to Hatfield in 2013, as is the current plan, about 1 million people will lose their cancer centre.

Mr. John Randall (Uxbridge) (Con): Can my hon. Friend confirm that, as we speak, the site for the proposed hospital at Hatfield has still not been identified, so not even the planning process can be started?

Mr. Hurd : I thank my hon. Friend for that intervention. He is right that there is tremendous uncertainty about the future of Hatfield, which only compounds the sense of uncertainty and frustration in my constituency about the future of the Mount Vernon cancer centre.

As I said, 1 million people will lose their cancer centre if it moves. The issue crosses borders. The strategic health authority has rejected the option of a walk-in radiotherapy centre at Mount Vernon to replace the oncology centre. It awaits the outcome of yet another review, the access and capacity review. It is expected to send a stark message to cancer patients in Hillingdon
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and Harrow that, if they suffer from cancer and require regular radio therapy and chemotherapy, they must travel to either Hammersmith or Hatfield.

The Minister should be aware that such a choice is   unacceptable for Hillingdon residents. Recently, I   chaired a meeting with local stakeholders and it confirmed that view. The intrepid reporters of the Ruislip & Northwood Gazette have timed the journeys. To either facility, it is a one-way journey time of between 45 and 90 minutes. Last year, my father-in-law died of cancer. He required regular chemotherapy. It would have been unthinkable for us to accept regular journey times of that length on his behalf. It would have exhausted him. I am sure that the Minister would apply the same standards for her family.

If matters are not okay for us, why should they be okay for the 1 million people for whom Mount Vernon is today the most convenient location? Apart from a trail of broken promises, what most upsets local people is the deafness of the centre to their arguments, and a growing feeling that the matter concerns cost reduction rather than patient convenience and care. I emphasise that, on the SHA's own figure, the demand for cancer services is expected to grow by 50 per cent. between now and 2013. The travel times to Hammersmith and Hatfield are unacceptable. The cancer tsar himself admits that we have a shortage of radiotherapy capacity in this country. Calculations by Community Voice involving 2001 data from the national cancer services analysis team make a strong numerical case for at least three cancer centres in north-west London.

Will the Minister consider seriously the option of an additional cancer centre in outer north-west London by 2013? It could be a satellite facility, spoke-linked to the hub. It could be free-standing. It should include chemotherapy, radiotherapy with oncologists and cancer beds on site treating palliative patients, but not necessarily all cancers. Where can it be located? The infrastructure is in place at Mount Vernon. The hospital enjoys superb community support. There is no hard clinical evidence to argue that patients are disadvantaged at Mount Vernon. If there were such evidence, why would the Department be sanctioning the £20 million investment that is going into the site now? During public consultation, the community would express profound anger if that option were not evaluated seriously.

If there is a better site than Mount Vernon, the community wants to receive a signal that the hospital has a long-term future that is relevant to the community, which gives it so much support. A growing voice asks, "Why not look harder at the opportunity to develop co-operation with another neglected and valuable site down the road, Harefield hospital?"

The final worry concerns the fallout from the general state of financial crisis in our local health institutions. Hillingdon primary care trust causes the greatest concern. All three hon. Members who represent the Hillingdon area recently met the temporary chief executive. It is hard to pin down the truth of what has happened. The special factor concerns the impact of Heathrow, and we should be grateful if the Minister received representations on the matter. However, there is a strong suggestion of overtrading over time and inadequate flows of information.
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Can the Minister enlighten us on the current deficit because the numbers seem to swing around? Can she explain the Department's view on what it considers the major drivers of the problem and why it was not controlled earlier? Given that outside help has been called in, will she say when a recovery plan is likely to be proposed and what consultation there will be? Residents are already beginning to feel the fallout. Much valued services have been cut, such as homeopathy, specialist orthodontics, therapy in the community and, most shamefully, therapy in specialist schools.

Mr. Stephen O'Brien (Eddisbury) (Con): My hon. Friend made an important request to the Minister about the current deficit. I hope that she will have the opportunity to gain that information during the debate. Some of the remarks that I have contemplated making depend a little on where we stand in respect of the deficit. If the information is in the room, it would be helpful if it were introduced in the debate earlier rather than when the Minister makes her final remarks.

Mr. Hurd : I thank my hon. Friend for that intervention. Is the Minister in a position to give us an update?

The Minister of State, Department of Health (Jane Kennedy) : I do not have the information in my immediate briefing, but I am looking for inspiration.

Mr. Hurd : I hope that the Minister's inspiration is fast in arriving.

It is felt that worse is to come because the trust is fiddling at the margin of the problem, the cumulative deficit. Several questions spring to mind. First, are Hillingdon residents now to suffer as a result of managerial incompetence? Are the Government sending out a firm message that trusts have to trade their way out of the problem or is there scope to discuss some restructuring of the historic debt if the books are balanced in the current year? Can a primary care trust in such a condition really handle the new responsibilities being devolved by the Government?

Dentistry is of particular concern. I accept that that is not the direct responsibility of the Minister, but I should be grateful if she took on board some specific concerns that may be reflected in other constituencies. First, I am led to believe that the Hillingdon PCT dental budget allocation contains a shortfall of £453,000. I should be grateful for her confirmation in writing about whether that is the case and what the Department of Health intends to do about it at this late hour.

Secondly, there is alarming anecdotal evidence about the intentions of local dentists to quit the national health service, due principally to inadequate funding, but also to uncertainty about whether children and exempt adult-only contracts are being offered. Thirdly, it is a symptom of Hillingdon PCT's apparent difficulty in managing the process that no decisions will be taken on the matter before 22 February, six days before dentists are required to make a decision on signature. Fourthly, I perceive cash flow risks for the PCT arising from the new contracts.

I am worried about the flow of incentives. I understand from local dentists that they are incentivised to send in data on treatments because that is how they
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gain access to NHS funds. However, under the new system, dentists will be sending in data only to allow the system to check how they are performing against contract and to calculate what needs to be deducted from their next gross payment from the PCT. If that is so—I stand ready to be corrected—where is the incentive to send in data on a timely basis? If there is no incentive, does that not carry a cash-flow risk for a PCT that is required to fund the contracted gross monthly revenue until an adjustment is agreed?

We are also worried that any money eventually recovered from inefficient or demotivated dentists will flow back to the Department of Health and be lost to Hillingdon. Is that the Minister's understanding of the position? Even if dentists submit timely returns, I detect significant IT risk arising from the fact that, apparently, every practice will be required to upgrade its software. A recent article in BDA News dated 2 February confirms that:

Is the Minister aware of how many local practices have upgraded their systems in anticipation of the new contract? Does she accept the seriousness of this IT risk in terms of potential system chaos, and also in terms of compounding the PCT cash flow risks?

