As the Minister will be aware, this is the second time that I have asked for and succeeded in getting an Adjournment debate on this issue. I called for this debate, first, because there is still a great deal of concern locally about the problems of Bromley and Orpington hospitals and, secondly, because the Government should be aware of that concern at ministerial level, because they have to play a significant part in the resolution of these problems if they are to be resolved satisfactorily. My colleagues, my hon. Friends the Members for Beckenham (Mrs. Lait) and for Bromley and Chislehurst (Robert Neill) supported me in calling for and getting this Adjournment debate because they, too, are concerned about the situation in our local hospitals.

Before I say anything else, I should say that I believe that the Bromley Hospitals NHS Trust is full of dedicated people who are doing fine work. [Interruption.] I am glad to see the Minister nodding. My sole concern is to see that they are put in a management and financial framework where they can be as good as they aspire to be, both from their professional point of view and with regard to the interests of the people of Orpington and Bromley.

I am always anxious to help the Minister give satisfactory replies. I want to summarise my five requests at the beginning of my speech rather than at the end, in the hope that this will further help him to come up with satisfactory answers when he replies. First, I want to see the merry-go-round of short-term six-month appointments at the top of the Bromley Hospitals NHS Trust management ended and a proper management team appointed with at least a three to five-year view. I have been saying that for a long time and it is time that the Government took notice of that fundamental point.

Secondly, the question of the treatment centre at Orpington should be considered not solely from a short-term financial point of view, dealing with making short-term financial savings, but from the point of view of clinical requirements, particularly taking into account that the Princess Royal university hospital has for years been working at total capacity—well above the 85 per cent. capacity that is considered optimal. Orpington treatment centre can make a contribution to achieving that aim.

Thirdly, the trust should be given challenging, but not impossible, financial targets. In that context, bringing down last year’s £18.5 million deficit to zero in one financial year was always unrealistic, although I accept that that was embraced by the interim chief executive. Fourthly, providing that the trust makes progress—I do not want to let it off the hook in making progress on dealing with the operating deficit—the Government should be prepared to make a financial arrangement that allows it to deal with its £100 million of overhanging debt, and with the structural and financial problems arising from the private finance initiative.

Fifthly, I hope that the Government will be sensible about asking Bromley to meet the national target of 18 weeks for referral to treatment, which all trusts are supposed to meet by December, given that the starting point for Bromley Hospitals NHS Trust at the moment is that that standard is met in only 57 per cent. of cases. It is asking a huge amount of the trust to go to 100 per cent. in the next two or three months.

Those are my five requests that I want the Minister to focus on in his reply to my speech. The main hospital in the trust is the Princess Royal university hospital, which was opened seven years ago as one of first PFI hospitals. Also in my constituency is Orpington hospital, which is very much older but which, five years ago, had a treatment centre built for elective orthopaedic surgery: knees, hips, hands and feet, and so on. That treatment centre had an additional theatre built only two years ago, which was opened by the current Secretary of State for Defence.

The Minister was in Orpington yesterday, I think. I do not know whether he had the opportunity to visit the treatment centre at Orpington hospital. [Interruption.] He says not and I understand why; diaries sometimes prevent such things from happening. None the less, that would have been an opportunity for him to see in situ what an excellent facility this is.

Bromley Hospitals NHS Trust has accumulated a deficit of £100 million. Last year it lost £18.5 million as an operating deficit. The trust commissioned a report from an independent expert in financial management, Mr. Michael Taylor, into how it got into this mess. That report, which was published recently, is, I am afraid, damning and spares no one: not the previous management, the board, the primary care trust, the London NHS or the Government. One saving grace was that the previous management’s passion for high clinical standards was applauded.

I want to focus on the handling of the proposed closure of the Orpington treatment centre, since that is causing great concern in Orpington and because it is an example of how things are going wrong. As I have said, the Orpington treatment centre was opened five years ago; it has been universally praised and the theatre was expanded two years ago as a consequence of its success. The centre meets all the Darzi requirements for having elective surgery quite separate from acute and emergency services.

