Motion made, and Question proposed, That this House do now adjourn.—[Alison Seabeck.]
May I thank Mr. Speaker for allowing me this brief debate on the future of services at Queen Mary’s hospital in my constituency in Sidcup? I thank the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), for being in her place to reply today. I am also delighted to see my hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett), who has been at the forefront of the campaign to protect our services, the hon. Member for Erith and Thamesmead (John Austin), who shares with us representation of the borough of Bexley, and our parliamentary neighbour the hon. Member for Eltham (Clive Efford). I hope that they will catch your eye later, Mr. Deputy Speaker. I will not make my remarks overlong so that, with your consent, they can contribute to the debate.
This matter is of enormous concern in Old Bexley and Sidcup, the borough of Bexley and the neighbouring areas that use the facilities at Queen Mary’s hospital in Sidcup. Like many hospitals across the country, it has had severe financial problems. The four acute hospitals in south-east London, three of which have private finance initiative status and were new builds, have had special difficulties. Queen Mary’s hospital is much older, but in 2005 it still had a £20 million deficit. That has been reduced this year to just under £2 million—£1.8 million. That required an enormous effort by the clinical staff at the hospital in how they go about their business, and by the administrative and management staff. The turnaround has been remarkable, and they should be congratulated on and praised for that.
As the Minister will no doubt tell the House, the cost of operating at hospitals is based on a cost average set at 100 points on the scale. In 2005-06, Queen Mary’s was just over that at 104 points, but that is because it was frequently paid under tariff by our local care trust. This year, it is below that 100-point tariff. The institution is now financially efficient in the health care that it provides. There were more than 23,000 emergency and 3,000 elective in-patients over the past year. There were 16,500 day cases, and 52,000 new out-patient appointments. There were 132,000 follow-up out-patient appointments. The number of patients treated is of a high order at this very effective local acute hospital.
The accident and emergency department is under threat of closure, which is obviously of major concern. Over the past year, 74,682 people attended the department, of whom 10,803 had to be admitted. There is clearly great demand, and people are given very efficient treatment: 98 per cent. of those patients were seen and treated, discharged or admitted in under four hours. Not only is Queen Mary's financially viable, but it has one of the most efficient accident and emergency units in the country. That is why we are concerned about the clinical proposal to cut provision from four hospitals to two. There would not be enough beds, doctors or space. Super-trauma centres may be the way of the future, but people are worried about whether they will be able to cope with the volume.
Of particular concern to those of us who represent London areas, particularly in south-east London, is travelling time. It is not so much the distance that is the problem. The journey from the gates of the House of Commons to the boundary of my constituency can take 40 minutes—legally—but it can also take as long as two and a half hours, with great deal of bad language and bad traffic.
The maternity unit at Queen Mary's is under threat of complete closure. Some say that a midwifery unit may remain, but at the moment nothing is intended to remain. Yet the maternity unit is superb. It has been clinically assessed as being at level 2, which is the highest rating in the London area. Last year it dealt with 3,021 births. People keep telling me that the number of births is falling, but that is not borne out by the figures. This year, the number has risen to 3,360.
As the Minister will know, the Royal College of Midwives has set 3,000 births a year as the benchmark for an acceptable and viable unit for training midwives. Although those of us with children will pay tribute to the services and expertise of midwives, a midwifery unit alone is clearly not enough. My elder son was born in distress and required surgical intervention to arrive safely with us. More than 20 per cent. of births in this country require surgical intervention, which a midwife cannot provide. A midwifery unit alone will not give our constituents enough reassurance. I am sure the Minister will be concerned to learn that the United Kingdom is now 19th in the world survey of birth safety. We hoped that the situation would get better, not worse.
Although Queen Mary's is one of our older hospitals, its infection rate is much lower than those of many of its neighbours, especially those in London. There were no cases of MRSA—I hope the House will forgive me if I do not give the name in full; that would be too much of a challenge—in June, July or August. Two years ago there were 41 cases; the number was down to 12 this year. The number of cases of clostridium difficile fell by 30 per cent., against a national rising trend, and the board has allocated an extra £500,000 for cleaning.