As I mentioned, Hillingdon PCT is not the only concern. Redevelopment of Hillingdon hospital was two years in the planning. That is urgently needed to improve the fabric of a hospital that has suffered from persistent problems with hospital cleanliness, but the redevelopment has been called in. The community waits anxiously for smoke signals to emerge from the Department of Health. Can the Minister confirm when we can expect some clarity of intention in respect of that development?

On a smaller scale, the proposed redevelopment of the Northwood and Pinner community hospital has been frozen. Back at Mount Vernon, the plastics and burns service collapsed last week, following a number of consultant resignations. In his letter of explanation, the chief executive of West Hertfordshire Hospitals NHS Trust says:

I have tried to throw a spotlight on what is happening in the part of outer west London that I represent.

Jane Kennedy : In respect of the question that was asked of me, the House might be interested to learn that Hillingdon PCT's deficit in the year 2004–05 was £13,470,000. For the current year, the six-month figure is £25,657,000. That is a significant deficit.

Mr. Hurd : I am grateful to the Minister for coming back to me with those data, which confirm the figures I gave earlier.

As I said, I have tried to throw a spotlight on what is happening in the part of outer west London that I represent. I sincerely hope it is not typical, although I note the comments of my hon. Friend the Member for
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Hammersmith and Fulham (Mr. Hands)—he cannot be with us as, ironically, our party leader is visiting Charing Cross hospital with him as we speak—who wanted to raise the ongoing huge deficit at Hammersmith Hospitals NHS Trust, which is running at £37   million, the second largest in England. My hon. Friend tells me that the effect of that is the axing of 200 beds in the trust, 300 redundancies and thousands of operations being postponed. Therefore, it is clear that the situation in Hammersmith at least is also very serious.

I hope that the Minister will respond to my questions and be able to reassure me that the future of health services in my constituency and the London borough of Hillingdon is not as bleak as it appears to be. Labour came to power singing, "Things can only get better." All I can do is quote to the Minister from the front page of today's Ruislip & Northwood Gazette; the headline of an article on dentists deserting the NHS is, "You're Having a Laugh!"

Several hon. Members rose —

David Taylor (in the Chair): Order. Four Back Benchers are seeking to catch my eye, and about 37 minutes remain before I intend to call the Front-Bench speakers. If that fact is reflected on, we will get to hear from more Members.

2.53 pm

Mr. Andrew Slaughter (Ealing, Acton and Shepherd's Bush) (Lab): I congratulate the hon. Member for Ruislip-Northwood (Mr. Hurd) on securing the debate, and on his trenchant presentation of his concerns about his constituency's local health service. However, I congratulate him less on his concluding remarks on the Hammersmith Hospitals NHS Trust, which I intend to address at length, and about which he does not, perhaps, have such expert knowledge. He should not believe everything that the hon. Member for Hammersmith and Fulham (Mr. Hands) tells him about that.

I have the privilege of having two PCTs and two hospital trusts covered by my constituency. Although not all the hospitals in those trusts are within my constituency, they are all used by many of my constituents. I should begin by saying that in each of them I have encountered only the highest standards of clinical care, innovation and research, and I pay tribute to all the staff—professional and otherwise—at the Hammersmith, Charing Cross, Ravenscourt Park and Ealing hospitals, and at Hammersmith and Fulham PCT and Ealing PCT.

The Hammersmith Hospitals NHS Trust is under scrutiny, and for some good reason. I shall address the majority of my comments to that. As the    hon. Member for Ruislip-Northwood said, his comments and mine coincide with a visit by the Leader of the Opposition to one of the hospitals in that trust. In reading for this debate, I have learned about the real performance achievements of the trust's hospitals, and the serious concerns over the deficit and the future of some facilities at Charing Cross hospital. I must also say that there has been a great deal of black propaganda about what is said might be planned. So far as I am aware, no decisions
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have been taken in respect of closing or moving any facilities. In fact, the contrary is the case; there is a continuing commitment to all the hospitals that my constituents use. I hope that the Minister can give me some reassurance on that.

I do not know which of those areas—the achievements, the genuine concerns or the black propaganda—the Leader of the Opposition will address during his visit today. I can only conjecture; my sources within the trust say that when his office contacted them, it did not at first know why he was going, and then said that it was for world health month. That might be right, but the fact that he planned a half-hour visit to a major teaching hospital, and that the clinician he requested to see is the father of the leader of the local Tory group, suggests that the purpose of his visit might be the last of those categories—propaganda. [Interruption.] I am shocked, as is my hon. Friend the Member for Hayes and Harlington (John McDonnell), but that happens from time to time.

The Leader of the Opposition has extended his visit, and I hope that now that he has done so he will see the genuine achievement of staff and management at that hospital in ensuring that—my hon. Friend the Member for Brentford and Isleworth (Ann Keen) had direct professional experience of this in the past—we have teaching hospitals of excellent standard. We should be proud of them, and we should continue to be. I believe that the Leader of the Opposition told the Health Service Journal yesterday that politics should be taken out of the health service. Let us hope that starts with his visit to Charing Cross hospital today, but frankly, from the information I have gleaned, that does not seem to be the case.

Let me talk a little about the achievements before going on to the concerns. It is important to do so, because unless one understands how the health service is being run in west London, it is difficult to see the problems in perspective. The Government are presiding over the largest ever increase in health service funding—a doubling so far, and a tripling by 2008. A substantial amount of that is going into the hospitals that serve my constituency. All those hospitals have achieved the waiting time strictures, such as those of 13 weeks for out-patients and six months for surgery waiting times.

Mr. Peter Bone (Wellingborough) (Con): Regarding the six-month maximum wait guarantee, is the hon. Gentleman satisfied that that has not increased average waiting times for operations?

Mr. Slaughter : It is my understanding that the average waiting time for operations is about eight weeks. It comes somewhat ill from Opposition Members, whose party presided over a health service in which one in 10 people waited two years or more for operations, to criticise this extraordinary achievement of bringing waiting times down over the past seven or eight years, a trend that is continuing. In accident and emergency services, 98 per cent. of people wait for less than four hours and the general waiting time is far less than that. There has been a sea change in the service that my constituents receive from hospitals in the area. Whatever Opposition Members say, that is the real-
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time, every-day experience, and I contrast that with the now abandoned patient's passport, which, nevertheless, was the policy written up only some 12 months ago—

David Taylor (in the Chair): Order. May I bring the hon. Gentleman back to the topic of the debate, which is the provision of health services in west London?

Mr. Slaughter : I am grateful to you, Mr. Taylor; I should not be provoked into bringing politics into the health service in that way.

