Stoke Mandeville Hospital

– in the House of Commons at 2:12 pm on 8th February 2002.

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Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kemp.]

Photo of David Lidington David Lidington Shadow Financial Secretary 2:30 pm, 8th February 2002

I am grateful for the opportunity to raise the future of Stoke Mandeville hospital in my constituency. The Under–Secretary of State for Health, Ms Blears—who I am delighted to see in her place—will know that Stoke Mandeville has a national and international reputation, the latter deriving in particular from the record of its famous spinal injuries unit.

But to my constituents, it is, above all, their local hospital; the district general hospital on which they rely for their treatment and that of their families. I should declare a personal, as well as a constituency interest, as my family use Stoke Mandeville, although I have now reached that stage of family life when my visits are no longer to the maternity unit but more to the accident and emergency and paediatric units.

The hospital employs more than 2,000 staff, making it one of the biggest employers in my constituency and in Buckinghamshire as a whole. I want to spend most of my speech talking about the proposals for the future redevelopment of Stoke Mandeville hospital, but first I want to refer briefly to some serious allegations made in The Observer on 27 January.

Much of that article dealt with matters that were to do with the employment of individual doctors or with the removal of previous executives and directors of the trust. Those matters either still are, or have recently been, the subject of disciplinary proceedings or an industrial tribunal. I do not think that it would be right for me to comment on those in any detail now. The point is that, as the Under-Secretary will know, the article made public and serious allegations that patient safety within the accident and emergency unit was at risk.

The Under-Secretary will know that I have received assurances from the trust management that those allegations have been thoroughly investigated and that no evidence has been found to suggest that patients are at risk. I should be grateful for her assurance this afternoon that the Department is also satisfied that everything possible has been done to give patients confidence that they will continue to be well treated in the accident and emergency unit.

I wish to refer to the rebuilding project for Stoke Mandeville, something with which I feel I have been living ever since I was first elected to the House a decade ago. Stoke Mandeville is renowned, but it still relies, in part, on isolation units that were built in the 1940s. The hospital as a whole occupies a ramshackle complex of buildings spread out over a vast site. Patients and staff often have to walk—or, in the case of some patients, be transported—long distances between one unit and another. Inevitably, this means that the quality of treatment is not what one would expect in a modern 21st century hospital, despite all the professionalism and efforts of the staff, to whom I am most willing to pay tribute.

The site also creates economic inefficiency because the costs of heating, cleaning and maintaining such a ramshackle spread of buildings add to the unit costs of the treatments provided by the hospital. That inevitably has an impact on the health care that the hospital can offer to local people within the money allocated to it. The present plan, which is slowly moving forward, is for a £25 million redevelopment to include new medical and paediatric wards, a day procedures unit, an admissions ward and assessment unit and the refurbishment of other trust buildings. The rebuilding is long overdue.

There has been some new building on the Stoke Mandeville site, under this Government and their predecessor, but the current plan for major redevelopment has been subject, over the last decade, to repeated delays, causing increasing frustration to staff and the wider local community. It might be helpful for me to sketch in brief the chronology of the story during my time as Member of Parliament for Aylesbury.

As far back as 27 June 1994, the Department of Health said that the business case for a Treasury-funded scheme for Stoke Mandeville's redevelopment had Government approval. A written answer in 6 June 1995 informed me that the scheme

"has received full business case approval."—[Hansard, 6 June 1995; Vol. 261, c. 34W.]

Yet in the late summer of 1995, the trust was informed that the Treasury scheme had to be tested against a PFI alternative. By October of that year, the trust was informed that no Treasury money could be forthcoming, and that it must look to a PFI scheme or to nothing.

In 1996, the first PFI consortium collapsed and the project was re-advertised. By the summer of 1997, the trust had reconstituted its bid and was ready to proceed to preferred bidder status with the second consortium. At that stage, of course, a new Government were elected, who decided to put all PFI schemes on hold, at least temporarily, pending a reassessment. After a period of reassessment, 12 were allowed to proceed as a first tranche, but Stoke Mandeville's scheme was not included.

In 1998, when I last secured an Adjournment debate on this topic, Stoke Mandeville was allowed to advertise for the third time for a PFI partner. By March 2001, the trust's annual report was able to say:

"Construction of the new facilities is due to begin in 2002 and will take two years to complete."

Last autumn, however, the Government picked Stoke Mandeville as one of three pilot projects for the new policy of contracting out the management of ancillary staff at acute hospitals. That has led to yet another delay.

