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I am grateful for the opportunity to hold this debate. I am grateful to my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), to the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt) and to the Minister for being here to debate this matter well into the witching hour.
It is difficult to exaggerate the scale of concern about the future of acute health services in East Kent, and particularly at Kent and Canterbury hospital. I have received more than 3,000 individually written letters on the subject. It would be out of order for me to refer to the Gallery, but considerable interest is being shown—
Order. The hon. Gentleman is quite correct. It is out of order, and I would be grateful if he did not do it again, on this or any future occasion.
Indeed, Mr. Deputy Speaker.
Since this subject was last debated, the situation has worsened. The hospital is the most heavily used and cost-efficient of all the hospitals in Kent, and the only one in East Kent with a mixture of regional specialist services. I believe that the plans in the "Moving Forward" document will put at risk health care in the whole of East Kent.
In December 1998, the then Secretary of State for Health concluded his considerations of East Kent health authority's so-called "better balance" proposals and sent a letter to Members of Parliament on 22 December, with a further letter following at the end of March to the chairmen of the trusts. The first letter said:
my decision is to endorse the Health Authority's proposals, subject to a number of conditions.
By any standard, the conditions were major. The letter went on to say that
the proposals to the Kent and Canterbury A&E … are not satisfactory and must be improved.
The letter said that EKHA must
guarantee that onsite consultant and anaesthetic surgical and medical cover will be provided at the Kent and Canterbury during the day and on-call cover in these specialities … out of hours.
That was even reinforced by the condition that
there will be a designated consultant to develop and lead the Canterbury emergency centre … to ensure that a substantial proportion of consultant time is spent at Canterbury",
consultant medical cover for the coronary care unit at the hospital
and a physician with an interest in coronary care.
The Secretary of State also demanded a full review of the provisions for renal medicine.
In his second letter, the Secretary of State gave a further critical guarantee. He said:
it is clear that many of the respondents to consultation were under the misapprehension that the proposal was to move specialist cancer services, rather than simply the management of those services".
The retention of specialist cancer services at Kent & Canterbury Hospitals was part of that decision. Specialist cancer services at Canterbury, therefore, have a firm future.
He also made a firm commitment to at least 232 beds in Canterbury, as against around 390 at the Kent and Canterbury and the Nunnery Fields hospitals together.
Has my hon. Friend seen the recent letter written to the chief executive of the East Kent hospitals NHS trust by Mr. Paul Watkins, chairman of the South East Kent community health council, in which Mr. Watkins asks that the implementation of the proposals in "Tomorrow's Health Care" be deferred until the Secretary of State has devised the national strategy that he has promised on the number of beds to be provided in the NHS? Does my hon. Friend think that that suggestion by Mr. Watkins has some merit?
I do indeed. Both my right hon. and learned Friend and Mr. Watkins are right on that point. Last year, in reply to a question that I asked in the House, the previous Secretary of State said in relation to the Kent and Canterbury hospital:
If it looks as though things are going wrong, I am prepared to step in and ensure that the bed reduction does not proceed as quickly, or as far, as presently agreed".—[Official Report, 11 January 1999; Vol. 323, c. 45–6.]
Even with the commitments that he made, the Secretary of State's decision caused dismay. It will mean the rundown of the full A and E department, which has been in the top third of the major trauma outcome survey for every year since the survey was launched in 1988, and transferring those services to distant units that are still to meet the full standard.
Furthermore, our area is suffering a winter that has seen the most severe pressure on East Kent hospitals. In recent weeks, two out of three acute hospitals in the area have, on several different occasions, been simultaneously closed to all but blue-light work, with bed use running at well over 100 per cent. of nominal capacity, including trollies pushed into offices and corridors. Flu has been part of the cause, but East Kent has some of the largest and busiest road arteries in Europe. Because the mild winter has brought relatively little ice and snow, the road accident work load has been well below average, but still the hospital system has been stretched to near breaking point.
A Government with a large majority can do as they wish. Despite all those considerations, when the Secretary of State made his decision, I decided that the best way that I could defend the services was to engage, rather than simply oppose. He did at least leave us with a single trust responsible for health care, and I have welcomed the meetings with Mr. Conrad Blakey and Mr. David Astley, the new chairman and chief executive.
It was, therefore, with incredulity that I read the "Moving Forward" document, the opening sentence of which reads:
On 22 December 1998 the Secretary of State endorsed the Health Authority's proposal".
That statement was repeated five times in the text without any mention of his lengthy conditions. On those conditions, I shall leave description of the fiasco over renal services to the hon. Member for Sittingbourne and Sheppey. As for the rest of the items that 1 have already listed, the Secretary of State's findings on coronary care merit a brief mention on one page, but appear to play no part in the actual plan. Every other pledge has disappeared. The commitment to retain a full cancer centre has been ignored. The commitment to 232 beds has been ignored and no specific bed numbers are mentioned for that site. Consultant cover for emergency work at the Kent and Canterbury hospital has been ignored again.
