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Royal National Orthopaedic Hospital (Stanmore)

Volume 593: debated on Wednesday 4 March 2015

It is a pleasure to serve under your chairmanship, Sir Alan, in this vital debate that is important not only locally in my constituency, but nationally. The Royal National Orthopaedic hospital in Stanmore is a national and international institution par excellence. I will use a quote that I gleaned when doing some research. The RNOH delivers

“Outstanding clinical outcomes for patients”

in premises that are

“not fit for purpose—it does not provide an adequate environment to care and treat patients.”

I and the staff of the hospital could not have put it better. That is a direct quote from the most recent inspection by the Care Quality Commission in August 2014.

The hospital premises were built during the second world war to house airmen who were defending our shores and to ensure that facilities were available to treat our brave soldiers, airmen and seafarers returning home. Sadly, we still have the same premises that existed during the second world war. I want to put on the record my tribute to the brilliant work that is done by all the medical staff, all the clerical staff and the entire team who provide facilities and services at the hospital. Many charities that are associated with the work of the hospital also operate from the site.

I wanted this debate today because I took the then shadow Secretary of State for Health to Stanmore in January 2010 to see the hospital at first hand. He gave a commitment to the board, the staff and everyone associated with the hospital that, were there to be a Conservative Government after the election in May 2010, the hospital would be rebuilt.

Just before the election, in March 2010, the then Secretary of State for Health, who is now the shadow Secretary of State for Health, announced funding for the redevelopment. It is fair to say that immediately after the election, when hon. Friends discovered there was no money left at the Treasury, I had to work very hard with civil servants and elected politicians at the Treasury to ensure that the promised funding for the rebuilding of the hospital was safeguarded in the emergency Budget that took place immediately after the election.

Here we are now, four and a half to five years on, and there has been very little progress on the rebuilding work. The trust that runs the hospital—I have worked with the board of the trust and others—has responded to every question posed by the trust development authority. It seems almost impossible to get through the positively Kafkaesque process of repeated reviews. The only beneficiaries of that process are the management consultancy firms. Patients and the medical staff have not benefited one iota.

I believe—I stand to be corrected if this is not so—that some £75 million has been spent on management consultants. It has not been spent on the consultants who treat patients, but the people who come and do management studies. I think that that is a disgrace and a waste of public money. All 13 independent reviews have concluded that the orthopaedic hospital offers excellent, high-quality, world-class care. The CQC has rated outcomes as “outstanding”, and the trust is regularly in the top 10% of all hospitals in respect of infection control and friends and family tests.

All independent reviews concerning the hospital’s geographical location have concluded that there are no better alternatives to having the hospital on the Stanmore site. All independent reviews concerning the financial risks associated with the redevelopment have concluded that the Stanmore site development offers the best value for money and that no “more affordable” option is available.

In the meantime, the future of the trust continues to be reviewed, debated and deferred. As I have said, more than £70 million of costs have been incurred, with a severe waste of money on project fees of £20 million, maintenance costs of keeping these rotten buildings going of some £15 million and the lost efficiency opportunity of some £35 million. In this modern day and age, that cannot be right.

By way of background, the hospital is a centre of international expertise in the diagnosis and treatment of neuromusculoskeletal conditions, which include acute spinal injury, bone tumour and complex joint reconstruction. This centre of expertise is not replicated anywhere else within the national health service. It has the largest spinal surgery service in Europe, with a third of UK spinal scoliosis surgery and two thirds of specialist nerve injury work being carried out on the site.

Some 95% of patients rate the care as “good” or “excellent”, and 90% of staff and patients would recommend the hospital to their friends or relatives. The hospital was the longest-standing in London with no MRSA infections in the past five years. Without question, this hospital delivers services and medical treatment that are the best in class. The clinical excellence and innovation are beyond doubt. The problem is that the buildings were built to last for a limited period, but that has stretched to 70 years. It cannot be right that we insist on brilliant medical staff operating in substandard conditions that would shame the third world.

