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Royal National Orthopaedic Hospital

Volume 129: debated on Friday 18 March 1988

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Lennox-Boyd.]

2.30 pm

I am grateful to Mr. Speaker and to you, Madam Deputy Speaker, for giving me the opportunity of raising the vital matter of the future of the royal national orthopaedic hospital in Stanmore. I thank my hon. Friend the Under-Secretary of State for coming to reply to the debate.

The phraseology on the Order Paper has had to meet with the wishes of the Table Office. The appropriate adjective would be "threatened" closure rather than "proposed" closure because I should make it clear that there is no formal proposal for closure of the hospital. However, it is not possible to use the word "threatened" in this context with the approval of the Table Office.

My hon. Friend the Under-Secretary will be well aware of the tremendous anxieties that exist and the enormous worry about the future of the hospital, which is one of the most illustrious medical institutions in the country. It is a famous hospital in national and world terms where fantastic work has been done to help disabled and injured people over many years. As I have said, my hon. Friend will know the history of this illustrious institution so I shall not go into detail now.

I have been worried since 1984 when I first raised the subject on an Adjournment debate. Even then, the anxiety had been gnawing away at all those concerned with and worried about the future of the famous hospital for over a year. With the uncertainty dragging on since 1983, I am sure it is possible to imagine how worried people have become and what effect that has had on staff morale.

So many people have been involved and if I had time I could pay tribute to a long list of tremendous supporters of our local and national campaign. The community health council is, at this very moment, drafting another letter to the divisional general manager at the Middlesex hospital about the proposal to close the accident and emergency unit. I know that there was a meeting of the Bloomsbury district health authority on Wednesday this week and perhaps my hon. Friend the Under-Secretary will refer to that.

The anxiety was beginning to come to a head again at the end of January last year when I once again wrote to Mr. Speaker pleading with him for permission to raise this matter on the Adjournment either through the ballot or through his selection. In my letter to him dated 26 January 1987 I said:
"The waiting list on 31 December 1982 was 1,248. At the present time it exceeds 2,100 patients in spite of a 15 per cent. improvement of turnover as a result of better management of the beds by the consultants and administration. The present bed state at Stanmore has been reduced from approximately 300 to 210 beds."
To some extent there has been a slight alleviation of the problems. However, the acute problem of that reduction in capacity remains. I pay tribute to the enormous work done by the special charity called ASPIRE which has raised money for projects in the hospitals and is currently raising some more money for a specific project. If I had time to read out the list of patrons, apart from myself, people would be aware that it is a fabulous list. It consists of people such as Frankie Howerd, Lulu, Warren Mitchell, distinguished Members of Parliament, Baroness Seear, Lord Ennals, Willie Carson and John Conteh. That shows that throughout the world that institution is held dear for good and cogent reasons—not just for reasons of sentimentality, but because it has done a fantastic job over the years. The staff have a traditional dedication to service and quality that needs to be preserved and expanded.

In September of last year my hon. Friend the Under-Secretary referred to this matter in a letter to then shadow spokesman for health, the hon. Member for Peckham (Ms. Harman), who is not in the House today, and there is no particular reason why she should be. My hon. Friend said:
"It may help if I describe the present position with regard to the Hospital. Discussions have taken place between Bloomsbury Health Authority … and North East Thames Regional Health Authority about the future role and the location of the Hospital. Underpinning these discussions has been the agreed principle that the RNOH would keep both its identity and its post-graduate status, whatever was decided."
Later in that same letter she said
"I appreciate the concern that the current uncertainty may be arousing. Please be assured that there are no plans to close the RNOH."
The central purpose of today's debate is for my hon. Friend to enunciate that conclusive reassurance that the hospital is safe in her hands and in the hands of the DHSS and will be preserved for the future and expanded.

I pay tribute to the unanimous support from Harrow council and other local bodies and individuals.

On 23 September 1987, the council passed a resolution that:
"This Harrow council supports the excellent medical provisions of the Royal National Orthopaedic Hospital, Stanmore, and in particular the Accident and Emergency Unit. We urge the Bloomsbury Health Authority to maintain all its provisions on the Stanmore site and to resist its Working Party's suggestions of any possible closures or transfers to other sites."
On 14 October, when our national petition for the RNOH was gathering about 70,000 signatures — the present figure is approaching 100,000 signatures—a massive public meeting was held at the hospital which passed the following resolution:
"This public meeting declares its strong and determined commitment to campaign to keep the Royal National Orthopaedic Hospital in Stanmore. It calls upon the Bloomsbury Health Authority, the North East Thames Regional Health Authority and the DHSS to recognise that the only acceptable option for the future of the Hospital is its continuation in Stanmore."
That illustrates once again the massive, incontrovertible strength of local public feeling and international support. We have received letters from as far afield as Australia and elsewhere.

