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Hospital Facilities (Isle Of Sheppey)

Volume 170: debated on Friday 20 April 1990

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. Nicholas Baker.]

2.38 pm

I welcome this opportunity to raise in the House the closure of acute hospital services on the Isle of Sheppey and the urgent need for new hospitals on Sheppey and in Sittingbourne. I am pleased that my hon. Friend the Minister for Health is here to reply to this important debate.

To many, an Adjournment debate in the House may seem to be a modest affair. However, I assure the House that it is of the utmost importance to my constituents that Parliament and the Government understand that there is a sense of crisis prevailing on the Isle of Sheppey.

Three months from now we face the closure of acute medical and geriatric services on Sheppey. Three years ago we saw the closure of surgery, obstetrics and gynaecology on Sheppey—a modern maternity unit. Before that, some years ago, the full casualty service, children's wards and the paediatric service were also closed.

The Isle of Sheppey is in the prosperous south of England, and has a population of 35,000 that more than doubles in the summer months. It is an important industrial area, containing one of Britain's successful ports, one of its most successful steel mills and much more. Its only link with the mainland is a lifting bridge and an inadequate road system. Now it has no acute hospital facilities. Is it any wonder that its residents are angry, and that many consider the problem to be literally a matter of life and death?

All this follows years of progressive rundown. It is almost exactly 20 years since, in a maiden speech, I spoke of the need to defend our local hospitals, and I have done so again many times since while presenting petitions and in Adjournment debates. Often dedicated local action groups such as the Sheppey watch committee have sent deputations to Ministers—Conservative and Labour—and have received kind and helpful assurances; nevertheless, the rundown has continued. We now feel that we have come to the end of the road.

My constituents and I want real, tangible help, and I intend to continue to press for that help from the Minister and the Secretary of State. We want new hospital facilities—not in the 21st century, but soon. We are not crying for the moon; we are merely asking for the implementation of sensible, practical proposals that already form part of a proper district and regional strategy. Our plea is for the minimum level of hospital services that the people of Swale are entitled to expect in the 21st century. It is also a plea for extra resources, and Ministers can exert their influence directly in that regard.

We want a fairer share of those resources for the Medway health district, to enable it to build new hospitals and to finance it from year to year. For years local Members of Parliament, among others, have argued that Medway is a deprived district in an otherwise prosperous region. In 1985, under the old resource allocation working party formula, Medway had reached only 77 per cent. of its target. To correct the shortfall, we were entirely dependent on the rate at which other districts in the theoretically over-provided south-east could reduce their expenditure—and that was a pretty forlorn prospect.

Surely it is self-evident nonsense that the largest, most concentrated population centre in Kent—which is certainly not the wealthiest part of the region—should receive the poorest hospital provision. When it was decided to end the RAWP system, many of us thought that Medway would at last receive proper funding from the region or from central Government; sadly, we now learn that that is not to be. Under the new resident capitation rules—I am not sure whether they have been finalised—Medway will remain much poorer than most other parts of the region. It will be £13 worse off per resident than the next worst-funded district in South East Thames. Medway will receive £173 a head, and Brighton some £212. The teaching district of Lambeth will receive about £400 a head and Greenwich about £268 a head, although I accept that different considerations apply there.

It has always been suggested that a safety net figure of about £200 a head should be built into capitation. Such a fair system would give Medway about £9 million a year, and Brighton about £13 million. That would enable us to fund our much-needed hospital programme, which has already been largely agreed in principle by all concerned.

As I understand it, the reason for the under-provision proposed in the new arrangements lies in the fact that the region has a number of districts with a higher proportion of elderly people. But in those districts there are almost twice the number of private hospitals and private nursing homes per 1,000 population over 65 than we have in Medway. Does it make sense to give more money to relatively prosperous retirement areas and less money to poorer or relatively poorer, more concentrated industrial areas? The logic of that does not bear too much analysis. I ask my hon. Friend the Minister to look at that matter closely, urgently and sympathetically. If we can get this matter right, other things will follow.

The first thing that we need is a fair allocation of extra revenue—for example, the missing £9 million plus for Medway. The rules are not being changed, and this is the moment for the Minister to help us. The next thing that we need is approval for the Medway hospital phase 3C project which was taken out of the programme this year—that was a tremendous shock in Medway, which has a history of a sense of deprivation—just when the project had reached tender stage. It was another major setback for us. At the same time we need my hon. Friend's help to secure immediate funding for our primary care hospitals on Sheppey and in Sittingbourne.