We need to ensure that the rebuilding takes place. I understand completely that the health service has a process for business cases and has to offer value for money. We would all support that in principle. However, as this is a specialist hospital of international renown, it has a special place within the national health service. Successive Governments and the health service have prevaricated on the future of the RNOH for decades—literally 30 years. We have to have a different, more proactive approach to resolve the problem. It is clear that the board that runs the trust will have to conclude at some stage that it can no longer offer safety to patients in the substandard conditions in which it operates.

The creditability of the Government, the national health service and everyone involved is on the line here. Political leadership is required to ensure the best interests of patients and taxpayers. I look to my hon. Friend the Minister for some suitable answers, because this has been going on publicly and privately for the past five years that I have been involved, and, before that, for the past 30 years.

So the RNOH has a track record of delivering financial and performance targets. It responds time and again, updating and revising financial plans and risk assessments and refreshing commissioner support. Every time the board responds, it appears that we do not move forward, but backward. That cannot be allowed to continue and we must reach an appropriate arrangement. We need an innovative and alternative financing option—that is not encouraged through the current NHS process—to ensure that the hospital is delivered.

We should be clear that the key to resolving this matter is the top-up of public money by capital or a loan of some £20 million. It should be understood that the board will build a private hospital alongside the NHS hospital, and that will generate income. The board will also sell off land for housing development, which the area needs, but the board takes the sensible view that it will realise the land receipts gradually as the need arises for the programme’s funding. That will maximise their value and provide a decent level of housing in the local area. Both those things have been positively embraced. The RNOH and the trust development agency have been developing the outline business case since September 2014. In March 2015, we are still waiting to see whether it will be approved and action taken, so that the redevelopment can take place.

It is time that the Department of Health acknowledged that highly specialist hospitals and providers such as the RNOH need a different approach from that taken with the generality of NHS providers. It cannot be right that a super, specialist organisation with such excellent results is denied facilities for the want of a relatively small amount of public money.

In summary, the RNOH is a vital national provider of treatment for the most complex orthopaedic conditions and the rehabilitation for people with life-threatening conditions, such as spinal cord injuries. It does vital work on the innovation of new treatments, leading-edge research and development, the manufacture of state-of-the-art prosthetics and the training of future orthopaedic specialists. The hospital has treated many famous individuals, including Lord Tebbit’s wife after the Brighton bombing and Princess Eugenie. Moreover, the RNOH recognises the financial constraints it operates within and has continuously demonstrated that mitigations to affordability risks are available. Demand for services grows every day. Major land sale receipts will be available. Planning permission is in place; there is no hold-up on that. Housing and employment for the local population will be increased by the proposal, and major private patient income will come in.

The RNOH has a track record of delivery against every target that it has ever been set. It has responded time and again to the requirements of the TDA and every other aspect of the health service. It is clear that every time there has been a step forward, there have been two steps back. Every time proposals have come forward on alternative financing options, we have just ended up spending more public money. If that £75 million had been invested in the project, we would now be looking at new hospital facilities on the site. We would have first-rate, world-class facilities for world-class medical professionals.

No one believes that anyone wants to see the facility closed down, but the reality is that the Department of Health has to move forward and instruct the TDA to abandon the position that it has adopted, so that the RNOH can move forward to development. If we do not do that, we might as well close the hospital. That would be an absolute tragedy for all the specialists, medical staff and patients. By bringing those services together, the medical professionals have developed world-class techniques and an ability to cure individuals of very serious problems. Indeed, the medical staff of the RNOH provide national and international services way beyond the bounds of the hospital. I urge the Minister to give us some good news and to ensure that we get the funding required for the hospital to be rebuilt and for facilities to be provided for the brilliant staff, who do a brilliant job for the patients.

Before you begin, Minister, I want to pass a message on. Generally when debates are answered in this place, the Parliamentary Private Secretary is present. There was not a PPS in the last debate or this debate, and that might happen in the next debate, because I see the Minister for it standing by. When a PPS for the Minister is not present, it is usual for someone from the Whip’s Office to be involved. Sometimes mysterious pieces of advice appear from other places and have to be passed forward to the Minister. When those people are not present to do that, we have to rely on House of Commons staff. They have enough to do, and we should try to help them where possible. I am not saying that it is anything to do with the Minister, but I would be grateful if he could pass that expectation on to the Whips or the PPSs.

