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29 Apr 2008 : Column 66WH—continued
“There has been a complete failure to bring the elements of policy together...When they started PFI 10 years ago they were just blithely modernising hospitals and the ideas which are now prominent about centralising specialisation and shifting care into the community weren’t strong policy commitments. So the policies are now out of sync. It’s a mess.”
My conclusion is that modern facilities exist in the Bromley hospitals NHS Trust and there is an excellent medical staff. Therefore, the opportunities to provide good health care for the people of Bromley exist. The Government have a responsibility, for the reasons that I have given, to put the trust in a position to deliver that, but the Government can do so only if they take sensible decisions along the lines that I have described. Having taken them, they should let local people get on with it. There is no time to lose.
1.47 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for Orpington (Mr. Horam) on securing the debate on Bromley Hospitals NHS Trust. I congratulate, too, the health staff in his constituency on their hard work to improve services and performance. The hon. Gentleman will be pleased to know that the figures on the issues that he raised about accident and emergency and hospital-based infections are moving in the right direction, and millions of people—not just in his constituency but around the country—receive high-quality, safe services every day. However, he is aware, as I am, of the serious challenges that have confronted health care provision in south-east London for some time now. They go back several years.
In spite of record investment in the NHS—Bromley primary care trust received a 30 per cent. increase in funding for the three years between 2003 and 2006, and
a 17 per cent. increase for the two years between 2006 and 2008—Bromley Hospitals NHS Trust, along with the three other outer south-east London NHS trusts, continues to report a deficit, and the Bromley trust was designated as one of the financially challenged trusts at the end of 2006-07, reporting a forecast year-end deficit of £18.5 million for 2007-08. The financial problems of that trust resulted from poor financial management over several years, but the new executive team is tackling the issues, and, as the hon. Gentleman acknowledged, although he expressed some scepticism, their plan is to break even in the financial year 2008-09.
As a result of some of the challenges, what to do about health care in south-east London has been hotly debated now for a considerable time, but at long last the health service in the area has come together with proposals that have gone out to consultation. The hon. Gentleman, being very interested in the subject, will I am sure be aware of the details of the proposals, and I do not want to go through them in detail now, but I want to highlight the fact that the Princess Royal hospital in Farnborough, the main part of the Bromley Hospitals NHS Trust, has been proposed as a major admitting hospital under all three options subject to the consultation. Indeed, under all the options, his hospital’s services would be enhanced.
Enhancements would include improvements to maternity, including more options for mothers, midwife-led and home births and 98-hour consultant cover; an enhanced critical care facility with improved quality for patients; and improved specialist rotas for medically ill patients, allowing them to be admitted under a doctor who specialises in their condition.
I am also aware of the representations that the hon. Gentleman mentioned about the future of elective services at Orpington hospital. They will be considered in the round as part of the consultation, but I assure him that whatever the outcome of the final consultation, Orpington hospital will continue to provide a valuable outpatient and diagnostic service to his community.
We all know that it is natural for concerns to be raised when changes are proposed to how health care is organised in a particular area, but changes are not made for change’s sake or to save money, although waste and duplication in public services should be deprecated. The reason for the proposals affecting south-east London is that doctors there tell us that the current pattern of care delivers a substandard service to the public and even puts lives at risk. The four medical directors of the hospitals involved said:
“We have looked at the best way to provide hospital services for the whole population. We have not been talking about which site provides the service, but rather how we can best meet the hospital needs of the 1 million people in the area as a whole. There is a high level of consensus amongst colleagues about the recommendations we are making. It has taken a lot of work to get this far, and everyone is very excited about the opportunity for those who deliver the service to take advantage of this opportunity to provide better care for our patients.”
Professor Sir George Alberti, the country’s leading expert in service design and in emergency care in particular, said:
“It has been obvious for some time that safe, high quality services will not be possible in the future unless services in outer south-east London are redesigned.”
Mr. Horam: The Minister may be aware of other papers produced by substantial numbers of consultants, such as those at Queen Mary’s hospital in Sidcup, which state the contrary opinion that although some of the change is certainly necessary, some is not, and that to close down new facilities that work well in favour of facilities not yet built is complete madness.
Mr. Bradshaw: I am sure that the hon. Gentleman will acknowledge that it is also in the nature of consultations on service reorganisation for some consultants at hospitals that do not expect to come out as well as others to have a different view. It is the job of health care professionals and the management of primary care trusts in south-east London to sift through all the proposals and work out in consultation and in a transparent and open way what the best outcomes are for the public in the area, rather than bowing to special pleading on behalf of some professionals.
Mr. Horam: Obviously, some people are arguing for their own interest, but I would not like the Minister to go away with the idea that the consultants are united on the issue.
Mr. Bradshaw: I would never do that. They very rarely are on a process such as this.
