I should like to express my thanks and the thanks of thousands of my constituents to you, Madam Speaker, for allowing this debate to take place. The people of Leeds were shocked and angered by the death of my constituent, Mrs. Edna Harrison, and it is a tribute to your sensitivity to hon. Members' constituency problems that you have so quickly permitted the subject to be debated.
I also wish to pay tribute to my local evening paper. The current Secretary of State for Health, his predecessor, now the Secretary of State for National Heritage, and the Minister here today, the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam), are aware that, over a substantial period, the Yorkshire Evening Post has kept the issue of bed shortages in the public domain. As the Minister knows, health provision is largely run by political placemen in the health authorities, who do not see it as being their duty to acquaint the public with the details of local health matters. The public are largely kept in the dark about the true state of the service. That intensive care bed shortages are a matter of public knowledge and concern in Leeds is a sign of how consistently the Yorkshire Evening Post has raised the issue and it deserves the thanks of the people of Leeds for performing that service.
The Minister will be aware that Mrs. Edna Harrison collapsed in her back garden on a quiet Sunday morning two weeks ago. The ambulance arrived at her home and she was rushed to her local hospital, less than one mile away from her terraced home in east Leeds. That hospital is the 1,500-bed St. James's hospital, famed as "Jimmy's" in the Yorkshire Television documentary that has run for some years. It is reputed to be one of the largest, if not the largest, teaching hospitals in western Europe. Despite all that, no intensive care bed could be found for Mrs. Harrison and, four hours later, she was admitted to a Hull hospital over 60 miles from Leeds where, sadly, she died later that week.
Mrs. Harrison's husband and family have shown great dignity and have expressed nothing but praise for the medical staff at both hospitals. I spent some time with Mr. Harrison on Saturday, discussing his wife's sad death. He continues to show great dignity, but he and his family want to know why the long journey to Hull was necessary and why Mrs. Harrison could not have been treated in her local hospital, thereby minimising the danger of travel. The Minister will accept—as does the working party report to which I shall refer later and which the Minister mentioned in his statement of 6 March—that, for an intensive care patient, travelling is always dangerous. The danger can be minimised, but it should be avoided where possible.
Mr. Harrison and his family would have wanted the danger of travel minimised and they would have wanted Mrs. Harrison to be where they and their friends could have an opportunity to visit her, albeit sadly for the last time before she died. They and I accept the conventional wisdom in various statements by Ministers and health officials about the high cost of intensive care beds and the need not to leave them lying empty. Mrs. Harrison may just have been unlucky as she needed treatment at a time of peak demand, and perhaps it was inconceivable and even unreasonable to expect such a scarce and expensive bed to be available locally.
Time will tell, and that individual case is not the reason for this debate. It may have been a factor, but I have asked for a local inquiry into Mrs. Harrison's death, and Healthcare, the local authority and the St. James's trust—the hospital involved—are conducting one. I am far from happy with the initial details sent to me by the authority, which seems unnecessarily defensive about the whole matter. A fuller and more objective report will no doubt follow.
After our discussion on Saturday, the family and I intend, unless the report is acceptable, to raise a number of other matters. Those include the sheer inconvenience of a family having to travel 60 miles to see a seriously ill mother; the impracticality of the husband finding himself in Hull with no money and being told that he must find his own accommodation and his own way back; and the sadness and distress of the son driving 60 miles having been told that, when he arrived, his mother would be dead. All that, when that family live almost in the shadow of the biggest teaching hospital in western Europe. Those practical problems were compounded by the shabbiness of the accommodation for families staying on the premises because the patient is expected to die, and the fact that other family members and friends could not join in the grieving process as the death occurred 60 miles away in the middle of the week and it was impossible to get the time to leave work and go there.
The family have rightly raised a number of matters that will be referred to the ombudsman. I am sure that, somehow, we shall have the circumstances surrounding Edna Harrison's death properly examined. I was pleased to see that the Minister, in a public statement, expressed his sorrow about it and his determination to ensure that the facts were thoroughly looked at and any lessons learned.
Does my hon. Friend know whether an inquiry was made as to whether a bed was available at Leeds general infirmary, which is only two to three miles from Mrs. Harrison's home? I understand that there is a system whereby the nearest bed can be obtained, and perhaps that was in Hull. It seems incredible, however, that with two such large hospitals within such a short distance of that lady's home, she could be found accommodation in neither. Clearly, the travel problems that my hon. Friend describes would not have been the same had she been able to go to Leeds general infirmary.
I thank my hon. Friend for that intervention. He is aware that, although I shall primarily discuss east Leeds, for which St. James's is the local hospital, all Leeds Members and, because of the regional significance of both hospitals, all Yorkshire Members, know the pressure that is consistently put on intensive care beds at both LGI and Leeds general hospital.
I am advised that there are intensive care beds at Dewsbury hospital, but because there is no money to finance their introduction, they are left idle and without function. That should be dealt with also in the Yorkshire region.
My hon. Friend makes a valid point. Both my hon. Friends remind me of a pertinent fact that deserves examination by the Minister: the two beds that were even nearer but were not even considered. They were at Killingbeck hospital, which has been the subject of an Adjournment debate between two hon. Members present today. Killingbeck hospital is due to close next year and it will be terrible if those beds are not brought into operation simply because of that fact. The explanation is that the beds are ring-fenced for cardiac cases, so no one thought to include them on the register or even inquire whether they were empty. A rumour is going round Leeds that they were empty and available, and they are even nearer to Mrs. Harrison's home than St. James's hospital, so that matter deserves investigation. It would be criminal if bureaucratic ring fencing, however good the reasons for it, excluded Mrs. Harrison from prompt treatment at a hospital that was so close to her home.