I will of course pass that message on, Sir Alan. It is a pleasure to serve under your chairmanship for, I think, the first time in the almost three years I have been a Minister. I heed and take note of your comments. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing this debate on an issue that is important to him and his constituents—and, more broadly, to many others. As he rightly outlined, Stanmore is a centre of national excellence in orthopaedic care. It has an international reputation. With the care it provides to its patients, it is one of the best centres in the world.

Before I address the issues my hon. Friend raised, I pay tribute to all those who work in our NHS—not just in his constituency, but right across the country—for their dedication, determination and commitment in providing first-class services to all whom they care for. I know that he made his remarks in that spirit. First-class, dedicated NHS staff need to be supported with the right facilities to provide that level of care. That is exactly why he raised the issue today, and I hope my remarks will bring him some reassurance.

One issue I wanted to pick up on was consultancy spend. I agree with my hon. Friend that hospitals spending money hand over fist in that way on consultants is completely unacceptable. I hope he will be pleased to know that the consultancy spend in the NHS has been reduced by £200 million since the previous Labour Government were in power, which is a strong step in the right direction. Many of the issues that he raised on that are historical. We have introduced new section 42 guidance for trusts that are in deficit to ensure that they are much more rigorous in how they spend their money when they want to receive additional Government cash. Looking at consultancy spend and ensuring that money is not wasted in the way that he outlined are important parts of the new criteria.

As we have heard, the RNOH is the largest orthopaedic hospital in the UK and is regarded as a leader in the field of orthopaedics in the UK and worldwide. It provides a comprehensive range of neuromusculoskeletal health care, ranging from treatment for acute spinal injuries to orthopaedic medicine and specialist rehabilitation for those who suffer from chronic back pain. The range of specialist treatments provided by the trust includes: the rehabilitation of people with life-threatening conditions, including spinal cord injuries; the innovation of new treatments, which is increasingly important, particularly in the areas of care provided by the hospital; leading-edge research and development; the manufacture of state-of-the-art prosthetics; and the training of future orthopaedic specialists. The trust is a national provider of health care: 45% of the trust’s patients live in London, a further 22% are from the remainder of the south-east, 31% are from further afield in the UK and 2% are international, which shows the hospital’s outstanding reputation.

The RNOH plays a major role in teaching. More than 20% of all UK orthopaedic surgeons receive training there, which is testament to the desire of the surgeons of tomorrow to ensure that they train and have experience of providing care at an outstanding centre of excellence. Patients benefit from a team of highly specialised consultants, many of whom are recognised for their expertise both in the UK and abroad. As my hon. Friend outlined, according to the friends and family test, Care Quality Commission inspections and many patient indicators, Stanmore is a centre of excellence and produces the very best possible care and results for patients.

The RNOH’s proposed redevelopment of the Stanmore site is key to ensuring that it can continue to improve the care it provides. I am aware that most of the buildings at Stanmore date from the 1940s, and many are no longer appropriate or fit for purpose for the high-quality care and excellent clinical outcomes that the RNOH provides for its patients. The plan is to rebuild the hospital so that it can continue to provide its specialist orthopaedic care to thousands of patients, young and old, with conditions too complicated for other larger general hospitals to handle. The new hospital will be a state-of-the-art facility that reflects and enhances the medical excellence that already exists at the RNOH. It will provide 124 beds, the majority of which will be in single rooms, thereby greatly enhancing patient privacy and dignity and helping to reduce the transference of infection, the incidence of which, as my hon. Friend outlined, is remarkably low at the trust.

Patient experience will be enhanced through a number of en-suite single rooms and modern, spacious and well-equipped communal areas. Improved facilities for staff will give them a better environment in which to work, enabling them to provide the best possible care. The RNOH is renowned worldwide for its clinical excellence, and manages to maintain high standards of outcomes despite the condition of the estate. The trust looks forward to continuing that high standard of care in the new hospital, which will provide an enhanced setting both for patients, and for support staff delivering the highest possible quality of care.