This imaginative document, "Moving Forward", involves a degree of creative accounting that I can only describe as remarkable. East Kent health authority has carefully kept the capital investment figure just inside the £50 million mark, so that it does not go back to Ministers. Is the Minister content that a health authority can brush aside pledges by the Secretary of State? Is she content to see £50 million of taxpayers' money, along with substantial further sums hidden in revenue flows, go forward without referring the matter back to the Secretary of State to see that the pledges have been maintained?
It is very sad to see EKHA restating the same half truths from the old debate. For example, the document states:
an economic and social impact study confirmed that the greatest concentration of both the elderly and the socio-economically deprived in East Kent are located in Thanet".
As independent studies show, there are far more elderly people and a slightly greater number of deprived people in the catchment area for the Kent and Canterbury hospital. I raised that point with Mr. Mark Outhwaite, the chief executive, at a public meeting. He pointed out that the people in Thanet live closer together. He is quite right—technically, the largest concentration of elderly and deprived people is in Thanet. Do the people in rural areas, and in small towns such as Whitstable and Faversham, matter less because they live further apart, even though there are more of them? The population figures are flawed throughout the document. Where EKHA got the fatuous growth figure that was fed into the York study team, I cannot imagine. Has it never heard of Serplan, with its projections for huge population growth?
Page 11 of the document says that an implementation plan has been agreed. Yet on page 22, in excusing itself for giving no detail on plans for the Canterbury site, the same document says:
the detailed site plan will be drafted when a robust medical services model has been developed.
What sort of medical organisation embarks on £50 million worth of capital spending without a robust medical plan?
EKHA' s overstretched financial plans—and they are overstretched, because of the sheer scale of the capital spending, which is disguised in revenue—include £600,000 for investment in transport services. There is no mention of continuing spending. Most of East Kent's scattered rural communities, and some small towns, have no public transport access to the other two hospitals. Even if that allocation survives, does anyone really believe that an all-embracing taxi service can be delivered by East Kent's undermanned and overstretched ambulance service?
One sinister sentence explains how the financial circle is to be squared. It says:
the largest single savings will come from bed reductions
and from "improved efficiency". Presumably, no one from EKHA saw the trolleys in the corridors and the offices this winter. Yet the whole document hinges on 15 per cent. fewer beds. Vast capital expenditure and a shift from Kent's lowest cost hospital to less efficient sites is to be financed by removing beds. Is that what the Government want for the future of health care in East Kent? Will the Secretary of State require EKHA to resubmit its plans to see that at least those minimum pledges are met, and to take account of the new national findings on bed numbers?
I should like to end by asking the Minister a few specific questions. Will Canterbury retain the full range of services of a joint cancer centre, as defined under the Calman-Hine guidelines? Will a new linear accelerator be purchased, as promised, or just a second-hand one, which can be readily abandoned? Do the pledges on emergency cover and coronary care at Canterbury stand? Does the pledge of at least 332 beds stand, and does the hon. Lady think that that is adequate for our burgeoning population?
People all over East Kent, relying on our overstretched service, are waiting for answers—the old, the vulnerable, children, accident victims, doctors, nurses and health care workers. I urge the Secretary of State to call in the plans to see whether the earlier pledges are being maintained and whether they go far enough for the future of acute health care in East Kent.
I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing the debate. My constituency lies to the east of the West Kent health authority area and to the west of the East Kent health authority area. If there were a north Kent authority, we should lie to the north of that, too. In short, we sit right in the middle on this matter. If one lives in Warden Bay or Leysdown, it takes at least an hour and a half to get to the hospitals at Medway or Canterbury. It also requires the use of three or four public transport services—up to two buses and two trains. It simply is not possible to get to hospital at some times.
In addition, the Isle of Sheppey is not always connected to the mainland. We have specific problems, including having more socially excluded people than anywhere in the south-east of England outside Folkestone. The issues raised by the hon. Gentleman represent serious problems for my constituents, who prefer Canterbury because they do not yet trust the new arrangements at Medway Maritime hospital.
I wish specifically to address problems with renal services in East Kent. There has been a serious change. Margate hospital has been designated for services from spring 2003, but it is unacceptable to my constituents. It is on the far eastern side of Kent, which will cause access difficulties for all patients from my constituency and for staff, particularly those from West Kent.