This is a hospital that is serving the community well—it is both cost-effective and clinically effective—and has a lower rate of infection than is found elsewhere. Despite all that, however, it is subject to perpetual rumour and speculation, which undermines public confidence and is understandably of great concern to the excellent men and women who work at the hospital and provide us with such cover. The panic locally was started by Lord Warner, a former Health Minister in the present Government who has been appointed chairman of the NHS provider agency.
When the four acute boards were instructed to merge their chief executive posts, no account seemed to be taken of the £3 million or £4 million redundancy costs that that would involve for senior staff. At a number of meetings, Lord Warner has said that he would like to see the Queen Mary's site cleared for housing, which gives us no reassurance at all. Although the site near the A20 is no doubt valuable, we would prefer it to be kept for a hospital.
There are clinical proposal groups which will report by the end of the month. They will go to Professor Alberti for scrutiny. We all wonder what the Darzi plan overlay will be for that, because everything seems to be very confusing. There is a tremendous race to get all this done by mid-December before Christmas, so a valued local hospital and dedicated staff are being pressured into accepting something they do not wish to happen.
There have been problems at the hospital, but they have been met, despite the hospital not having a financial level playing field for a number of years. We accept that there must be some changes. Nobody is sticking their head in the sand. What is confusing, however, is the number of fingers in the pie. NHS London seems to be wobbling all over the place. Who will count, Darzi or Alberti? Will the clinical boards take into account travel times? I am told that that is not part of their remit. The “A Picture of Health” consultation is being steamrollered through, so the number of hospitals will fall from four to two with no one sure what is intended. The care trust has got its finger in the pie, and the acute trusts are all over the shop. Meanwhile, behind the scenes, Lord Warner pushes on through the swirling, confusing mess.
I have a warning for the Minister. We are glad that she is present, and we look forward to hearing what she says, but those who stand behind her who are creating this swirling mess need to know that closure of the hospital will be bitterly opposed.
The hon. Member for Old Bexley and Sidcup (Derek Conway) has highlighted the anxiety felt by his constituents and those of other Members present. People are attached to their local hospitals for very good reasons, and he has identified some of the reasons why so many people are attached to Queen Mary’s, Sidcup.
We need an assurance from the Minister that there will continue to be four hospitals serving the boroughs of Bromley, Bexley, Greenwich and Lewisham, whatever the outcome of the consultations. Queen Mary’s has been financially challenged, but there has been a turnaround both financially and in quality of care.
The Bexley Care Trust is, however, more financially challenged, and some of us fear that some of its proposals have been financially driven rather than patient-driven. Maternity services offer an example of that. According to the Royal College of Midwives, a unit needs to have 3,000 births per year to be registered for training, and it also needs to meet that target for the Royal College of Obstetricians and Gynaecologists to be able to guarantee obstetric cover. The care trust has told us that the number of births has been falling below that. I would be the first person to say that the unit might need to change if it were not meeting such targets, but the care trust made its calculation in terms of the places it had commissioned at the hospital, ignoring those coming from the constituency of my hon. Friend the Member for Eltham (Clive Efford) and from Bromley. As the hon. Member for Old Bexley and Sidcup said, there are more than 3,000 births this year, and there is no reason to close the maternity unit on the grounds that it cannot meet the RCM or RCOG figures.
With accident and emergency, I accept that there might be an argument for change. There might be a cogent argument for there to be fewer accident and emergency units. If I suffered a stroke or a cardiac arrest, I would not necessarily want to be taken to my nearest accident and emergency unit. If I had a stroke, I would want to go to a specialist unit where a proper diagnosis could be made instantly as to what kind of stroke it was, so that the right treatment could be given—and similarly with cardiac arrest. However, the proposal that Bromley, Lewisham, Greenwich and Bexley should go from having four acute trauma and accident and emergency units to two shows complete ignorance of the traffic situation in that area and the transport infrastructure.
