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28 Oct 2008 : Column 208WH—continued
Huw Irranca-Davies:
The difficulty was the rapid way in which the decision was made. I believe that everybody would have preferred to have more time and the ability to put in place the right structures, but British Waterways was faced with an immediate challenge, and we must recognise that. It was a difficult dilemma but a classic
example of one of those hard decisions. Faced with the predicament of repair, as it was, how should it move ahead? I take the hon. Lady’s point, and I believe that British Waterways would also say that, in an ideal situation, it would want to spend more time putting in place the right structures. Sometimes things happen in such a precipitous fashion that one has to take rapid action, but I understand the hon. Lady’s question.
Involving central Government in funding decisions and adding a potential new tier of bureaucracy to the process to achieve a national framework on directives and funding would therefore not be appropriate or practical. However, we agree that further consideration should be given to how financial risks are borne. Investment by British Waterways in restoration projects is a matter for the board because its job is to manage risk and balance the books. It has mechanisms in place that enable it to prioritise its contribution to such projects. Under the DEFRA deal with British Waterways, the Department has agreed not to micro-manage British Waterways, and the board has agreed to manage risk and to be accountable for its decisions.
The Select Committee also raised concerns that the long-term financial strategy of British Waterways was constraining its enthusiasm for restoration projects and expansion of the network. This again brings me to the need to make hard choices. When planning its activities, British Waterways must consider financial implications. It needs to keep it in mind that, unlike regeneration projects adjacent to the existing network, it rarely owns the land alongside restoration projects and such projects rarely produce new income streams. They tend to go to local communities and councils.
Some of the projects that have we seen are the Manchester, Bolton and Bury canal, the Liverpool canal link, the Droitwich canals and the Bow Back Rivers construction at the new Prescott lock, which I hope to visit shortly. Even if it cannot make a direct contribution to restoration work, British Waterways still does all that it can to facilitate restoration projects.
In conclusion, we can be proud of what has been achieved over the past 10 years. This debate shows the passion that is still there and the need to drive forward on maintenance and, where we can, on expansion and further restoration. I thank my hon. Friend the Member for Staffordshire, Moorlands for securing this debate at such an early point in my ministerial career. I welcome it very much, as well as the enthusiasm and knowledge of Members. Our waterways will continue to deliver a full range of public benefits, and I am determined that the public will continue to enjoy those benefits now and in the future.
I assure Members that I have made assiduous notes on concerns that I have not been able to address in detail, and I will certainly take up invitations and offers of occasional meetings with Members.
NHS (Bromley and Orpington)
12.30 pm
Mr. John Horam (Orpington) (Con): As the Minister will be aware, this is the second time that I have asked for and succeeded in getting an Adjournment debate on this issue. I called for this debate, first, because there is still a great deal of concern locally about the problems of Bromley and Orpington hospitals and, secondly, because the Government should be aware of that concern at ministerial level, because they have to play a significant part in the resolution of these problems if they are to be resolved satisfactorily. My colleagues, my hon. Friends the Members for Beckenham (Mrs. Lait) and for Bromley and Chislehurst (Robert Neill) supported me in calling for and getting this Adjournment debate because they, too, are concerned about the situation in our local hospitals.
Before I say anything else, I should say that I believe that the Bromley Hospitals NHS Trust is full of dedicated people who are doing fine work. [Interruption.] I am glad to see the Minister nodding. My sole concern is to see that they are put in a management and financial framework where they can be as good as they aspire to be, both from their professional point of view and with regard to the interests of the people of Orpington and Bromley.
I am always anxious to help the Minister give satisfactory replies. I want to summarise my five requests at the beginning of my speech rather than at the end, in the hope that this will further help him to come up with satisfactory answers when he replies. First, I want to see the merry-go-round of short-term six-month appointments at the top of the Bromley Hospitals NHS Trust management ended and a proper management team appointed with at least a three to five-year view. I have been saying that for a long time and it is time that the Government took notice of that fundamental point.
Secondly, the question of the treatment centre at Orpington should be considered not solely from a short-term financial point of view, dealing with making short-term financial savings, but from the point of view of clinical requirements, particularly taking into account that the Princess Royal university hospital has for years been working at total capacity—well above the 85 per cent. capacity that is considered optimal. Orpington treatment centre can make a contribution to achieving that aim.
Thirdly, the trust should be given challenging, but not impossible, financial targets. In that context, bringing down last year’s £18.5 million deficit to zero in one financial year was always unrealistic, although I accept that that was embraced by the interim chief executive. Fourthly, providing that the trust makes progress—I do not want to let it off the hook in making progress on dealing with the operating deficit—the Government should be prepared to make a financial arrangement that allows it to deal with its £100 million of overhanging debt, and with the structural and financial problems arising from the private finance initiative.