As my hon. Friend the Minister knows, renal care requires lifelong associations between patients and doctors and nurses, who provide great care that involves frequent visits to clinics. On average, a patient may have to be admitted for in-patient treatment once or twice a year, and there is an average stay of nine days. It would not be possible for relatives to visit patients in Margate. They could not afford it. It is essential in a modern health care service to consider not only patients but their families, whose love and care contribute physically to their well-being. It is a serious matter if families cannot get to hospital to see their loved ones.
The proposed relocation would increase travel times and travel costs beyond the reach of most of the people on the Isle of Sheppey. Does my hon. Friend really believe that the nursing staff will transfer to Margate? If not, where will nursing staff come from? We all know that there is a shortage of trained nurses for this specialty.
The relocation of the unit to Margate is opposed by patients, by the head of the renal medicine department at the Kent and Canterbury hospital and by the community health councils for Medway and Swale and for Canterbury and Thanet. Those are reasonable people who have thought the matter through. I ask the Minister to think again about the renal unit and to keep it in Canterbury.
I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing a debate on a matter of great concern to his constituents. He has keenly supported his local hospitals for many years, particularly Kent and Canterbury and Nunnery Fields. His interest bears testimony to his commitment to the needs of local people, who are keen to see a high-quality health service for themselves and their families. I assure the hon. Gentleman that we share their vision.
The debate on hospital services in the East Kent health authority area has gone on for some time. I should like to spend a few moments outlining the reasons for the change in acute services, but I will address the hon. Gentleman's specific points later. First, I convey my thanks and those of the House to all the people in the national health service who worked over winter to cope with extraordinary pressures arising from the combination of an extended Christmas holiday, the millennium celebrations and the flu.
I shall outline the context of the changes to acute services in East Kent. They are not primarily driven by money, as has been suggested. I should record the fact that the health authority is receiving an additional cash increase of more than £23 million, which represents real growth of 3.7 per cent. No matter what the funding stream, changes would still be necessary to services in Kent.
In East Kent, the major issues are not only money, but the supply and training of doctors and the changes in medical technology. NHS services cannot stand still—locally or nationally. Changes in the NHS are complex and, as we all know, contentious. People want to fight for their local services. That is only right.
However, in East Kent, the process of modernisation has been a long one. As the hon. Gentleman pointed out, it started back in 1997, after detailed examination and the most exhaustive local consultation ever carried out for the NHS. As he said, the matter was referred to Ministers.
The then Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), gave careful consideration to the issues that had been raised and to the representations that had been received. He made his decision at the end of 1998. I fully accept that his decision was not universally popular, especially in the constituency of the hon. Member for Canterbury. However, I assure the hon. Gentleman that such decisions are never taken lightly.
Ministers need to combine the needs of the local population for access to local services with the requirement to provide top-quality treatment in a safe environment, in facilities that are fit for the 21st century. The decision taken will ensure that high-quality care will be provided on three sites—the Kent and Canterbury, the William Harvey and the Queen Elizabeth the Queen Mother hospitals. It will provide the opportunity to develop the scope and capacity of local primary care services. We must not forget what happens in primary care. The decision lays the foundation for acute and specialist care that will be of long-term and sustainable benefit to local people.
I make it clear again—although it has been made clear on previous occasions—that the decision announced by my right hon. Friend is not negotiable. I reiterate that: we shall not revisit the overall decision. However, it is important to point out that we shall ensure that the framework for that decision is properly implemented on the ground; that the plans are robust; and that the needs of the local population are met. I have, therefore, asked officials from the south-east regional office of the NHS Executive to monitor the progress of implementation to ensure that it takes place in a proper, sensitive and well-managed way.
The three trusts are merging to become the East Kent Hospitals NHS trust. That is right, because the new trust structure supports the implementation of the changes to hospital services. A single trust is much better placed to achieve that goal. The new trust combines the benefits of strategic oversight of hospital services in East Kent with a commitment to be responsive to local communities and their primary care groups.
The new trust has moved swiftly with its NHS partners to draw up an implementation plan for the service changes. The hon. Member for Canterbury referred to the document "Moving Forward". That document sets out the strategic development plan for acute services in the area. It builds on the work of clinical specialty groups. It sets out proposals to build new services and estates configurations.
However, it is important to be clear as to the purpose of the document. Although it addresses a variety of audiences, it has a specific purpose. It is not a consultation document, nor, as the hon. Gentleman implied, is it intended to set out in detail the clinical models for each specialty. Its key purpose is to obtain approval to move through the private finance initiative process to the outline business case stage. It has been referred to the regional office of the NHS Executive—not for the executive to provide the funding, but to ensure that due process is followed.