The trust hopes to move to the next stage in March, but the Minister needs to understand that, in the light of events under Governments of both major political parties—I am being non-partisan—there is considerable cynicism among the general public, and among staff and the wider medical community in Buckinghamshire in particular, as to whether this much-needed and much-wanted redevelopment will ever take place. A great deal of money has been spent, but to little conspicuous purpose. About £3.5 million was spent on new internal roads and utilities, and on a brand-new roundabout outside the hospital that is ready to serve the new buildings, for which we are still waiting. In the past eight to 10 years, a considerable sum must also have been spent on consultancy fees, let alone on trust management time, as four different schemes were worked through.

Inevitably, those events have demoralised the hospital's doctors and nurses. General practitioners have told me that, in their view, there is a hidden agenda to run down Stoke Mandeville and make it little more than a cottage hospital—an outpost of either Wycombe general hospital or one of the Oxford hospitals. Despite repeated assurances from the health authority and the NHS regional executive that that is not their agenda, I must tell the Minister that such assurances are received with scepticism because of what has happened in the past 10 years.

To raise morale locally, the bulldozers need to be on-site as soon as possible, so that reconstruction can get under way. I hope that the Minister can assure me that that will happen soon and that the Government do indeed treat the redevelopment of Stoke Mandeville as a priority. I hope, too, that she can offer a time scale, so that my constituents will know when work on the site will begin and when the new services will be completed and in operation, providing modern health care for the people of Buckinghamshire.

Local concern has also been aroused by the way in which the goalposts for the redevelopment scheme have been shifted from time to time to take account of real changes in the administration and organisation of health care, or in the development of clinical practice. I hope that the Minister will take account in her response of some of the issues that continue to cause worry.

One is the future nature of the relationship between the Stoke Mandeville hospital and Wycombe general hospital, which is part of the South Buckinghamshire NHS trust. A review of acute services in mid-Buckinghamshire is being carried out at the moment, and I understand the clinical reasons for that, including the arguments being put forward by the royal colleges, and the new deal on junior doctors' hours. It is right to examine how services are provided and what the correct configuration should be over the next 20 or 30 years. We must not be hidebound by the pattern of provision that was best in the past.

I hope, however, that the Minister will be able to assure me that the review and the pending decision about a possible merger between the trusts will not cause any further delay to the redevelopment at Stoke. I also hope that she will be able completely to deny the suggestion that these reviews and discussions conceal a secret agenda to move acute services away from Stoke and to concentrate them in High Wycombe because, locally, some people believe that that is what is going to happen.

I hope that the Minister will also tell me where the Government stand on a possible merger between the two trusts. My understanding is that a decision has been on the Secretary of State's desk for two or three months now as to whether to go out to public consultation over a trust merger, and I would be interested to know the Government's view on that proposal.

The second cause for concern relates to the creation of the new strategic health authorities and the consequent abolition of Buckinghamshire health authority. I am worried that the new SHA might wish to go back to square one, to re-examine anew the case for Stoke Mandeville's redevelopment, and to review acute services provision on a sub-regional Thames Valley basis, rather than accepting the agenda as it has developed over the last decade. I hope the Minister will say that that is not the case, and that the SHA, when it comes into being, will remain committed to a good district general hospital in Aylesbury, and give its full backing to the Stoke Mandeville redevelopment plan.

I want to say something about the financial resources available for health services at Stoke Mandeville and in Buckinghamshire generally. I also want to question the Minister about the number of beds provided for in the current redevelopment plan for Stoke Mandeville. A recent written answer that I received from the Minister, confirmed that Buckinghamshire will still get some £12.2 million less in the forthcoming financial year than the Government's formula—the so-called weighted capitation formula—suggests that the county ought to receive from the NHS pot. That is a continuing source of concern and frustration locally. I understand that the Government are now considering replacing the weighted capitation system altogether. I would like to hope that that means that our deficit will not simply be brushed aside and forgotten, and that the problem of Buckinghamshire getting less than the Government's formula suggests it should receive will be addressed by the funding reforms.

On bed provision, Buckinghamshire health authority's consultation document published in 1998 envisaged that redevelopment would mean a fall in the number of acute beds from 378 to 320, and a fall in the number of spinal beds from 115 to 108. Again, I acknowledge that there are clinical reasons for different judgments about bed numbers being appropriate now, compared with 20 or 30 years ago. Advances in day surgery and improvements in anaesthetics are two obvious reasons.

Against that, we must balance the increased demand that will be placed on Stoke Mandeville by the major increase in the local population, particularly in the town of Aylesbury, envisaged in the local plan. We are looking at the prospect of the population of Aylesbury increasing by about one third over the next 10 years or so. Will the new-look Stoke Mandeville have adequate bed capacity under present plans to deal with those numbers of people, or will the Government review the situation?