I also think the proposals are premature. There is a great deal of merit in what Professor Darzi has suggested about, for example, the treatment of stroke and cardiac disease. Let us consider other conditions, too. If someone close to me had breast cancer I would not want them to go to the nearest general hospital to be seen by some general surgeon who does a bit of this and a bit of that. I would want them to go to a specialist unit. There is an argument for the concentration of specialist services in centres of excellence.
There is also much merit in Lord Darzi’s proposals for local elective centres. At the end of the day, Queen Mary’s might become a centre of excellence, dealing with very real needs in the community—hips, knees, hernias, routine gynaecology and cataracts. That would not be a downgrading of the hospital, as long as it continued to provide 24-hour emergency care for people who are not blue-light emergency cases. It would be providing a vital service.
However, all such discussion is premature, because we have not yet had the debate about Darzi and what kind of health service we want for the next five or 10 years. I want an assurance from the Minister that we will not be reduced to only two hospitals serving our area—that there will continue to be four hospitals, and that the decisions will be about what services are provided at which hospital, and which services might be more effectively provided in the community.
I say this to the Minister: if the proposed changes are patient-driven and can be proved to be safer and more effective and have better outcomes for my constituents, my hon. Friend the Member for Eltham (Clive Efford) and I shall support the Government. However, if we are not convinced that they are safer and offer better outcomes for our constituents, and we think that they are financially driven, we will join Opposition Members in opposing the proposals.
Order. I should say to hon. Members with an obvious interest in the debate that I have to protect the hon. Member for Old Bexley and Sidcup, who secured it, by ensuring that there is a full ministerial answer to what is obviously an important local matter.
I congratulate my hon. Friend the Member for Old Bexley and Sidcup (Derek Conway), my constituency neighbour, on securing this important and much-needed debate. The future of services at Queen Mary’s hospital in Sidcup is a major concern to my constituents and there is real fear locally about the possible closure of the accident and emergency and maternity units. There is also concern about a downgrading of services across the board in that excellent hospital. Queen Mary’s is much loved, used and supported not only, as we have heard, by people in the borough of Bexley, but by those from across the border in Bromley and Greenwich.
My late dear father Norman Evennett was treated superbly by the accident and emergency unit at Queen Mary’s last year. The continuing excellence of the professionalism and commitment of the medical staff has been evident—from that emergency, which I experienced personally, and from the experiences that constituents have told me about. The maternity unit is extremely popular with my constituents; many new mothers express to me great satisfaction with the service that they have received from it. However, they are concerned about its future viability.
My hon. Friend has explicitly and effectively put forward his concerns. I share them; I have campaigned on all those points in public—in meetings with the Bexley Care Trust and with the chief executive of Queen Mary’s. I pay tribute to all the local people campaigning against cuts in vital services—I am thinking of the petition in the Bexley Times and of Councillor Sharon Massey, the Bexley council cabinet member for social services, who is campaigning with us to save vital services in our borough. I am, however, disappointed that Bexley Care Trust has not been more robust in its support for Queen Mary’s hospital, fighting for vital local services for the people of our borough.
My hon. Friend referred to the fact that Queen Mary’s has had problems in the past. We acknowledge that, but we should also give credit to its chief executive, Kate Grimes, and her team for their work in turning round the hospital’s problems. This week, we have heard debates and comments about hospital infections—Queen Mary’s has done superb work in removing hospital infections, particularly MRSA; it has done superb work on the clinical front as well.
My constituents have been writing to me. I shall quote just two of them. One wrote:
“In the event of A & E closing, to which hospital will its patients from Bexley be taken, and will this hospital, or hospitals, be able to meet the four-hour deadline with the extra 223,000 patients?”
As my hon. Friend mentioned, the real concern is that if we cut back or downgrade the services at Queen Mary’s and if there are accident and emergency units only at the other three hospitals—or perhaps two; the hon. Member for Erith and Thamesmead (John Austin) has highlighted that fear of ours—the extra time taken to get people to those units could prove disastrous.