As I said, all the local hospitals are meeting targets. Let us look at the improvement in the performance of the Hammersmith Hospitals NHS Trust, for example. In the past year, it has treated 13 per cent. more emergency cases, 9 per cent. more elective cases, and 7    per cent. more out-patients. Quite extraordinary amounts of investment are going into such improvements, and into Charing Cross hospital, too. No doubt I will have the pleasure of accompanying the all-party kidney group—of which the hon. Member for Uxbridge (Mr. Randall) is co-chair—to Hammersmith hospital next week to visit the new £40-million west London renal and transplant centre. It is the largest such centre in Europe and has 200 beds. It is a state-of-the-art facility available to all in west London. Notwithstanding that, dialysis and other local services are continuing at Charing Cross hospital and other hospitals in the area.

That combination of concentrating large investment and expertise on particular sites and still having local services available—as was suggested in the recent White Paper—is exactly the sort of development that I welcome. I hope that that will continue in the health service of west London.

Significant investment continues to be made in Charing Cross hospital. There are new lineal accelerators, a new 72-hour day-and-stay surgery unit, new research facilities, and new mental health services. Quite possibly, there will be an emergency clinical decision centre on the site, too. That gives the lie to accusations that Charing Cross hospital is under threat   and will close. There is continued, large-scale investment in that hospital, year on year.

Ann Keen (Brentford and Isleworth) (Lab): On that point, I worked at Hammersmith hospital in 1993, when the Conservative party was in power. The then Secretary of State for Health talked about the future of Charing Cross hospital in market terms, saying that we should let the market decide what would happen to it. That was very different from the discussion taking place today, in which we are consulting the wider public and health professionals in general.

Mr. Slaughter : I am grateful to my hon. Friend. She is tempting me back into politics, because she and I   remember a concerted campaign fought in the late 1980s and early 1990s to save Charing Cross hospital. That was not a Labour party campaign, but a campaign by all parties—although not the Conservative Government—and, particularly, local residents. The site was cynically going to be sold off simply because no investment was being made in the health service at that point. That contrasts with the amount of investment now.
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Of course, I pay tribute to Imperial college, which is a major funder and bringer-in of private funding. The Hammersmith Hospitals NHS Trust, which includes the Hammersmith and Charing Cross sites, has £28 million going into the construction of a clinical imaging centre that is to be completed this year. Also, £63 million from the Medical Research Council is going into research facilities on the Hammersmith site. Those are sums of money and facilities that would make many trusts around the country green with envy.

I have concentrated on the Hammersmith Hospitals NHS Trust, but I should mention the Ealing Hospital NHS Trust; the managing director asked me to point out that it is making a surplus at present.

John McDonnell (Hayes and Harlington) (Lab): A surplus!

Mr. Slaughter : Yes, a surplus. I know, the terminology is interesting. Some £14 million of investment—the largest single investment for that hospital ever—has been made in Ealing hospital in the past 12 months. It has a new cardiac catheter laboratory and a new magnetic resonance imaging unit; it has refurbished wards; and it has firmly dealt with its previous problems. That is the story in west London and across the health service in this country.

I will limit the length of my contribution as you suggested, Mr. Taylor, but I shall now come to the real problems and put them in some sort of perspective. There is a substantial deficit in the Hammersmith Hospitals NHS Trust, but let us not be fooled into thinking that it is a permanent feature, or that the deficit per se is affecting services. The deficit is controlled to the extent that, month on month, the core trust at Hammersmith is breaking even; there is no accumulating deficit.

The deficit is hugely enhanced by the issue of Ravenscourt Park hospital. I do not have time to go into that subject in detail, but I know that the Minister is aware of the issue. The problems that there have undoubtedly been with that hospital have turned a manageable deficit into a very large one, and clearly that needs to be dealt with. I draw that to the Minister's attention, if indeed I need to do so.

The problem has to be dealt with quickly, not least because it distorts the position of the Hammersmith Hospitals NHS Trust and makes the problems there seem far greater. Also, it allows for a great deal of mischief-making about the link between the deficit and the future of services on the site. As far as I am aware—and I would be grateful if the Minister answered this point—there is no such link. Savings are being made through efficiencies, without loss of health services. To someone with a local government background like mine, that is a familiar trend. It may be somewhat newer to the health service; I do not know. Improving patient care and discharge times for orthopaedic and other injuries has meant that substantial savings of some £20 million are being made this year without any loss of service. That is the context. Nevertheless, there is an accumulated deficit, and that needs to be dealt with. I am pleased to say   that the Government have intervened by putting KPMG into hospitals to help address that point.
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I   hope that it is clear that it is wrong to associate that   temporary problem with the long-term future of facilities on the Hammersmith and Charing Cross sites.

In conclusion, my constituents are looking for the following assurances from the Government. They want to know that there will be a continuation, and indeed improvement, of the excellent facilities on the Hammersmith, Ealing and Charing Cross sites. The latter serves a large number of people in the south of my constituency. It has been my local hospital all my life; all my family have been treated there, and some, sadly, died there. In fact, my uncle designed the electrical systems for the hospital, so there are long associations for me.

Everybody in Fulham, Hammersmith and Shepherd's Bush knows the Charing Cross hospital well. It was an NHS site long before the current buildings were there. The site is in the middle of a substantial, quite deprived population area and is accessible. It is an excellent facility and it must stay there, and investment in it must continue. I think that that view is held by all parties. The White Paper model looks for services to be available locally and to be accessible, and that must be right. That is what is provided by the hospital sites, and by other sites in my constituency.

I am delighted that the Hammersmith and Fulham primary care trust has plans for a new collaborative care centre, bringing together diagnostic day surgery and substantial general practitioner practices. That will be adjacent to the White City estate, on the old leisure centre site. A planning application is due to be made very shortly. That is perhaps one of the first examples in the country of how the White Paper proposals will come to fruition. All those are excellent developments, but they must be preserved so that future generations can benefit from the accessibility and the high standard of care provided by hospitals and other health facilities in west London.

Several hon. Members rose —

David Taylor (in the Chair): Order. That is 20 more minutes gone, so there are 16 minutes left and three speakers. I call Mr. John Randall.

3.9 pm

Mr. John Randall (Uxbridge) (Con): Thank you, Mr. Taylor; I shall endeavour to be extra brief. First, I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd), not only on obtaining this important debate but on a speech that was such a tour de force that I really can be brief, as he has already touched on most of the issues.

