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Charing Cross Hospital

Volume 229: debated on Tuesday 27 July 1993

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. Lightbown.]

9.41 am

I am grateful for this opportunity to debate the future of Charing Cross hospital.

The underlying philosophy of the national health service often divides the political parties, but on the Charing Crosss there is an almost unique identity of views between Conservative Members and across the spectrum in west London. Liberals, community groups, management and medical staff at the hospital and trade unions have supported the campaign. Hardly anyone has not been involved in campaigning to keep Charing Cross hospital. I make no apologies for saying that our purpose in the debate is to try to influence events following the recent publication of the London implementation group and the review reports as well as, earlier in the year, the Tomlinson report which led to the hospital's possible closure.

I ask the Minister not to dismiss the debate as special pleading. I know how easy it is for people to assume that, just because a hospital is under threat, everyone will unite to save it. There are good and coherent arguments for saving Charing Cross hospital. I shall leave time for one or two Conservative Members to intervene, but I want to focus on the future role of Charing Cross hospital. Therefore, I hope that the Minister will see my speech not as a negative approach of special pleading but as showing the way forward.

I acknowledge, as do most people, that the NHS must change. I have never taken the view that there is never a case for closing a hospital; that is not appropriate or realistic. I also accept and have long believed in the concept of community care. Properly funded community care reduces hospitals' workloads, as does changing technology, such as day operations; they will inevitably increase patient turnover. All that is to be welcomed.

Counterbalancing factors include the aging population, resulting in people who need greater health care in the later stages of their life. Hammersmith and Fulham and its surrounding area has also been dramatically affected by the opening of the Chelsea and Westminster hospital. I shall not say too much about that. I had and have strong views about the cost of that hospital and the decision to build it when circumstances would obviously change. But that is water under the bridge: the hospital is there. However, that gives us the opportunity to consider the provision of health care in west London in order to make the best possible use of the existing resources. If the matter is approached from that angle, any proposed closures will, I hope, fit into that structure, rather than simply closing the hospital in order to remove the 2,500 beds that Tomlinson recommended should be lost in London, a proposal which is worrying many of us at the moment.

The hospital is 20 years old and that, in itself, makes it rather special. It was purpose built to a high standard with good facilities. The estimated cost of building and equipping it today would be some £450 million—half a billion pounds. The hospital is on a 16-acre site, which is not only a good size but allows flexibility and development —an important factor in its favour. It is also, to use a phrase current in the health service, a one-stop shop providing many supporting services in addition to operations and treatment.

The hospital has good transport links, which is not true everywhere in west London. Local people are acutely anxious that, if the accident and emergency department is closed, an ambulance may have to travel down Fulham Palace road, which will be particularly difficult if Chelsea and Fulham are playing at home, in order to reach the other hospital. That is a major transport problem. I know the arguments about ambulance paramedics' extra provisions, but I am not satisfied with the way in which they work out the figures for getting from A to B in ambulances to have enough confidence in their ability to transport a seriously injured person from Hammersmith Broadway to the accident and emergency department at the new hospital.

The hospital has a high volume of patients, which is an asset for undergraduate teaching. It has eight lecture theatres which are linked by a unique closed circuit, fibre optic colour teaching system, which is one reason why Tokai university in Japan has selected the hospital as its United Kingdom centre of excellence for Japanese undergraduates. That fibre optic network links a number of hospitals, enabling undergraduates to watch operations in different settings without leaving the area in which they are being taught. That is part of the hospital's teaching facility which is of profound importance to the health service, not just in London but nationally.

With all those advantages one might well ask why on earth we are even thinking of closing such a valuable asset. The answer lies in the Tomlinson report, which suggests the loss of 2,500 beds, and, to some extent, in the building of the Chelsea and Westminster hospital, to which I shall not return other than to say that it was justified on the basis that it would replace five other hospitals, and it did just that, taking up the services of those five hospitals. It was not intended to replace Charing Cross hospital. The concept was rather that there should be one hospital on two sites.

Clearly, the key issue is the Tomlinson report which basically suggested the closure of the accident and emergency department, the phasing out of the district general hospital approach and an emphasis on speciality services there. There are flaws in that argument, not just in the figures but in the philosophy behind that report. That is not to dismiss the Tomlinson report, which is a high-status report which deserves to be taken seriously, but there is a growing view, well founded on evidence, that some of Professor Tomlinson's figures are flawed. Perhaps the best example of that is the research done by Professor Jarman, which was published in an article in the British Medical Journal a few months ago. One of the critical factors in the Tomlinson report is the proposal to close Charing Cross and the need to lose 2,500 beds in London. The article said that London has about the same number of beds as the national average and the Charing Cross area is 20 per cent. below average for acute beds.

