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Kent And Canterbury Hospital

Volume 403: debated on Monday 7 April 2003

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.— [Jim Fitzpatrick.]

8.9 pm

I am delighted to have another opportunity to extol the virtues of a great hospital and its dedicated staff. It saddens me, however, that, after five Adjournment debates, so many years of public outcry and protest and so much evidence, the future role of the Kent and Canterbury hospital should still be in doubt.

It is perhaps worth looking back at the beginning of a long, sorry saga that affects a hospital that has served the local community and, through it specialties, the wider region so outstandingly well. The story started in 1996, shortly after the opening of the new development at Margate—the Queen Elizabeth, the Queen Mother hospital—when the then East Kent health authority,EKHA, made a proposal to run down the children and maternity units at the Kent and Canterbury hospital and focus them on two other sites.

EKHA's argument for that dramatic change was the need for concentration to ensure that training recognition continued with the royal colleges. I should say that no royal college has threatened to remove training recognition at any point from the Kent and Canterbury hospital. At that time, the Kent and Canterbury was by far the most efficient of the seven hospitals in Kent. In 1995, a national league table showed that it was the third most efficient hospital in England.

The proposals for that partial run-down were firmly rejected by the then Secretary of State, my right hon. Friend the Member for Charnwood (Mr. Dorrell), who Insisted on a more imaginative approach, whereby the three main sites—Canterbury, Ashford and Margate—carried out joint training. Immediately after the 1997 general election, however, EKHA leapt into a process of fervid activity and within a matter of months, in December, came up with an ill-founded proposal to reduce Kent and Canterbury hospital to a day centre with one solitary ward of geriatric beds.

Battle was joined in earnest. A campaigning organisation—Concern for Health in East Kent—was established, drawing support from prominent figures, Including all three political parties locally, and I cannot pay it strong enough tribute to the battle that it has fought. EKHA modified its proposals and decided instead to keep roughly half the hospital, but to close the accident and emergency unit and remove almost all the specialist facilities.

The proposals were put to the then Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). He modified the EKHA proposals yet again, insisting, in particular, that coronary care should be retained at Kent and Canterbury hospital and pledging that it would remain a joint cancer centre with Maidstone. Indeed, that joint centre underpins the cancer outstations at the other five main hospitals in Kent.

After that, EKHA decided that the proposals were unworkable and began the consultation process all over again—jointly this time with the newly created East Kent hospitals trust. There was another long, bitter round of campaigning, with CHEK leading the way again. Astonishingly, EKHA brushed aside the all the proposals on which it had consulted and introduced an unheard of fifth proposal for a diagnostic and treatment centre at Kent and Canterbury hospital, but it still proposed to focus the accident and emergency units on the other two hospitals, leaving only a minor injuries unit to deal with accidents at Canterbury, while keeping a sizeable bed capacity to cover elective care.

Cancer was left out of the document and confined only to an uncosted annexe, and the trust responsible for delivering cancer care at Kent and Canterbury hospital was not even a signatory to the document. For some months, that proposal has now been with the Department of Health, where Ministers are, no doubt, rightly giving it very thorough scrutiny. I am delighted to see the Minister in her place to respond to this debate, as we have exchanged views on a number of occasions. Indeed, last July, the Secretary of State received a delegation of MPs and specialists, led by me, to discuss the proposals.

Fortunately, things have moved on. With the demise of EKHA and the much more open and straightforward approach of the new Kent and Medway health authority, the impetus for change appears to have altered. Since our meeting with the Secretary of State, two important developments have taken place—one national, the other local.

At national level, the Government have published the White Paper, "Keeping the NHS Local—a New Direction of Travel", which represents a reversal of the trend towards ever larger centres and emphasises the importance of access. I welcome the document, which applies directly to our own case. Let me quote two of three core principles; I shall return to the third in a moment. First, it demands a
"focus on redesign, not relocate".
Amen to that. Secondly, it refers to the need to
"take a whole systems view … to exploit the contribution of different hospitals, primary and intermediate and … social care providers".
Both those principles would rule out the proposals currently before the Secretary of State. Indeed, the reason that all the Kent branches of the Royal College of Nursing rejected the latest consultation document was that it had been prepared without the involvement of community health services. That is made explicit on the covering page of the Royal College of Nursing commentary. Perhaps the Minister may be able to tell me in her winding-up speech whether the proposals before her will be referred to the reconfiguration panel, which forms an important part of the White Paper. Indeed, it is the note on which the White Paper ends—a very important body.