Hillingdon is a living example of taking politics out of the health service; that is represented by the fact that we three Members representing that borough are here and pretty much singing from the same hymn sheet. It is pretty immaterial to us and our constituents who is in power, as long as they are delivering the services. I pay tribute to the Government for putting money into the health service, as I believe all Governments have done; the problem is what is happening to that money, as we see with the deficits in the PCT. There is no question but that the PCT has a great deal of resources, but we are facing a problem with the deficit.
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As my hon. Friend the Member for Ruislip-Northwood said, we are far from convinced that the PCT has got a grip on where the money is going. If it cannot understand where the problem is, I find it difficult to understand how it will rectify it. I was a little disappointed to see that, however capable he is, the gentleman acting as chief executive was doing it as a part-time job with a neighbouring PCT that also had a deficit. That situation has been changed, but in the meantime, while we try to appoint somebody else—I speak with certain business experience—things could be getting a bit out of control.

In the meantime, my constituents and all of us in Hillingdon have problems with services that are labelled as low priority and are being cut. There are problems with district nurses, getting people seen by an incontinence nurse and with therapy, special schools and orthodontics. I will not go on about dentists, but the Uxbridge and West Drayton Gazette—published by the same group that publishes the Ruislip & Northwood Gazette and the Hayes & Harlington Gazette—is all about dentistry and related problems faced by people. That is a real issue. The hon. Member for Hayes and Harlington (John McDonnell) has been active on that matter. We have all met local dentists. There is a pressing problem, which we must look at.

We want Hillingdon hospital to be rebuilt. The Government were going to do it with a PFI, but that has been called in and I am not surprised. I have reservations about PFI, but if it can be done properly, that is great. We might just sneak out one advantage while this matter is being looked at. I have asked the Department to consider, because of the slippage of time regarding a PFI, whether it might be possible to look again at re-siting the hospital on the RAF Uxbridge site due to be vacated by the MOD. That suggestion has not been dismissed by the strategic health authority.

That site would be much better for everybody in Hillingdon. It would be a wonderful transport centre. Everything would be good about it. There was just the problem of tying it in and not wanting to lose the money that the Department of Health was putting forward, while, at the same time, having to wait for the MOD to vacate. This might be the very moment. It is a once-in-a-generation opportunity. Something positive could come out of the situation. I urge the Minister to consider that.

My hon. Friend the Member for Ruislip-Northwood said a lot about Harefield hospital and Mount Vernon. I back him entirely on that and have done so in plenty of other places, as anybody can read. Just before Christmas, I asked the Prime Minister if he could find out why Health Ministers did not take part in the independent review of what went wrong with Paddington health campus. He said that he would look into that. He wrote me a letter, which just told me that Department officials took part, but not why Ministers did not. I wrote back to say that he had not quite spotted what I was after and found out he had passed the matter to the Department of Health, However, I have not heard anything for a while. If there is any way of stirring that up, I would most grateful if the Minister could do it.

A letter from a local ambulance driver addressed to the hon. Member for Hayes and Harlington and I came across my desk the other day. It is important, because it has implications all across London. I will not name the gentleman, because I did not have time to clear the use
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of his name, but he is asking me to bring the matter up with the relevant Ministers, so I am sure that he will not mind. The letter is to do with the

I am sure that many of us have seen the motorcyclists as well. Although that policy has some potential in the crowded streets of London, it is also possible that there is an agenda, with the trusts wanting to meet their response times.

I do not expect anybody to be completely conversant with my constituency, although the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) spent some time there a few years ago. However, two Sundays ago, I saw some vehicles sitting across the Swakeley's roundabout all day. I wondered what they were; I thought that the local police had put them there because they looked a bit like police cars and that would get people to slow down on the A40. Although I am a layman and do not know, that did not seem a perfectly good use of resources.

There were some repercussions. I think that I shall write to the Minister about this matter, which could have been severe and very serious indeed. I should like the Department and the Minister to consider this, because there is sometimes a danger that managers will get carried away trying to meet the targets. That should be looked at urgently.

I shall conclude my remarks, because I am anxious to hear from the other two hon. Members who wish to take part. I say to the hon. Member for Ealing, Acton and Shepherd's Bush that with regard to the visit next week he has mentioned, I am afraid that his business managers have made it difficult to go on any visits next week.

3.16 pm

John McDonnell (Hayes and Harlington) (Lab): Can I enter this debate in the spirit in which the three hon. Members representing Hillingdon work together, relatively objectively and co-operatively? I congratulate the hon. Member for Ruislip-Northwood (Mr. Hurd) on securing the debate.

I was elected in 1997. I was a member of the Hillingdon health emergency campaign, which was involved in the occupation of Northwood and Pinner hospital. I slept for six weeks in Hayes cottage hospital; well, I picketed it to save it. I was never sleeping. When I was elected, we inherited a system whereby three cottage hospitals—Harlington, Hayes and Uxbridge—had been closed. Hillingdon hospital was also in decline. There had been a lack of investment and it was in a poor physical condition. Despite some investment since then, I think that we all agree that the area needs a new hospital.

The surgeries in my constituency were largely decrepit—they were largely converted houses—and provided appalling conditions in which people worked and patients were treated. There was a staff crisis in terms of recruitment and retention. Since then, we have had investment on a scale never seen before and we appreciate that. In my area, I have opened three new medical centres; I enjoy opening things. Cedar Brook, Hesa and the Townfield medical centres area are
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flourishing. GPs' practices have been refurbished throughout the constituency. We are attracting more staff now, including health visitors, GPs, nurses and so on. We still have the problem that a large number of GPs are retiring within a limited period; we still have that challenge.

Although we lost Hayes cottage hospital, it was reopened as a nursing home and we are now investing in   a blood transfusion service on-site. We are still campaigning for a community hospital in the area. I notice that in the White Paper we now go back to the commitment to local community hospitals. We will be knocking on the Minister's door for some investment on that.

We have a proposal for the PFI scheme for Hillingdon hospital. I agree with the hon. Member for Uxbridge (Mr. Randall). I am not supportive of PFI schemes, but if this is the way to secure the money fair enough. However, there is a blip in terms of the Treasury review of the PFI, and this could be an opportunity not to delay the scheme, but secure it and consider an alternative site. I agree that the RAF site might be available, as long as we can get our act together and synchronise with the MOD.

We have had a flood of investment on a scale never seen before, and I congratulate the Government on that, but sometimes they have to put their hands up to mistakes. I have to say that Harefield and the Paddington basin were a catastrophe. It is best to at least understand how Government got there, admit the mistake and move on. The way to move on is exactly as the hon. Member for Ruislip-Northwood said and exactly as Jean Brett, who was campaigning, said.

I remember John Wilkinson, when he was the hon. Member for Ruislip-Northwood, predicting on a platform, which we all shared, that eventually this scheme would collapse because of bureaucratic inertia and its impossibility. We need to return to investment at Harefield to secure the site, because it is such a site of excellence. I agree with what the hon. Member for Ruislip-Northwood said about Mount Vernon. There is potential to build on existing strengths. We need to look again, but to be honest about the mistakes that we have made in the recent past.

