Orders of the Day — Princess of Wales RAF Hospital, Ely
Mr James Paice (South East Cambridgeshire)
I am grateful for the opportunity of this Adjournment debate, because on 4 August this year, the year in which we celebrated the 50th anniversary of the battle of Britain, I was one of thousands who celebrated in the city of Ely the 50th anniversary of the Princess of Wales Royal Air Force hospital—a hospital which was founded before the dark days of 1940. but which ever since has been part of the life of the community and the city of Ely, and a hospital to which, only three years, ago Her Royal Highness Princess Diana gave her name.
In those 50 years, very large sums of money have been raised for the hospital. Many RAF personnel have retired to live in Ely. Indeed, on a number of occasions medical staff have left the service to become practitioners in the national health service in Ely. However, over the last few weeks there has been a cloud over that hospital, with rumours that it is to close. We know that the Surgeon General has been carrying out a review of all military hospitals. We know, of course, and everbody welcomes the fact, that, as a result of the end of the cold war and the abolition of the iron curtain, it has been possible for us to reduce defence expenditure. We heard in the House only last week about the way in which those savings are being channelled by my right hon. Friend the Chancellor into the important services that we all value so much. It is followed by today's announcement of the closure of two large RAF bases in Germany, which bodes somewhat ill for tonight's debate.
If the rumours are right and Ely is to be closed, it would be sad and ironic that the widely acclaimed and welcome changes in priority spending, which I entirely support, should be at the expense of the people of Ely and their health care. There are two other RAF hospitals in Britain—the Princess Alexandra hospital at Wroughton and the Princess Mary hospital at Halton. In disciplines, there is little to choose between any of them. Ely and Wroughton have casualty and accident and emergency units and Halton does not. Halton has nuclear medicine and oncology units. Ely has renowned skills in tropical diseases. That stems largely from the fact that East Anglia's regiments were at the forefront of the fighting and subsequent imprisonment by the Japanese in the far east. Even today, many ex-prisoners of war of the Japanese still attend Ely for treatment.
The actual numbers of patients from the services treated show clearly that Wroughton is the largest hospital. But more importantly in this context, Ely has consistently treated more service personnel than Halton. Only once in the past five years has Halton treated more service personnel in-patients than Ely. In every one of the past five years, Ely has treated considerably more out-patients from the services than Halton. In the past year, it has treated 3,000 more out-patients than Halton, and in the year before it treated 3,600 more. That is service out-patients, not dependants or NHS patients. So that discrepancy of 3,000 disproves any claim that Ely's location is inconvenient. On top of all that, there has been massive public investment in facilities at Ely—£9 million in the past six years. That includes a complete new theatre block, costing £4·5 million.
As we all know, rumours feed on each other. Originally, it was rumoured that RAF Halton had been selected for closure and Ely was to remain open, for the very reasons that I have described, as the most modern hospital which was best able to provide the full range of training for RAF staff. The rumour has now been reversed, and it is said that Ely is to close. The cynics believe that it is because Halton is a rather grand hospital and the home of so many senior RAF and retired personnel.
I am the first to recognise that simply treating NHS patients is not a justification for keeping an RAF hospital open, but it is essential that the treatment of those patients is considered as part of any review of the hospital's future. The RAF provides a notional 65 beds across all specialties for NHS patients in the Ely area. It has a major out-patients department and, most importantly, a full accident and emergency casualty unit.
The next nearest casualty unit to Ely is at Addenbrookes in the constituency of my hon. Friend the Member for Cambridgeshire, South-West (Sir A. Grant). That is some 24 miles away, on the wrong side of Cambridge. When I checked the journey in my car at the weekend, I found that it is a good 45-minute run. To expect people in villages in the constituencies of my hon. Friends the Members for Cambridgeshire, North-East (Mr. Moss) and for Norfolk, South-West (Mrs. Shephard) to be taken all that way can have only one effect—greater risk to their lives. Indeed, only last week someone was seriously injured on the Littleport bypass, and it took 45 minutes for the ambulance to reach him. If it had had to return to Addenbrookes, he would have had to wait over one and a half hours before receiving treatment. That would be unnecessary risk to human life.