At local level, the parallel development, which is also welcome, is that the East Kent hospitals trust has introduced some interim proposals that represent an important step forward in two respects. First, that document effectively recognises the stark reality that the health authority will not get the money—figures of £100 million, £200 million and even £300 million have been bandied about—required for that sort of radical proposal. As a result, it seeks to build on existing arrangements, rather than on greenfielding. Secondly, there has been a genuine attempt to engage with medical staff in a way that did not happen in earlier proposals, although that process has been uneven.

None the less, even those interim proposals suffer from several severe faults. First, the costings are completely unrealistic, and I confess to having a background in corporate finance. For example, the actual removals cost for each facility is listed at £5,000—less than Pickfords charge for moving the contents of a large house. The building estimates, too, bear no resemblance to reality. In combination, the building cost budgeted—about£15 million—probably amounts to less than the actual cost of relocating one or two of the departments.

The truth is that NHS capital projects have tended to overrun massively, and the most recent in east Kent—the Queen Elizabeth, the Queen Mother project—was no exception. This project would certainly be no exception even on those provisional costings. The net saving for option 3, which would involve the largest move away from Kent and Canterbury hospital and is the only one fully financially assessed, amounts to only £3 million a year. In practice, given the vast underestimate in capital costs and the interest charges inevitably associated, that option would almost certainly worsen the already dire financial position in east Kent, rather than improve it.

Cancer has been excluded, presumably because it is the responsibility of another trust. It is, however, dependent on 28 other facilities provided in the Kent and Canterbury hospital, so it must be brought into the picture.

The most important weakness of all, in my view, goes back to the original flawed proposals for children's and maternity services in 1996. More than a third of the population of east Kent live in villages. Many rely on buses to Canterbury, or on volunteer drivers, many of whom are elderly and, while willing to give their time generously, are understandably willing to drive only so far. Hardly a single village in east Kent has decent access to Margate. One or two provide access by public transport, but most are a long way away.

My right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) pointed out in a speech that many villages that, as the crow flies, are closer to Ashford than they are to Canterbury have decent bus access only to Canterbury. In fact, the vast majority of villages provide the best access to Canterbury on buses. Canterbury is the hub of the east Kent bus system. Moreover, there are two railway stations, one on each of the two main railways lines through east Kent. A number of small coastal towns also have much better access to Canterbury—Whitstable, which I represent, Herne Bay and Faversham. I am delighted to see my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson), who I hope will say a few words later. He has been a stalwart supporter of the campaign.

The number of patients who cannot reach hospitals by buses or volunteer drivers would inevitably increase greatly, even with the interim options; yet the heavy extra cost to the ambulance service, which is already overstretched, seems to have been ignored, perhaps because it comes from a different budget. The price in lost access to the family and friends of patients cannot be costed—but it will be paid, in terms of a lower recovery rate for patients whose loved ones cannot get to their beds. The truth is that, for roughly half the population of east Kent, Canterbury is by far the most accessible of the three sites.

Further problems arise from the consideration of individual service configurations. I do not want to go into detail, but I will say something about accident and emergency services, which are most important and which have simply not been thought through. As I have said, Canterbury is at the centre of east Kent, and Margate is inaccessible. The interim accident and emergency proposals for Margate, however, are flawed in principle. What sort of A and E centre would have no facio-maxillary, no vascular surgery, no ear, nose and throat services and no eye facilities? If that is what is proposed for Margate A and E, surely it is not viable in the long run. Who would want to work in an accident and emergency system that was supposed to provide a full service with consultants, but whose structure was so incomplete?

In fact, the interim proposals leave east Kent with only one real. long-term A and E centre, at Ashford. Ashford is an important place and is expanding, but it also happens to be the only place in east Kent with excellent road access to another A and E service—at the huge hospital at Maidstone, just 15 minutes up the motorway. It is surely ridiculous to propose that east Kent's main A and E facility should be at Ashford, the only east Kent population centre with really good access to west Kent's premier A and E centre.

Two weeks ago there was a multi-car pile-up at Brenley Corner in the morning fog. Mercifully, there were few injuries, largely because of the extraordinary bravery of a crane driver who risked his own life to avoid the crash. Had it not been for his heroism, there would probably have been many serious casualties. That is the view of the ambulance service; it is not just my view.