I turn to the issue of the PCT. Given our understanding and the figures that the Minister has given today, it looks as if the problem involves about £30 million. I place on record my tribute to the hard work done by the previous, transient chief executive, Graham Betts, who took a hit for that deficit and resigned. He was an excellent chief executive who managed the system as well as he could and won the admiration of his staff. He was caught in a dilemma partly set by the Government, because of the issues around targets, and partly due to our need to learn lessons about the structures and systems required to ensure adequate control of overall expenditure.

The issue for the PCT is that it is carrying a £30 million deficit. We were advised that by the end of the financial year it could be taken down to about £22 million, but that there would be a historic carry-over of more than £22 million to the next year and probably beyond. That would mean that the whole system being dragged down year on year. I agree with the hon. Member for Ruislip-Northwood that we
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should consider restructuring the deficit. My view is that at some point the Treasury will have to write it off, because its is so large that otherwise it will encumber the decision-making processes of the PCT in the long term.

It looks as if the deficit has been caused partly because the influx of new money has laid down a new range of access points and pathways into care, but there has been inadequate triaging and assessment of how those pathways will link up, particularly at the local hospital. As a result of that, the hospital is building up an excellent service and treating large numbers of patients. The primary care trust has to pay for those patients but has no control over them. Many staff on the ground believe that elements of the service are using it as a simple referral point, partly to overcome their own heavy work loads and partly to shift some elements on the budget.

We need to consider how to change the systems to ensure the management of that budget in future. Indeed, we are doing so; that is why the hit squad went in. We shall never secure that adequate management if we have a continuing deficit on our backs of more than £20 million—or anything between £10 million and £20   million—during the next few years. The three Members who represent the Hillingdon area would be happy to meet the Minister to go through the detail and ascertain what further assistance, such as restructuring the deficit or writing it off, could be given to the PCT.

The issue of Heathrow airport was raised earlier. I welcome the opportunity for the three Members who represent the Hillingdon area, with representatives from the primary care trust and the local authority, to meet the Minister to talk about our special problems in respect of Heathrow. A cost burden falls on our shoulders because visitors and others enter via Heathrow, fall sick and sometimes need intensive support and care, particularly in cases that involve mental health problems.

The cost of that falls on the local primary care trust, the local health service and the body responsible for mental care in the area. We also have Harmondsworth and Colnbrook detention centres, which have quadrupled in size during the past five years. All those costs fall on our local area. We would like to meet the Minister as we believe that we have a justifiable case for special assistance to be provided to our local area to overcome those problems in respect of Heathrow.

At the moment, the problem that needs to be addressed is specific to the PCT. However, I commend the Government for their investment in our area. The staff on the front line have risen to the challenge. Many members of the community appreciate that, and we do not want that reputation to be tarnished in any way by this currently intransient problem.

3.24 pm

Steve Webb (Northavon) (LD): I congratulate the hon. Member for Ruislip-Northwood (Mr. Hurd) on securing this debate and on how he introduced it. We have heard several knowledgeable contributions about the situation in west London. I should like to reflect on
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the level and pattern of provision for that area, and on the issues that have been raised, in the context of national policy.

By way of apology to the two Front Benchers, I   should say that, in the interests of the provision of dentistry in west London, I shall shortly run down the corridor to vote in the Committee that is considering delegated legislation on NHS dental services. The majority of those who have contributed so far will be pleased with how I shall vote in the Division. I hope that they will not think it a discourtesy that I shall not see the end of this debate; I undertake to read the contributions that the two Front Benchers make after I have gone—although I am not sure whether the Minister will be as gracious.

The hon. Member for Ruislip-Northwood properly paid tribute to the international reputation of Harefield hospital, and I am pleased to echo that on the record. The hospital clearly has problems that need to be addressed, but he is right to say that the Heart of Harefield Campaign has done a tremendous job. We need to value our centres of excellence and our specialisms because they are the way of the NHS. Increasingly, the all-purpose district general hospital is under threat. The sense is that more is going to be done in the community.

The hon. Member for Hayes and Harlington (John    McDonnell) mentioned the possibility of not exactly reopening but revisiting the idea of community hospitals in his area. There will be those hospitals and the high-tech specialist regional centres, but I am not sure what the Government's vision is for the all-purpose hospitals in the middle.

The centres of excellence clearly need to be maintained. The hon. Member for Ruislip-Northwood talked about the future of Mount Vernon hospital and his personal family experience of it. For many of us, our experience of hospitals in our area is shaped not only by our professional role, but by personal experience. I was pleased to hear that he saw a place for such provision; he mentioned three cancer centres across the area.

There is a danger of always trading off one constituency against another. For example, we might not want to lose a facility, but no doubt Hatfield wants to gain one. It is important to establish the optimal provision from a clinical point of view. There is a danger in saying, "I want something that is world famous and world renowned and I want it at the end of my street." A degree of realism is needed. I was interested in the hon. Gentleman's idea of using Mount Vernon as a hub, with some satellite or spoke provision. We need to do such creative things to balance the desire for high-quality local services with the fact that inevitably there will be only a limited number of centres of excellence.

I agree with the hon. Gentleman that, when there is consultation on the future of cancer centres such as Mount Vernon and more generally, the broadest possible range of options must be presented to the public. In my experience, there is increasing scepticism about consultations, which are seen as being stitched up before they begin. The hon. Member for Wyre Forest (Dr. Taylor) referred to them as "Blue Peter" consultations—"Here is something we prepared earlier"—that the public are expected to rubber-stamp. Clearly, consultations need to be comprehensive and
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not rule out options before they begin. Critically, decisions about the future of services in west London, as elsewhere, should be about the priorities of the people in the area, informed by the guidance of the clinicians, whose judgment needs to be respected.

My worry about the whole Paddington basin scenario, and a lot of what we have heard today, is the    difficulty of following the thread to who was responsible. In too much of what goes on in our health service, it is hard to pin responsibility and accountability on anybody, particularly anybody whom we could vote out if we did not like the way they did things. Many more decisions about the strategic health framework for a local area such as west London need to be made by locally accountable people—not by Whitehall or unelected and unresponsive health authorities.

The PFI review was mentioned in the context of Hillingdon hospital, although schemes around the country are on hold for the same reason. From what we have heard this afternoon, it appears that there might be a silver lining and that at least the option of an alternative site might be explored. That ought to be seriously considered. However, I share the scepticism of the hon. Member for Uxbridge (Mr. Randall) about PFI, although I accept the practical comment from the hon. Member for Hayes and Harlington: it is the only game in town.

