Westminster Hall
Tuesday 1 May 2007
[John Cummings in the Chair]
Health Services (West London)
Motion made, and Question proposed, That the sitting be now adjourned.—[Jonathan Shaw.]
9.30 am
Mr. Nick Hurd (Ruislip-Northwood) (Con): May I say what a pleasure it is to serve under your chairmanship this morning, Mr. Cummings?
Few institutions have the need to manage as much change as the national health service. Sometimes it feels like it has spent the past 25 years in a culture of permanent revolution. This debate is a chance to talk about some of the changes under way to health services in west London and the impact that they will have on patients and communities. I wish to limit my remarks to the future of two specialist hospitals that enjoy extraordinary support in the communities that I represent, but whose futures remain uncertain, as the cards get shuffled again in the game of power politics within the health economy of west London—a game that has so far benefited management consultants far more than patients.
Harefield hospital ought to be the jewel in the crown of the NHS. Benefiting from its long association with Sir Magdi Yacoub, Harefield is one of the best known heart hospitals and heart science centres in the world. In fact, I would argue that very few hospitals in the NHS system enjoy the same international reputation as Harefield. The heart science centre is recognised for groundbreaking advances in the regeneration of the heart in last chance cardiac patients and in the generation of human heart tissue. Surgeons in the hospital there continue to pioneer groundbreaking treatments to save lives at minimum disruption and pain to patients. Instead of building on that centre of excellence, however, the NHS has mucked it around. The Minister is aware of the story, because he was good enough to meet all three Hillingdon MPs—my hon. Friend the Member for Uxbridge (Mr. Randall), the hon. Member for Hayes and Harlington (John McDonnell) and me—and Mrs. Brett, the chair of Heart of Harefield, which is well represented here today.
Now is not the time to revisit the horrors of the Paddington health campus fiasco. The Chairman of the Select Committee on Public Accounts put it well, in his characteristically understated way, when he said in January:
“The collapse of the ambitious Paddington Health Campus project after five years was the direct result of appalling planning and forecasting of costs by the NHS Trust partners”.
Of course, this being the NHS, the partners did not pay the price; in fact, the individuals involved all got promotions. The price has been paid by the taxpayer, who will have to pay more for future refurbishments, by patients, who could have had better facilities by now, and by staff, who had to live with such uncertainty for so long.
Thanks in large part to Heart of Harefield and the clear-headed leadership of Bob Bell, the chief executive of the Royal Brompton and Harefield NHS Trust, the emperor was finally revealed as wearing no clothes and the plan collapsed. The board of the Royal Brompton and Harefield knew how it wanted to respond. It wanted greater freedom to run its own affairs, aspired to achieve what the Government say they want all trusts to achieve—foundation trust status—and received tremendous support in the community for that aim.
The Royal Brompton and Harefield had been a three-star specialist trust for two years running, with an outstanding clinical record and a strong financial position, so its application for foundation trust status should have been plain sailing. So everyone was puzzled in August 2006, when the Department of Health did not support the application. Puzzlement turned to anger when the Department had to admit that the cause of not proceeding was the need to respond to vehement, personal objections by the outgoing chief executive of the strategic health authority for north-west London, one of the leaders of the Paddington health scheme and clearly a man with a personal axe to grind. The local community was so incensed that it was prepared to go for a judicial review. However, it was reassured by the Department’s response, which was to make it clear that it supported the trust going into the next round, which it has since done, with the full support of the London strategic health authority.
We now find, however, that another rock has been laid in the road, obstructing progress towards foundation trust status. Monitor has let it be known verbally that it intends to block the application. Indeed, it took the unusual step of asking the Royal Brompton and Harefield to withdraw it, which, quite sensibly, it has refused to do. Why has Monitor taken that position? It has said that it is a result of Government reforms to the allocation of research grants, under the “Best Research for Best Health” strategy. In Monitor’s view, the Royal Brompton and Harefield is assumed to be a loser and will stay a loser—to the tune of approximately £20 million over three years.
Monitor has also taken the strangely dogmatic position that the Royal Brompton and Harefield will not recover that money in a more competitive research market, despite the fact that the trust’s research programmes are all rated as strong by the Department, most recently in January this year. Even the chief executive of the NHS has written to the chief executives of London hospitals—I have a copy of the letter with me—who had written to him expressing concerns about the new process and the plans for adjustments and transition. He wrote back robustly, saying that they should not assume that they would be net losers from the process, and that everything depended on the quality of research and competition in a more transparent market.