The hospital at Ely provides acute surgical beds, acute medical beds, a coronary care unit, acute obstetric and gynaecological beds and, of course, pathological and radiological services to doctors in the area. If people did not have this facility they would have to go at least 24 miles to the next nearest facility. For the doctors in the area, that would mean a considerable delay in treatment.
In 1988, 5,247 NHS patients were treated as in-patients, more than 31,000 as out-patients and over 6,500 through the casualty unit. You will see, Mr. Speaker, from all those figures, that the loss of these facilities would have a catastrophic effect on the health services provided to the people of Ely and the surrounding areas. In recognition of that, the local paper, the Ely Standard, organised a petition, which I have with me. This petition, with 15,000 names, was presented to me in Ely last Saturday. It urges and begs the Government to ensure that these facilities are retained for the use of the people of Ely.
I shall try to be constructive about the future of that hospital. We could start by looking at a combined NHS and military hospital—a hospital with a military wing, such as has been so successful in Belfast. Yet another rumour is circulating, which is that the RAF would wish to have a military wing at a different hospital in Cambridgeshire. If the rumour is true, and if that were to happen, it would be an immense insult to the hospital and the people of Ely. I and many others would resist it vehemently.
There is the possibility of the NHS and the private sector having a joint operation to run those facilities. By far the most sensible course is that the hospital should be set up as a free-standing NHS trust. That would be a first-class opportunity for the Government to demonstrate beyond all shadow of doubt what we on this side of the House know: that this aspect of our NHS reforms not only can but will work and will prove to be the salvation of this hospital.
I recognise that there is a capital asset tied up in Ely hospital. I recognise also, as we all do, that the Treasury will look for receipts from that asset. However, it is not beyond the wit of man to find some mechanism whereby community gain and development can go hand in hand, to the advantage of the Treasury and, more important, to the advantage of the people of Ely. It would make absolutely no sense for these modern facilities to be lost with more than £9 million of public money invested in them in the past few years. There must be a way to ensure that we keep them, preferably under the RAF but, if not, certainly in some other guise, so that they are available for the treatment of any NHS patient in my constituency and those of my hon. Friends.
We are awaiting an imminent decision by my right hon. Friend the Secretary of State for the Environment about the location of a new settlement of initially 1,500 houses, probably rising to 3,000 houses, which means an additional 10,000 people. We know that it will be within five or six miles of Ely. Ely, Littleport, Soham and other nearby settlements expect to take many hundreds of extra houses as part of the current structure plan. It would be ludicrous if this health care resource were to be lost to those people. Fenland people have long memories, as I have come to know in my years of helping and representing them. The loss of this hospital would not be quickly forgotten.
I am looking at my hon. Friend the Minister who is to reply. I am sure that he will recognise the strength of my arguments. I hope that I can leave here tonight able to tell the people of Ely that their hospital—they consider it their hospital, although it is nominally an RAF one—has a future. I hope that I will be able to inform them also that they can look forward with confidence to their future care.
I hope that you, Mr. Speaker, will recognise my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss), who has worked closely with me and in the campaign that has been waged so far, and whose constituency boundary comes within a few miles of the hospital. I know that he too supports the case that I made tonight.
Mr Malcolm Moss (North East Cambridgeshire)
I thank my hon. Friend the Member for Cambridgeshire, South-East (Mr. Paice) for the opportunity to contribute to his very important Adjournment debate. I congratulate him on his success in securing it, and on the excellent and persuasive way in which he made the case for his constituents and mine.