John James is the chief executive of the Kensington, Chelsea and Westminster commissioning agency. He said:
"Living in this part of London, you are less likely to be admitted to an acute hospital bed than the average for London as a whole, or for the rest of the country. It is quite substantially lower."
The problem is not that Professor Tomlinson was just plain wrong; it is more complicated. He was asked to look at acute services in inner London. Charing Cross deals with a different area and other services. One of the failings of the report—this cannot be laid at the door of Professor Tomlinson—is that we needed a review of the wider London needs, not just acute services. He did not look at the whole of London or at services such as geriatric, psychiatric, maternity and so on. When one looks at those services, one sees a different approach to the argument. That is why we need a different philosophy.

Our argument—I say "our" because it includes community groups, general practitioners, management, trade unions, medical staff, some Conservative Members and others—is different and we want the Government to look at that carefully before making any decision to close Charing Cross. Our argument is that closing the accident and emergency and the district general hospital facilities at Charing Cross is a mistake, even if the Government concentrated other specialties there. Surely the growing weight of evidence, not just in this country but overseas, is for a move towards science-based hospitals. That is profoundly important in the west London area. Such hospitals would provide, as Tomlinson says, a one-stop health shop, accessibility—we all accept that Charing Cross has that and it is indicated in the reviews—modern buildings and site flexibility. All that is present at Charing Cross. Also, although I do not agree with the philosophy of a market approach for the health service, Charing Cross pays its way in the market. The Minister must address that point, as it is that by which the Government are saying hospitals should he judged.

Closing the accident and emergency facilities would inevitably undermine the hospital's other facilities. At present, cancer patients who have complications such as renal failure, respiratory failure or neurological or psychological difficulties can all be treated on site. That is important, because patients do not have to be moved from a specialist hospital to a general hospital for treatment and then moved back again. That is a big advantage and it is one reason why in so many areas that have large populations there is a move towards science-based hospitals which have a wide range of facilities on site.

In reality, Charing Cross hospital is already the trauma centre for west London. It handles some 60,000 new accident and emergency patients per annum. I obtained that figure from the hew health authority the other day. Over 100 major trauma cases per annum are admitted through accident and emergency and a further 200 per annum are admitted via neurosurgery. That is equivalent to the model trauma centre that the Government recommend people to visit in Stoke-on-Trent. If the Government want to save money, people from the south of England who want to visit a trauma centre could visit Charing Cross instead of travelling to Stoke-on-Trent.

Charing Cross has a high reputation. One of the medical staff was selected, with the hospital, to treat George Bush when he visited Britain as President of the United States. Charing Cross is well located should there be a major accident of the type that happened in Amsterdam when the aircraft crashed. It is well located to be the trauma centre for west London, or perhaps even for a wider area. The facilities are there. If the Government make the mistake of closing Charing Cross or forcing it to concentrate on particular services, at some stage they will have to focus on the need for a trauma centre in or near London. Why do that when the facility exists already?

I want to put some positive proposals to the Minister. If the Government really want to improve health care in west London, they need to look at Charing Cross as not only a trauma centre, but as a hospital that should be linked, not so much with the Chelsea and Westminster hospital—although I do not rule that out—but with Hammersmith hospital. Hammersmith is an internationally known and world-famous hospital with enormously respected postgraduate teaching facilities. I am not arguing for the closure of Hammersmith, because the sites do not fit into each other and I am advised that it would take at least five years, or perhaps 10, to move one site to another. However, there is no doubt that a proper working link between Hammersmith and Charing Cross would produce a world-class hospital. Charing Cross could be used as the trauma centre with accident and emergency and district general hospital facilities, and Hammersmith could be used as the postgraduate research teaching and general research facility, together with some of its other functions. Such a hospital would offer enormously good facilities to the people of Hammersmith and Fulham and a much wider area of west London.

I accept that decisions about how such a link should be developed and how close it should be would have to be made by medical staff, the management and so on. However, I have no doubt that such a link would be useful. I do not want to give the impression that there is a quick saving on all this. The Government have a problem about how much they are prepared to spend on the health service, but closing one site and moving to another is not a cost-effective argument. I do not want to anticipate the speech of the hon. Member for Fulham (Mr. Carrington), but I think that he may deal with that aspect. My argument is that we should have a science-based hospital in that area.

If the site was closed and sold, even in the slightly expanding property market, I should be surprised if the site would fetch £15 million or £20 million. It may fetch more in a year or two, but it is not a particularly valuable site. Sadly, that is even more true of the Hammersmith hospital. Not many developers want to locate modern premises next to Wormwood Scrubs prison, although it may advise them of some of society's problems if they did. The capital invested in those sites and the expertise of the people working there should be used to produce the science-based hospital about which I have been talking.