One is bound to feel sympathy for the Bloomsbury health authority. In a sense the hospital should not have been put into Bloomsbury. It is an anomaly, because of the original link with the town hospital and so on—we know the background only too well. I have enormous sympathy for Bloomsbury's financial crisis. It is just about the most important DHA in the country with enormous burdens and obligations, yet we know that it is strapped for cash.

I believe that nationally, and in regard to Bloomsbury, the Government must provide emergency financial assistance and proper funding for the NHS, which I do not believe is unlimited because of a so-called and illusory unlimited demand. I believe that the demand is limited and tangible and that a modest amount of money is needed to put the NHS back on a footing whereby most of the closed wards would be reopened and the staff and nurses paid properly. I suppose that the amount of money needed over the next year or so, coincidentally, is about the same amount of money as the Government have given back in higher rate tax remissions in the latest Budget.

The underprovision for inflation is a serious problem for Bloomsbury. Once again I express my anxiety about that and my sympathy for Bloomsbury. However, I do not want the serious acute problems of Bloomsbury DHA to be visited upon the RNOH. That would be most unfair. The problem has become worse and Bloomsbury, lacking about £5 million or £6 million, faces a grossly acute crisis this very week. It does not know quite what to do and is milling around waiting for suggestions. I do not criticise those running Bloomsbury, unless they attack the RNOH, as I believe that that should be dealt with in a separate way which I shall try to explain later.

In mid-November I wrote to my hon. Friend the Minister for Social Security and the Disabled, and invited him to visit the hospital. As chairman of the Stanmore Hospital Action Committee I wrote him a letter saying:
"I am writing to request that you pay a visit to the Royal National Orthopaedic Hospital Stanmore in the very near future. This excellent national institution is under the threat of closure but fighting very hard to survive. There has not been a Ministerial visit for four years now and I know that the management and staff would welcome the chance to show you round their excellent facilities. I would by very grateful if you would consider such a visit soon".
With great courtesy, the Under-Secretary of State for Health and Social Security, my hon. Friend the Member for Derbyshire, South (Mrs. Currie) replied on behalf of the Minister. Her reply contained a paragraph that provided some reassurance about the threat of closure, but referred to the question of location.

The future location is now the determining and emergent key to this whole conundrum. If Enfield has now been rejected—for very good reasons—as an alternative, and if relocation at Northwick Park hospital is unrealistic for all sorts of complicated reasons, which I cannot discuss because time is short, the essential point is that the DHSS now has the opportunity, formally, publicly and fully to abandon any lingering doubts and anxieties about threatened closure and to reassure us conclusively and finally that the RNOH is safe for the future.

However, doubts still remain. On 18 January, in another letter to my hon. Friend the Minister for Social Security and the Disabled, I said:
"The Regional Health Authority is now returning to Bloomsbury District Health Authority with its responses to the Bloomsbury Members' recommendation that the Hospital remains in Stanmore. These continued delays in consultations back and forth, whilst parts of the hospital remain under-resourced and partly closed with staff shortages, mean that its future viability is always under pressure.
In addition, the DHA Managers have returned to the idea of closing the Accident and Emergency Unit".
Once again, I hope that those reassurances are a result of this week's decisions. Staff attrition, loss of morale and erosion of confidence have become a scandal in recent years. It is time for the DHSS to show that it has a full psychological and financial commitment to the hospital.

All the people on the RNOH action committee have done excellent work. I have been merely its chairman, which has been a great honour and privilege. The committee's dynamic secretary Mrs. Lydia Correa, in particular, and her colleagues have continued their magnificent work for more than a year through a tremendous campaign on the streets of the locality. There have been letters, press conferences, television appearances and all sorts of meetings to emphasise that we are committed and realistic.