Another constituent said:
“The withdrawal of any of the services at Queen Mary’s can surely only be to the detriment of the community and any proposals to do so appear to be based on financial considerations rather than health ones.”
We look to the Minister and the Government to deal with this issue. Yes, there have to be changes; we know that nothing stays the same, as my hon. Friend the Member for Old Bexley and Sidcup said. However, we must make sure that the changes are driven by clinical, not financial, considerations. Many of us worry that the good facilities that we have will be undermined for financial reasons, and not in the pursuit of clinical excellence.
I realise that time is pressing and that I must conclude, Mr. Deputy Speaker. If our accident and emergency units and maternity units are removed from QMS, Bexley alone of the four boroughs will be without the facilities that Bromley, Greenwich and Lewisham have. That is neither fair nor acceptable, and it will result in an inferior service for my constituents, those of my hon. Friend and those of the hon. Member for Erith and Thamesmead. Vital services should not be cut. The medical care of our constituents requires a decent service at Queen Mary’s. I hope that the Minister will take that on board.
I am grateful to you for calling me, Mr. Deputy Speaker, and may I also thank the hon. Member for Old Bexley and Sidcup (Derek Conway) for giving me this opportunity to make a contribution? I will be brief, and I will take your guidance.
There are some who, in local papers and other local forums, are trying to portray what is happening as cuts, and I want to put the situation in context. Back in 1997, more than 14,000 people were waiting longer than 13 weeks for treatment in the four hospitals in the area; that figure is now down to 1,394. In 1997, 4,619 people were waiting more than 26 weeks for treatment; this July, that figure was down to just one—across the four hospital trusts. Between 2003 and 2008, Greenwich PCT had an increase of £133.4 million, and Bexley PCT one of £100 million. Across the four PCTs, the increase has been £518.7 million, so we are not talking about cuts in hospital and health service expenditure. We are talking about a reconfiguration of services to meet the modern needs of our NHS—new drugs, new forms of treatment and patient choice.
My PCT is about to consult on the reopening of a town centre cottage hospital in my constituency, which was closed several years ago, as a 24-hour, seven-days-a-week, walk-in GP treatment centre. That proposal is enormously popular in my constituency and people are very happy about it, but it is bound to have an impact on services elsewhere. But that is not cuts; it is meeting local patient need through the reopening of that hospital.
I accept that services have to change, but we have to move forward on the basis of four hospital sites that each have urgent care facilities. The most urgent and traumatic cases must be dealt with in centres that can provide treatment safely and in a modern setting, providing people with timely interventions that increase the likelihood of survival and of making a full recovery. That is what we are duty-bound to deliver and what our constituents deserve, and it is what we must strive for. There should be no scaremongering about cuts; rather, we should be talking about improving the service. I will accept changes that will improve the service for my constituents, but I am not going to accept changes forced on us because of financial considerations. That is the basis on which we must move forward, and on which Ara Darzi and others must consult my constituents.
I congratulate the hon. Member for Old Bexley and Sidcup (Derek Conway) on securing this debate on the future of Queen Mary’s hospital, Sidcup. I also thank those of my hon. Friends and other hon. Members who have participated so well in the debate and shown passion for and concern about their local NHS—a passion and concern that we all share nationally regarding the changes that we are to make in the health service. I know that this issue is of concern to the hon. Gentleman and his constituents, and I appreciate the comments that he and others have made in the House today.
I also congratulate Queen Mary’s Sidcup on how it has turned itself around—I acknowledge the remarks and tributes of the hon. Member for Old Bexley and Sidcup at the beginning of this debate—and staff in south-east London on the hard work that they have put into improving services and performance. Millions of people are receiving high quality and safe services every day. The best of the national health service is among the best health care in the world. We should all be proud of its achievements and, given the comments made in this House today, I know that all hon. Members are.
For that reason, I understand that when we talk about potential changes in services, it leads to huge public interest, debate, and, in some cases, anxiety. I recognise that change is difficult and appreciate that it can provoke powerful reactions from stakeholders. When people talk about the reorganisation of services, they think that it is about saving money; it is not. It is about saving more people’s lives and making care more convenient for local people.