Many of us have to swallow our judgments on such things sometimes. However, the delay is not helpful to anybody, and I hope that the Minister will put on record a clear statement—I shall read it tomorrow—on where the Government are up to on all this. Is the review just routine? I have tabled questions on the subject, and the suggestion was that the review was just to check things through. Is the review more fundamental than that? When will it be resolved? Who is considering it? We need to know, and the people of Hillingdon clearly need to as well.

The hon. Member for Ruislip-Northwood asked whether certain dentistry issues are unique to his area. I think he knew the answer; as he rightly suspects, they are far from that. We have concerns about the implications of the new contract. I genuinely do not know whether he is being too harsh on his PCT for its delay. In many cases, PCTs can move only as fast as central Government have allowed them to. The situation of his PCT may be extreme, but the fact that, as we speak, we are voting down the corridor on regulations to bring in new personal dental services contracts makes me think that central Government have more to do with the delays. His PCT might not be helping, although I do not know about that.

Where do we go from here? The critical point must be to address the issue of deficits. We have heard a plea for them to be written off. We have all got local deficits and we all think that it would be nice if that were done. If that happened in aggregate, it would not be clear where the money would come from. My judgment is that trusts need far longer to adjust where there is financial imbalance. The manic pace of reform and the constant revolution that is creating the instability must be addressed. It might be that trusts need to adjust and that better financial control is needed. Doing all these things rapidly and at the same time is not a rational way to manage the process.
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Debates such as this are helpful because rather than dealing in generalities we are dealing in specifics. Many of the specifics that have been raised in a constructive and cross-party manner illustrate broader points about national policy and the instability that the constant reform is creating, not only in west London, but in the NHS as a whole.

3.31 pm

Mr. Stephen O'Brien (Eddisbury) (Con): I am delighted to have the opportunity for the first time to serve under your chairmanship, Mr. Taylor.

I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) on securing a debate that is important for him, his constituents and those who are equally affected by the issue. It is also timely, given the pressures of decision and the pent-up demands and concerns that exist. I thought his speech was particularly eloquent and discerning. It is clear that he has been unflinching in holding the health service to account at a local and departmental level on behalf of his constituents.

We all know that my hon. Friend is a doughty campaigner for Harefield hospital and for Mount Vernon and its cancer centre. I, too, would add our party's tribute to the Heart of Harefield campaign and Jean Brett, and, equally, to all that has been going on at Mount Vernon, which is also world renowned.

I think that my hon. Friend is the first person who has put on record, at last and through Nietzsche—as he says, it is power not truth—the real definition of the word "spin". We have sought that for a long time.

It was equally powerful to see the three hon. Members who represent the area working in such close harmony on the issues. Such an approach needs to be taken on behalf of constituents and their interests, if we are to be genuine as politicians in saying that we want a patient-led NHS rather than a politics-led one. I hope that many will follow the example that has been in evidence in this debate.

My hon. Friend rightly emphasised that the cuts that the strategic health authority is making in his area are not, as everyone would wish, as a result of patient choice or strategic health planning. We can all understand the pressures, but they are more of a simple knee-jerk response to the deficits that are faced in the NHS, especially the one created by Hillingdon PCT.

I am glad to have the opportunity to cross swords with the Minister, although that phrase does not seem particularly appropriate given all that is being said. We had our first engagement yesterday, in the debate on the Floor of the House about PCT restructuring. Many of the points made then are wholly appropriate to today's discussion. There was a lack of conclusiveness about yesterday's debate because for some reason, which I fail to understand, the Government did not agree with the official Opposition's motion, which would have helped us reach the answer. There was a small exchange during the debate.

At month six of the current financial year, Hillingdon PCT was predicting a year-end deficit of £25.6 million—that was helpfully confirmed by the Minister—which is almost double the 2004–05 outturn. Some £25.6 million represents 9.1 per cent. of its annual turnover. We do
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not know how high the figure has risen since then, as the Secretary of State, having published the figures once this year, is sitting on the updates.

Interestingly, the Royal College of Nursing recently estimated that the expected deficit across the NHS has risen from approximately £800 million in month six to £1.2 billion gross now. By that reckoning, it is not unreasonable to suppose that Hillingdon PCT could be facing a year-end deficit of £30 million—a figure mentioned earlier—or £35 million.

That is important because the strategic health authority's recent board paper gives a month seven figure. It shows a marked drop in the deficit, which is why it is so baffling. We must ensure that we are talking about the right figures. There are consequences of the deficits, about which we debate endlessly and about which Opposition Members rightly seek to hold Ministers and the Government to account. There seems to be a serious threat of implementation of a series of front-line patient service cuts. I accept that it might be that an extract does not necessarily tell me whether I am looking at a gross or a net figure. However, the board paper gives a month seven figure of £12 million.

We must try to get a handle on the matter. The Government have refused to publish more estimates of the NHS financial position—I know that it is an uncomfortable position for them. They said it was

I simply ask the Department to consider carefully revising that. Many of our debates will be hugely dependent in terms of the options and the outturns on the real expectation of the figures. If the Department is working from one set of figures because it has internal, private information and we are examining another set that it has published at month six, we are in grave danger of having a false debate. That would be of no benefit to anybody's constituents.

We must ask ourselves where the deficit has come from. In no small part, the problem has been caused by    the disaster that was the Paddington health campus. The hon. Member for Hayes and Harlington (John McDonnell) mentioned a catastrophe. We eagerly await the National Audit Office's report on the fiasco. In the meantime, some fairly severe criticisms can be levelled at the North West London Strategic Health Authority, the Department of Health and the Treasury.

If fault, or if a cause, is found in the design and implementation of policy, that would be the fault of Government. What flows from that is that the damage should not be visited on the constituents of my hon. Friends the Members for Ruislip-Northwood and for Uxbridge (Mr. Randall) or of the hon. Member for Hayes and Harlington.

There is a thing in Government called the Contingencies Fund, albeit funded by the taxpayer; it is still taxpayer cost. It does not exist only for unpredicted events that need to be funded. Anyone who has been in business—my two hon. Friends to whom I referred have—knows that it is a valid and important self-insurance policy. The self-insurance should be used when the promoter of a policy has found that it is the
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cause of the fault. Blame should not always fall on the PCTs so that local people take the rap for a design fault by central Government.

As my hon. Friend the Member for Ruislip-Northwood referred in depth to the report, I will just pick out a couple of themes that run through it and apply them more generally. In addition, the Liberal Democrat spokesman, the hon. Member for Northavon (Steve Webb), is absent, which is understandable as he needs to vote further down the corridor; I fully support that.

The independent review panel directly criticised the North West London SHA by saying:

Instead, the SHA again unquestioningly signed off the outline business case.

