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House of Commons Hansard
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Northwick Park Hospital
22 June 2010
Volume 512

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I am grateful for the opportunity to raise the future of Northwick Park hospital on the Floor of the House today. Although I have no financial interest to declare, I should declare that the hospital has looked after me and my family and friends at many points in my life, dealing with things ranging from running injuries through to dislocated shoulders as a result of canoeing accidents. I continue to be extremely grateful to the staff of Northwick Park hospital. Although no speech in the House could ever be regarded as anything other than political, I hope that this one will at least be judged to be not partisan. I have sought to give the Minister and my parliamentary neighbours notice of the issues that I intend to raise. I see in their places my hon. Friend the Member for Brent North (Barry Gardiner) and my immediate neighbour, the hon. Member for Harrow East (Bob Blackman).

Northwick Park hospital is the primary hospital serving my constituents. Mount Vernon and the Royal National Orthopaedic hospitals are nearby, but Northwick Park sees the vast majority of work involving Harrow NHS hospital patients. I want to raise with the Minister four issues: the case for capital investment for the rebuilding of the hospital; the ongoing revenue budget of the hospital; the hospital’s move towards foundation hospital status; and whether the hospital will be designated as a major acute centre for north-west London.

The hospital is 40 years old, having been opened by Her Majesty the Queen in 1970. It has a certain celebrity status, having featured in, for example, the Channel 4 comedy “Green Wing”, in “Prime Suspect” and—I suspect this will worry my constituents a little—in the 1970s horror film “The Omen”. More recently, the hospital merged in 1994 with St Mark’s hospital, a national centre that is world renowned for gastrointestinal medicine. Northwick Park is also home to the British Olympic Association’s Olympic Medical Institute and, together with Central Middlesex hospital, forms part of the North West London Hospitals NHS Trust.

Northwick Park is in general extremely well run. After 13 years of substantial investment in the NHS, I now rarely receive complaints about the quality of care at Northwick Park. Its mortality rate—a crucial indicator of quality—shows Northwick Park to be one of the best hospitals in the UK. I pay tribute to its current management team and the trust board for a job that I think they are doing well.

The hospital provides a range of services that straddle acute and community care. It also provides a large range of important regional services, including maxillofacial services for all of north-west London and parts of the NHS Eastern and South Central regions; a neuro-rehabilitation medical in-patient centre for NHS London and the east of England; bowel cancer screening; clinical genetics; and a dedicated infectious diseases centre. If it is not the largest acute hospital in north-west London as a whole, it is certainly the largest in outer north-west London. It has a very busy accident and emergency department, is a key part of the Imperial College Healthcare NHS Trust trauma network and, crucially, was recently designated as one of eight hyper-acute stroke units in London. The decision to have an acute stroke unit there enabled the hospital to take a significant step towards formally securing designation as a major acute centre for north-west London. First, therefore, I formally ask the Minister, can he confirm that a journey that the hospital has been on towards designation as a major acute centre is complete and that crucial status has been secured?

Secondly, the trust board has faced and still faces a challenging financial picture, in part, as I understand it, because of the level of usage of the Central Middlesex site. The trust has succeeded in meeting many of its financial targets, but has faced pressure in part because of the impact of the polyclinic model of care and, more generally, the steady move of out-patient services from hospital settings into the community. I should make it clear that my constituents and I are strong supporters of the Rayners Lane polyclinic, run by the excellent Ridgeway Surgery group of GPs. Can the Minister confirm that there will be no cuts to Government funding for NHS London or, crucially, to NHS Harrow—the chief although not the exclusive source of funding for the hospital? Can he set out to the House how he sees the hospital’s financial future?

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I applaud my hon. Friend for securing the debate and for all the remarks that he has made. Does he share my concern that we should hear from the Minister about the business case for £23 million that has been presented to the Department for a series of essential works as a result of the Arup review in 2009? Does he agree that it would be extremely helpful if the Minister could give us some indication about the outcome of that to settle the minds of our constituents?

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I certainly agree with my hon. Friend. That maintenance work is essential, as I shall come on to say, and it would certainly be good to hear the Minister’s reaction to that bid.