The Bow Group is not something that I usually pray in aid. However, its paper estimates that there will be a cost of £100 million in additional capital expenditure simply to relocate services, beds and pre-clinical facilities if Charing Cross were to be closed. The Bow Group is watching the Minister. It has done its research well. I have read the document and I am impressed by the arguments.

Charing Cross has been able to reduce the cost of its 1993–94 services by 18 per cent. compared with 1992–93. It was an enormous burden for a hospital to have to achieve and it was difficult for a manager to make such a dramatic cut. That is one of the reasons for the morale problems in the hospital. Everybody was worried about the future of the hospital and their jobs.

There is a real opportunity to improve health care in west London. It could be done in the way that I have described with a science-based hospital providing world-class facilities in the west of London. I urge the Minister to consider the arguments seriously before any final decision is made.

9.59 am

I am pleased that the hon. Member for Hammersmith (Mr. Soley) has secured this debate and I am grateful to him for allowing me to intervene in it. He and I have been trying together to get Adjournment debates on the subject, and I am glad that his name came up. I congratulate him on his effective speech.

Charing Cross hospital is in my constituency, but of course it serves a wider population than my constituents; it serves the constituents of my hon. Friend the Member for Brentford and Isleworth (Mr. Deva) and those of the hon. Member for Hammersmith. In one sense Charing Cross is not a local but a regional hospital, although it serves a large local population as well.

As the hon. Member for Hammersmith said, the threat to the hospital originates from the Tomlinson report and from earlier reports on the future need for health care in London. The threat was based on the assumption that London had too many hospital beds for its population, because a decreasing population in London meant that fewer beds were needed, and also on the assumption that as health services outside London improved there would be less need to bus patients in to major centres of excellence in London. To some extent that is true, but the research by Professor Jarman of St. Mary's hospital in Paddington, to which the hon. Member for Hammersmith referred, shows that that process has already taken place. The British Medical Journal of 19 June revealed that the number of beds in London, especially in the north-west quadrant in which the Charing Cross hospital is located, has already been reduced, so that inner London now has no more beds per head than are available elsewhere in the national health service as a whole.

The reasons for that are straightforward. First, we have already closed a great many hospitals in London. The Chelsea and Westminster hospital replaced five other hospitals, resulting in a substantial net reduction in the number of beds. Moreover, London, especially west London, has certain characteristics which affect both my constituents and the constituents of the hon. Member for Hammersmith. There is a large transient population, a population of people commuting into work, and a tourist population. There are also refugees. All those people throw pressures on to hospitals as opposed to primary health care facilities and their needs must be catered for.

The length of the waiting lists for hospitals in the area proves that that is a reality. London waiting lists can largely be explained by reference to the nature of the population and the use that that population makes of health facilities. Nowhere is that more true than at the Charing Cross hospital, where the waiting lists are still substantial despite the opening of the new Chelsea and Westminster hospital. The accident and emergency unit is still heavily used.

Another myth about London's health service has helped to cause the threat to the Charing Cross hospital. The story is that, with 15 per cent. of the population, London receives 20 per cent. of NHS resources. On one level, that is true. London does have 15 per cent. of the population and it does receive 20 per cent. of the resources. However, there are two straightforward reasons for that. First, teaching and research are carried out in London to a greater degree than elsewhere. The special health authorities have not yet been brought into the internal market, although that is about to happen. Although teaching and research are compensated for in the calculation of the sums allocated to London for health care, no one in teaching or research—or, indeed, in the NHS in general—believes that such calculations are an exact science. If anything, they do not compensate sufficiently for teaching and research.

Secondly, London has to cater extensively for commuters, tourists, refugees and all the other problems of inner-city life, which throw a greater weight of need on to NHS resources. Perhaps 20 per cent. is too high a proportion for London, but I have yet to meet anybody who understands what is going on in London's health care who believes that it would be possible to reduce London's share to the 15 per cent. that would equate with its 15 per cent. share of the population.

Charing Cross is a large hospital, with 790 beds on a 16-acre site. It is also an excellent hospital, which came out well in the London specialty reviews. Its cancer services, neurosciences, plastics and burns units and its renal work were all highly commended. Closing the hospital would be extremely expensive and difficult. One would be closing more than just the acute beds. About one third of the hospital caters for geriatric and mental health patients of one sort or another. All those services would have to be relocated elsewhere.

Does my hon. Friend agree that Charing Cross is also a major trauma centre? For example, one of the busiest international airports in the world is at the other end of the motorway and if an accident such as happened in Amsterdam were to happen in London, Charing Cross would be the only hospital capable of giving the appropriate emergency treatment.