We are not talking about enormous amounts of money. Future RNOH budgets could be rather modest at the margin if proper decisions are made about buildings and there is the necessary investment in new equipment. As chairman of the league of friends of the hospital I know that not only do we rely on public money but charitable effort is committed to supporting the hospital through additional, marginal private efforts and initiatives that make it a much more civilised and human environment.

If only the time were not ticking away so rapidly, I could refer in detail to the many meetings and decisions of our action committee. At the end of January, the committee sent an official letter to the leader of Harrow council—I pay tribute to its leader and all the councillors for their support—referring to the dilemma of Bloomsbury. We asked whether it was right that the hospital should remain within the North East Thames regional health authority or whether it should be located within the North West Thames regional health authority. We asked whether it was right to consider other options, such as setting up a special health authority or including the hospital within the Harrow district health authority, although it is a teaching hospital, provided the local DHA had the extra funding necessary to meet the budget.

The position of the local unit general manager and her colleagues in the hospital has been of interest. One can understand their dilemma as they are caught, like salami in the middle of the sandwich, between Bloomsbury's financial problems and the staff shortages while expressing great sympathy. Although I do not have time to go into the details, I shall refer to a circular letter that the unit general manager sent on 29 January 1988 which referred to the future of the orthopaedic service and the report to the health authority on the outcome of public consultations.

The agonising debate has continued, but the sword of Damocles still hangs over the hospital. That is unacceptable in terms of not only staff morale, which is important, but patients' welfare, which is equally important. Since the staff have responsibility for looking after the patients, I have expressed it in that order.

I am grateful to my hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security for again writing to me on 10 February. The concluding paragraph of her letter said:
"The day-to-day management of the Hospital is a matter for the Bloomsbury Health Authority, but I hope that our public commitment to the RNOH provides some reassurance to staff at the Hospital."
Phrases such as "some reassurance" causes anxiety. We want 110 per cent. reassurance. I think that my hon. Friend the Minister understands why I put it in those terms. I did so not only for obvious reasons, as the local Member, but as one who, over many years, has been deeply committed to the future success of this famous national teaching institution.

In the last month, the action committee referred again to the effect of its continuing campaign in imparting knowledge and information about the absolute necessity for the survival of the RNOH to all concerned. I pay tribute to the media for all they have done in this matter. The campaign continues.

Despite the decisions made by Bloomsbury at its agonising meeting this week, question marks remain over the future of the hospital. As I said, the options for relocation seem to be closed in practical terms. Therefore, the hospital must surely remain in Stanmore and it must not be underfunded, underinvested or understaffed. We must bear in mind that the hospital is slightly remote and that it is difficult for staff to get there because of transport problems such as the lack of buses.

I hope that my hon. Friend the Minister will seize this opportunity. She has that look on her face and I am beginning to feel optimistic that she will now reassure not only me, but the public and the many supporters of the RNOH both in Stanmore and elsewhere that the hospital will not only survive but expand.

2.45 pm

The Parliamentary Under-Secretary of State for Health and Social Security
(Mrs. Edwina Currie)

Having read the history of the marvellous institution that we are debating, I feel honoured to participate and I am delighted to congratulate my hon. Friend the Member for Harrow, East (Mr. Dykes) on winning the ballot and raising this subject. My hon. Friend has taken every opportunity to express his interest in the hospital to Ministers, both past and present. The files are full of his representations, not only on behalf of his constituents but on behalf of mine, and on behalf of disabled people everywhere. Let me put on record our appreciation of his courtesy and his careful marshalling of the facts, which is of great assistance to Ministers in making decisions on difficult matters.

My hon. Friend has been associated with the Royal National Orthopaedic hospital not only as the focal Member of Parliament concerned with its activities at Stanmore but as a former governor and as chairman of its League of Friends. We should also acknowledge the interest of other hon. Members on both sides of the House from whom we have received many representations on the matter. I pay tribute to all of them for representing their views to us and showing such compassion for the disabled people needing the services of the hospital.

I appreciate that the continuing uncertainty over the future of the RNOH is unfortunate. The concern will, I am afraid, remain until the matter is resolved. In that sense, I owe my hon. Friend an apology. It is now five years since the Le Quesne report was published, but I am sorry to have to tell my hon. Friend that I cannot guarantee that firm decisions will be made quickly.