I have just come down from my office having done a local radio programme involving Mrs. Harrison's brother-in-law. He wanted to make it absolutely clear that the care that she was offered by doctors and nurses was the best in the circumstances, but that the system was wrong, which is the point that my hon. Friend is making. Has he looked at how beds are managed in the Northern and Yorkshire region, in the light of the Government's abolition of the regional health authority? In the past five years, our region has lost more hospital beds—27 per cent.—than anywhere else. The regional health authority's role in planning care was important for the likes of Mrs. Harrison. I should be interested in my hon. Friend's thoughts on that point.
My hon. Friend makes an important point. The cuts in hospital beds in Yorkshire have been savage. Only last week, my hon. Friend drew the House's attention to an unhappy case and the circumstances surrounding it, at Pinderfields hospital in his constituency. Yorkshire's grave health funding problems and the underlying problem of a lack of intensive care beds become an issue when they culminate in individual cases such as this. Although Mrs. Harrison's death prompted me to raise this matter, the real issue is the fact that the local hospitals' inability to admit her when she desperately needed intensive care treatment was not an isolated incident. Such an incident was predicted, but, as with other events in Leeds, elsewhere in Yorkshire, Warrington and Newcastle, the House was told that it would not happen, as Ministers had listened, learned and taken steps as a result of similar incidents last winter.
I primarily make the case on behalf of my community for an examination of the situation and prompt action in my local hospital. There has been an increase arising from the March statement—one adult intensive care bed and one paediatric intensive care bed—but at the risk of seeming ungracious and ungrateful, I emphasise that we desperately need more. Whatever the situation elsewhere, Yorkshire and the north-west seem to have problems, as explained so well yesterday by my hon. Friend the Member for Warrington, South (Mr. Hall). When a senior figure in the national health service refuses a Member of Parliament a document on the matter, that must make alarm bells ring throughout the service, if not in the House.
I shall let my colleagues make the case for their areas. Apart from the common problem of growing debts and underfunding, the matter should be judged in the light of local circumstances. I am content for the situation in Leeds to be judged on its merits.
The House may not need reminding of last winter. We in Yorkshire witnessed a number of horrifying incidents, culminating in the death of a young child who had been driven through a snowstorm from Manchester. We witnessed the spectacle of a retired policeman being touted round a dozen hospitals in Yorkshire before being flown 60 miles to Scarborough, where he died before he could be admitted. We heard senior, well-respected consultants in Leeds speak of a crisis.
I want to get across to the Minister a point that the Secretary of State seems not to take on board, especially in respect of Leeds and Yorkshire: throughout the year, the two city hospitals in Leeds regularly—not just seasonally—turn away patients. Yesterday I was at St. James's hospital and saw the book of refusals, in which there was not a blank page. Certainly the situation gets worse in winter, but the two consultants responsible for managing intensive care beds at the two major hospitals in Leeds have consistently said that it is not a seasonal problem. It may be exacerbated seasonally, but it is a regular problem. They made that statement last winter, when once again they had to turn away seriously ill patients because they had no spare intensive care beds.
So serious was the position in Yorkshire and elsewhere that after last winter the Secretary of State was obliged to make a statement in the House in March. Last week, sadly, he refused to do so when similar incidents were being reported this winter. On 6 March he stated:
I told the House earlier this year that I would undertake to ensure that we learn the proper lessons from the general pressure on the emergency services this winter. I shall set out to the House this afternoon the steps that I am taking to ensure that that happens."—[Official Report, 6 March 1996; Vol. 273, c. 356.]
In three brief paragraphs, he dealt with the intensive care beds crisis. He relied largely on the report of a professional working group that examined best practice in the use of intensive care, to which I shall return. With his Commons performance on 6 March, the Secretary of State drew a line in the sand. He accepted that there were lessons to be learned from last winter, he outlined his solutions and the inference was clear: this winter, we would not expect a rerun of the unhappy experiences of last winter.
Sadly, we continue to experience problems in Leeds and Yorkshire. I have raised the tragic case of Mrs. Harrison. The week that she died, Dr. Mark Bellamy of St. James's hospital commented:
We are sailing extremely close to the wind and sooner or later we are going to come unstuck.
The same week, the following examples occurred: a Leeds patient faced a possible trip to Birmingham or London; Leeds patients were sent to Grimsby, more than 80 miles away; patients were sent from Airedale to Stoke; Bradford patients were sent to Doncaster; and Newcastle patients were sent 100 miles to Edinburgh. In the week that Mrs. Harrison of Leeds died in Hull, a 71-year-old male pensioner was sent from Hull to Leeds for an intensive care bed and died a few days later. Those patients were not sent to a particular centre of excellence because of their specific complaints—they were shipped around because of bed shortages.
A Leeds consultant and British Medical Association representative commented after the death of Mrs. Harrison:
There are many more incidents which are not reported in the media. The fact that it is going on is very worrying.
A Leeds consultant, Dr. Mark Darowski, was quoted as saying:
Mr. Dorrell has not learnt the lessons of last winter.
Dr. Andrew Cohen, the St. James's intensive care manager with whom I spent some time yesterday, said:
Resources are stretched to the absolute limit. The strain has been caused by the increase of illness we always see in winter and the only way we are going to avoid this sort of problem is if there is an increase in intensive care beds. There is a chronic shortage across the region and the country as a whole.
Dr. Andrew Bodenham, intensive care manager at Leeds general infirmary, stated:
We are just playing musical chairs all the time.
I do not think that he meant to be humorous when speaking about seriously ill people.
It is accepted that last winter there was a shortage of intensive care beds. The Minister took steps in good faith to overcome it, but the signs are that the problems continue. As it is a matter of life and death, the Secretary of State should act urgently. Yesterday, during the health debate, he attacked my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), claiming that all that my hon. Friend did was
to parade a few individual cases that are supported by incomplete facts, to make a half-researched charge about the Government's record, wave a shroud, repeat the mantra that Labour will abolish the internal market and base metal will be transformed into gold."—[Official Report, 21 January 1997; Vol. 288, c. 755–56.]