I appreciate the concerns that have been expressed. My hon. Friend called some of the challenges Kafkaesque, and I share his frustration at the difficulties experienced in developing and improving the facilities at the trust. It has taken a long time to get the proposed redevelopment to this point. Nevertheless, it is important that the business case is affordable. We know some of the historical dangers and challenges of unaffordable private finance initiative deals. In fact, a PFI deal crippled the South London Healthcare NHS Trust; that serves as a reminder to us all of the challenges that hospitals will face in achieving sustainability and delivering high-quality patient care if they take on unsustainable and unaffordable PFI deals.

I know that it has been frustrating, but we must ensure that the financial arrangements for the loan, as well as those underpinning the new development package, are sustainable, in order to ensure that the future provision of services is not jeopardised by a rush into an imprudent financial arrangement. It is in that spirit that there has been a lot of due diligence, although I accept that it has been frustrating.

In April 2013, the NHS Trust Development Authority took over responsibility for approving business cases for estate redevelopment. Between April and December 2013, the TDA worked with the trust to address the additional assurances required on the draft appointment business case. Both the trust and the TDA are clear that the right solution must enable the provision of excellent services to patients, be affordable, and offer value for money.

In December 2013, the RNOH trust board determined that it was unable to give its continued support for the draft appointment business case, because the trust concluded that the risks to affordability and flexibility associated with continuing with the scheme as then proposed were not sustainable. At that point, recognising the importance of the proposed redevelopment, the TDA committed to supporting the trust in working up alternative options for funding. The TDA has been supporting the RNOH to develop a business case that offers value for money and stands a good chance of securing the necessary funding to enable important improvements to be made for the benefit of patients. Serious consideration must also be given to the impact on the long-term sustainability of the trust.

In January 2014, when the financial modelling was complete, the trust concluded that a PFI scheme was unaffordable and that it wished to pursue an alternative scheme. In May 2014, the trust presented to the TDA an outline of its new preferred option for the redevelopment of the Stanmore site. It is a smaller-scale capital redevelopment, costed at around £40 million, as my hon. Friend said. The cost is to be met jointly through public funds and the proceeds from land sales.

Hospitals and trusts sometimes have surplus land that is not used for patient care, and that it costs them money to maintain—money that does not go to front-line patient care. It is of course right that, if they would like to redevelop facilities for the benefit of patients, they should use some of the capital receipts from the sale of that land to contribute to any planned redevelopment. It is in that spirit that the new package was put together. Indeed, it is in that spirit that the section 42 guidance for trusts in deficit that require finance, which I outlined earlier, was drawn up. Where trusts have surplus land that they could release because it is not required for patient care, that land can be freed up in order to provide affordable homes for local people, support the construction industry and, of course, reduce the overall cost of running a trust’s estate. That is a win-win situation for the NHS, as well as for the local economy and, often, young families in the area. I am sure that that will be a benefit of the proposed new scheme, as my hon. Friend said.

The TDA supports the approach that has been put together as part of the £40 million package, and will advise and support the trust on the development and submission of its application for public funding and its business case for the sale of land.

Looking to the future, I understand that the TDA received the trust’s revised outline business case on 29 January. The TDA is now assessing the business case with the aim of making a decision at the earliest opportunity; its board meeting will be held on 19 March—in less than three weeks’ time. This morning, I spoke positively to the TDA about the business case. I have every hope that the outline business case will be strongly supported. We must obviously wait for the outcome of the meeting, but I hope that my hon. Friend and his constituents will hear good news later this month.

The TDA recognises the unarguably poor quality of the Stanmore estate, and the great challenges that that presents to the delivery of high-quality health care and a positive patient experience in the months and years ahead. It is mindful of the need to make a swift decision, so it is committed to working alongside the trust to agree a business case for clinical quality reasons. It is vital that that is done in a way that safeguards important services for patients. Now that the TDA has received a formal business case to review, the process will continue at pace. Once the business case is approved, the TDA will support the trust in developing a full business case and finalising any outstanding assurances that might be required, in the shortest time possible.

I hope that my hon. Friend is reassured that a very active process is now in play, with the Trust Development Authority proactively supporting the trust to progress its business case, which I am optimistic will be approved in its outline form later this month. I hope that my hon. Friend’s constituents will then receive some very good news that will be welcomed not only at Stanmore and by his constituents, but by orthopaedic patients in this country and elsewhere in the world who receive the best possible care from the trust.