My hon. Friend is absolutely right. What he said highlights one of the key factors affecting Charing Cross hospital—its superb location. It is on the A4, which is one of the best routes out of London, and is easily accessible. Three underground lines service it and five bus routes pass its front door, so it has good connections with the public transport system—better, in fact, than those of any other hospital in west London.

Tomlinson was trying to achieve two things—to improve patient care and to save money. Closing the Charing Cross hospital would not improve patient care. The hospital services a deprived population which continues to use it extensively. The need for such a hospital in that inner-city area has never been greater. As my hon. Friend the Member for Brentford and Isleworth and the hon. Member for Hammersmith have said, the hospital is also ideally located as a trauma centre.

The Tomlinson report was also about saving money. There is no question about the fact that closing Charing Cross hospital would cost a considerable amount. Simply relocating the facilities at the Hammersmith hospital site would cost a substantial sum, and relocating the medical school would cost £60 million, so there is no saving of money to be made. I urge my hon. Friend the Minister to consider the proposals carefully and to decide that the Charing Cross hospital has a future role in west London's health care.

10.7 am

My main role today is to congratulate the hon. Member for Hammersmith (Mr. Soley) on initiating a debate of enormous importance to his constituents and to tell him that I have listened carefully to what both he and my hon. Friends have said, which will be carefully studied. I was glad that the lion. Member made such a constructive speech. I especially noted his remarks about Professor Jarman and about trauma centres—a subject of considerable importance and one of great personal interest to me—and his views on the future of the Hammersmith and Charing Cross sites.

As the hon. Gentleman said, this is not a partisan matter, and that fact should be taken carefully into account. I was impressed by his tribute to the views of the Bow Group on this subject—I see that two former members of the Bow Group are sitting on the Benches behind me. The alliance between the hon. Gentleman and my hon. Friend the Member for Fulham (Mr. Carrington) is impressive and demonstrates the intensity of their feelings on the subject under discussion.

The hon. Gentleman has not rejected the concept behind Tomlinson. He spoke constructively about the report and is aware of the need for change. Therefore, I shall not go over all that ground. He is also aware of the six specialty reviews that were set up as a result of Tomlinson to form a major part of the decision-taking process. With all these outstanding decisions he will forgive me if I do not go into detailed arguments on the points he raised. Everyone is aware that there is a problem of substantial duplication of some specialty services in London which may work against the provision of long-term, high-quality, patient care. Therefore, decisions must be taken.

Where are we now? The London implementation group under Sir Tim Chessells will make recommendations to Ministers in the autumn in the light of the specialty reviews, the option appraisal of central London hospital sites, which is already under way, the outcome of the recently published review of special health authority research and the views of health care purchasers and academic interests. There is a great deal of work to be done before proposals are developed further and there will be full public consultation on any major changes that are proposed as a result.

What, then, are the implications of those various processes for Charing Cross hospital? As the hon. Gentleman knows, there has been no decision as yet. Many factors will be taken into account. We have asked the London implementation group, working with the regional health authority and local health authorities, to bring forward detailed proposals by the autumn for the future of Charing Cross hospital, having regard to the Tomlinson report's option for closure, the site appraisal and the local review of accident and emergency services. The recommendations of the specialty reviews will also need to be fed into the consultation process on the joint Charing Cross-Chelsea and Westminster trust application, which ends in early August. No decision will be taken on that application until the other reviews in west London have been completed.

If I had more time I would have said more in detail about the extent of accident and emergency services at Charing Cross hospital. All that I will say is that in the light of the outcome of the reviews and other outstanding decisions, the district health authority has concluded, rightly in my view, that it would be premature to make a decision on the future of those services at Charing Cross at this stage. I listened carefully to what the hon. Gentleman said on the subject and I can assure him that there is no question of allowing any such services to close unless it is proved beyond doubt that alternative facilities are available.

I should like to make a few general points in conclusion. First, a feature of Tomlinson is that if London has too many acute beds and there needs to be a reduction in their number, it must be accompanied by the provision of better primary care. The hon. Gentleman probably knows that there are plans for an additional £43 million for improving primary care in London and £170 million over the next six years for capital developments. Some of that money is earmarked for the Hammersmith area—in other words, the area of the Charing Cross hospital.

Secondly, the Government realise how unsettling and difficult all these outstanding decisions are for staff, patients and hon. Members' constituents. These are difficult times while decisions are awaited. I must make it clear that it is the Government's intention to come to a decision at the earliest possible moment, depending on all the reviews that are now under way having reported and all the information being taken into account.

What is happening in London mirrors what is happening in the great conurbations in the rest of the country. These are painful decisions, but where they are necessary, they must be taken with a view to the best operation of the health service over the coming years—