I have not waved any shrouds. Without getting angry, I have tried to express the anger felt in Leeds. I have not used political comments. I have used comments from doctors who have the unhappy task of deciding who is to have an intensive care bed and who is to go on the dangerous search for a bed elsewhere.
I hope that the Minister will consider the following points. First, he underestimates the regular demand for intensive care beds in cities such as Leeds. The consultant at St. James's hospital is a sober, responsible, committed person who weekly faces the task of turning away seriously ill people.
I thank the Minister for the two additional beds that were made available after the March statement. However, the ward has 13 beds, but 18 bays. I do not understand why it seems to be impossible for health officials to sit with the consultant responsible for the service, examine the records, determine the true level of demand and make provision accordingly. It seems that Ministry officials would prefer not to ask the question, because they do not want to know the answer. They fear that the reply may not suit them.
I understand the cost implications, but if that is the reason for the failure to ask questions when lives are at stake, that is unacceptable. As part of the discussions arising from the Minister's March statement, Andrew Cohen made a number of requests. Apart from the additional one paediatric and one adult intensive care bed, nothing else has arrived.
The Minister should understand and make allowances for the effect on demand when intensive care beds are located in a hospital with many regional facilities. I am told that my constituents in east Leeds gain from having so many specialties or centres of excellence at St. James's hospital. However, the Minister knows that those specialties make regular demands on intensive care beds. When someone such as Mrs. Harrison collapses, she must compete for a bed with patients who have been moved to intensive care from other departments within the hospital. Dr. Cohen must decide whether to stop an operation or deal with the inevitable emergency that will result from denying new patients intensive care beds. He advocates separating dedicated intensive care beds from general intensive care beds at Leeds general infirmary and St. James's hospital, and that proposal should be considered.
What is happening with the trust and health authority regarding the provision of high-dependency beds? The Minister appreciates the vital role that those bodies play, both physically and financially, in providing a valuable safety net. However, the health authority and the trust have taken no action to increase the number of high-dependency beds at St. James's hospital—in fact, all eight high-dependency beds are dedicated to the other specialties. In March, the Secretary of State and the professional working group said that such beds play a vital part in health strategy. When patients are admitted to hospital, staff usually determine the availability of intensive care beds with a view to moving patients to a high-dependency unit. That is not possible at St. James's hospital and we must ask why.
The Secretary of State requested discussion, consensus and transparency between intensive care beds, high-dependency beds and the other specialties, but nothing has happened. The trust and health authority have used the Government's money to provide only two extra beds. Is the Minister aware of that fact? Is he monitoring the situation? If so, what is he doing about it; and, if not, why not, as it was a vital part of the 6 March statement?
Does the Minister agree that there is something slightly obscene about forcing seriously ill patients to criss-cross the country in search of intensive care beds? I accept that, if patients require specialty treatment that is available only in Birmingham, it is common sense to transfer them to that hospital. However, seriously ill patients should not be expected to criss-cross the country in search of treatment. Surely specified geographical areas, such as west Yorkshire and south Yorkshire, could combine and squeeze out enough money to provide an agreed safety net, so that we do not see ghoulish transfers of seriously ill patients to hospitals 60, 80 or 100 miles away. It is acceptable for my constituents to travel to Bradford, but not to Bridlington.
I am three years older than the health service, so I have not known anything else—in a way, it is responsible for me, although I have worn better than it has. No hon. Members catch my eye when I say that, but like others of my generation, I know about the pre-health service conditions. Mr. Deputy Speaker, you come from a mining community and you will understand what I am about to say. Why do we cherish and love the health service? Why do those who know nothing else protect it instinctively? It is because our dads and grandads have told us what happened before the NHS was established. You will know more about it than I do, Mr. Deputy Speaker, as you have a long history in the mining industry, and mining communities established many health schemes.
We cherish the national health service because, before it existed, doctors would visit their patients at home. They would ask, "Where is the patient and what is wrong?" The next question would be, "Do you have insurance and can you pay?" Millions of people who could not pay invariably did not receive treatment. The health service introduced free treatment at the point of service that was available when needed. That is why we cherish the health service. The NHS should be there for anyone who requires its services—it may be a matter of life and death. Unfortunately, in the past few years, people have complained that—for whatever reason—the health service was not there when they needed it. That is why Mr. Harrison is aggrieved and why I was prompted to seek this Adjournment debate.
My hon. Friend makes a very good point. We should remind the Minister that many hospitals in Yorkshire—such as Castleford, Normanton and District hospital and others in Hemsworth and south Kirkby—were built using contributions from miners who had small wages, but who knew the value of health care. I am pleased that my hon. Friend has expressed a sentimental view. It would be wrong not to highlight the fact that those hospitals have closed or are now in private hands. That is the disaster that affects mining communities: hospitals built with miners' contributions can no longer serve the people. I am pleased that my hon. Friend has drawn attention to that important issue.
My hon. Friend makes a good point.
I ask the Minister to consider the quiet points that I have made. I understand that individual cases will always cause concern, but there are too many serious incidents at present and that is totally unacceptable.
I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on securing this Adjournment debate and on the way in which he has expressed his feelings about the health service and his constituents. I hope that his comments will be well received by the Minister. My hon. Friend did not engage in tub thumping, but adopted a measured view of what is occurring in the health service. I hope that the Minister will respond in kind.
Hon. Members wish to debate the intensive care beds situation because there is a real crisis in the health service. We do not wish to panic people: this is what our constituents are telling us. It is tragic that we must debate the same subject every winter because the internal market is not working properly. My hon. Friend
mentioned the statement made by the Secretary of State on 6 March 1996—almost a year ago—in which, referring to the winter before last, he said:
This winter has seen those emergency services put under considerable strain.
I have … charged the chief executive of the NHS with a specific responsibility of reporting to me at the end of June and again at the end of September on the plans being made by each health authority for emergency services in its area."—[Official Report, 6 March 1996; Vol. 273, c. 356.]