As the Minister knows, under an exercise called “A picture of health for south east London”, it is proposed that the centre should, despite its success, be transferred to Queen Mary’s hospital, Sidcup, which may be losing its accident and emergency department under that same exercise. It was expected that it would be two or three years until that proposal became operative. In March the Bromley Hospitals NHS Trust said that it would like to keep the treatment centre open in Orpington. However, in July, which is not that long ago, the new interim chief executive said that the Orpington treatment centre should be closed. A press statement said:

“Incoming Chief Executive Michael Marchment has pledged to make savings whilst maintaining high quality patient care: ‘We can close operating theatres without having an impact on patient care by improving the way that we work. The most efficient way of doing this is to close three theatres at Orpington Treatment Centre and bringing the staff and equipment to the Princess Royal University Hospital’”—

not, it may be noted, at Queen Mary’s, Sidcup, but at Princess Royal university hospital. The press statement continued:

“Bromley Hospitals is in discussion with staff about the closures which will be in place by the autumn.”

I think that the trust suddenly realised that it was possibly not taking account of the consultations under “A picture of health”, because on the following day a further press notice was issued:

“However, we recognise that such a move will require discussion with staff, and Bromley Council Health Scrutiny Committee, and possibly consultation.”

I think that there were some quick second thoughts there.

It seemed then that the centre was going to close in the autumn. At that point, one of my constituents, Mrs. Julie Mott, started a petition that has gathered nearly 19,000 signatures, which is a huge number, as the Minister will be aware, given the numbers of signatures gathered in such situations. I have nothing but admiration for Mrs. Mott and her supporters, who have truly performed a public service.

There were second thoughts and we learned that the treatment centre closure was postponed until January 2009. When I rang the chief executive of the primary care trust, not 10 days ago, he still thought that it was closing in January. However, we learned subsequently that the closure was going to be brought forward again, to 30 November. There was consternation about that and, once again, the date was revised. Mr. Marchment has said in a letter to me that the closure would not now take place until well into the early part of next year.

A press statement yesterday went further and said that the treatment centre will not close until 31 March. Obviously, I wholeheartedly welcome that decision to postpone the precipitate closure, but there have been four decisions in four months on when the centre will close. That smacks of incompetent management that is not in control. One can hardly imagine how the situation could have been handled worse than it has been. It has created uncertainty, and that is bad not only for staff morale but, I am told, for staff retention, which is extremely important. Clearly, people are concerned about the uncertainty and different decisions being made almost from week to week about when the centre will close. What are they expected to do when teams are broken up and people receive offers from elsewhere? Uncertainty is a matter of great concern.

The reason for the proposed closure is that it is alleged that the treatment centre is losing £1 million a year, and that that will be saved if it is closed. Whenever the suggestion is made to bring the closure forward, the argument is always that closure will save £1 million a year, which would make a contribution to the current year’s savings. When it is suggested that closure should be delayed, the argument is that capacity can no longer be met. The original decision was based on the idea that there was enough capacity for the Princess Royal university hospital to meet the needs if the Orpington treatment centre is eliminated.

The capacity point is important. At the last board meeting on 24 October, it was said that 350 patients would have to be farmed out to other hospitals, including Hillingdon, which is a long way from Orpington, to Ilford and to various private hospitals, because they could no longer be dealt with if the Orpington centre were closed. However, I have a copy of an internal memo in which those 350 patients suddenly became 700. The memo is dated 23 October, the day before the board meeting on 24 October, and says that

“in order to meet the 18 week target we will need to substantially increase the numbers of patients on the waiting list that we are sending out to the private sector to upwards of 700 patients.”

When the board met the day before the memo, it said that only 350 people would be involved. It seems that the board does not know what is going on. The Taylor report accused the board of not knowing what was going on in the hospital, and this seems to be yet another example of that. Things have not improved. Will those “upwards of 700 patients”, in the light of yesterday’s decision to postpone closure of the Orpington treatment centre, still be sent out to other private and public hospitals? Perhaps the Minister knows. I certainly do not know, and no one in Orpington seems to know.