Such an attitude in SHAs across the country has led to the imposition of turnaround teams, at vast and avoidable cost to the taxpayer. The taxpayer has to fund the turnaround teams because of the complete failure of the people who have been employed, also at taxpayers' expense, by the NHS to performance manage—their single task. If they failed at that, they should be sacked so we would not have to pay twice. Such a situation has happened in trusts up and down the country—we know which ones. The SHAs have failed time and again in their performance management responsibilities. Clearly, as we have often argued, they should be scrapped. You and I, Mr. Taylor, had an exchange on the Floor of the House yesterday on that very matter. If they are not up to the task and have no other function, we can see no justification for retaining them.

The Treasury and the Department of Health are each partly responsible for the fiasco. The Chief Secretary to the Treasury had concerns about the project as far back as October 2003, and that led to an independent review, which was not followed up. In January 2005, a Department of Health official wrote to the trusts inviting them to consider project termination, but that, too, was not pursued. I salute the hon. Members who are here today for their concern, and their measured criticism of a very sorry chapter, when they could well have been shrill.

The trusts received different signals from different parts of the Department of Health about whether new space standards for beds were mandatory. According to the independent review panel, the project was also undermined by uncertainty about payment by results. At least that uncertainty has been resolved, albeit with effective stealth cuts for PCTs and acute trusts, as tariff increases beyond the rate of allocation increase. Stealth cuts in funding lead to cuts in patient services, as yesterday's press release from the six NHS organisations in Gloucester recognises. They face, as they put it, "difficult choices" over the coming months—a clear euphemism for cuts in patient services.

Uncertainty is a common theme in today's NHS. The hon. Member for Northavon made the valid point that that is causing deep instability, which is evident in the ongoing debates about drugs, practice-based commissioning and reforms of adult social care. It is especially apparent in the farce of PCT restructuring, a
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departmental initiative with direct bearing on the provision of health services in west London. Nobody in the profession—apparently nobody in the Department, official or Minister—has a clue what the function of the new PCTs is to be, so to talk about restructuring now is farcical. Not only is the situation creating uncertainty among health professionals; it is seriously hampering joined-up local government, because social services and other council agencies involved in health have no idea who or what they might be working with in the near future.

Jane Kennedy : I hope that the hon. Gentleman acknowledges that in London the proposed primary care trust will remain coterminous with local authorities, as I said yesterday. The main influence in London was the benefits to local people from that coterminosity. I hope that he will accept that that is the case.

Mr. O'Brien : I certainly accept that. However, I am conscious that the west London area is not far from the edge of London, and that is where the knock-on effect is creating uncertainty. The one thing that can be said about a health economy is that it does not fit easily between the convenient lines that Whitehall Departments might like to draw for it. While that might be a challenge, it should not be a driver for how services are provided.

Most gallingly for the taxpayer, no responsibility seems to have been taken for the colossal waste of money: £14 million of taxpayers' money was spent on the Paddington health campus project—a sum dwarfed by the opportunity cost to the nation as a whole, due to building inflation over the long duration of the project, which was itself a consequence of unproductive effort. Let us hope that, once the Public Accounts Committee has looked into the National Audit Office's report, which we hope will be published at Easter, the Secretary of State will be   prepared to give a proper account of what went on. She should acknowledge that on this occasion the Government have made a mistake, and accept the consequences, so that local patient services are not cut.

It is not only Hillingdon that has accrued a huge deficit. Among others, Hammersmith hospitals trust is running at a deficit of some £36 million, which the Prime Minister has acknowledged, although he is inclined—I suspect that the Minister might reflect his habit in her response—to shift the blame for such deficits back to the PCT, rather than recognising the accountability of Government. I hope that I demonstrated what would be my approach when we discussed the matter yesterday on the Floor of the House. In response to a parliamentary question from my hon. Friend the Member for Hammersmith and Fulham (Mr. Hands), the Prime Minister said that the obligation to correct the deficit

We would agree with him if only the trusts did that, but the Government's structures do not foster proper financial management. Leaving aside the fact that they continually decide on structures before they have sorted out functions, they seem incapable of holding officials
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accountable, so we have chief executives conveniently resigning or suffering from ill health while deficits balloon.

The problems in west London will not be solved until the institutional problems in the NHS are solved. North West London strategic health authority has presided over the biggest PFI disaster so far, and it continues to drag its feet over the future of health care in north-west London. No plans have been published and there has been a complete abdication of commitment to public or patient involvement, even though it appears to be considering various options. That stands in stark contrast to the fact that we know west London to be a most active area, in which patients and public continually make successful and admirable efforts to ensure that their views are heard. The hon. Members representing them here today have demonstrated the same commitment.

Changes in hospital structure should be driven by genuine changes in demand, not bureaucratic plans. Until the Government realise that and pass that knowledge down to their administrative bodies, we cannot hope for anything other than a continuation of the crisis and its inevitable conclusion—cuts to patient services.

3.46 pm

The Minister of State, Department of Health (Jane Kennedy) : It is a pleasure to be here under your guidance and leadership, Mr. Taylor. I am sure that you will join me in wishing the right hon. Member for Witney (Mr. Cameron) a successful visit to Charing Cross hospital where, no doubt, he is receiving treatment for the wounds that he received today at Prime Minister's questions.

I join all hon. Members who have spoken this afternoon in congratulating the hon. Member for Ruislip-Northwood (Mr. Hurd) on having secured the debate. I know that he feels strongly about the issue. He spoke forcefully about what he perceives to be a lack of leadership and a lack of willingness to listen to local concerns, which was a theme of contributions this afternoon. I want to respond directly to some of his points. I acknowledge the strength of the international reputation of the clinicians who work at Harefield hospital. Indeed, I join with those who pay tribute to all NHS staff who work in the area. I know that they are committed to improving the quality of local services.

I also acknowledge that the historical lack of investment in Harefield hospital has resulted in poor facilities and a long-standing uncertainty about its future. That lack of investment goes back over a long period. Failure to reach a definitive decision about the future of—for example—surgical services at Harefield will lead to a further decline in morale, with the inevitable loss of commitment to the trust. That would, in turn, threaten the quality of clinical services. The current uncertainties stem from 2004, when the Royal Brompton and Harefield NHS trust contacted the strategic health authority because of concerns about the surgical services provided at Harefield. The trust was concerned about the persisting discrepancy between the respective post-operative wound infection rates at Brompton and Harefield. That is something in which I have an interest, and I was glad to be able to read about it in the briefing for this debate.
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In addition, there were reported differences between the two sites in early survival rates following coronary artery bypass graft, surgery and aortic valve replacement. There is also a recognised difficulty in accessing appropriate sub-speciality support for emergency conditions arising in Harefield patients following surgery. All those matters are serious, and it is appropriate that we take time to consider the options for improvement. Hon. Members will know that a 90-day review has been undertaken by the Royal Brompton and Harefield trust of the short-term issues raised by the clinical governance report and the long-term development of the service. That report is due shortly and it would not be appropriate for me to comment on it while I am awaiting its results.