Nevertheless, we hear that in Yorkshire, in London, in the north-west, in the north-east and everywhere else people are experiencing exactly the same problems this winter, if not worse, as they experienced last winter. I hope that the Minister, in his response, will take into account the fact that we believe that what the Secretary of State said on 6 March last year has come to nothing. Indeed, difficulties in our health service seem to be a great deal worse.
I shall mention only two issues. First, I shall talk about my local hospital at Lewisham. Secondly, I shall refer to one of my constituents. I make no apology for raising a constituent's case. I do not believe that individual cases are isolated. Surely they are examples of what is happening throughout the service. I agree with my hon. Friend that many incidents are not commented upon in the media. Indeed, he quoted a doctor to that effect. The cases that we can raise in the House, or which are raised in the media, are only the tip of the iceberg. That is the problem. We are able only by individual cases to draw Ministers' attention to what is happening throughout the service.
Lewisham hospital is a general hospital serving the people of Lewisham, although it is part of the Lambeth, Lewisham and Southwark health authority. Early in December 1996, it was necessary to cancel all non-elective, non-urgent surgery cases. It is ironic that the health authority felt that it could not fund any more such cases. Why was that? That situation was reached because Lewisham was doing even better than had been predicted. The hospital was seeing more people, treating them and doing all the things that the Secretary of State constantly tells us is happening.
So successful was Lewisham, however, that it ran out of funding and could no longer proceed. As a result, people who had dates to go into hospital to be treated were told at the beginning of December, "We can no longer admit you because additional funding is not available." Indeed, that funding will not be available until after the end of March this year.
With my hon. Friends the Members for Lewisham, West (Mr. Dowd) and for Lewisham, Deptford (Ms Ruddock), I have spoken to the health authority and to a Minister. I am not convinced, however, that Ministers are aware of the depth of the crisis. People in Lewisham, particularly, have been waiting for four months and more for admission—over and above the time that they waited to get their date for treatment in the first place. There will be more suffering, people's needs will become greater and costs will increase. As my hon. Friend said, costs will inevitably increase if people are not treated at the time of need.
I shall now move on to the specific case of one of my constituents, Mrs. Queenie Harrild. The case has had a media profile because Mrs. Harrild's family wants to ensure that what happened to her will not happen to anyone else. I pay tribute to the family's courage at a time of bereavement in being able to speak up for others when Mrs. Harrild died. She died because she had to wait five times to have a heart bypass operation. The operation was cancelled on every occasion. I shall go into the case in some detail.
Queenie Harrild was 69. She had been retired for only about four years. Like anyone at that age, she deserved to have a long and fruitful retirement with her husband. She had a bypass operation seven years ago. During the last few months, however, she had been suffering chest pains. She was admitted to Guy's hospital on 13 December.
On 16 December, she was told that she would be transferred to St. Thomas's hospital the next day. She was packed and ready to go. Her husband was at the hospital with her comforting her, giving her support and ready to go with her in the ambulance to St. Thomas's. Late that afternoon, however, she was told that the ambulance had not turned up and that she would be going to St. Thomas's the following day.
On 18 December, Queenie was packed and ready to go again. Again the ambulance did not turn up. This time, she was told that there were no beds available at St. Thomas's and that she was to be discharged, yet the family was told that her name was at the top of the list for the operation at St. Thomas's.
On 21 December, she was told, again, that she was to be transferred to St. Thomas's the following day to be operated on on the Monday. Late on Sunday afternoon, she was told, yet again, that she would not be transferred because no one had told the ward at St. Thomas's that she would be arriving.
On 23 December, Queenie was bathed twice. She went without food in preparation for the operation at Guy's. She was told that she would be sent to St. Thomas's some time that afternoon to be operated upon the following day. Again, later that afternoon, the operation was cancelled.
That process went on until 3 January. In between times, Mrs. Harrild was told that she would be discharged and sent home. She was then told that she would be sent to Lewisham hospital. These instructions went back and forth. She was prepared for an operation on four occasions with a pre-med. She went without food so as to be ready for an operation, only to be told that it had been cancelled. It was cancelled because an intensive care bed was not available. On five occasions there were planned operations. On five occasions her consultant said, "You will have your operation tomorrow."
Mrs. Harrild died on Saturday 4 January, three weeks after she had been accepted into hospital. Of her last 48 hours, 34 were spent without food or drink because she believed that she was to have her operation. At one point she was told that it would be performed privately. It appears that the doctors realised the emergency that they were facing, but that did not happen either.
Mrs. Harrild's family feel—I think that they have some cause to feel—that they lost their mother because the doctors involved had to make a choice between one patient and another, and determine who would be given the spare intensive care bed. It is not the role of doctors to play God, and no doctor wants to do so. It is outrageous that they are forced to make such choices.
The consultant at Guy's who was caring for my constituent said that heart surgery at the trust had been severely affected "for several months". That being so,
Mrs. Harrild's case is not an isolated incident at Guy's. There has been a crisis for some time. The consultant said that heart surgery had been severely affected "for several months" because intensive care beds were permanently full. Dr. Bob Knight said:
This was a disaster for Mrs Harrild and a terrible tragedy for her family, made worse by the feeling that if things had been dealt with in some other way she would still be here.
Dr. Knight is absolutely right. It is a terrible tragedy for Mrs. Harrild's family, but it is one that they could come to terms with if they had any confidence that the Government will ensure that what happened to Mrs. Harrild will not happen to other people. That is why I am participating in the debate today. I want to hear from the Minister that the Secretary of State's speech of 6 March 1996 was not just warm words, but had some significance, that it meant that something will happen about intensive care beds, and that the crisis that we suffered last winter, and are suffering again this winter, will not happen a third time.