Monitor has continued to adopt a doomsday scenario, however. Moreover, it has refused to believe that a trust with a strong financial position operating in cardiology, which I understand to be one of the most lucrative fields in the market, will have the financial wherewithal or nous to adjust its business plan in the unlikely event of failing to win research grants. The
absurdity of that position has reached new heights, as the chief executive of the Royal Brompton and Harefield has revealed that he now expects to have around £250,000 of taxpayers’ money to spend on paying consultants to help him draw up a contingency plan that he knows is not needed.
More alarming for the community that I represent is the fact that the chief executive will be forced to freeze development plans at Harefield hospital, where we had been extremely excited about his commitment to investing £20 million in refitting the hospital to make it even more fit for purpose and safeguard its future in the community. As a consequence of Monitor’s position, all those development plans will have to be put on ice. The chief executive, who has performed heroics in raising the morale and sense of permanency in a trust that had to live through five years of uncertainty about its future, now has to go through that management challenge all over again.
That all seems very strange, and must be worrying for Great Ormond Street hospital, another prestigious hospital and similarly emotive institution a little further down the track that is now in a similar situation. Surely it was not the Government’s intention to undermine those great hospitals. What is going on? A clue lies in a comment from Monitor to the Royal Brompton and Harefield. Monitor said that the trust had
“no future as a standalone Trust”.
If reported accurately, that raises concerns that Monitor may be exceeding its remit and taking views on the configuration of assets in London, at a time when it is known that both University College London and Imperial college are locked in a power game to secure a marriage with the Royal Brompton and Harefield.
In that dialogue and courtship, many compelling clinical reasons will be trotted out for such a marriage, and some of the vows may be true. But at the heart of the issue, as everyone acknowledges, is land—the Brompton site, which is valued at up to £1 billion and a source of cash for grand plans; land that the Royal Brompton and Harefield would control if it achieved foundation trust status and that it could use to fund ambitious plans to redevelop and improve services.
The consequence, intended or otherwise, of Monitor’s intransigence will be to condemn the Royal Brompton and Harefield to being stuck in a less ambitious rut and, in effect, to force it into the arms of a suitor. I am sure that the Minister shares my concern that Monitor’s activities and decisions should be entirely divorced from any commercial interest or power play within the NHS, and should be seen to be so. Will he therefore reassure me that the strict remit of Monitor is to assess applications for foundation trust status and to regulate those trusts, and not to make judgments on the future configuration of services? Will he reassure me, either today or in writing, that no person at Monitor has any formal or informal interest in the negotiations on the future of UCL, Imperial or the Royal Brompton and Harefield?
In relation to the flows of research funding, can the Minister say what impact analysis was conducted on the London hospitals affected by the changes? Can he
confirm that it is not the Department’s intention to destabilise those institutions? Will he also take this opportunity to echo David Nicholson’s view that there is no reason in theory why trusts with strong research programmes, such as the Royal Brompton and Harefield, should not continue to win research grants under the new system? Can the Minister confirm whether the three-year phasing-out timetable is set in stone? If not, I urge the Department to consider a phasing period of five years. That would certainly help the Royal Brompton and Harefield to meet Monitor’s objections, but this is not just about one hospital or one trust.
I should say that there appears to be no objection to the principle and the objectives of the proposed reforms to research grant. The concerns appear to be about the timing and the thinking through of the consequences of changes that are a systematic challenge to all hospitals involved. It is not clear that the consequences have been thought through carefully enough. I am sure that the intention was not to destabilise trusts such as the Royal Brompton and Harefield and Great Ormond Street, but that seems to be the consequence.
Moving to five years would give those hospitals more time to adjust and adapt. It would also allow more time for high-class research capacity to be built up outside London. As was said to me, we should not underestimate the fact that it took 20 years for trusts and institutions such as the Royal Brompton and Harefield to build up the centres of excellence that they have developed. It would be a shame if financial pressures forced high-quality research capacity to be cut in London before appropriate capacity had been built up outside. People would not see the sense in that. A move from three to five years would not dilute the principles or direction of travel of reform, just the pace of the journey. I hope that the Minister will give it serious consideration and give us a meaningful answer in his response, either in this debate or in a follow-up letter.