The need for a review is made even more marked by the conspicuous pressure on beds. I know from a constituency case that on one day at least this week, Stoke Mandeville hospital was on divert. Patients were being sent to Wycombe general, which was itself on red alert and finding it difficult to accommodate all the patients whom general practitioners wished to refer there. I have been told of at least one weekend last month when Oxford was diverting to Milton Keynes, Milton Keynes was diverting in part to Stoke Mandeville, which was in part diverting to Wycombe general, which again had to close its doors to some additional patients whom doctors wished to refer there. There is great strain on accident and emergency provision, and I hope that the Government will examine the issue, particularly in the context of Stoke Mandeville, but also in the sub-regional context.

I hope that the Minister will be able to give my constituents cause for hope and optimism. For example, a large chunk of the Stoke Mandeville site is in the ownership of the Secretary of State and designated for housing development. I hope that at least some of the capital receipts that the Department will gain might be used for the provision of services to my constituents.

Above all, I go back to the previous debate on this subject on 29 January 1998. It may be some consolation to the Minister to know that the junior Minister who had the dubious privilege of replying to me at the time is now Secretary of State for Health. Mr. Milburn said then:

"Stoke Mandeville is a hospital with a bright future. It has the strong support of its local population and of the Government."—[Hansard, 29 January 1998; Vol. 305, c. 618.]

The hospital still has the very strong support of the local population in and around Aylesbury. I hope that the Minister will be able to reassure me that it still has her support and that of the Government.

Photo of Hazel Blears Hazel Blears Parliamentary Under-Secretary (Department of Health) 2:47 pm, 8th February 2002

I congratulate Mr. Lidington on securing the debate. It is a matter of considerable importance to him, to other Members and, most importantly, to the people of Buckinghamshire. I also thank the hon. Gentleman for giving me notice of the issues that he would be raising. That always makes it easier to have a more focused debate. I hope that it will provide his constituents with reassurance, hope and optimism, and confirm to them the original comments of my right hon. Friend Mr. Milburn that Stoke Mandeville hospital has a bright future.

The hon. Gentleman has a keen interest in the hospital. He is, quite rightly, eager to ensure that the highest possible standards of health care services are secured for his constituents. I assure him that the Government are committed to providing high-quality services for everyone, no matter where they live.

More than 35,000 patients were admitted to Stoke Mandeville hospital last year, 11,000 of whom were emergency cases. Some 39,000 patients attended the accident and emergency department and 76 per cent. of those were seen in less than four hours. More than 200,000 patients were seen in out-patient appointments last year, with 93 per cent. seen in less than 30 minutes. Those figures reflect the nature of Stoke Mandeville as a typically busy and hard-working hospital.

The future of the hospital has been the subject of extensive debate. as the hon. Gentleman said. I am delighted to put on record the Government's plans for the future, not just of Stoke Mandeville but of acute services across the sub-regional area.

On the private finance initiative scheme, I can reassure the hon. Gentleman that contracts will be signed later this year and that building works will commence either late this year or very early next year. I understand that the building works will take some two years to complete, so the new facilities for local people should operate from 2005 if everything goes smoothly and according to plan. That perhaps offers a firmer timetable than it has been possible to give before. I am also delighted to say that the advent of the new strategic health authority will not take us back to square one. Planning is well under way, and the scheme is much wanted by local people.

Plans for services are still subject to consultation, and I want to ensure that no comments that I make can be taken to pre-judge that consultation, on which a decision will be taken shortly. Buckinghamshire health authority and the Stoke Mandeville and South Buckinghamshire NHS trusts have proposed that the two trusts should merge. Those who support the merger have advanced good reasons for it. First, they refer to the need to protect and develop clinical services at the two trusts. Hospitals, such as Stoke Mandeville, that serve relatively small populations may find it increasingly difficult to meet standards set by the royal colleges, as the hon. Gentleman said. It is felt that a merger would give the successor organisation more scope to meet and maintain those standards so that local people may be assured that they will receive excellent services.

Secondly, there can be no doubt that maintaining and developing high standards depends crucially on the recruitment and retention of staff with the right skills. As the hon. Gentleman is no doubt aware, skilled NHS staff are a scarce resource, particularly in the south of England. There is evidence that more people are likely to be attracted to organisations that offer personal opportunities for professional development. The feeling that they are participating in the development of excellent clinical services is a real draw for staff. New staff need enough variety and experience to allow them to develop their potential to play a key part in providing good services in future. Larger organisations sometimes find it easier to recruit and develop staff than small organisations that may find it difficult to offer the same development opportunities. That is not the case in every organisation; some excellent smaller organisations take the trouble to develop their staff, but it is usually true that if there is more going on, there are more opportunities for staff.