I do not know whether my hon. Friend has seen a press release that the Department of Health put out on 24 December showing that £500,000 was spent on purchasing additional intensive care beds in the South Thames region. It lists the extra beds by authority, but not one additional pound of expenditure has been allocated to Lambeth, Lewisham and Southwark, my hon. Friend's health authority. Will she press the Minister specifically on why the allocation is as shown in the press release and why her inner-city health authority, which faces problems that were so graphically described to the House, was excluded from the additional allocations?
I am grateful to my hon. Friend for raising that point. He described very succinctly the problem in funding for Lambeth, Lewisham and Southwark. As there has been a crisis right across that health authority for some time, I hope that the Minister will make a specific response.
I repeat once again that I hope that the Minister can assure us that the case of Mrs. Harrild, like that of the constituent of my hon. Friend the Member for Leeds, East, will not be repeated; that he will not say that these are isolated incidents; that he will recognise that they are symptoms of the deepening crisis in the health service; and that he will commit the Government to doing something quickly to resolve it.
I shall follow on from exactly where the hon. Member for Lewisham, East (Mrs. Prentice) left off. She and I have spoken. I have also spoken to a third colleague who, coincidentally, reflects, because of the party membership of each of us, the fact that this concern is not a party issue. All Members of Parliament have a duty to ensure that the health service works. The hon. Lady told the story of her constituent, Queenie Harrild. Queenie's son and his wife are represented by the right hon. Member for Old Bexley and Sidcup (Sir E. Heath), and the hospital Queenie died in is in my constituency.
Like the hon. Members for Leeds, East (Mr. Mudie) and for Lewisham, East and me, who have participated in the debate, other hon. Members also wanted a debate on intensive care facilities, because in spite of the efforts that the Minister and the Government have made in the past year, which I recognise, we are clearly not providing sufficient intensive care beds.
The White Paper "The National Health Service: A Service with Ambitions", which came out in November, set out the four principles on which the Government believe the NHS should be run. It should be
universal in its reach, available to anyone who wishes to use it; high-quality; … available on the basis of clinical need
responsive, a service which is sensitive to the needs and wishes of patients and carers.
By definition, that means that, in both emergency services and intensive care services, the facility has to be where it is needed and when it is needed.
The announcement that the Secretary of State made last year, to which colleagues have referred, which was the starting point of the last chapter of this debate, was very clear. He said:
Decisions about the resourcing of intensive care cannot be subsumed into general arrangements for other areas.
We have to look at intensive care—and with it goes high-dependency beds and other extra care beds—but we have to look at it separately. When considering resources, beds and their availability, as the hon. Member for York (Mr. Bayley) implied in his intervention, we have to look at this category of service on its own.
I should like to know, either this morning or by answer later, whether the Minister can now update the figures that show where all the additional beds have been allocated. I ask because, in addition to the announcement made just before Christmas, the Secretary of State, in yesterday's debate on the national health service, said that he had announced the distribution of some of the money— £4 million—just after Christmas to bring forward to this financial year the expansion of intensive care planned originally for next year. He said
it would be used to deliver almost 100 extra adult intensive and high-dependency beds in the last quarter of this financial year."— [Official Report, 21 January 1997; Vol. 288, c. 761.]
Apparently, there are to be a further 100 beds between 1 January and 31 March. We need to know not just where they are but which are intensive care beds and which are high-dependency beds.
When we ask the cost of an intensive care bed, we are always told that it is in the region of £500,000 but, amazingly, the Secretary of State seems to have announced £4 million for 100 intensive care or high-dependency beds. Is that funding to last up to the start of the new financial year? Will the Minister assure the House that the full year's funding in the next financial year is available in the health service budget?
That is another very good point to which we need to know the answer. Of course intensive care beds cost more than high-dependency beds; that is why we need to see the breakdown by area and type.
The third special report of the Select Committee on the Parliamentary Commissioner for Administration, published on 16 October 1996, made it clear that
one of the prime duties of the NHS Executive is to ensure that Parliament is not … deprived of information by which it can judge the overall performance of the Health Service.
Parliament, and representatives of people like the family mentioned by the hon. Member for Leeds, East, and the Harrild family, need information regularly.
The Royal College of Nursing tells us that there are two reasons why there is a problem. First, there is a shortage of intensive care nurses. I should like the Minister to respond to that. It cites the example that the Royal Sussex county hospital had 11 vacancies out of an establishment of 65, and that Manchester has to recruit intensive care nurses from abroad. Secondly, the RCN says that the guidelines that set the establishment of intensive care beds are too strict. The British Medical Association, in its recent review of the winter crisis, confirmed that the shortage of intensive care beds was a national, not a localised, problem.
After the initial speeches in the debate last night, I went to Guy's hospital, because, coincidentally, the community health council meeting was also taking place. The first item on the agenda was the case of Queenie Harrild, and David and Pauline Harrild, her son and daughter-in-law, were there. The meeting accurately highlighted the questions that I want the Minister to answer.
At the meeting last night, answering questions was the consultant in charge of intensive care at Guy's, Dr. Richard Beale, who is clearly a man of huge sympathy. He told us the story of how the beds at the hospital that he manages are always under pressure; how staff are being reduced to danger levels to be able to take people in; and how they are having to juggle, as the hon. Member for Lewisham, East rightly said, between people who are brought into hospital to wait, and people who suddenly overtake them because they are emergency cases who will otherwise die, almost in the next minute or two.
At the end of the meeting last night, Pauline Harrild said that her mother-in-law was in Guy's "waiting to be saved", but she was not saved. We want to know whether we will have a health service that has sufficient intensive care beds to ensure that a bed is available for people who are identified as needing an operation that requires an intensive care bed. We have, I am told, fewer intensive care beds per head of population than all similar comparable countries. If that is true, we clearly need more. That does not mean that there should not be high-dependency and other beds to which people requiring intensive care can be released, but we must face the hard fact that more intensive care provision is needed.
The consultant was clear about the fact that our area in south-east London—the Lambeth, Southwark and Lewisham health authority area, containing Guy's and St. Thomas's trust—needs more beds. If it had had more beds, people such as Queenie Harrild would have been treated. There is no escaping the simple resource implication: more beds are needed, and more staff are needed to look after them.