To continue, George Alberti said:
“Many good ideas are included in the current proposals...we were impressed by the enthusiasm for making tangible improvements...None of the Emergency departments are adequately staffed with consultants. It is recommended by the College of Emergency Medicine that there should be eight to 12 consultants per Emergency department, with the aim of having a consultant presence in the department from 8.00 am to 12 midnight, 7 days per week. None come close to this.”
Similarly, the outer south-east London surgery and critical care group said:
“Some patients require ‘critical care’ in the Intensive Care Units—either as the result of an accident or emergency...There is considerable evidence to show there is a better chance of survival in a larger unit”.
The outer south-east London maternity group said that the Royal College of Obstetricians and Gynaecologists recommends that the consultant presence on labour wards be increased from 40 to 98 hours a week. The group agreed recently that
“the...standards for 98 hour consultant cover, which will provide safer maternity care, can be achieved if services are reconfigured across the four hospitals”.
I admit that clinician support for one or another of the options on the table is not unanimous, but it is strong.
Formal consultation on the proposals ended on 13 April. I am informed that about 9,500 responses have been received. They are being collated and will be independently reviewed by Imperial College’s Centre for Health Management. I understand that the team in charge of developing the proposals expects to make the consultation results publicly available in June this year, and that the primary care trusts aim to take a final decision at the meeting of their joint committee this summer.
To respond to the hon. Gentleman’s points about finances, I referred earlier to the fact that Bromley is one of a small number of financially challenged trusts. Most of the financially challenged trusts with which we had to contend some years ago have reached solutions
to their problems. Indeed, most of the 17 announced last year have now agreed solutions with their strategic health authorities that will help resolve their problems. The four in south-east London are slightly behind the curve because of the seriousness and complexity of their problems and the connection with reorganisation. However, I understand that NHS London’s provider agency continues to work with each trust to develop a range of options for solving indebtedness while maintaining standards of patient care and value for money.
I cannot promise the debt write-off requested by the hon. Gentleman, as that would not be fair to other trusts that have been through serious problems and taken difficult decisions to get themselves into financial balance. We have managed to find solutions for trusts in other parts of the country, enabling them to agree long-term recovery plans so that services are not negatively affected and they can get on with planning patient care without constant concern for a long-standing debt hanging over them. I assure the hon. Gentleman that my Department is working closely with the London strategic health authority to identify solutions for the trusts in his area similar to those that we have implemented in other parts of the country.
Mr. Horam: The Minister says that the four trusts are behind time in achieving some results. When does he expect results will be forthcoming—this year or next year, perhaps? When can we expect some results?
Mr. Bradshaw: Within the course of this year, I hope, as we proceed with the consultation and the outcome of the consultation as a package. I hope that the strategic health authority will be able to reach an arrangement with the trust similar to the arrangements reached by other SHAs with the small number of remaining financially challenged trusts around the country. I cannot give the hon. Gentleman a categorical assurance of that, but it is my hope.
The hon. Gentleman raised local issues about audiology waits, which I know have been a problem in his area. I am told by Bromley hospital that it currently reports no waits of more than six weeks for audiology assessments. In January 2008, Bromley Hospitals NHS Trust received an extra £250,000 from Bromley PCT to meet the
increased demand for audiology services. The funding has allowed the trust to appoint an additional audiologist to work with the team and to send a significant number of patients to Guy’s for treatment. On the Primrose centre, I am advised that the trust is willing to reach an agreement and confident of reaching one that will satisfy him and his constituent about the problem. If he writes to me about it, I will send him written clarification that he might find helpful.
I am sure that the hon. Gentleman recognises—I think that he acknowledged it in his speech—that the status quo is not an option for the NHS in south-east London. It has gone through a difficult period for historical reasons, but it is now coming through and has finally developed a vision of the area for the future. I hope that after the consultation is over, the PCTs can agree on a forward strategy behind which we can all unite. The health service in his area has made huge progress in the past few years despite the difficult backdrop, thanks to the hard work and dedication of its staff. With increased funding, that has enabled the provision of better care for patients.
When we talk about reorganisation, we are not talking about cost-cutting, although in a situation such as Bromley’s where there are historical financial difficulties, it is always difficult to attempt any reorganisation without people claiming that it is about cutting costs. However, I hope that I have illustrated with views taken from leading doctors and other clinicians in the hon. Gentleman’s area that we intend to reorganise to provide better, safer services for his constituents, better outcomes for patients and better safety and quality of care. That is what is driving change.
I hope that the hon. Gentleman is reassured that whatever happens—this is not necessarily the case for some of his fellow south-east London MPs—the hospitals in his constituency have a very positive future indeed. They will enjoy an enhanced future, whatever option is decided on. I appreciate his role and interest in expressing his constituents’ concerns about the future of health services in his area, and I encourage him to continue to engage locally with the NHS to help it improve services.
Adjourned accordingly at one minute to Two o’clock.
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