Lifestyles, society, medicine, technology and the NHS itself have all changed over the past 60 years. Medicine is, and always should be, dynamic. Change is nothing new in the NHS. It has always responded to change and the latest treatments by organising itself to deliver that care. We are responding to a variety of drivers for change now.
The aim of the “A Picture of Health” project is to improve the quality, safety and patient experience of local services. That can be achieved only through changes in how those services are delivered. The proposed benefits to patients will be services available closer to their home and specialist hospital services concentrated closer together. That is the aim of all reviews and of this one in particular. That approach will improve patients’ experience by providing safer services and ensuring that all specialists have the appropriate experience and expertise.
The “A Picture of Health” project is clinically led. Clinical staff across the four outer south-east London boroughs and in the four hospital trusts take a lead in determining how services should best be delivered in the future in those four trusts. More than 100 hospital-based staff took part in a plenary session held on 25 September and further consultation with clinical staff working in the community is also taking place. In addition, there has been strong stakeholder engagement throughout late 2006 and 2007, beginning with “The Big Ask” website consultation run by Ipsos Mori from October 2006 to January 2007 and continuing with four public engagement events.
The national clinical advisory team, under Professor Sir George Alberti’s leadership, is reviewing the emerging options for change during October 2007, giving further assurance that the clinical case for change can be delivered. Further to the events organised during September and October to gather opinions from clinical staff, Sir George Alberti is talking to a wide range of local stakeholders during October and there will be two public feedback events ahead of full public consultation. Examining the health service involves such a dramatic change, and this is a good way of consulting. I know that all hon. Members will take part in those consultations with their constituents.
As part of the consultation, I also understand that Sir George Alberti visited Queen Mary’s Sidcup yesterday morning and discussed the case for change and the emerging proposals with a range of doctors and other health professionals. Perhaps hon. Members would like to look into what happened following those discussions. I believe that there will be an opportunity for the hon. Member for Old Bexley and Sidcup to discuss any concerns that he has with Sir George before he concludes his review. I reassure him that consultation on proposals for service change will not begin before Sir George has reported on his review.
I appreciate the great interest that the hon. Gentleman has taken in the review at a local level, and the way in which hon. Members have spoken in this debate. I understand the specific issue that the hon. Member for Old Bexley and Sidcup has raised today in relation to the “A Picture of Health” programme.
On 30 August, Lord Warner, the chair of the NHS London provider agency, agreed with the chairs and chief executives of the four hospital trusts that a proposal for a single executive team across all four trusts should be looked into. Each of the four trusts is currently assessing, individually and collectively, the merits of establishing a single executive team to support their own separate trust boards, which would be retained. A final decision has yet to be taken, but I understand that this proposal could help to facilitate the significant change programme across the local health economies and enable the development of services that will provide best value for money in the future.
The four south-east London trusts are on the Department’s list of financially challenged trusts. The NHS London provider agency continues to work with each trust to develop a range of options for solving the indebtedness while maintaining standards of patient care and value for money. Our Department is working closely with strategic health authorities to identify long-term solutions for the trusts. I must reiterate that this work is not the driving force for the review of services—that is the clinical case for change.
I understand what the Minister is saying and this is a helpful reply. Can she assure the House in relation to Lord Warner’s activities that no chairman or chief executive of any of those four acute hospitals will be dismissed if they object to the way in which he is driving the measure behind the scenes?
The hon. Gentleman’s point is valid, but it would not be appropriate for me to comment while the executive team is looking at the structure.
I am assured that Queen Mary’s Sidcup will not close as a result of the “A Picture of Health” programme, and that any future disposal of land at Queen Mary’s Sidcup would only involve land no longer needed for patient services. Assuming that proposals for change in the “A Picture of Health” programme also proceed to public consultation, it is for the local NHS to ensure that there are appropriate consistencies between the two consultations—
The motion having been made 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 seven minutes past Three o’clock.