Where would those people have been sent? Getting to Ashford would have meant a long, slow journey down a tiny country lane. Had Canterbury lost its A and E centre, would the ambulance crews have ended up picking and choosing according to category? Would those with minor injuries have been taken to Canterbury—by far the closest destination—while those with facio-maxillary, vascular, ENT or eye injuries were sent to Ashford, the least accessible point, down the little winding country lane? The rest, presumably, would have gone to Thanet.

It is worth considering overstretch, which has featured so much in the national press. Last year, sadly, east Kent repeatedly made the national news with stories of people in their eighties and nineties waiting for two or even three nights for a proper bed in A and E. Blind statistics hide the individual humiliations and tragedies of people such as Connie Jones, who, in her nineties, waited two days for a bed, and octogenarian Ray Gilson. His family, who have owned a little seafood shop on the Whitstable waterfront for many years, in desperation scraped together the money to get him into the Chaucer private hospital so that he could spend his last few days in some sort of dignity rather than hanging on without a bed in A and E.

Mercifully, this year the overstretch has been greatly reduced, partly through some innovative changes in the hospital, for which the hospital must take due credit, partly because of extra money that the Government have provided and partly because of a considerable shifting of the burden on to our community hospitals, which hitherto have provided an excellent service, yet find themselves increasingly struggling to meet the extra challenges placed on them by the acute hospitals—challenges that they are not equipped to face. I have never had a complaint about the Whitstable and Tankerton hospital, until the past year or so, when there has been a drip-feed of people saying that it is overcrowded and overstretched. Interestingly, there are also signs of over-administration under the new arrangements.

The worst case that I have received in the past 12 months involves the Queen Victoria hospital, the cottage hospital in Herne Bay, and the interface between the Queen Victoria hospital and the Kent and Canterbury. I do not wish to go into the details of the case here, save to mention that my constituent, Mrs. Florence Jones, a 73-year-old suffering from dementia, twice fell over while she was at the Queen Victoria hospital awaiting an operation at the Kent and Canterbury because she was not escorted to the lavatory, and on the second occasion she broke her wrist. She suffered a multiple fracture. She was left for three days, apparently without fluids, and has, sadly, died. Her son and daughter brought the case to me.

The extent to which inappropriate problems are being pushed on to our community hospitals, and the extent to which the interface is not working, are partly demonstrated by the administrative muddles in the paperwork in that case as it went to and fro, but, worst of all, by the fact that Mrs. Farnham, Mrs. Jones's daughter, virtually had a stand-up fight in A and E to prevent her mother from being transferred back to the Queen Victoria from A and E overnight, when her operation was delayed until the following morning.

I do not want to criticise any medical or nursing staff at the Kent and Canterbury. They are desperately overstretched. So many former patients have had so many words of praise for them over the years, right up to the present time. However, we must recognise that we are still desperately short of capacity, and any proposals for capital expansion must take full account of the fact that, with our huge financial overrun, we cannot afford a further debt burden and the interest charges that that would bring.

We must also recognise that Canterbury is not just the most accessible site in Kent, and the one with the concentration of regional specialties, but remains the main centre for surgery in east Kent. I have a graph of surgical operations at the main hospitals in east Kent over the most recent 12 months. Of the in-patient cases—the major surgery cases—Canterbury carried out more surgery than the William Harvey hospital in Ashford in every month of the past 12, save one. In some months it carried out as much as a third more than the William Harvey.

Compared with the Queen Elizabeth, the Queen Mother hospital in Margate, the disparity is much greater. In the two most recent months for which figures are available, January and February this year, the Kent and Canterbury carried out 1,466 in-patient operations, almost double the 802 achieved by the Queen Elizabeth, the Queen Mother hospital in Margate, yet it is Kent and Canterbury hospital that is threatened.

I am anxious that this should be a constructive exchange, and I welcome the willingness of Ministers to discuss the problem. I particularly welcome the fact that the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), has been down to see for herself. Her Government's new framework is based on looking at services as a whole and—I quote again—"redesigning, and not relocating". It is time to realise that Canterbury is by far the most accessible point in east Kent. It has the hospital with the greatest success in recruiting medical staff—a hospital that continues to remain the premier surgical facility and is the centre for all east Kent's regional specialties.