I shall not rehearse the arguments for and against the concept of primary care hospitals. However, for many years many of us have campaigned for what was the declared policy objective—a second district general hospital in Swale or the so-called bi-polar strategy. That district general hospital, which would have been at Sittingbourne and would have replaced Sheppey general hospital and other facilities, obviously would not have satisfied the aspirations of the people of the Isle of Sheppey to have their own district hospital. The concept of a second district general hospital has been so reduced and undermined as to have lost credibility and support. Of course, there are those who urge that Sheppey general hospital should be restored to its full general hospital status—120 beds, a full range of services, casualty, surgery, medicine, maternity and so on. I should like nothing better than that.

In practice, we are faced with the overpowering logic not of politics or resources—not in any meaningful sense, anyway—but of the changing medical technology and more stringent standards that are imposed on us by the royal colleges. We understand also that a new district general hospital with a full range of consultant cover is designed to serve a much greater population than the population of the Isle of Sheppey. That is the argument for or against a new hospital. As much as we should like it, we recognise that there is little prospect of it ever happening. Our view and that of most people on the island and of Medway health authority has always been that we should retain the widest range of acute services until we can get new provision for hospitals in Swale. That consensus has been underminded by the royal colleges.

I must now record my resentment and anger at the behaviour of the royal colleges. I have said elsewhere that their attitude makes them appear not as protectors of the public, which is how I presume they would see themselves, but as predators. That is a harsh thing to say, and they will understand why. They always seem concerned that their senior house officers might suffer from remoteness and not get the necessary training and experience from hospitals such as Sheppey general hospital, but apparently they do not care that that very remoteness endangers the lives and well-being of the patients whom they are supposed to serve. It was only two years ago that the Royal College of Physicians accepted the present arrangements at Sheppey, but now it gives us just a few months' notice that, in effect, acute medicine and acute geriatric services must be withdrawn from Sheppey.

We now come to primary care hospitals. Let me make it clear that this is no cheap-jack solution. It is estimated that the four primary care hospitals planned for Medway would cost as much as a district general hospital. I believe it to be a good concept, but it is certainly not cheap. The concept has been approved by Medway district health authority and by most local bodies, including the community health council. The region has accepted that a case of need exists, and it goes along with the concept.

Each primary care hospital is expected to be based on between 30 and 72 in-patient beds, sites between three and six acres, entrance and reception areas, day hospital areas, out-patient clinics, treatment rooms for minor casualties, minor elective surgery, X-ray facilities and some pathology facilities. The primary care philosophy would depend for its success on a major contribution from general practitioners. That must be funded if only because it will mean extra GPs. It would depend on greater reliance on senior nursing skills, which would be welcome, extensive out-patient clinics, which would involve all consultants, and limited casual facilities. Such hospitals could obtain the confidence and involvement of the local communities and be seen as a logical complement to the high-tech district general hospitals.

Primary care hospitals must be purpose-built, modern and well-funded. There is talk of using existing buildings as an interim measure, given the present emergency. That is not a good solution, but it might be the only one available. None the less, we should not lose sight of the urgency and importance of obtaining funding for the new primary care hospitals.

How can we obtain approval and the resources for the new hospitals at the earliest opportunity? I hope that my hon. Friend the Minister will say that if we come forward with proposals for what I might call unconventional funding we shall have her support in securing approval from her Department and the Treasury. If we simply ask for conventional funding I hope that she will do her utmost to persuade the regional health authority of the necessity of giving Medway district health authority its fair share of support as a matter of extreme urgency. My hon. Friend could do a tremendous amount to help us on the Isle of Sheppey in those important matters.

I shall make two more brief points. Although I could spend much more time on the subject, that time is not available. Last year the Secretary of State insisted that a transportation study should be undertaken to examine the problems that arise from the remoteness of many people on the Isle of Sheppey, in Sittingbourne and elsewhere, and their difficulty in gaining access to centralised hospital facilities following the closure of local facilities. What has happened to that report? Has it yet been received and when can we expect results from it?

My last point is important, but I do not have time to deal with it at any length. It is what I call the "life and death" question for people living in remote areas. They have seen acute emergency local hospital services progressively run down. That might be an inevitable consequence of changing technology and centralisation but none the less people are entitled to the assurance that they will receive the same, or better, immediate life-saving and emergency treatment as in the past. Presumably, that depends on increased paramedic ambulance services, and on the provision of a range of life-saving equipment at local and community hospitals and at doctors' surgeries.

People on the Isle of Sheppey will want to know how the hospital service in its broadest sense will give them and their families the assurances to which they are entitled. On that matter and the general question of our inadequate hospital services in Swale, I hope that my hon. Friend can help us.