The third and most important of the issues that I shall raise today relates to the issue alluded to by my hon. Friend—the case for additional investment out of the NHS’s capital budget for the redevelopment of the hospital. A fire in the hospital’s basement in February last year led to the trust board commissioning a report into the maintenance situation at Northwick Park. It recommended up to £65 million of improvements to the infrastructure on the site to ensure that it remains fit for purpose. Indeed, on the basis of annual NHS estate returns, the trust has one of the largest backlogs of maintenance in London. It has been clear for a considerable time that a major redevelopment process is required.

In November 2004, a strategic outline case for redevelopment of the whole site was approved, and private finance initiative credits of more than £300 million were made available the following March. However, redevelopment did not start, on the grounds of the project’s affordability. Various reviews of the PFI project, all crucially linked to an ongoing debate about levels of usage of both hospitals in the trust and therefore likely levels of income, have not yet led to enough clarity about how redevelopment of the hospital might proceed. I believe that it was not until February 2009 that the PFI project was formally cancelled.

There has been and remains, in my view, little doubt that major redevelopment of the whole site is required. Indeed, senior figures in NHS London have consistently accepted the need for a major rebuild. There is unfinished business on the redevelopment of the hospital. I therefore ask the Minister, does he accept that the case for a rebuild is strong, and on what timeline does he envisage such a redevelopment taking place?

To be fair, the NHS has certainly not ignored Northwick Park. There has been significant capital investment in clinical and IT equipment; in reducing the backlog in maintenance and ward refurbishments, particularly in refurbishing maternity services; in a new children’s centre and paediatric accident and emergency; in oral maxillofacial services; in bowel cancer screening; and, as I mentioned, in the new stroke unit. Indeed, more than £85 million of capital investment has been put into Northwick Park since 2005. There have also been more than 300 extra staff at Northwick Park, the bulk of them clinical, since 2005. However, the need for capital investment remains.

I should make it clear that I remain a very strong supporter of foundation hospital status. Its governance model will, I think, help to bring the hospital closer to those who use it. The mutual element of foundation hospitals has long been championed by the Co-op party, of which I am lucky enough to be the chair. In particular, I welcome the role of the board or council of governors that foundation hospitals have. The council of governors comes from staff, patients and members of the public and from other local nominating partner organisations, who together form a local membership base for such hospitals and can introduce a hugely important local level of accountability into NHS decision making. They also help to draw local people closer to what can sometimes seem a remote, albeit local, institution. There are other benefits to foundation hospital status, but it is that greater access to senior figures within the hospital, and therefore the greater sense of ownership of their local hospital, that will be of most long-term benefit to my constituents.

I therefore ask lastly of the Minister, when will my constituents be able to sign up to become members of the North West London Hospitals NHS trust? I have welcomed the opportunity given to me by the Speaker to put an issue of profound concern to my constituents before the House, and I look forward to the hon. Gentleman’s response.

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I begin by congratulating the hon. Member for Harrow West (Mr Thomas) on securing the debate. I wish also to pay tribute to the NHS staff, not only at Northwick Park hospital but across north-west London, who do so much, day in, day out, to look after patients and, it turns out, the hon. Gentleman and his family. The staff consistently deliver first-class care, benefiting his and other hon. Members’ constituents throughout north-west London.

Before I get on to the hon. Gentleman’s specific points—I shall seek to deal with all the issues he raised—I wish to set out the general financial situation. All decisions around NHS funding need to be seen in the context of reducing the deficit. Despite the massive debt acquired from the previous Government, and the measures to rectify our situation, which are to be set out later today by my right hon. Friend the Chancellor of the Exchequer, the NHS budget is protected. More than that, it will receive real-terms increases in each year of this Parliament. That underlines the Government’s commitment to the national health service.

However, the NHS still faces a huge challenge to improve patient outcomes and meet the increasing demand for services and new medicines within a tight financial settlement. North West London Hospitals NHS Trust, which runs Northwick Park hospital, is still dealing with long-standing financial difficulties. Two years ago, the trust was almost £24 million in debt. Since then, NHS London has been gradually helping the trust to return to economic stability one step at a time. I know that clinical staff and managers are working hard to ensure that cost savings do not come at the expense of patient care. Savings can be and have been made by providing more effective and efficient care for patients, and by reducing the burden of back-office costs. Notable examples of cost savings by 2010-11 include: recruiting permanent staff to replace, and reduce reliance on, higher-cost agency staff; a 10% reduction across all corporate areas, such as finance, human resources and information technology; and improving procurement, principally through bulk buying and working in collaboration with the London procurement programme.