I do not think that anybody still thinks that the proposal that theoretically remains before the Secretary of State will ever fly, not least for cost reasons. It is time to bring to an end this five-year saga of proposal and counter-proposal, and to all the misery that that has brought to our overworked staff at the hospital. We need to build on what we have in our three acute hospitals in east Kent and focus on reinforcing strength—and by far the strongest hospital is the Kent and Canterbury.

The good things that can be picked out of the trust's interim proposals should be picked out, including ideas for consolidating one or two services at individual hospitals where that can be done without compromising interlocking dependencies. Any change must be implemented in a way that leaves our acute health facilities available where patients can best get to them without saddling our local budget with the heavy interest charges that come from huge capital spending.

In the words of the third guiding principle of "Keeping the NHS Local", options for change should be developed
"with people, not for them, starting from the patient experience"
and by
"working with staff to find new ways of delivering services."
Let us shift the emphasis back to the hospital that is most accessible to the largest proportion of people by far, where the largest output of major surgery is achieved and which has the greatest concentration of specialities—the Kent and Canterbury hospital: and, please, it ain't broke, so don't let's break it.

8.31 pm

I rise to speak in support of my hon. Friend the Member for Canterbury (Mr. Brazier). In doing so, I should like briefly to pay tribute to the work that he has done on behalf of the Kent and Canterbury hospital over very many years. He has done an enormous service to his constituents in Canterbury and to many from throughout the wider east Kent population. I should also like briefly to pay tribute to all the members of the Campaign for Health in East Kent—I do so not least because they are present—who have done marvellously well in keeping up their enthusiasm and keeping the campaign going. They have been a tremendous tonic to those of us who have been fighting the political battle.

I wish to represent the interests of my constituents in Faversham and the surrounding villages, who will be severely affected by any changes to the Kent and Canterbury, perhaps more than anybody else in east Kent in many ways, for six reasons. I shall confine my remarks to concerns that are specific to my constituency, rather than to the much wider issues to which my hon. Friend referred. Of course, he made some very specific points, and I should like in particular to draw the Minister's attention to his comments about cancer, which is a huge problem area.

My particular concerns are as follows. The first is transport. Transport links in east Kent are known to be extremely poor. It is sometimes difficult enough to make a journey from Faversham to Canterbury, but it is always difficult to travel from Faversham to Margate. To make a journey from Faversham to Ashford, as many of my constituents will have to do, is almost impossible on many days. As my hon. Friend said, the road is small and winding and is used by farm traffic. Lorries regularly jam the road and a protest group is currently forming to express concern about its current traffic level. If we were to add all the traffic that would travel along it carrying people to hospital, the situation would become intolerable. Public transport provision in that part of Kent is also hugely inadequate.

Secondly, on the question of location, as my hon. Friend said, Canterbury is at the hub of east Kent. It has a cathedral and a huge student population. By any judgment, it is the correct location for a hospital in that part of the world, regardless of where the others are situated. Neither Margate nor Ashford has any of those advantages.

Thirdly, there is the question of capacity. The Government have announced huge house-building plans for much of the south-east. Many of the houses will be built just to the south of my constituency border. That will clearly bring an enormous number of extra people into the county, and they will have health needs. With that capacity increase in the wind, surely it is not time to be shutting, downgrading or closing hospitals.

Fourthly, there is a lack of alternative facilities for my constituents. Faversham cottage hospital is an excellent small local hospital to which I pay tribute. However, it is not and was never intended to be the Kent and Canterbury. I should have thought that it was eminently sensible to build up local facilities before downgrading the Kent and Canterbury. Clearly, that has not happened.

Fifthly, there is a problem of deprivation. Although some areas of east Kent are extremely wealthy, others are extremely poor. My market town of Faversham has a relatively prosperous mediaeval core and a Victorian part, which was built with the arrival of the railways. A third generation of people came from the east end of London to pick fruit in the summer. It has a huge area of social housing. Downgrading the local hospital will lead to many people feeling excluded from the health service. They will feel that their local hospital has gone and they will suffer from that loss because they are often heavy users of the health service.

Sixthly, delay is a problem, to which my hon. Friend the Member for Canterbury has already alluded. The saga has gone on for a long time and has undoubtedly affected the confidence of many of the excellent people who work in our hospital. It has certainly affected the confidence of many constituents. I hope that the Under-Secretary and the Department can soon bring it to an end.

Given the bigger political picture in the national health service and in population growth throughout Kent, I am surprised, if not amazed, that the Government should even consider downgrading the Kent and Canterbury hospital. In my view, it is simply the wrong option at the wrong time. Perhaps I would say that as I was born there 40 years ago. I urge the Under-Secretary, in the strongest possible terms, to reconsider the decision.