2.53 pm

First, I congratulate my hon. Friend the Member for Faversham (Mr. Moate) on so persistently, carefully and thoughtfully setting out the understandable anxieties of his constituents about the development of health services in his area. He forcefully made it clear that in the prosperous south-east the Isle of Sheppey has special circumstances and needs. I know the area moderately well because in a previous role I visited the Isle of Sheppey to look, not at health services but at birds. I am therefore well aware of some of the geographical features, and especially of the fact that the Isle of Sheppey is bound to the mainland by one bridge. I am also aware of the understandable effect of those geographical conditions on the provision of health services.

As my hon. Friend the Member for Faversham said,, he has raised the concerns of his constituents on several occasions in the House and I congratulate him on securing this Adjournment debate to rehearse these precise points once again. Before responding to his case, I wish to point out—as I am sure my hon. Friend is aware—that it is the Government's policy to delegate responsibility for the provision and organisation of local health services to local management. The Government provide a framework for those services by setting priorities and guidelines and by providing resources to the regional health authorities to allocate in turn to the district health authorities.

I shall be taking up a number of points that my hon. Friend has raised in more detail with the chairman of the regional health authority to see what further room there may be for manoeuvre and clarification and to ensure that my hon. Friend's constituents receive the improving quality of patient care that we wish to see throughout the country.

I understand my hon. Friend's concern about Medway health authority's recent announcement that further acute in-patient facilities will be removed from the island to hospitals in the Medway towns on the mainland. As he said, the circumstances are similar to those which led to the transfer of obstetric and gynaecological services from Sheppey general hospital to the mainland initially on a temporary basis in 1987. My hon. Friend the Under-Secretary of State approved proposals to make the changes permanent in May 1989 and, in making his decision took account of the higher standard of care—in the form of the comprehensive back-up facilities and expensive medical technology—that would be offered by centralising acute in-patient services.

My hon. Friend thoughtfully spelt out some of the considerations that arise from the changing technology of medical care. Whereas in the past it was possible to have several district general hospitals, offering roughly equivalent standards of care, increasingly with the techniques that are becoming available and the methods of resuscitation, intensive care and the number of facilities that are normally expected, health authorities have to think again about the way in which their resources are deployed.

My hon. Friend expressed something stronger than disappointment about the announcement by the Royal College of Physicians that from 31 July 1990 it is planning to withdraw accreditation for junior doctor training at Sheppey general hospital. The facilities offered for training there are, indeed, limited. There is no coronary care unit, no on-site surgery; a limited range of radiology and pathology facilities; library facilities are poor and there is no accommodation for any postgraduate activity. The withdrawal of its accreditation for training means that it would be difficult to staff the hospital in its current role. I well understand my hon. Friend's reaction to that announcement. I am sure that he will understand that as I also have responsibility for junior hospital doctors, I have perhaps more understandings of their position on this matter. Nevertheless, I am well aware of my hon. Friend's reaction to the implications for his constituents.

As my hon. Friend pointed out, the health authority's long-term strategy was to offer acute services from a centralised site at Medway district general hospital in Gillingham and to suport them by local primary care hospitals, one of which would be Sheppey general. Again, my hon. Friend spelt out in some detail the important contribution that primary care hospitals can make. However, the royal college's decision means that the health authority finds it necessary to proceed with long-term plans for Sheppey earlier than intended. I should emphasise, however, that the health authority will be considering carefully the consultation required, given that it believes that it is necessary that the changed pattern in service should be in place by August, but certainly the community health council's views will be taken into account.

Similarly, I understand my hon. Friend's concerns about transport. We have already described the geographical location of Sheppey. My hon. Friend the Under-Secretary of State for Health recognised those problems in May 1989 when he approved Medway health authority's plans involving the permanent closure of obstetric and surgical in-patient services at Sheppey general hospital and requested that a report on transport services for Sheppey residents should be made. As my hon. Friend is aware, Medway health authority officials will shortly be meeting Kent county council officials to review transport services. Following that, I hope that it will be possible to give further information to my hon. Friend.

My hon. Friend will also be aware, no doubt, that since the transport survey was undertaken, the excellent south-east air ambulance is now operational. The primary role of that service is to provide speedy transport to the hospital services required, especially for patients who are ill or injured in isolated rural areas such as Sheppey, where access may be difficult.

I am aware that in particular the lifting bridge, giving the only road access, has been a source of serious concern. The helicopter service carries a team of specially trained paramedics who can provide on-the-spot emergency treatment and stabilise patients before transporting them to hospital services. It is based at Rochester airport and became operational in December. Since then, it has proved its worth in speeding accident victims to hospital and transferring patients to units that provide the specialist care that they require for their recovery. From the date that it was put into service until April of this year, it has already responded to seven calls from the Isle of Sheppey, four of which resulted in the patient being speedily removed to hospital on the mainland.