The implementation plan has been agreed locally between the trust, health authority, community health council, primary care groups and the regional office. The hon. Gentleman referred to capital spending of £50 million of taxpayers' money. That is not what the plan is about. It is intended that the sources of capital will come from the private sector. If the PFI developments are approved, the plan will be developed over five years. Only when the future models of care have been agreed will there be any redevelopment of the Kent and Canterbury site. Even when the changes are fully implemented, about 85 per cent. of patients who would currently expect to attend the Kent and Canterbury hospital will continue to be treated there.
I shall come to the issue of bed numbers about a paragraph from now.
The health authority has stated that, in accordance with the then Secretary of State's decision, it is committed to ensuring that robust services at alternative sites are in place before any service is transferred from its current location. To assist it in this process—because, as the change occurs, there will be some duplication of services—the authority has applied for special assistance funding to help it during this period. A decision on that is expected shortly.
I now turn to the specific issues raised by the hon. Member for Canterbury and the right hon. and learned Member for Folkestone and Hythe (Mr. Howard). First, I shall discuss bed numbers. The number of acute beds will increase from the 1,395 that were originally proposed to 1,417. We do of course recognise the public concern about the eventual number of beds in the area and the pressure that they have been under this winter, and we expect the health authority to continue to monitor and review bed numbers closely. The right hon. and learned Member for Folkestone and Hythe made reference to the national bed survey, which I assume is what was covered in that letter. Some of those findings will be incorporated, but the overall decision by the Secretary of State stands.
How does the Minister reconcile what she has just said—about nothing happening immediately and about working in line with that detailed programme—with EKHA' s announcement, out of the blue, that Nunnery Fields hospital, with almost a quarter of Canterbury's beds, is to close this summer?
I was going to discuss the Nunnery Fields hospital situation, especially in relation to the care of the elderly. The hospital provides a rehabilitation service for the elderly. It is an old workhouse. It is no longer suitable for the type of care and rehabilitation that we expect to give to elderly people and which they deserve. We expect that, once the reconfiguration has taken place, the hospital care will take place within the Kent and Canterbury.
As I have said, we should focus not only on hospitals but on what is happening in primary care and the support services that allow people—especially elderly people—who do not need to stay in hospital to receive care and support at home or at primary care level. We have spent some £2.5 million to develop primary care and community-based services for the elderly, and there will be an additional £5 million further investment in acute services. More than £500,000 will be directed into the development of transport facilities. I know that the hon. Member for Canterbury feels that that may be insufficient, but I think that we should not sneer at what is a significant amount of money.
I shall now address the issue of the care of the elderly in East Kent, because allegations have often been made that they have been neglected or even marginalised. Nothing could be further from the truth. The health authority is looking after the elderly in East Kent in a very responsive way. For example, community assessment and rehabilitation teams—a joint initiative, which is so far being implemented in only one part of the area, although the plan is that there will be four such units—are helping to develop models of care to ensure that elderly patients avoid hospital admissions wherever appropriate, and that patients can be discharged much sooner than they are now.
Modernisation does not only focus on the care of the elderly. We should also take account of such improvements as the booked admissions pilot system. Since it commenced last year, about 40 per cent. of patients who require day surgery have been able to agree their surgery date at their first out-patient appointment.
Two areas were specifically mentioned, one of which was cancer services. The collaborative arrangements whereby we develop a tertiary cancer centre to provide services through an umbrella network managed by the Mid Kent trust are being taken forward. The Kent oncology centre appointed its director in 1999 and there is a policy board to develop the standard of services and support. Radiotherapy services provided at the Kent and Canterbury will continue to be an important part of that service.
I shall deal next with the concerns about renal services that were expressed by my hon. Friend the Member for Sittingbourne and Sheppey (Mr. Wyatt). On the travel argument, he said that his constituents look first to Medway hospital, but as I said before, even within the reconfiguration, 85 per cent. of the people in his area who are expected to go to the Kent and Canterbury will continue to do so. However, the model agreed for the reconfiguration of renal services looks to East Kent and West Kent health authorities providing four satellite dialysis units at Canterbury, Ashford, Maidstone and Medway to support the main renal unit, when it is established in Margate.
Once the new arrangements are in place, they will result in an increase in the number of dialysis stations available, and that relates to the concerns raised about families and travel arrangements. There will be more dialysis stations in the county and the number will increase even further over a 10-year period. At the end of that time, we shall have 26 dialysis stations, which will make life easier for renal patients in the county.
I shall not, in view of the time.
Let me conclude with three assurances for the hon. Gentleman. First, we will ensure that the former Secretary of State's decisions are fully implemented. Secondly, patient safety will not be compromised during the implementation process. The hon. Gentleman was concerned about accident and emergency services and I remind him that, so far, no changes have been made to the services provided in the Kent and Canterbury and none will be made until alternative provisions are in place. Thirdly, robust and adequate services will be put in place in relation not just to accident and emergency, but to all the other services, before there are any changes or any services are transferred.