8.36 pm

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing the debate on a matter of concern to him and his constituents. I also acknowledge the passion with which the hon. Member for Faversham and Mid-Kent (Hugh Robertson) made the case on behalf of his constituents. Health service issues always cause concern. That is right because our constituents greatly value the health service.

The people of Kent deserve a fully modernised health service, which provides them with the highest quality services. Everybody acknowledges that reconfiguring acute services is an integral part of the agenda. I stress to all hon. Members who have contributed to debates on the subject that the decision will be made in the interests of all the residents of east Kent. It is right and proper to say that.

For that reason among others, the Secretary of State has decided to refer the case to the independent reconfiguration panel for consideration. The new advisory body was announced in the NHS plan to help ensure that decisions on the outcome of major health service reconfigurations are fair and objective. The panel's remit is to consider three main items: whether the proposed service configurations are sustainable., whether they fully support modernisation and whether they result in improved service for patients. The panel will provide advice to the Secretary of State, who will then make an informed decision, taking the panel findings into account.

The NHS plan sets out a challenging 10-year programme for NHS reform. Far-reaching changes are inevitable to try to provide the best possible services for patients. We all acknowledge the pressures on the service, not only in east Kent but throughout the country, of trying to increase capacity so that patients can get ready, quick and responsive access to services. We want not only to increase capacity but to raise clinical standards generally.

There are major inequalities in the health service throughout the country and we are committed to tackling them. We must also ensure that services are accessible and flexible. We want to design services around the needs of patients. The NHS must no longer be configured around the needs of institutions. We must follow the patient pathway and wrap services around the patient's journey.

As part of the modernisation programme, many NHS trusts are considering changes to the way in which they organise their services. I believe that we all recognise that hospital services need to change if we are to continue to fulfil patients' needs and improve access. Things cannot remain in aspic. There are a number of different pressures on the service, including the working time directive and certain clinical governance issues. All those issues need to be taken into account as the health service changes.

We want to try to help trusts that are developing their plans for service expansion and redesign to have a direction of travel in their minds when they were considering the changes. That is why we have published the new guidance, "Keeping the NHS Local: a New Direction of Travel", to which the hon. Member for Canterbury has referred. This is a significant piece of guidance for the health service, in which we try to say that the drive towards "big is best" is not always the direction in which we want to travel, and that we will try to make services responsive to local people.

In providing advice to the Secretary of State, the independent reconfiguration panel will be asked to take into account the contents of the guidance and, in particular, the three core principles that the NHS should consider when planning reconfigurations. The hon. Member for Canterbury has referred to these. They are first, the need to involve the public and staff in developing options for change. This is a big change for us. It is about saying that the public and staff should be involved in the design of services right from the outset—not just when preferred options are developed—because we believe that, in that way, the partners will sign up to change and that change will be sustainable in the longer term.

The second principle is the need to redesign existing services rather than simply going for relocation, with primary care trusts increasingly taking the driving seat with the budgets. They are doing some incredibly innovative work on providing services closer to people's homes out in the community, and making them more accessible to people. The third principle involves trying to take a whole systems view of the whole health economy. This involves looking not simply at the role of the acute trusts, but at how they integrate with intermediate care in community hospitals and how they relate to services at primary care level. So we are looking at the whole health economy when designing services and trying at every step to work in partnership with other health providers in the area.

The document sets out the importance of public involvement, and says that any change must have support and engagement from staff and patients. The hon. Member for Canterbury highlighted one of the most important phrases in it, which states that the NHS needed to develop options for change "with patients" and local people, rather than for them. Again, it is a real culture change for the NHS to be working together with local people. We also now have the section 11 duty under the Health and Social Care Act 2001, which provides that every part of the NHS is under a statutory duty to involve patients and the public. We have issued guidance as a result of that statutory provision, and are now beginning to develop a proper framework against which trusts can measure their proposals.