Broadly, I agree that we need to base decisions about the future of important hospitals such as Harefield on whatever should lead to the provision of the best service to patients. I am more than happy to receive representations from hon. Members—I always am—about any concerns arising from the discussions that are taking place locally.

The hon. Gentleman talked about Mount Vernon cancer centre—

Mr. Randall : I am grateful to the Minister for giving way, and for her offer. Will she also agree to meet representatives of Heart of Harefield?

Jane Kennedy : In my time as a candidate and as a newly elected Member of Parliament, I became used to working closely with the kind of groups that have been described. I well know how dedicated local volunteers can be when campaigning for improvements in local health services, and I would be happy to meet a delegation if hon. Members wanted to bring one.

The burns service at Mount Vernon is housed in temporary buildings. I know that it is a complex site; the hospital is a general acute hospital, but housed there are the West Hertfordshire Hospitals NHS Trust's burns and plastic surgery services and the cancer services provided by East and North Hertfordshire NHS Trust. I accept the point made by the hon. Member for Ruislip-Northwood about the complexity of such service configurations.

The Bedfordshire and Hertfordshire strategic health authority feels that the condition of the buildings means that they are not suitable for the delivery of 21st century care. The hon. Gentleman probably agrees on that point. A project board is considering a short-term replacement build and where it should be, and is receiving representations from the Bedfordshire and Hertfordshire SHA, the North West London SHA, Hillingdon and Harrow PCTs and Community Voice. A lot of discussion is going on, and I assure hon. Members that I take a close personal interest in that debate.

One of the biggest reviews of how and where health services are delivered to more than 1.9 million people in the capital is being carried out by the North West London strategic health authority. Notwithstanding the criticisms that have been levied today, I believe that is the appropriate place for these discussions, although I am following them closely.
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The hon. Member for Ruislip-Northwood asked about the financial position at Hillingdon PCT. I said that I would receive representations on such issues. He asked detailed questions about dental allocations and raised concerns about dentistry. Rather than spend time today trying to answer questions about an area on which I am not most expert, it is better that I should write a detailed response to him. However, I agree that it is desirable that there should be a clarity of intent regarding the development of services in west and north-west London.

The hon. Gentleman asked about specialist trusts. We support the development of specialist trusts and recognise that the UK's reputation of being at the leading edge of health service developments, new treatments and new medication comes from the quality of our specialist services. Indeed, I have a specialist trust in my constituency in Liverpool—a cardiothoracic centre. There is no animosity in the Government toward specialist trusts. The challenge that faces the NHS in west London is the same as that facing the NHS anywhere: not only how to maintain the clinical excellence and the services that are being provided in a rapidly changing environment, but how to do this in a way that maximises access and convenience to patients.

What patients really care about is not how many beds are available to them locally, but that they can get high-quality care when they need it. It is worth me saying this, and I like saying it, so I shall take the opportunity to do so: under this Government, waiting lists are at a record low. The NHS is not in the crisis that it is too often portrayed as being in. Waiting times for operations have fallen to a maximum of six months, and 97 per cent. of people who go to an accident and emergency unit, even in west London, wait for less than four hours either to have their treatment determined, to be admitted to hospital or to be sent home. Death rates from heart disease are down 27 per cent. since 1996 and death rates from cancer are down 12 per cent.

It is important that we recognise that bed numbers will decrease overall as the NHS uses beds more efficiently and provides more care closer to home, but where we need more beds, there are more beds. The number of critical care beds is 35 per cent. higher than in January 2000. In an environment in which NHS spending has more than doubled since 1997, bringing more doctors and nurses and better facilities, the intention of Government policy is now to bring about a similar revolution in the quality of care to that which has taken place with the quantity of care.

Following the termination of the Paddington health campus scheme, the North West London SHA is undertaking a sector strategy review. Health services cannot remain static; they must change to meet medical advances and developments in clinical practice, as well as the wider interests of patients. The review is in its early stages. I understand that it aims to develop a 10 to 15-year strategy for health services in north-west London. Those services need to be not only high quality, but accessible to the patients who need them, in line with the recommendations of the recently published White Paper.

As the hon. Member for Ruislip-Northwood is aware, many of the buildings that we are discussing provide health care in poor quality conditions. Almost a third of them were built before 1948, when the NHS was set up.
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I am talking not just about the facilities at Hillingdon, but about those described by my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter), which serve his constituency. Patients have the right to expect that health services will be provided in modern, fit-for-purpose facilities. That is why the strategy that is being developed considers options that will enable local services to be delivered in the best possible way.

Hon. Members asked several questions, which I shall seek to answer now. My hon. Friend the Member for Ealing, Acton and Shepherd's Bush asked about the finances of the Hammersmith Hospitals NHS Trust. I    have received representations on many such matters    since taking responsibility for services in    London. The Under-Secretary of State for International Development, my hon. Friend the Member for Harrow, West (Mr. Thomas), regularly speaks to me about such issues in the corridors. He would want me to remind hon. Members of that.

The Hammersmith trust has worked hard to identify how it can reduce its costs while treating more patients and maintaining high clinical standards. I seek to reassure colleagues that where there are deficits, the work of the turnaround teams is not to cut services simply to make financial savings. I applaud the approach of the Hammersmith trust, which has worked hard to identify how it can reduce its costs. In the past 18 months, doctors, nurses and managers there have improved efficiency by reducing the length of stays, minimising inappropriate referrals, undertaking more day surgery, developing and implementing innovative care for patients, reducing dependence on locum and agency staff, better bed management, reducing hospital-acquired infections and more effective prescribing. They have also sought to maximise income from additional activity where possible. All those results are real improvements for patients.

Mr. Stephen O'Brien : My only argument is why it takes consultants to do that. Surely the Minister must be accountable for why, when the SHAs were created, people with the skills to do that were not appointed to them.

Jane Kennedy : The hon. Gentleman might not have heard what I said. This has been going on for 18 months; the Hammersmith hospitals trust has been working to grapple with its underlying financial problems for 18 months. All the steps that I listed have been to the benefit of service delivery and patients, so he is wrong to say that it has suddenly happened.

Mr. Hurd rose—

Jane Kennedy : I shall give way; we have one or two minutes left. The deficit is persisting, which is why I think that the turnaround teams will help Hammersmith to understand the underlying problems.

Mr. Hurd : I am grateful to the Minister for her constructive approach to the debate—

David Taylor (in the Chair): Order. We now come to the next debate.
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