As well as savings, there are new investment proposals on the table, as the hon. Gentleman said. They aim to address the essential and immediate needs of the hospital, and to improve the fabric of the hospital and the facilities on offer to patients. If approved, the programme will complement other investments in recent years, including: the £4.1-million new hyper-acute stroke centre, which he mentioned; the £6.7 million for three dedicated elderly care wards; and a £4.3-million bowel cancer screening hub based at Northwick Park—one of six such hubs across London.

The total value of the proposed programme is £65 million, with most of the money coming from the existing budget. A business case for the additional £23 million needed—a point that the hon. Member for Brent North (Barry Gardiner) raised—was submitted to NHS London for approval on 7 June. After careful consideration, the hospital trust was asked to improve the bid. NHS London received the strengthened business case last Friday, and we hope that it will be ready for consideration by the Capital Management Group on 25 June, a little later this week. If the business case is approved, my Department will then thoroughly consider the loan application from NHS London. Let me be clear: my officials will need to see a sound and credible recovery plan before they can agree to the investment.

I am afraid that I cannot give a specific time when a final decision will be reached, but we are acutely aware of the urgency of the issue, and we will reach a conclusion as quickly as we possibly can. I hope that that reassures both the hon. Member for Harrow West and the hon. Member for Brent North.

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Can the Minister give a guarantee that he will write to the three hon. Members present—there is one behind him—to let us know the outcome of that bid, ideally in advance of any public notice?

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I can categorically give the hon. Gentleman an assurance that at the appropriate time, before the announcement, I will make sure that my office contacts all three hon. Gentlemen present to ensure that they have advance notice of it.

On the question of foundation status, the hon. Member for Harrow West raised the possibility of North West London Hospitals NHS Trust attaining foundation status. The Government strongly support all trusts that aspire to that aim. Foundation-trust status enables the local NHS to develop stronger connections with communities, so that health care better reflects patient needs. It also creates the conditions for improving performance, which can only benefit patient care. More than half of all eligible NHS trusts are now foundation trusts, but we want to go further. We want to reduce Government control over the health service and set trusts free to innovate and take decisions based on what is right for their local populations. That includes North West London Hospitals NHS Trust.

The trust serves its population well and delivers good-quality care, as the hon. Member for Harrow West mentioned, but to step up to this new challenge, the trust needs to establish a solid financial foundation and needs to gain the support of GPs and commissioners. Bearing that in mind, I understand that the trust is likely to apply to become a foundation trust in 2012, and I wish it well in its application.

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I am grateful to the Minister for giving way; he has been most generous. He talked about building the confidence of local commissioning GPs. My understanding is that under his Department’s new arrangements, the ring-holder for the GP commissioning groups set up under the auspices of Brent primary care trust—I am sure the same applies in Harrow also—will no longer be the primary care trust. How does he propose that those groups of private businesses avoid the risk of being providers of services that they commission? Who will hold the ring, as the PCTs used to do?

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The hon. Gentleman is tempting me to go down a path that it would be unwise to go down at this stage. The reason I say that, and why I will not be tempted, is that as he is probably aware, my right hon. Friend the Secretary of State and my ministerial colleagues are doing a considerable amount of work putting together and fleshing out our vision for the NHS, not only for the next five years but thereafter—a vision that puts patients at the heart of the NHS and that is driven by the needs and improved care standards of patients. It would be inappropriate and wrong of me to succumb to temptation and to start to unveil, in this august debate, what my right hon. Friend the Secretary of State will announce in due course. The only good news that I can give the hon. Gentleman is that he will not have long to wait before all these mysteries are explained to him, and I am confident that he will be reassured and pleased by what my right hon. Friend the Secretary of State has to say.

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One of the key issues for Northwick Park hospital is how it deals with both Brent and Harrow primary care trusts. Both are in desperate financial straits, as I think hon. Members would agree. My concern is how that will be manipulated for Northwick Park and St Mark’s hospital trust in the future.

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My hon. Friend raises an interesting point. It is true, as I hope I have explained, that there have been challenges for the North West London Hospitals NHS Trust with regard to its finances in recent years. However, as I explained—I will go into more detail on this later—measures are being put in place to seek to minimise the problems. I can assure my hon. Friend that when it comes to dealing with PCTs, trusts and the finances, I do not recognise the word “manipulate” as being in the lexicon. Everything is done to ensure that the maximum amount of money is made available to PCTs and trusts, to ensure that we protect front-line services, and to provide the best health care possible for my hon. Friend’s constituents and those of all hon. Members throughout the country.