It seems to me that our ultimate aim should be to distinguish between emergency and elective or planned admissions, otherwise someone like Mrs. Harrild will always be overtaken by another patient who is, for example, suddenly downstairs in the accident and emergency department. We must ensure that there is planning so that we do not experience such crises. That planning must be national, regional and local, and must be done accountably and democratically. Unless we have such a system, we shall regularly fail our constituents and the public as a whole.
As for now, we plainly do not have enough intensive care beds. That is clear to many hon. Members on both sides of the House. Let me tell the Minister that, if there is one thing that must continue to be given priority by the Government in this financial quarter and in the remaining time of this Parliament, it is that we act in a way that ensures that the deaths that have been reported to the House today have not been in vain.
First, let me pay tribute to Warrington hospital, of which we are all proud. It has a dedicated staff, an efficient chief executive and a chairman who takes a deep interest in what goes on there.
Warrington has a population of 200,000, which is growing year by year. The hospital, however, must also serve the surrounding region, which brings the total number to 350,000. At present, there are only three intensive care beds for all those people. It is impossible for the hospital to manage with so few beds. As a result, patients have had to be transferred, and one of those patients—a Mr. Pitcher—unfortunately died during the process. The coroner took the unusual step of being highly critical of the fact that that gentleman had been subjected to a 30-mile journey.
The shortage of beds worries not only Warrington hospital and trust, but the purchasers, North Cheshire health authority. The problem is finance. We had an extremely constructive meeting with the authority on Monday, following which we understand that one extra intensive care bed is to be provided. That is good news, which is welcomed not only by my hon. Friend the Member for Warrington, South (Mr. Hall) and me, but by the people of Warrington.
As we have heard this morning, however, the crisis affects not only Warrington or, indeed, the north-west region, but the whole country. I invite the Minister to deny the fact—which has been reported to me—that three weeks ago there was not a bed to spare in the whole of England, and that if more admissions had been necessary, patients would have had to go to Glasgow.
I particularly want to draw attention to the strange story of what happened when my hon. Friend the Member for Warrington, South asked the north-west regional office for copies of the reports prepared for the Secretary of State, which have been mentioned by my hon. Friend the Member for Lewisham, East (Mrs. Prentice). They were sent to the chief executive, Alan Langlands, but they were for the attention of the Secretary of State. Having applied to the regional office, my hon. Friend was given a copy of the report on emergency care. I have a copy here. When he asked for a copy of a similar report on intensive care, however—it had been submitted to Alan Langlands—my hon. Friend's request was refused.
How can Members of Parliament do their job if they are not given all the information that they need in order to present their case? Surely this should not be allowed. Will the Minister answer these questions: why was that report suppressed, who made the decision to suppress it, and will it now be released? It seems to me that, in relation to intensive care, there must be a horrible smell at the bottom of the NHS garden. Will the Minister now come clean? Will he tell us that we can have the report on intensive care, and will he explain why my hon. Friend the Member for Warrington, South was not allowed to see it?
I thank my hon. Friend for raising this issue. I believe that the document has been published, but that the region did not want to release it to me in time for yesterday's debate. It is a cover-up, and the Minister should first apologise and then give a commitment that the report will be placed in the Library. Then we shall all be able to see for ourselves whether that intensive care report submitted to Alan Langlands and the Secretary of State does indeed show that there is a problem in our region.
I hope that not only that report, but similar reports from every other region, will be released to the Members of Parliament who need to see them. Otherwise, it will be impossible for us to be well informed and to do the job that our constituents sent us here to do. That shows above all else that there must be a crisis in intensive care throughout England and Wales.
I congratulate my hon. Friend the Member for Leeds, East (Mr. Mudie) on securing a timely debate on an important issue. I thank him for the measured way in which he spoke of a distressing incident involving the death of one of his constituents, whose family obviously took it very hard. I hope that we do not hear more of the accusations of shroud waving that we heard in yesterday's debate. We are all here to represent people and, I hope, the national health service itself. If attention is drawn to the deficiencies in the service, that should not be interpreted as shroud waving. We should be engaging in an honest and earnest debate about the problems in the NHS.
That brings me to what was said yesterday, and what was said today by my hon. Friend the Member for Warrington, North (Mr. Hoyle), about the report on the Warrington intensive care unit that has allegedly been published in the north-west. If that report has indeed been published, it should be available to hon. Members, and also to the public in the north-west, who pay taxes and use the NHS. I hope that, if it has been suppressed internally, the Minister will sort the matter out.
I am sure that hon. Members on both sides of the House have noted the growing concern about what is described as the "winter crisis" in the health service, which has appeared to increase daily. Across the country, intensive care bed capacity has been stretched to the limit because of seasonal upturns in emergency demand. It is clear that there are simply not enough intensive care beds to cope with what most of us would consider to be reasonable demand for this time of year.
Clinicians are unable to perform other surgery in hospitals because intensive care beds are full. Operations are being cancelled, and waiting times are increasing because of insufficient spare capacity in the system to cope with sudden fluctuations in demand for emergency care. So the debate is about not one problem but three. First, lack of intensive care beds strains hospitals' ability to cope with emergencies. Secondly, use of general hospital beds for emergency cases results in cancellation of routine work. Thirdly, postponing treatment for cases sometimes referred to as "non-urgent" leads, by default, to those cases worsening and turning into emergency cases. The shortage of intensive care beds aggravates all those problems.
The build-up of pressure in the NHS was entirely predictable, because no one should be surprised that winter comes between January and March or that winter increases demand on our health service. The situation is similar to the annual need to grit roads after snowfall, when everyone seems to be caught out and gritting lorries are not ready to deal with the crisis. This year, we should have been ready for increased winter demand on the NHS, as the problem has been flagged up year after year. I see that the Minister is smiling at the analogy, but the problem has caught us out again.