The involvement of the public has always been a key factor in the proposals for east Kent. I know that the hon. Member for Canterbury feels that the proposals have not taken account of the views of local people, but it was a pretty comprehensive process. It aimed to ensure that the proposals were widely disseminated to staff, patients and other key stakeholders. The chief executive wrote to every member of the trust's 8,000 staff, inviting their views, and all staff received a summary consultation leaflet. Three rounds of staff seminars were held at each of the trust's five hospitals, with evening seminars for night staff, and 12,000 summary leaflets were distributed to members of the public. These were available at GPs' surgeries, hospitals and pharmacies, and a range of other public outlets. The leaflet was also included in a local newspaper delivered to 227,000 households in east Kent. More than 100 voluntary groups were invited to take part in seminars, and around 2,000 people attended a series of public meetings. As the hon. Gentleman mentioned, I was delighted to visit Canterbury last July. I spoke personally to health professionals, patients and representatives of the local authorities about the proposals. It is certainly fair to say that, during the consultation, the issue was well ventilated in the community, even if the process did not deliver a result that either of the hon. Gentlemen would support.

I am grateful to the hon. Lady for giving way, and I am particularly grateful for the announcement that she made at the beginning of her speech. That was excellent news. However, I put it to her that, however many people went to the meetings—most of which were actively hostile—the central weakness of the whole process was that it did not involve the community hospitals and health care provision in the area as a whole. That was the explicit reason that every branch of the Royal College of Nursing in east Kent rejected it. It is now central to the Minister's own White Paper.

I am sure that that is one of the matters that the independent reconfiguration panel will want to take into account. It is part of the guidance on keeping the NHS local, and the integration of the service will clearly be a key factor for the panel.

I want to say a little bit about the proposals, and what they mean in terms of service delivery for patients. The four shortlisted options included in the consultation document set out an important role for Kent and Canterbury. Three propose the retention of an acute hospital role, while a fourth proposes the provision of community-based services at the Canterbury site. A 24-hour nurse-led minor injuries unit would still be provided at Kent and Canterbury under all the options. I want to give local people the reassurance that the role for the Kent and Canterbury would still be substantial.

Under all options, a number of core services would be provided at Kent and Canterbury. As well as those for minor injuries, they include day surgery, out-patient paediatrics, services for older people, community assessment, intermediate care, a day care hospital, out-patient clinics, midwifery-led services and cancer services, which are hugely important to people in that community. I want to say a word or two about those.

First, I commend the good work done by hospital. There is a major programme of investment in cancer care, involving both equipment and staff. Recent developments include a new £1 million breast screening unit and a new £1 million linear accelerator for radiotherapy treatment, which will make an important contribution to improving detection and treatment of cancer. I reassure Members that cancer services will remain a central part of the services that Kent and Canterbury will offer.

Key points need to be made. First, Kent and Canterbury hospital is part of the Kent cancer network. It will remain so under the recommended option. The network, which is very successful, serves a population of nearly 1.8 million people, including residents of Kent, Medway and Hastings and Rother. East Kent's service for radiotherapy and chemotherapy day attendees will continue at Kent and Canterbury, supported by high-quality diagnostic and treatment services.

Under the recommended option, Kent and Canterbury will develop an ambulatory and out-patient model of care, which will allow the vast majority of patients to continue to receive their cancer care locally. In fact, it is the model that most patients undertake now in terms of their diagnostic, screening and initial treatment options for cancer. Therefore, it is right to say that the cancer option that has been set out means that Kent and Canterbury will still be part of the Kent cancer network and will be providing high-quality services to people in the area.

I am most grateful to the Minister for giving way once more. Does she accept that, during the consultation process, two of the three consultants responsible for delivering those cancer services spoke out most vehemently against the weaknesses in the proposals? At the end of the process, when Professor James, who has overall responsibility from Maidstone, alleged that medical staff were in favour, the third was so angry that she too spoke out vehemently against them. No consultant at Canterbury believes that the proposal on the table would deliver long-term, viable joint cancer centre services.

I am aware that the proposals are controversial, as are the rest of the proposals for Kent and Canterbury, but I am also aware that the national cancer director, Professor Mike Richards, went down to the hospital and his information is that the consensus was perhaps larger than the hon. Gentleman suggests in terms of the reassurance given to local consultants on the quality and safety of the services that would be available. Inevitably, when there is change—I understand this—local clinicians are extremely concerned, because they have the real interest of patients at heart in trying to provide those high-quality services. In terms of the cancer network, reassurances have been given on ensuring that Kent and Canterbury remains a key part and that it can provide good-quality services to local people.