Before the 1983 boundary change, the Royal Air Force hospital was in the Isle of Ely constituency, but when the city of Ely was taken out of that constituency, it reverted to north-east Cambridgeshire. The virtual boundary between my hon. Friend's constituency and my own is close to the hospital, and its catchment area includes a substantial proportion of my constituency and that of my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard).
At the heart of the matter is not that the presence of the RAF hospital is crucial but that the existence of a hospital is vital. The RAF connection is, of course, important. It is valued by and has the affection of the people of Ely and its environs, and the community think of the hospital as their own—as Ely's hospital. I cannot emphasise enough that it would be most unwise to underestimate the strength of local feeling.
My hon. Friend the member for Cambridgeshire, South-East drew attention to the substantial growth of housing and development earmarked for our area under the Cambridgeshire structure plan, and the settlement that he mentioned is in my own constituency, near the village of Wilburton.
I believe that there are four options. The people of Cambridgeshire would, I think, vote for the status quo. If that is not achievable, the second option would be a revision of the current situation, taking into account Ministry of Defence considerations for greater NHS funding. Thirdly, the district health authority could take over the facilities. Finally, the district and regional health authorities could revise their priorities and the provision of health care in our area. They could utilise the existing facilities either wholly or in part, and adopt my hon. Friend's excellent suggestion for establishing an NHS trust to run the new hospital. I assure my hon. Friend the Minister and the House that such a development would have the overwhelming support of the local people.
Whatever decision is made, it is imperative that the various agencies and Government Departments work in harmony with the local authorities, district and regional health authorities, general practitioners and the Treasury. The Ministry of Defence—more specifically, the RAF—has a long and distinguished association with Ely and the surrounding areas which has been reciprocated by the local people, and which has developed over the years into a very fruitful relationship to mutual advantage.
The people of Ely, north-east Cambridgeshire, south-east Cambridgeshire and south-west Norfolk seek an assurance from my hon. Friend the Minister that the Ministry of Defence will not abandon the community's health needs to the forces of uncertainty and doubt but will co-operate in working for the continuation of health facilities at Ely, in some form or another.
Sir Archie Hamilton (Epsom and Ewell)
I am grateful to my hon. Friend the Member for Cambridgeshire, South-East (Mr. Paice) for raising the issue of the future of the Prince of Wales RAF hospital, Ely. I am also grateful for the contribution from my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). I am well aware of the keen interest that they have consistently shown in the hospital and in the contribution which it makes to the provision of treatment for national health service patients in the Cambridge district health authority. I am conscious that their interest is particularly shared by all those hon. Members with constituents who have had occasion to use the facilities of this RAF hospital. It is helpful to have this opportunity to explain some of the background to the review of service hospitals to which my hon. Friend the Member for Cambridgeshire, South-East referred and to remove some of the uncertainty that arises when there is speculation about decisions of this nature.
As my hon. Friend will be aware, the hospital has a long and distinguished record of service covering the past 50 years. It was constructed between 1938 and 1940 in response to the requirements of the second world war. During the war, there were nearly 50 operational flying stations in the area from which it drew its patients. As the pattern of casualties during the war became established, Ely became one of the national centres for the treatment of burns.
With the changing requirements in military and civilian medical treatment, the hospital is now smaller than in its heyday and able to help with the treatment of a number of NHS patients which has been of great assistance both to individuals and the local health authorities. The out-patient and casualty departments were opened by the Princess Royal in April 1963. The hospital was granted the freedom of the city of Ely in 1977, and in July 1987 it was renamed the Princess of Wales RAF hospital during a visit by Her Royal Highness.
The hospital has therefore given fine service and been justly honoured. There will be many who are indebted to it for its contribution to the service and civilian communities over the years. Nevertheless, despite its line record in the civilian community, it is a service hospital first and foremost and its future has to be determined against the current needs of the armed forces.