To take up my hon. Friend's point about the importance of recognised paramedic qualifications, after the disappointment that surrounded the dispute this winter there has been widespread recognition of the importance of paramedic training for real accident and emergency cases. That issue is being considered by the Department of Health, throughout the Health Service and in the regions. I shall certainly incorporate my hon. Friend's comments in our thinking on the matter.

My hon. Friend also raised questions about the finances of Medway health authority. He will be aware that the allocation of resources to the health authority is a matter for South East Thames regional health authority. Last year, the health authority received an allocation of just over £66 million. That has risen to just over £73 million for this year.

The region as a whole will benefit from the new weighted capitation system of funding, to which my hon. Friend referred. The region's interim proposals for the pace of change for districts from the resource allocation working party system of funding to a weighted capitation system of funding mean that Medway will receive the same growth money as that previously planned under RAWP—a sum of £870,000 for the current financial year.

My hon. Friend referred in detail to the nature of his constituency and to social deprivation. The formula used by the Department to allocate funds to the regions takes account of the size, age and health of a region's population, with an additional allowance for the higher cost of providing services within London. To some extent, deprivation is recognised in that formula, as in taking account of the pattern of ill health the Department uses information related to premature death rates, which are known to be closely correlated with measures of deprivation.

Regions will allocate money to districts using a weighted capitation formula, but they also have discretion to include weightings in addition to those used in the national formula in order that funding may be sensitive to local circumstances. The Department has encouraged regions to consider factors such as social deprivation, if that is appropriate and significant locally.

The question of social deprivation is one which South East Thames regional health authority is currently considering. Discussions are in progress as to whether that factor might be taken into account and, if so, on what basis. I cannot say, as yet, what the outcome might be for Medway health authority. However, I urge my hon. Friend to take up his views on social deprivation in Medway with the chairman of South East Thames regional health authority. I am sure that he would welcome the opportunity to consider that aspect, in view of the regional health authority's continuing discussions on that matter.

We should not lose sight of the fact that when the weighted capitation system of funding comes fully into play, the role of the districts will have changed. They will be not the providers but the purchasers of health services for their resident population. That important but subtle distinction, which is part of our proposals for reforming and improving the Health Service, means that the district health authorities, along with the family practitioner committees—to be known as the family health service authorities—will have a special role of examining the health needs of their local population and deciding how best to meet those needs within the available resources.

My hon. Friend also expressed his concern about the delay in starting the next phase of Medway district general hospital. He will know that a £35 million capital programme is being undertaken. He will appreciate that, along with a number of other capital programmes in the region, the time scale for it has had to be reviewed because of falling land prices. It is a matter that will require further consideration and I shall certainly take into account the important points that my hon. Friend made, particularly in the light of the new circumstances surrounding the royal college's decision. However, I should not wish that setback to detract from the recent achievements in the health authority's capital programme. I understand that there has been a 1·8 million development at Keycol hospital, which will provide day care and in-patient facilities for the elderly mentally ill. That facility has recently become operational. It serves a group who, frankly, in the past, were not given the priority that they deserve. It will serve the Isle of Sheppey and Sittingbourne.

Earlier this year, another major stage of Medway district general hospital started taking its first patients. It was a £13·8 million development taking patients for psychiatric, psycho-geriatric and geriatric treatment. I am delighted to have accepted an invitation formally to open that development and very much look forward to seeing at first hand some of the new, modern facilities at Medway district general hospital that can provide improved care.

My hon. Friend spoke about the role of primary care hospitals and the way in which they can be funded and further progress made. When specific proposals are brought forward, I and my ministerial colleagues will consider them carefully and have urgent discussions with the regional health authority about the best way in which progress can be made.

In referring to the enhanced role of the family practitioner service, my hon. Friend hit upon one of the fundamental directions in which we wish our Health Service to move. There has been a substantial increase in spending, in numbers and in the care that general practitioners provide to their patients. Our recent proposals, including the contract and the opportunities provided in the National Health Service and Community Care Bill, are a vote of confidence in general practitioners and will ensure that the family practitioner service works closely with the community services. The acute services will be fundamental to providing the quality and standard of health care that I know my hon. Friend seeks. He represents a constituency—

The Question having been proposed after half-past Two o'clock and the debate having continued for half an hour MR. DEPUTY SPEAKER adjourned the House Without Question put, pursuant to the Standing Order.

Adjourned at eight minutes past Three o'clock.