Every year, hard-working doctors and nurses battle against the odds to do their jobs in a winter crisis. On Monday, I was at a district general hospital in north-east England, and people there told me about how staff had voluntarily worked on new year's day because of staff illness and other problems. They had to keep the hospital going, and it was wonderful to see their dedication. Ultimately, however, I can only wonder why, time after time, the same crisis sneaks up on us.
I do not think that the Government's solution to the intensive care bed crisis—as reported in the press at Christmas, although we could detect the crisis developing well before Christmas—is sufficient. I am bothered because the NHS chief executive has
ordered all casualty and intensive care units to stay open in the run-up to polling day".
That policy was reported after seven London casualty departments had been forced to close for some time during the previous six weeks. Within days of the announcement of the new NHS policy, however, trusts were being forced to defy the order because of a severe lack of intensive care beds and an upsurge in medical emergencies.
Since the new year, there have been numerous problems inside the NHS. Two Surrey hospitals have closed their doors to emergency cases. Two Lancashire consultants announced that they were quitting because of a desperate shortage of hospital beds. The Royal Gwent hospital was accepting only medical emergency cases, and the list goes on. On the situation in London, my hon. Friend the Member for Lewisham, East (Mrs. Prentice) told us that, because of the current winter crisis, all non-urgent surgery has been cancelled in the Lewisham hospital. Patients at St. George's hospital—21 of them at one point—have had to spend nights on trollies. Such an environment is unacceptable to people who work and care for patients in our hospitals, to the British public—who pay taxes to fund the NHS—and to patients and their families, who are under enough stress when a family member is admitted to hospital.
Drawing on 20 years' experience, a consultant at St. George's A and E department said:
I don't think I have ever seen such a terrible state of affairs.
Such quotes come not from shroud wavers but from those who work every day in our health service to care for people who need care. The head of A and E at the Royal Edinburgh hospital said:
the whole acute hospital service is stretched beyond its ability to cope.
A senior manager at Edgware general hospital said that the situation was "horrendous". Even the head of the emergency bed service, which is supposed to co-ordinate provision for intensive care places, said that now there was "no room for manoeuvre". The service reported that it was "frantically busy" dealing with shortages in intensive care places.
My hon. Friend the Member for Lewisham, East spoke in detail about the sad death from a heart attack at the beginning of this month of a 69-year-old London woman. A hospital spokesman had said that
an increase in medical emergencies had put the hospital's intensive care beds under pressure over the New Year.
The very next day, a 70-year-old man who had been seriously ill with liver failure was transferred 90 miles, from Birmingham to Sheffield, because no intensive care bed was available locally. He died soon after, and a spokesperson at the Sheffield hospital said:
He was in a desperate condition. The transfer would not have been good for him.
I wonder what families think when they hear such statements from a hospital to which their relative has been sent, but such service now seems to be acceptable. In some cases, people who are in desperate need of intensive care can be put into ambulances and transported more than 100 miles to receive care. The situation in our national health service, despite what has been done over the past 12 months, is not acceptable.
In his speech, my hon. Friend the Member for Leeds, East went into some detail about a patient being taken from Leeds to Hull. As he said, another patient was transported in the other direction, when a man was taken from Hull to Leeds, where a bed was available. That man died also. Last week, a spokesman for Guy's hospital inadvertently provided the best summation of the Tory crisis. He said:
Every time we thought an intensive care bed was about to become free, an emergency patient arrived. There was no possibility of transferring"—
a sick patient—
to another hospital because everyone else is in the same situation.
Such circumstances demonstrate that we have major problems in our NHS.
As everyone knows, since the internal market was introduced into the NHS, five years ago, we have lost 25 per cent. of NHS beds. That reduction does not help. A fortnight ago, Dr. Sandy Macara, chairman of the British Medical Association, said that the crisis faced by the NHS has occurred because
There just aren't enough beds, including emergency care, available to deal with what ought to be a predictable and predicted peak demand, and that's because of the way that the internal market works and just not having enough money in the system.
The intensive care bed crisis in the NHS is also a cash crisis. As we now know, so that trusts can continue to operate, the Government will allow trusts, by the end of this financial year, to spend £150 million that should be spent in the following financial year. The Government are
effectively deferring NHS cuts until future years. It is unacceptable for Ministers to tell the House that, year on year, more money is going into the health service, because we know that that is not the case. Ministers should ask health service practitioners about efficiency cuts in the NHS. If they were to do so, they would discover that efficiency drives have led to the increased bed loss. Real problems in our NHS will be stored up for the future if we do not tackle the issues head on.
My hon. Friend the Member for Leeds, East said that St. James's university hospital, in Leeds, was able to set up two extra intensive care beds—although there are still empty bays on the ward. We cannot run away from the fact that one of the problems facing the intensive care service is the lack of nurses available to staff beds, even when the beds are available. No one can question the fact that that problem exists. I have here a Royal College of Nursing brief for today's debate, which states that the Royal Sussex county hospital has 11 vacancies out of an establishment of 65. I have no doubt that is a major problem across the country.
I conclude with a quotation from a study that the Department of Health commissioned from the London School of Hygiene and Tropical Medicine. The report stated:
The main reasons for patient refusal is lack of ICU facilities; either the unit is full and no bed available, or beds are physically available but there are insufficient staff to provide adequate nursing".
Something is wrong. It is to the Government's credit that millions of pounds have been put into the service but there is still a problem with intensive care beds. Whatever has been done in the past 12 months is clearly not enough to cater for the needs of our constituents. I hope that the Minister will reply to some of the issues in the time available to him.
It seems a long time, Mr. Deputy Speaker, since you and I were in the House debating health matters earlier this morning. It is as if you and I were nailed to our seats—the Opposition will undoubtedly say that that is a penance.