It may be helpful if I now say a few general words about the role and function of service hospitals. The Royal Navy, Army and Royal Air Force medical services contribute together to the effectiveness of the armed forces by their commitment and ability to care for wounded service men in the event of armed conflict. Even as I speak, medical personnel from service hospitals in the United Kingdom and Germany are with our troops in the Gulf, ready to provide this service should the need arise.
I am sure that hon. Members on both sides of the House would wish to join me in paying tribute to the professionalism of the defence medical services and the high standard of training and skills that go to make up that professionalism. It is with great credit that this enables them to step directly into the role assigned to them in such situations as the current deployment to the Gulf. Service medical and dental officers, the nurses and their supporting personnel both military and civilian fulfil an important role in the armed forces.
I must emphasise that the primary role of the defence medical services is to treat the casualties of war, and where possible to return them fully fit to the front line. In this respect the defence medical services can be regarded as force multipliers. The main purpose of service hospitals in peacetime is to train the medical staff for their military medical role and to provide prompt treatment of service personnel by medical staff who are aware of the levels of fitness required and rigours of the tasks of their respective services. A distinction can be drawn between the hospital, as a building, and its staff, most of whom would in war practise their skills on the battlefield. Those factors must therefore be our main concern in any consideration of the numbers and location of the service hospitals that we require in the United Kingdom.
While the medical services are directly responsible for providing primary and secondary care for service personnel, they also provide treatment for NHS patients, where a service hospital is available and within the spare capacity not taken up by its primary functions. In general, this treatment is provided free of charge, although provision exists, as in the case of the Princess of Wales RAF hospital, for some services to be purchased by district health authorities at less than full cost.
The advantage to the defence medical services is that the additional number and variety of patients which these arrangements enable them to treat help them to maintain the highest professional standards. In return, NHS hospitals provide treatment for service personnel. This arrangement thus benefits both the health authority and the defence medical services.
The initial stimulus for the recent review of service hospitals which was undertaken by the previous surgeon general, was provided by the National Audit Office, whose report on this subject was considered by the Committee of Public Accounts in the 1987–88 Session of this Parliament. The Committee's report stated that United Kingdom service hospitals should be fully utilised in the interests of NHS patients and the taxpayer and urged the Ministry of Defence to consider
whether there need to be as many as eight separate Service hospitals and also to consider with the DHSS the practicability of a military wing in an NHS hospital.
At the same time, the continuing pressures on the defence budget reinforced the need for the Ministry of Defence to scrutinise very carefully its future requirement for service hospitals. Accordingly, the Surgeon General put in hand a review of the numbers, size, function and location of the hospitals required by the services in the United Kingdom, taking account of the war roles of the defence medical services, including the training requirements of that role.
The review was carried out in two main phases. The first report established that, if one service hospital was closed, the displaced military medical staff, who would still be required to meet the war role, could be absorbed into the remainder. It did not, however, recommend which hospital should be closed.
The second phase of the review involved the complex task of determining which closure would result in the least detriment to the ability of the defence medical services to meet their war role and achieve the savings to the defence budget for which we were looking, even before the changes in defence policy and priorities announced by my right hon. Friend the Secretary of State for Defence on 25 July. I should say at this stage that, during the course of the studies for the review, the Department of Health and district health authorities which have service hospitals within their boundaries were consulted. Not unexpectedly, none welcomed the closure of a service hospital. Nevertheless, a choice has had to be made.
I am now sorry to have to confirm to my hon. Friends that it has been decided to close the Princess of Wales RAF hospital, Ely, by 31 March 1993.
Mr Anthony Grant (Cambridge South West)
The Minister has made a grave statement. Has he considered the consequences of his decision on the famous Addenbrookes hospital, which is in my constituency and which is under considerable pressure? Will he discuss the matter with his colleagues in the Department of Health?
Sir Archie Hamilton (Epsom and Ewell)
I am grateful to my hon. Friend for that intervention. We are carrying out extensive consultations with local health authorities, and we are well aware that, if this closure were to go ahead and nothing else were to happen, it would put a considerable extra burden on the hospital in his constituency.