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I wish to correct any suggestion that Brent PCT is in any way financially embarrassed. [Interruption.] My hon. Friend the Member for Harrow West (Mr Thomas) wishes to correct any such suggestion for Harrow as well. Three years ago, Brent PCT was running a deficit of more than £20 million. It took the necessary measures, and that deficit has now been turned into a surplus of £12 million.

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I appreciate what the hon. Gentleman says. I am sure that my hon. Friend the Parliamentary Secretary, Cabinet Office, will have taken that on board, and the record will certainly reflect the accurate assessment that the hon. Member for Brent North makes of the situation. However, it is fair to say, particularly in the case of the constituency of the hon. Member for Harrow West, that there has been a problem with the finances. As I said earlier, the requests for a loan and for money that are being considered reflect a need to bring finances into better alignment without affecting front-line services. I am hopeful—probably a bit more than that—that, with the actions that have been taken and the proposals that are awaiting decisions, there will be positive movement.

I come to the point raised by the hon. Member for Harrow West about new hospital build. He mentioned his desire to see completely new build at Northwick Park. As he knows, plans were put forward in 2004 to build a brand new £305-million hospital for his constituents. In 2005, at an early stage of the business case and planning application processes, the plans for the scheme were put on hold by the trust and the local PCTs due to concerns about their affordability. After more than a year on hold, the proposals were formally cancelled by the Department in the summer of 2008. That is standard procedure for schemes that are not progressing and that have been put on hold for a specified period of time. I am afraid that those limitations remain. While the trust is working hard to achieve financial stability, I regret to say that it is still a long way from realistically being able to afford such a large building project.

The hon. Gentleman also raised the issue of designating Northwick Park hospital a major acute centre within the context of the north-west London sector review. The proposals, which I understand are still at a very early stage of development, would need to pass the Secretary of State’s four tests. They would need the support of GP commissioners; the support of the local community; to be evidence-based; and to develop patient choice. That relates to the decision that the Secretary of State took a few weeks ago to strengthen the criteria for considering any reconfiguration by placing more emphasis on gaining support following full consultations with GPs, clinicians and local stakeholders. I am sure that the hon. Gentleman, being a reasonable man, would accept that that is a sensible improvement, with regard to seeking to reconfigure health patterns throughout the country and to ensure that the local community and the clinicians and GPs who deliver the services have more say and influence over what happens.

The hon. Gentleman requested a commitment from me, but there is not a lot that I can tell him at present, because the proposals are at such an early stage. What I can tell him—I hope this will go some way towards reassuring him—is that all proposals, when put together as a final package for consideration, will be fully considered in the context of the Secretary of State’s criteria, and a decision will be taken at the appropriate time.

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I should acknowledge the presence at this debate of the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who represents the fourth constituency with a strong interest in Northwick Park hospital. I am indeed a reasonable man, and the Minister has a reputation for being a reasonable man, so will he meet with those of us who are interested in the future of Northwick Park within a minimum of 12 months to review some of the issues that we have discussed today, and particularly the affordability or otherwise of any significant rebuilding of the hospital?

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I am grateful to the hon. Gentleman. He is a knowledgeable man who knows that flattery usually gets one everywhere. I cannot resist flattery. It would be a considerable pleasure to meet him and any of his or my hon. Friends. If he would be kind enough to get in touch with my office, a meeting will be arranged in the not-too-distant future.

In conclusion, the Government have made a clear commitment to protecting the NHS and to ensuring real-terms increases in funding. There remains, however, a responsibility on all parts of the NHS to be innovative, to become more efficient, and to reinvest the savings that they make to improve quality of care for patients. North West London NHS Trust shares that responsibility, and must continue to rise to the challenge. We will consider all the proposals that we receive very carefully and will reach a decision as quickly as we can. Moreover, we will work with the trust to achieve ongoing improvements for the constituents of the hon. Members for Harrow West and for Brent North, and those of my hon. Friends the Members for Ruislip, Northwood and Pinner (Mr Hurd) and for Harrow East (Bob Blackman). I hope that we will be able to consider the issue further when I meet the hon. Member for Harrow West.

Sitting suspended.