As my hon. Friend said, the Bloomsbury health authority met on 16 March and decided to take no action on the immediate temporary closure of the accident and emergency department, so that is still open. Consultation is still in progress on the possible permanent closure of the accident and emergency department and it will he some months before that issue is resolved. The North East Thames regional health authority is meeting on 28 March. It agreed in January that further examination of alternative sites, including Northwick Park hospital in Harrow, should take place before any major capital investment was made in redevelopment at Stanmore.

Whichever way the North East Thames regional health authority decides to proceed, it will be some time before any proposals can be put to Ministers on whether there should be major capital investment or not.

Like other hon. Members, I received a letter dated 17 March 1988 from ASPIRE, in which Shannie Ross said:
"The Secretary of State will take the final decision after North East Thames Regional Health Authority's meeting on 28th March."
Strictly speaking, that is true, but it is highly unlikely that the decision will be made immediately after that meeting. It will still be some time before we are anywhere near that stage.

I am sorry if the continued uncertainty is disappointing to my hon. Friend and to those who work at the hospital, but I can offer him three pledges. First, if decisions are put to Ministers, we shall decide in the interests of patients—not only my hon. Friend's constituents but disabled people and their families from a much wider geographical area. Secondly, of decisions put to Ministers, we shall decide as expeditiously as possible, I offer my hon. Friend the thought that while this has gone on quite long enough, I would rather everyone took a little longer and got it right.

Thirdly, as my hon. Friend will have heard before from one of my predecessors, my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten), there are no proposals that the RNOH should be abolished. In looking at the future, it has been the intention of Bloomsbury health authority, North East Thames regional health authority, and, indeed, the Government, that the RNOH and its associated institute should retain their identity and their postgraduate status as a nationally recognised centre for orthopaedic surgery, training, and research.

The issue is how RNOH can best fulfil that role, and what back-up services are required. Such considerations will affect not only the decision about its siting but the type and level of service that it provides.

My hon. Friend the Member for Oxford, West and Abingdon gave a commitment to hon. Members, in an Adjournment debate in May 1984 that was initiated by my hon. Friend the Member for Harrow, East (Mr. Dykes), that Ministers would take the final decision if any substantial change were proposed to the services currently at the Stanmore site of the RNOH. We have repeated that pledge many times previously—including in correspondence with my hon. Friend—and I am very happy to do so again today.

I hardly need to rehearse the history of these matters, but perhaps for the benefit of a new Parliament—many hon. Members will not be aware of previous debates—I could set out the bare bones of what is happening.

I shall quote from the Association of Spinal Injury Research Rehabilitation and Reintegration booklet that was distributed by the Mike Heaffey centre, because it sums up in two elegant paragraphs the special nature of what we are talking about. It says:
"The Royal National Orthopaedic Hospital Stanmore has been in existence since 1910 and is nationally and internationally renowned for its expertise and success in treating the complete range of musculo-skeletal disorders. Together with the Institute of Orthopaedics, it is the largest orthopaedic postgraduate teaching hospital in the United Kingdom. As London's only specialist orthopaedic resource, the RNOH is one of a group of London based postgraduate teaching hospitals which, in association with London University linked Institutes, undertakes specialist training and research in medical and related disciplines.
The London Spinal Unit. The Spinal Injuries Unit at the RNOH, Stanmore, was opened in 1984 by Her Royal Highness the Princess of Wales. This experimental 24 bed unit was built by the DHSS at a cost of £3 million and has a wide catchment area—Greater London, East Anglia and the south-east of England—approximately 18 million people. Its progressive philosophy encompasses a unique treatment programme for the advanced physical and social rehabilitation of its patients."
The RNOH is on a scattered site of more than 100 acres at Stanmore. As I have said, its work covers a remarkable range of services and it is a major national institution. Early-day motion 382 talks about its
"outstanding research and prosthetic work which has given so much hope to countless thousands."
I would certanly endorse those words. We have noted how many hon. Members have signed that early-day motion.

There is a general accident and emergency department at Stanmore, which covers not only orthopaedics but a wide range of work. My hon. Friend said that it is an anomaly that the hospital is managed by Bloomsbury. As he will know, if he has read the excellent booklet by John Cholmeley on the history of the RNOH, the hospital was originally located in London, in Great Portland street. The Stanmore site was intended to be an outstation, but like many babies it outgrew its parents.