I know that this will be a considerable disappointment to my hon. Friends and other hon. Members with a constituency interest, to the regional and district health authorities concerned and to the local community. All of them may dispute the decision, but on balance I believe it to be justified.
Although the decision to close the Ely hospital has been made following work done before "Options for Change" began, it was taken with the principles which underly that work very much in mind. It is only right that I should also inform the House that we are looking again at the requirement for service hospitals in the United Kingdom and Germany in the light both of future changes in the roles and deployment of the armed forces and of the reductions in their size which were announced by my right hon. Friend. I cannot, therefore, rule out the possibility of announcing further closures as our plans develop.
Last year, the Princess of Wales RAF hospital, Ely, treated 5,652 in-patients, 13,538 out-patients and 506 day patients who were NHS patients. That represented over 70 per cent. of all the patients treated there, and about 2 per cent. of all the NHS patients treated in the region. Bed occupancy rates are a widely used activity indicator in the NHS and in service hospitals. The Princess of Wales RAF hospital, Ely's bed occupancy is about 60 per cent. compared with about 80 per cent. in the NHS in England. Direct comparisons with the NHS are difficult, because of differing case mixes, but the Public Accounts Committee considered that service hospitals should aim for 70 per cent. occupancy.
I assure hon. Members and others with an interest in Ely hospital that, while this decision must stand, the Ministry of Defence will do everything possible to minimise the problems associated with the transfer of reponsibility for patients to NHS authorities. Preliminary soundings have already been taken from East Anglia regional health authority. Now that the decision has been announced, the service authorities will lose no time in discussing further with the regional and district health authorities involved the timetable for the rundown and closure of the Princess of Wales RAF hospital.
Mr James Paice (South East Cambridgeshire)
My hon. Friend will understand that the people of Ely will be devastated when they hear this news in the morning. It is a great tragedy that this decision should have been made; had I realised that it would be, I might not have asked for the debate. My hon. Friend referred to a number of statistics, all of which clearly identify the importance of that hospital to the people of Ely for their NHS care. He has just referred to the running down and closure of that hospital and the transfer of patients, which is worrying because it does not imply anything about the future of the facilities. Can he give me any assurance that the RAF will talk to the regional and district health authorities about the future of the facilities—the physical building, which is a modern, purpose-built hospital?
Sir Archie Hamilton (Epsom and Ewell)
I am grateful to my hon. Friend and am just coming to that point in my remarks. I can give him that undertaking. As he mentioned, we are under an obligation to get the maximum proceeds from the site, but we are open to any offer that the health authority might make, as I am about to say.
The service authorities will also be considering and, where appropriate, discussing with the responsible regional and district health authorities how best to provide secondary care for service personnel in East Anglia after the hospital closes. In this context, we shall be ready to consider, without prejudice, any proposals which those health authorities may wish to make on the possibilities for increased co-operation.
We expect that this closure will save approximately £40 million over the 10 years of the Department's long-term costing. We have not yet decided on the specific disposal strategy for the site and will need to discuss the various options in detail with the relevant authorities. However, I should make it quite clear that our normal policy is to maximise revenue by disposing of property on the open market and with the benefit of an agreed planning brief. We must do so, in view of financial accountability to this House and the taxpayer. Our intention would therefore be to dispose of the site at full market value as soon as any planning issues have been resolved with the relevant authorities.
By its very nature, any hospital quickly assumes a place in the affections of the local community, and we would expect the closure of any one to be a cause for sadness to that community. Obviously, I am deeply conscious, too, of the feelings of those who are currently employed at the hospital, not least the civilian staff, who will be most concerned about their jobs. I regret that one side-effect of making an announcement of closure at this late hour in the evening is that personnel cannot be informed of the decision before tomorrow morning, and there is the possibility that they may hear it first through the media.