Clearly, it is difficult for the Bromley Hospitals NHS Trust to meet the financial target of reducing its operating deficit to zero, and to meet the national waiting list target of reducing referral times for treatment to 18 weeks when that is achieved in only 50 per cent. of cases. That is asking the trust to do the impossible. It is almost asking it to do the splits, because the targets are in opposite directions.

Another reason for the treatment centre to remain is that last night, under the “A picture of health” proposals, the statutory joint committee on health overview and scrutiny referred all matters, under the statutory procedures, to an independent review by the Secretary of State. It called for that at last night’s meeting, and I draw the Minister’s attention to the statement, which he will receive shortly. It says:

“The JHOSC has serious concerns about the recent decision of Bromley Hospitals Trust…to relocate surgical services from the Orpington Treatment Centre to the Princess Royal University Hospital. This option was not included in the consultation document for the A Picture of Health Proposals. BHT took this decision without prior consultation with the public or the local overview and scrutiny committee despite the decision taken by the JCPCT on 21st July 2008 to move these services to Queen Mary's, Sidcup.”

There is a clear conflict between the medium-term plan and the trust’s immediate decision.

I want to make a few more points before the Minister responds. First, I mentioned the circus of interim chief executives. We have had four; three were there for less than six months, and one lasted slightly longer. That is deeply unsatisfactory. I am always told that the reason is that there is a proposed merger in the air with another trust, or perhaps two trusts, so contracts cannot be sensibly negotiated. On the other hand, if we had taken the sensible view and put someone in place two years ago, they would at least have gone two years down the track, and if they could turn round the mess that the trust is in, they could cope with an additional trust if that is what happens.

Secondly, on consultation, section 242(2) of the National Health Service Act 2006 says:

“Each body”—

that is, hospital trusts—

“to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on”

any changes. The minutes of the meeting on 24 July, immediately after the announcement of the premature closure of the Orpington treatment centre, say:

“The Nominated Representative, Health and Social Care Forum expressed concern that the proposal to close theatres at the”

Orpington treatment centre

“was made without consultation with members of the public.”

The minutes also state that the chief executive

“proposed to meet with the Local Overview and Scrutiny Committee to discuss the future of the OTC.”

That committee will be the relevant committee of Bromley borough council, but that does not meet the requirements of the Act. The council should have been consulted anyway, but the local scrutiny committee should also have been consulted under the national health service legislation. In any case, that meeting did not take place until September, when he originally wanted the treatment centre to be closed.

The people of Orpington and Bromley are intelligent, with a close knowledge of their health services. They want them to succeed, and I suggest that the flimsy consultation was a serious mistake and that that course should not have been followed.

On capacity, independent analysis by the Library shows a strong link between hospital ward overcrowding and the spread of deadly hospital infections such as MRSA and Clostridium difficile. Trusts with a bed occupancy rate higher than the Government’s recommended optimum level of 85 per cent. had a much higher rate of both C. difficile and MRSA. Research suggests that in 145 NHS organisations the level is more than 85 per cent., and in some it is more than 95 per cent. The Minister is well briefed on the subject, so I am sure that he knows that Bromley Hospitals NHS Trust has had the highest level of overcrowding and capacity. That should be addressed in any action that is taken.

The latest development is that I and my colleagues received a letter from the primary care trust indicating that the commissioning of acute care is to be merged. It is one of those letters that says that things will substantially change, but that nothing will actually change. One receives those curious bureaucratic letters from time to time, which are profoundly unsatisfactory. Lord Warner will address a meeting on Thursday, which suggests that mergers between local trusts will be proposed. All I can say is that this is the worst possible time for such structural change. People want a calm period and to be allowed to do their jobs properly. In the light of that, I look forward with immense interest, as do the people of Bromley and Orpington, to the Minister’s response.

I congratulate the hon. Member for Orpington (Mr. Horam) on securing the debate, and I join him in paying tribute to NHS staff, especially those in Bromley, whose hard work and dedication across the NHS are delivering a better quality health service than there has ever been. That has benefited not only his constituents, but people across England.