I was fascinated to read that booklet, to see the pictures of the open-air wards and solariums from the days when many of the patients suffered from tubercular diseases, and to see the delightful picture of His Royal Highness the Duke of Gloucester in bed at the RNOH in June 1977. I commend the booklet to any hon. Member who takes an interest in this subject; it is a fascinating piece of work.

What has happened since? Bloomsbury health authority, which is, whether we like it or not, responsible for the in-patient and out-patient services of both the RNOH at Stanmore and the Middlesex in central London, commissioned an orthopaedic working party, chaired by Professor Le Quesne, which reported in August 1985.

The working party report made a number of recommendations for services based at Stanmore, including a reduction in the number of beds provided and the closure of the accident and emergency department. It also considered the location of services and recommended that, while the future development of orthopaedics would
"be better served by close integration with the multi-disciplinary environment of a University Teaching Hospital".
a detailed appraisal of the options for capital development at Stanmore should be undertaken, as no suitable teaching hospital site appeared at the time to be available.

In 1987, therefore, following discussions with the regional health authority, Bloomsbury health authority carried out an options appraisal with the assistance of consultants Llewellyn-Davies Weeks. The appraisal considered not only hospital development at Stanmore but the feasibility of transferring services to the district general hospital at Chase Farm in Enfield health authority.

The options appraisal was issued for consultation last summer, and the comments received were considered by Bloomsbury health authority in December. The responses received showed little support for a move to Chase Farm—and that is probably putting it mildly. The regional health authority therefore considered Bloomsbury's report of the results of consultation at a meeting on 25 January this year. In view of the very limited professional and public support for the Chase Farm option, it decided that that option should be abandoned.

As I have said, Bloomsbury health authority this week rejected the closure of the accident and emergency department of the RNOH as an emergency temporary measure, but is consulting about its permanent closure. That is where we are now. As my hon. Friend knows, I may be in an appellate position in relation to that proposal, so I am hesitant to make any further comment on it.

As my hon. Friend may know, like many other hon. Members I was a patron of ASPIRE when I was a Back Bencher, partly because of my previous interest in health and some small links with the royal orthopaedic hospital in Birmingham, which was in my ward as a councillor. In 1985, ASPIRE started raising substantial sums to build a special centre on the Stanmore site to be named after Mike Heaffey. I fully understand ASPIRE's concern that the substantial funds raised have not yet been used, but it is surely sensible that a decision should be taken on the RNOH's immediate future, and especially its location, before construction of the centre begins.

I should like to take this opportunity to pay tribute to the work of ASPIRE and to all those people—some of whom my hon. Friend has mentioned by name and many others who perhaps work more quietly behind the scenes—whose close association with the spinal injuries unit at Stanmore has given it a particular commitment to the RNOH. ASPIRE is concerned that the delay may cause some charities which have pledged money to pull out.

Perhaps it will help if I ask publicly today that all those marvellous charities and their boards should be a little patient, bearing in mind the further pledges that I have given to my hon. Friend. It is important that the decisions about RNOH Stanmore are the right decisions as they will affect the contribution that the centre makes to orthopaedics both locally and nationally and will thus affect the return on the charitable contributions well into the next century.

Finally, I repeat our commitment to my hon. Friend the Member for Harrow, East, to ASPIRE and to the many other people in the Howe and at the royal national orthopaedic hospital, that no decision will be made about significant permanent changes for the hospital without our prior agreement.

I appreciate the very proper concern of the hon. Lady and of the hon. Member for Harrow, East (Mr. Dykes) for the RNOH, but does the Minister agree that, unless the Government come up with a large bundle of money—about £5 million—the choices before the Bloomsbury health authority and the regional health authority will be a matter of robbing Peter to try to save Paul?

No, I do not think that I would agree with that. The hon. Gentleman does himself no service by intruding in an Adjournment debate called by my hon. Friend the Member for Harrow, East. Like every district health authority in the land, Bloomsbury health authority has had an enormous increase in resources. I am sure that my hon. Friend the Member for Harrow, East recognises that. The authority is looking after substantially more patients than it did when the Labour party was in charge, at a much higher medical level and with a much greater level of success. We are all very proud of that.

Many of the options up for discussion in Bloomsbury seem very exciting indeed. I am sure that, whatever is decided and whatever proposals are put to us, the services in central London to many of the hon. Gentleman's constituents and to many other people who live and work in London, as I do, will be of tremendous benefit. On that basis, I conclude my remarks.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.