Fifthly, I hope that the Government will be sensible about asking Bromley to meet the national target of 18 weeks for referral to treatment, which all trusts are supposed to meet by December, given that the starting point for Bromley Hospitals NHS Trust at the moment is that that standard is met in only 57 per cent. of cases. It is asking a huge amount of the trust to go to 100 per cent. in the next two or three months.
Those are my five requests that I want the Minister to focus on in his reply to my speech. The main hospital in the trust is the Princess Royal university hospital, which was opened seven years ago as one of first PFI hospitals. Also in my constituency is Orpington hospital, which is very much older but which, five years ago, had a treatment centre built for elective orthopaedic surgery: knees, hips, hands and feet, and so on. That treatment centre had an additional theatre built only two years ago, which was opened by the current Secretary of State for Defence.
The Minister was in Orpington yesterday, I think. I do not know whether he had the opportunity to visit the treatment centre at Orpington hospital. [Interruption.] He says not and I understand why; diaries sometimes prevent such things from happening. None the less, that would have been an opportunity for him to see in situ what an excellent facility this is.
Bromley Hospitals NHS Trust has accumulated a deficit of £100 million. Last year it lost £18.5 million as an operating deficit. The trust commissioned a report from an independent expert in financial management, Mr. Michael Taylor, into how it got into this mess. That report, which was published recently, is, I am afraid, damning and spares no one: not the previous management, the board, the primary care trust, the London NHS or the Government. One saving grace was that the previous management’s passion for high clinical standards was applauded.
I want to focus on the handling of the proposed closure of the Orpington treatment centre, since that is causing great concern in Orpington and because it is an example of how things are going wrong. As I have said, the Orpington treatment centre was opened five years ago; it has been universally praised and the theatre was expanded two years ago as a consequence of its success. The centre meets all the Darzi requirements for having elective surgery quite separate from acute and emergency services.
As the Minister knows, under an exercise called “A picture of health for south east London”, it is proposed that the centre should, despite its success, be transferred to Queen Mary’s hospital, Sidcup, which may be losing its accident and emergency department under that same exercise. It was expected that it would be two or three years until that proposal became operative. In March the Bromley Hospitals NHS Trust said that it would like to keep the treatment centre open in Orpington. However, in July, which is not that long ago, the new interim chief executive said that the Orpington treatment centre should be closed. A press statement said:
“Incoming Chief Executive Michael Marchment has pledged to make savings whilst maintaining high quality patient care: ‘We can close operating theatres without having an impact on patient care by improving the way that we work. The most efficient way of doing this is to close three theatres at Orpington Treatment Centre and bringing the staff and equipment to the Princess Royal University Hospital’”—
not, it may be noted, at Queen Mary’s, Sidcup, but at Princess Royal university hospital. The press statement continued:
“Bromley Hospitals is in discussion with staff about the closures which will be in place by the autumn.”
I think that the trust suddenly realised that it was possibly not taking account of the consultations under “A picture of health”, because on the following day a further press notice was issued:
“However, we recognise that such a move will require discussion with staff, and Bromley Council Health Scrutiny Committee, and possibly consultation.”
I think that there were some quick second thoughts there.
It seemed then that the centre was going to close in the autumn. At that point, one of my constituents, Mrs. Julie Mott, started a petition that has gathered nearly 19,000 signatures, which is a huge number, as the Minister will be aware, given the numbers of signatures gathered in such situations. I have nothing but admiration for Mrs. Mott and her supporters, who have truly performed a public service.
There were second thoughts and we learned that the treatment centre closure was postponed until January 2009. When I rang the chief executive of the primary care trust, not 10 days ago, he still thought that it was closing in January. However, we learned subsequently that the closure was going to be brought forward again, to 30 November. There was consternation about that and, once again, the date was revised. Mr. Marchment has said in a letter to me that the closure would not now take place until well into the early part of next year.
A press statement yesterday went further and said that the treatment centre will not close until 31 March. Obviously, I wholeheartedly welcome that decision to postpone the precipitate closure, but there have been four decisions in four months on when the centre will close. That smacks of incompetent management that is not in control. One can hardly imagine how the situation could have been handled worse than it has been. It has created uncertainty, and that is bad not only for staff morale but, I am told, for staff retention, which is extremely important. Clearly, people are concerned about the uncertainty and different decisions being made almost from week to week about when the centre will close. What are they expected to do when teams are broken up and people receive offers from elsewhere? Uncertainty is a matter of great concern.
The reason for the proposed closure is that it is alleged that the treatment centre is losing £1 million a year, and that that will be saved if it is closed. Whenever the suggestion is made to bring the closure forward, the argument is always that closure will save £1 million a year, which would make a contribution to the current year’s savings. When it is suggested that closure should be delayed, the argument is that capacity can no longer be met. The original decision was based on the idea that there was enough capacity for the Princess Royal university hospital to meet the needs if the Orpington treatment centre is eliminated.