Let me close with some brief comments on another specialist hospital suffering similar uncertainties. Mount Vernon is a wonderful cancer centre that is clearly the most convenient location for a universe of about 2 million potential patients in the west London cancer network. The Minister will be aware that the very controversial decision was taken to move it to a shiny new hospital in Hatfield in 2013. The community was fobbed off with the promise of some walk-in radiotherapy capacity being kept on the site. However, that option faded away as it became clear that it was a second-class service with some risks attached to it. The local community then faced the choice of going to Hammersmith or Hatfield for regular radiotherapy, involving a journey of at least 45 minutes in a car, assuming moderate traffic. That is not a distance or an imposition on a patient that I would care to choose for my family and I am sure that the Minister would not, either. It was unacceptable to the local community.
Now we know that the Hatfield project has collapsed—it was considered unaffordable—we now face a vacuum of decision making and uncertainty about the future of a Mount Vernon cancer centre. The local community’s view is clear. They ask, “Why move it? Why move it if you have just invested £23 million of taxpayers’ money in new radiotherapy bunkers? Why move it when you clearly have superb people on-site,
offering brilliant treatment? Why move it if you have Hillingdon hospital, as the landlord of the site, now committed to the site, committed to turning it into a health village and providing there the adjacent specialisms that are required to complement a modern cancer centre? Why move it if you have such strong local support for the centre and the extraordinary charities that feed off it and support it? What could be more affordable than building on the excellence on the site? What could be more affordable than keeping cancer services at Mount Vernon?”
We keep being told that a heat map exists in the Department of Health. Personally, I do not believe that, but if it does exist, I urge the Minister to go back and put a large red sticker over Mount Vernon cancer centre, because the people are on the move and petitions are being signed. We are determined to send the strongest possible signal into the system that we want to keep cancer services at Mount Vernon.
I have spoken about two hospitals, but the same message. They are excellent hospitals. The message to the Department is: please support them in the same way the local communities do. Give them some stability—that is what they are crying out for—not in the interests of complacency or a quiet life, but in the name of progress, ambition and a desire to build on acknowledged excellence.
9.44 am
Mr. Andy Slaughter (Ealing, Acton and Shepherd’s Bush) (Lab): There is a slight “Groundhog Day” feel to this debate. I note from Hansard that, on 8 February 2006, the hon. Member for Ruislip-Northwood (Mr. Hurd) initiated a similar debate, in which I spoke, as did the hon. Member for Uxbridge (Mr. Randall). Indeed, I think that all the suspects are here again, save for my hon. Friend the Member for Hayes and Harlington (John McDonnell), who perhaps has other business detaining him at the moment. I am sure that the hon. Member for Richmond Park (Susan Kramer) will fill in the gap for her party in a similar fashion.
I hope that the fact that 15 months later we are in the same Chamber for the same debate does not mean that things have not moved on. Despite the comments that we have just heard, things have moved on in some respects for the better. It was reported in that debate, wrongly, that one of my local hospital trusts—Hammersmith—had a very considerable deficit, although it is true that it had a deficit. It now runs on a year-to-year basis, with a balanced budget and, occasionally, a surplus. More to do with NHS finance regulations than the efficiency of that organisation, there is still an underlying deficit of some £11 million, which is to be eliminated over the next three years. That is an improved situation.
There were rumours, which had persisted even then for a year or more, that services would be closed at Charing Cross hospital, which many of my constituents use as their regular district general hospital. Those rumours were always unfounded, but they persist, although they have become more muted, as the evidence does not support them. I note that there is a statement on the issue even today:
“There are currently no plans to close any A&E department, Charing Cross Hospital or any other site. In fact significant
investment continues to be made at Charing Cross, with new mental health services; a new 72-hour day-and-stay surgery unit”—
“four new linear accelerators...£6.5m...new research facilities; and a Maggie’s Cancer support centre due to open...later in 2007, £2.5m.”
The evidence of one’s eyes, as one drives down the Fulham Palace road, is that Charing Cross is a hospital that is thriving and into which more and more investment is going.