Before addressing the specifics of the changes to the hon. Gentleman’s local hospitals, I shall set out the context for those changes. During 60 years of the NHS, society, technology and medicine have changed beyond all recognition. It is important that our health service also changes and evolves to meet those challenges. Today, more and more conditions can be treated and cared for at home or closer to where patients live, in their local community. More services are therefore being provided outside the traditional hospital setting. Hospital care itself is also changing. If we go back 20 years, most surgery almost always required days or even weeks in hospital. Today, the majority of surgery is done on an out-patient basis and patients can be at home and in their own bed on the same day.

As medical science has advanced, our doctors and surgeons have become ever more capable of extraordinary feats of clinical care. There is a growing need for that expertise to be located in centres of excellence that bring together specialists from a number of different areas to work together as a single team. Given those wider trends—more community-based care and the need for greater specialism—the old way of doing things, which involved a local general hospital providing most of the care for a population, is not necessarily the safest or most medically effective way to treat patients. That is the context against which the reorganisation of health care in outer south-east London is taking place.

The other important thing that I need to make clear is that decisions on how local services are organised are no longer made by Ministers in Whitehall, and rightly so, but by autonomous NHS professionals on the ground—at least, that is the case in England. I should like to take this opportunity to commend the collaborative approach that has been taken by the primary care trusts and acute hospital trusts involved in the outer south-east London reorganisation. Given the local concerns and in some cases rivalries, it is no mean feat that they have managed to come up with a set of proposals that they believe will not only ensure safe and high quality services for the people of their boroughs, but put the NHS in outer south-east London at long last on a stable financial footing.

The process of drawing up the proposals, which are called “A picture of health”, has been led by doctors and other health care professionals and, as the hon. Gentleman is well aware, has involved extensive public consultation. The clear view of the clinicians involved is that, although many services can be devolved further out into local communities, the speciality or complexity of other services means that they need to be concentrated on three sites—rather than the current four sites—to make the most of available expertise. Under the respected surgeon Professor Sir George Alberti, an independent national medical advisory team reviewed the proposed changes in south-east London and said:

“It is obvious that no change is not an option. This has been stressed particularly by hospital clinicians… We support the view of concentrating acute services on fewer sites as soon as possible.”

As I am sure the hon. Gentleman is also aware, in July, the joint committee of the four PCTs involved agreed to recommend a variation of one of the four options that had been considered during the public consultation. The Queen Elizabeth hospital Woolwich and the Princess Royal hospital Bromley—his own hospital—will both become major admitting hospitals. University hospital Lewisham will become a medically admitting hospital and Queen Mary’s hospital Sidcup will become a borough hospital. That will lead to an enhanced role for his Princess Royal hospital as the major acute hospital that serves the people of Bromley and, more widely, Bexley.

The enhanced services will include improved maternity services, with more options for mothers, such as a midwifery-led maternity unit and the extension of consultant cover for the traditional maternity wards. There will also be an expanded critical care facility, improved specialist rotas for medically ill patients, who will be admitted under a specialist in their condition, and an increase in accident and emergency capacity, including increased numbers of senior medical staff to serve that speciality. The local NHS said that it believed that that solution would deliver the most clinical and non-clinical benefits to local people.

As the hon. Gentleman has said, and rightly so, the NHS in south-east London has faced serious challenges for a number of years. As he also noted, when we announced last week the early achievement of the historic milestone that, on aggregate across England, 90 per cent. of admitted and 95 per cent. of non-admitted patients receive treatment within 18 weeks, Bromley primary care trust was one of only five PCTs in England performing below 80 per cent.; in fact, it was the worst performing PCT in the country. That trust is receiving a high level of assistance from both the London strategic health authority and my Department’s intensive support team to resolve those issues. Urgent recovery action is under way with the trust and the local health community. It will be extremely challenging for the trust to improve performance sufficiently to meet the December targets, and for that reason, the plan to repatriate surgical work from the Orpington site to the Princess Royal university hospital in Farnborough has been deferred to 31 March.