I congratulate the hon. Member for Leeds, East (Mr. Mudie) on securing a debate on such an important subject. I appreciate the bipartisan, or non-political, spirit with which he approached the subject, and I should like to respond in a similar fashion. I think it was the hon. Member for Southwark and Bermondsey (Mr. Hughes) who said that it was the duty of us all to make the national health service work, and I assure him and the House that that is certainly the wish of Ministers.
I hope that the hon. Members for Lewisham, East (Mrs. Prentice), for Southwark and Bermondsey and for Warrington, North (Mr. Hoyle) as well as my old sparring partner the hon. Member for Rother Valley (Mr. Barron) will not mind if I concentrate, at least in the first instance, on the specific points made by the hon. Member for Leeds, East, to whom we are grateful for initiating the debate.
The Gentleman spoke graphically of the circumstances surrounding Mrs. Harrison's sudden illness. Those events are of course a matter of great sorrow, and I should like to express my sympathy and condolences to her family. The hon. Gentleman asked specifically what action was being taken by the health authority in the aftermath of those events although, as his remarks made clear, he will be aware of some of what is happening.
The hon. Gentleman will be aware that the authority plans further work on intensive care, and that work can be classified under three main headings. First, it aims to complete a thorough review—which, as the hon. Gentleman knows, is already under way—into the facts surrounding Mrs. Harrison's transfer from St. James's hospital to the Hull Royal infirmary. Secondly, it aims to ensure that arrangements are in place to guarantee that every possibility of a bed in Leeds has been fully explored before a transfer to an intensive care unit outside the city is considered. Thirdly, the health authority will convene a meeting with intensive care clinicians to consider with them the protocols and procedures within which intensive care services in Leeds operate.
The hon. Member for Leeds, East raised another important point about which we have corresponded—the situation at Killingbeck. We are in fact discussing a separate matter in relation to that hospital, but I shall say a little about intensive care beds there as he raised the matter today. As he knows, there are seven cardiac intensive care beds at Killingbeck hospital, which are dedicated for the use of cardiac patients and support the highly complex specialist services which Killingbeck and the Leeds general hospital provide. It is because of the specialist nature of these beds and the specialised training of the staff involved that they are not made available for general intensive care use. Their availability is therefore not reported.
It is not correct to say that those beds are ring-fenced financially; because of their specialist nature, they are not generally available. I hope that the hon. Gentleman will accept that. In view of the circumstances, however, the health authority has agreed to review, with the local trust, whether, in certain situations, those and other cardiac intensive care unit beds should be made available to provide general intensive care for local people. I must stress that the use of those cardiac beds for general intensive care would require very careful selection of cases—for example, infectious medical cases such as patients suffering meningitis would not be suitable for treatment in a unit containing cardiac surgery patients. The idea is being considered, but I hope that the hon. Gentleman understands that the matter must be handled with great care.
The hon. Gentleman also mentioned the general expansion plans for ICU beds in the Leeds area, a matter that we have discussed before. He knows of, and acknowledged, the investment of an extra £1 million in Leeds this year to fund one extra bed at Leeds general hospital and one at St. James's. That has been followed by the commitment of an additional £127,000 and a West Yorkshire-wide bid for a further £325,000 for intensive care. That significant investment builds on a general increase in intensive care beds in Leeds in recent years. For example, the number of paediatric ICU beds at the University of Leeds teaching hospital trebled between 1992 and 1996, and beds for adults increased from seven to 10 between 1993 and 1996. An average occupancy rate of 85 per cent. at St. James's ICU suggests that there are sufficient beds for most eventualities.
I have listened carefully to what the Minister said, but I think that he will accept from what he has heard this morning that there is a particular problem in the northern and Yorkshire region of the NHS. We have lost more beds in the past five years than any other region—27 per cent. of our beds have disappeared. That loss has a knock-on effect on intensive care provision in a wider area.
There is clearly a connection between the number of beds in absolute terms and the use of intensive care beds. Indeed, the hon. Member for Rother Valley commented on that. Nevertheless, in this particular instance I am talking about the provision of intensive care beds in the Leeds area and more generally. As the hon. Member for Wakefield (Mr. Hinchliffe) knows, there is a major new development at the Leeds general infirmary. The cost is £72 million, and phase I will come into operation this year. That offers the opportunity to look again at the balance of intensive care and high-dependency beds in the hospital to ensure that there is more flexibility to provide intensive care at peak periods.
A number of the paediatric intensive care beds in Leeds are specialist beds related to heart surgery, burns or other clinical disciplines and are not available, or appropriate, for general use. Will the Minister separate the figures for those specialist beds as it would be wrong to count them with general paediatric intensive care beds?
I take the point. Paediatric intensive care beds should be considered separately from general intensive care beds, although my information is that the intensive care beds I am talking about are for general, not specialist, use. The specialist beds that I was talking about are at Killingbeck.
I also take the point raised by the hon. Member for Wakefield. It is important to consider the matter not on a Leeds basis, or indeed a York basis, but on a regional basis.
The debate has been initiated by my hon. Friend the Member for Leeds, East so it is important that the Minister deals with the points that he raised, but I hope that he will leave himself time to say why the report was not given to my hon. Friend the Member for Warrington, South which, as I said earlier, prevented him from having all the information that he needed for yesterday's debate.
I should like to look into that. I shall write to the hon. Member for Normanton (Mr. O'Brien), who raised the point today and in yesterday's debate, and to the hon. Member for Warrington, North.
As a result of the additional regional funding that we have provided for adult intensive care and high dependency care this year—the £4 million that we were talking about—an extra five intensive care beds and six high dependency beds are being opened in the Northern and Yorkshire region. More will be opened in the region in the next financial year as a result of the extra £5 million that we have earmarked for adult intensive care and high dependency beds, to be matched by £15 million from the growth money provided by local authorities. A stream of new provision is under way.
In the little time that we have left, I should like to point out to the hon. Member for Lewisham, East, who commented adversely on the plans made for this winter by my hon. Friend—