There is perhaps slightly less good news on the progress of the White City collaborative care centre. That is an innovative LIFT—local improvement finance trust—scheme, a £50 million project, organised between the previous Labour council and the local primary care trust. I said when I spoke in the debate 15 months ago that I had great hopes for that project pushing on quickly. So far, not a brick has been laid; indeed, planning consent has not been granted. That is a great concern for me, as the centre will lie—I am still convinced that it will happen—in the White City ward, one of the most deprived wards in London or, indeed, the country. That flagship project, a building designed by the Richard Rogers Partnership, is much needed to bring not only health care but other facilities to the area.
The business case has now been approved, and I am given some assurance that we will see bulldozers on-site by the end of the year, but it is not a satisfactory situation and a good deal of the blame must lie at the door of the new Conservative-controlled council in Hammersmith and Fulham. One appreciates that, when there is a change of power, matters can be delayed, but the persistent renegotiation of the development for no good reason—in fact, for only bad reasons: to reduce the investment by the local authority in social care and to diminish the proportion of social housing on the site—has not only caused delay, but will mean that the development, when it does go ahead, will not be as good as originally planned.
I mention those matters because they deserve to be updated and to be put on the record, but the general pattern in health care, certainly in my part of west London, is of an improving situation, driven by the record investment that is going into the health service there. I could say a great deal more about each of these issues, but I want to speak only briefly today and to concentrate on one particular issue. It is appropriate that I do so today, because today marks the launch of what is an innovative and exciting project not only for my constituency and, indeed, the whole of west London, but for the country. I hope that my hon. Friend the Minister will confirm that when he responds to the debate, because consultation documents on the proposal for an AHSC are sitting in envelopes waiting to go out to all and sundry across west London as we speak.
The consultation period will run for three months, and I am confident, given the soundings that I have taken in the area over the past year, that the response will be resoundingly positive. The basic proposal for the AHSC will go to the Secretary of State in August and, if approved, will hopefully lead to the merger in October of three already excellent institutions—St. Mary’s NHS Trust, the Hammersmith Hospitals NHS Trust and Imperial college. That will result, in the first instance, in the first AHSC and, in due course, in the
first academic NHS trust. As I said, that is an exciting prospect, and it comes, as I think everyone will acknowledge, after some uncertainty about the organisation of health care in west London.
Other projects are under way to ensure that the standard and configuration of health services are improved, but I hope that the AHSC will take us to a new level of excellence. That is not to say, however, that the existing institutions are not in good shape. Indeed, the “Good Hospital Guide” for 2006 ranked Hammersmith Hospitals NHS Trust and St. Mary’s NHS Trust as the second and third best in the country respectively for clinical excellence, quality and safety. It goes without saying that Imperial college is one of the largest medical institutions in Europe, and its world-class reputation was recently confirmed in The Times Higher Educational Supplement, which placed the university fourth in the world for biomedicine and ninth overall. Perhaps that is a clue that we already have world-class excellence in research, particularly at Imperial, which is already based at the Hammersmith and St. Mary’s sites. However, the new configuration and single management under an academic trust are designed to set a new standard for health care in the UK.
I hope that the AHSC goes ahead. I am conscious that it would do so against the background of the review by the eight PCTs of health care in north-west London and Professor Ara Darzi’s review of health care in London—his “The Case for Change” document, which was published last month, and his framework for action, which is due at the end of this month. All those matters are taken into consideration in the proposal that is going forward today. I have read the consultation document, and it is very good; it deals with all the bureaucratic matters and shows how the AHSC will not only provide improved research and health care for my constituents, but use the NHS network to give people across west London and beyond access to higher quality, world-class health care.
We will all, I am sure, be greatly embroiled in discussions about the process and about who will take the AHSC forward. I recently met Lord Tugendhat and Steve Smith of Imperial, who are taking the lead on the issue at present. I am extremely impressed by their proposals and, indeed, by Professor Darzi’s proposals for health care across London as a whole—this is a new beginning for west London and for London as a whole. In both cases, I am most impressed that those involved have cut through the bureaucracy that bedevils the health service—whichever party is in government—to concentrate on the outcomes for patients. I sometimes wish that health professionals would stop referring to my constituents as guinea pigs and stop rubbing their hands at the prospect of gaining access to more of them, but I know that they are well intentioned at heart.
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