Technology is developing at an incredible rate. New drugs, therapies and equipment are being used, and that means more training and specialisation for the staff involved. Increasing specialisation can create problems for smaller hospitals that work in isolation. Specialist units need a regular stream of patients to keep staff skills at a high level.

It has been suggested that a merger could maximise the efficient use of resources. I understand the parties involved to mean that having two trusts ties up significant resources in running parallel management structures and processes. A merger could offer the opportunity to reduce those costs, and any consequent saving could be reinvested in direct patient care, which is a matter of concern to us all.

I reassure local people that the proposal relates only to management arrangements, not changes in clinical service provision. The three hospitals—Amersham, Stoke Mandeville and Wycombe—will continue to provide the same range of high-quality services that are now available. I can reassure the hon. Gentleman that there is certainly no question of a secret agenda or conspiracy to take away services. The proposal has to do with building up local services and acknowledging both that there are pressures on capacity and that people in Aylesbury are entitled to a high-quality national health service. The proposal would not affect the configuration of primary care services. Over the next few years, primary care will become increasingly significant in the configuration of health services in every area.

I reassure the hon. Gentleman with regard to bed numbers in the private finance initiative scheme. He mentioned the review of the local authority plan. Originally it was predicted that there would a growth in population of 3 per cent. over the next six years. I understand that the prediction now is that Aylesbury's population will grow by 10 per cent. but that there will be a corresponding 10 per cent. drop in the population of the rest of Buckinghamshire. Therefore, there is an increase in the population not of Buckinghamshire overall but of parts of it.

The proposals are still under discussion at local authority level, but clearly Stoke Mandeville is considering their impact and remodelling its plans within the context of the whole of Buckinghamshire. The outcome of the remodelling will be reflected in the full business case. If necessary, plans can be adjusted.

Where there are significant changes in capacity, it is sensible and logical to look at that. Perhaps one reason why there is such strain on many NHS organisations is that planning in previous years was not as closely aligned as it should have been. Getting the right beds in the right place at the right time, with the right number of staff to give people appropriate treatment, is the biggest challenge that all of us face.

I am pleased to deal with the investment issues that the hon. Gentleman raised. Investment in Stoke Mandeville has been considerable in the past few years. The trust has had an extra £302,000 to increase capacity, some of which is to provide 15 extra beds in the hospital to help to reduce the number of cancelled operations. A total of £73,000 has been allocated this year for extra nurses in the accident and emergency department, and an extra £300,000 will be made available for extra A and E nurses next year, recognising the pressure there.

There is extra investment to meet waiting times for in-patient treatment. The trust will receive a share of the £713,000 for delayed discharges in Buckinghamshire. Next year that money will be more than doubled. A total of £413,000 has been provided to modernise diagnostic facilities, including X-ray equipment in A and E, and £165,000 has been spent to improve cataract services. Various other sums have been made available to improve the physical environment and to modernise services, particularly in relation to booked admissions, so that patients get an appointment that is convenient to them and that meets their needs.

In relation to investment in Buckinghamshire, I note what the hon. Gentleman says about Buckinghamshire's distance from the capitation formula. That must be set in the context of the vast increase in resources that Buckinghamshire, with every other health authority in this country, has received during the past four years. Since 1997, I understand that funding for Buckinghamshire has literally doubled, a massive increase in resources. Although I take the point that he makes about the comparison with others and the formula, investment in Buckinghamshire has resulted in real improvements for local people.

I wish to put on record the improvements at Stoke Mandeville. Obviously the trust has struggled. It received a zero star rating and under-achieved on five of the nine targets, but in the past few months in-patient waiting lists have been down, waits of more than 12 months have been reduced by 58 per cent. and waits of more than 15 months by 71 per cent. Last-minute cancelled operations are down to below the regional average of 2 per cent. Good progress has been made in tackling delayed transfers of care. In the past two months, the hospital has appointed a discharge co-ordinator and the number of blocked beds has been reduced from 28 to 17—quite a dramatic improvement. I thank the staff and managers who have been involved in achieving those improvements.

I hope that I have reassured the hon. Gentleman and his constituents. I can give the final assurance in relation to patient safety, which he raised. That matter has been considered by an independent review. All the evidence has been examined. I understand that agreements have been reached for the future smooth running of the department. I and the interim chief executive do not believe that patient care has been compromised. Current practices are in line with A and E faculty guidance. The service is, I understand, working well.

I hope that what I have said has confirmed that Stoke Mandeville hospital has a bright future, and will serve its constituents by providing high-quality and excellent NHS services. It is right that we all pay tribute to the hard work and dedication of the staff. I hope that the hospital continues to serve patients in such a good way for many years to come.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.