I want to say a word or two about transport, which is another key issue. The hon. Member for Faversham and Mid-Kent has emphasised that. On my visit, I had the opportunity to travel some of the area's winding roads, so I appreciate the transport difficulties there. The matter has been reviewed by the Kent county council scrutiny committee, which has done an extremely thorough job in considering the proposals. The trust has now accepted that further work is needed on the feasibility of expanding NHS transport in the area, and it will continue to work with public transport providers to try to maximise travel opportunities to the hospital sites.

The Kent county council review found that services should be tailored to the needs of local people in terms of transport arrangements for patients and visitors. It is crucial for visitors to be able to attend hospital, as access to them is often a key factor in a patient's recovery. Such arrangements should be developed and implemented within the wider plans for reconfigurations. This is not an isolated issue in respect of east Kent, as a recent social exclusion unit report shows that people in many communities up and down the country often do not attend hospital appointments because they cannot get there using existing public transport options. We need to be much more imaginative in trying to find ways to facilitate easy access. The problems in rural areas are clearly sometimes exacerbated due to sparse rural transport.

The response from the trust has highlighted the positive steps that have already been taken. It is working on two projects to try to improve patient and visitor access, and is examining other rural transport schemes. It has plans to implement a green transport plan to address problems on-site, and intends to carry out further work to examine whether transport links can be improved across the region. Under the options, on which, clearly, Ministers have not decided, and which are subject to advice from the independent panel, I understand that 85 per cent. of patients would still be treated at Kent and Canterbury who could normally expect to be treated there. I am not seeking to minimise the transport problem: although not everyone will have transport problems, clearly it is a significant issue in this area.

The interim delivery strategy, to which the hon. Gentleman referred, has not been the subject of consultation and is certainly not the subject of decisions by Ministers. I am pleased, however, that he welcomes aspects of that strategy. It is being developed by a working group from the trust and the primary care trust., involving clinicians and public representatives. A draft strategy was presented to the East Kent hospitals trust board on 14 March, and three options were set out. I understand that the hon. Gentleman takes exception to the third option that has been set out, but welcomes some of the other proposals. It is an important strand of the overall programme to modernise and update services, and it demonstrates the commitment of the trust and the primary care trust, which, ultimately, will have to find the resources to sustain the changes—to make sure that services in east Kent are safe and sustainable—and, given the pressures within the system. attempt to have a best-value approach to ensure financial efficiency.

The hon. Gentleman mentioned the financial difficulties that the area faces. Services there will benefit from an increase in investment of around 30 per cent. over the next three years, which is similar to other areas in the country—the biggest ever investment in the NHS—but I recognise the pressures that the whole health service is under. We have a long way to go in terms of increasing capacity, dare I say, after many years of under-investment and a lack of capacity in the system.

All three options outlined in the interim strategy will mean that Kent and Canterbury will retain a number of core services. There are proposals to enhance emergency services with the introduction of an emergency centre, under which vascular surgery, urology and clinical haematology would be provided together at Kent and Canterbury. A clear, important and sustainable role for the hospital is therefore envisaged in some of the proposals.

In relation to the interim delivery strategy, the local health community has been engaged fully in the process to try to meet the third core principle of our new guidance: that there should be a whole systems approach to these decisions. The plans have also been shared with senior clinical staff and presented to the Canterbury and Thanet community health council.

In conclusion, I want to say a few words about the next steps in the process, as those will be of great concern to local people. I am very conscious of the length of time that it has taken to resolve these matters. For clinicians, the public, the patients and everyone who works in the trust, certainty is very important. Although, as I have said, the matter will be referred to the independent reconfiguration panel, which is the right thing to do, we will make it clear, as a matter of urgency, that we want the independent reconfiguration panel to report to us with their advice. We will be writing as a matter of urgency to the panel. We will set out the terms of referral. We will also write to the community health council chairmen who referred the case originally to inform them of the action that is being taken. We will certainly try to let local people know far as we possibly can that this matter is drawing to a conclusion. I expect the independent reconfiguration panel to look at the case quickly and to provide its advice to Ministers as a matter of urgency because, as I say, I am hugely conscious of the need to get some certainty into the process.

Regardless of the final decision that is taken, new facilities and models of care in this area are needed. They will enable the trust to provide health care to Canterbury residents. What is important for all of us involved is that those services be sustainable in the long term. They must provide an improved and better service for patients and the local community. That is what we are all aiming to achieve for the residents of the whole of east Kent. That is our overriding duty.

Question put and agreed to.

Adjourned accordingly at six minutes to Nine o'clock.