I also note, as I am sure the hon. Gentleman did himself, that the Healthcare Commission annual health check, which was published two weeks ago for Bromley Hospitals NHS Trust, rated the trust as only “fair” for the quality of services and “weak” for the use of resources. That is a deterioration in its performance from 2006-07, when it was rated “good” for services and “weak” for the use of resources.

The annual health check is an important independent tool for measuring performance across the NHS and identifying areas for improvement. The Department is working with the Healthcare Commission to take action against trusts that have performed badly, such as Bromley. Any trust that scores “weak” in either quality or finance must prepare an action plan that details the steps taken and further plans to address weaknesses. All of those plans will be monitored and trusts will be revisited in the new year.

Does the plan that the Minister says that the Bromley hospitals trust must produce include referring 700 or more patients to private hospitals in the area, or not?

I am afraid that I cannot give the hon. Gentleman confirmation of the exact figure; that is a matter both for the acute trust and Bromley primary care trust, which, as commissioner, has the responsibility for achieving the 18-week target. What is important for his constituents is that they get the same quality and speed of service as everyone else in the country now expects. If treating patients within 18 weeks means that Bromley PCT has to refer more patients or give them the choice of being referred to an independent or private sector provider that is not something that should be sniffed at. That is about delivering high quality care and the 18-week target to his constituents—something that people in the rest of the country already take for granted.

On that point, I recognise that giving people an option of where to go for their treatment is not to be sniffed at, as the Minister has said. However, there is concern about whether alternative sources have the right kind of equipment to deal with the complicated hip and knee operations that the Orpington treatment centre has—for example, the laminar flow equipment at Orpington is not available in some of the private hospitals. I do not wish to exaggerate that matter—I am sure that people do their best to give excellent treatment wherever they are—but, none the less, there is a real local concern that the alternative treatment might not be as good as the treatment that they would have received at the Orpington centre.

It is not for me to second-guess the decisions that are made correctly by commissioners locally. They will be cognisant of the need to ensure that his constituents get their treatment within 18 weeks, which is something that they should be able to expect and is something that people in most parts of the country already enjoy. However, as the hon. Gentleman rightly says, we must ensure that that treatment is of the highest quality. Many patients already choose alternative providers—for example, independent treatment sectors, voluntary sector organisations and charitable institutions—that give high-quality treatment, including some providers in his area. Indeed, sometimes that treatment is of a higher quality than that of local providers. I do not want to be dogmatic about that matter, because it is right that that decision should be left to his local commissioners in the PCT.

The hon. Gentleman also mentioned the critical report into financial management and governance at Bromley hospital that was published on 25 September. As he will be aware, the chairman of the board has publicly apologised for the corporate failings outlined in the Taylor report. There is now a new board and none of the executive or non-executive members of the board who were identified in that period of corporate failure remain on the new board. The hon. Gentleman will know that, for some time, his trust has been one of the most financially challenged in the organisation and that south-east London as a whole contains the most financially challenged health economies in the country.

The financial position of all trusts across London, including those in south-east London, continues to be monitored closely by the provider agency in NHS London. That monitoring process includes monthly reporting for each trust and escalation meetings between NHS London and the trust if forecasts change. Bromley Hospitals NHS Trust forecast out-turn position as presented in the 2007-08 final accounts was a deficit of more than £17 million, but the forecast out-turn position as presented in the 2008-09 plans is for a £203,000 surplus. As the hon. Gentleman recognised, that will be a challenge, but NHS London continues to work with the trust to look at further ways to save costs and to ensure that plans can be put in place.

There are many more points to which I need to respond, but in the minute that I have left, the most important thing to say is that the trust’s new chief executive has a high reputation across the NHS. I urge the hon. Gentleman to take part in the meeting of chief executives on Thursday—all MPs in the area have been invited—and to engage in the discussions taking place about the future organisation of management, which will have a vital impact—

Order. We must now move on to the next debate.