The capacity point is important. At the last board meeting on 24 October, it was said that 350 patients would have to be farmed out to other hospitals, including Hillingdon, which is a long way from Orpington, to Ilford and to various private hospitals, because they could no longer be dealt with if the Orpington centre were closed. However, I have a copy of an internal memo in which those 350 patients suddenly became 700. The memo is dated 23 October, the day before the board meeting on 24 October, and says that
“in order to meet the 18 week target we will need to substantially increase the numbers of patients on the waiting list that we are sending out to the private sector to upwards of 700 patients.”
When the board met the day before the memo, it said that only 350 people would be involved. It seems that the board does not know what is going on. The Taylor report accused the board of not knowing what was going on in the hospital, and this seems to be yet another example of that. Things have not improved. Will those “upwards of 700 patients”, in the light of yesterday’s decision to postpone closure of the Orpington treatment centre, still be sent out to other private and public hospitals? Perhaps the Minister knows. I certainly do not know, and no one in Orpington seems to know.
Clearly, it is difficult for the Bromley Hospitals NHS Trust to meet the financial target of reducing its operating deficit to zero, and to meet the national waiting list target of reducing referral times for treatment to 18 weeks when that is achieved in only 50 per cent. of cases. That is asking the trust to do the impossible. It is almost asking it to do the splits, because the targets are in opposite directions.
Another reason for the treatment centre to remain is that last night, under the “A picture of health” proposals, the statutory joint committee on health overview and scrutiny referred all matters, under the statutory procedures, to an independent review by the Secretary of State. It called for that at last night’s meeting, and I draw the Minister’s attention to the statement, which he will receive shortly. It says:
“The JHOSC has serious concerns about the recent decision of Bromley Hospitals Trust...to relocate surgical services from the Orpington Treatment Centre to the Princess Royal University Hospital. This option was not included in the consultation document for the A Picture of Health Proposals. BHT took this decision without prior consultation with the public or the local overview and scrutiny committee despite the decision taken by the JCPCT on 21st July 2008 to move these services to Queen Mary's, Sidcup.”
There is a clear conflict between the medium-term plan and the trust’s immediate decision.
I want to make a few more points before the Minister responds. First, I mentioned the circus of interim chief executives. We have had four; three were there for less than six months, and one lasted slightly longer. That is deeply unsatisfactory. I am always told that the reason is that there is a proposed merger in the air with another trust, or perhaps two trusts, so contracts cannot be sensibly negotiated. On the other hand, if we had taken the sensible view and put someone in place two years ago, they would at least have gone two years down the track, and if they could turn round the mess that the trust is in, they could cope with an additional trust if that is what happens.
Secondly, on consultation, section 242(2) of the National Health Service Act 2006 says:
“Each body”—
“to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on”
any changes. The minutes of the meeting on 24 July, immediately after the announcement of the premature closure of the Orpington treatment centre, say:
“The Nominated Representative, Health and Social Care Forum expressed concern that the proposal to close theatres at the”
“was made without consultation with members of the public.”
The minutes also state that the chief executive
“proposed to meet with the Local Overview and Scrutiny Committee to discuss the future of the OTC.”
That committee will be the relevant committee of Bromley borough council, but that does not meet the requirements of the Act. The council should have been consulted anyway, but the local scrutiny committee should also have been consulted under the national health service legislation. In any case, that meeting did not take place until September, when he originally wanted the treatment centre to be closed.
The people of Orpington and Bromley are intelligent, with a close knowledge of their health services. They want them to succeed, and I suggest that the flimsy consultation was a serious mistake and that that course should not have been followed.
On capacity, independent analysis by the Library shows a strong link between hospital ward overcrowding and the spread of deadly hospital infections such as MRSA and Clostridium difficile. Trusts with a bed occupancy rate higher than the Government’s recommended optimum level of 85 per cent. had a much higher rate of both C. difficile and MRSA. Research suggests that in 145 NHS organisations the level is more than 85 per cent., and in some it is more than 95 per cent. The Minister is well briefed on the subject, so I am sure that he knows that Bromley Hospitals NHS Trust has had the highest level of overcrowding and capacity. That should be addressed in any action that is taken.
The latest development is that I and my colleagues received a letter from the primary care trust indicating that the commissioning of acute care is to be merged. It is one of those letters that says that things will substantially change, but that nothing will actually change. One receives those curious bureaucratic letters from time to time, which are profoundly unsatisfactory. Lord Warner will address a meeting on Thursday, which suggests that mergers between local trusts will be proposed. All I can say is that this is the worst possible time for such structural change. People want a calm period and to be allowed to do their jobs properly. In the light of that, I look forward with immense interest, as do the people of Bromley and Orpington, to the Minister’s response.
12.49 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for Orpington (Mr. Horam) on securing the debate, and I join him in paying tribute to NHS staff, especially those in Bromley, whose hard work and dedication across the NHS are delivering a better quality health service than there has ever been. That has benefited not only his constituents, but people across England.
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