During the summer recess Adjournment debate that was held on
I want to raise two key issues about the acute hospital trust. The Department of Health's treatment of the trust's £16.9 million-worth of so-called accumulated debt is frankly indefensible. The trust has already paid off the debt once, yet the Department is insisting that it is paid off a second time by means of the creation of a surplus, which, in my book, means making a profit out of the needs of patients. The situation is simply unacceptable.
I appreciate that the process is being carried out under the resource accounting and budgeting Government accounting system. However, as the Minister and her Secretary of State know, the Audit Commission has made a categorical recommendation about applying RAB to NHS trusts. The recommendation, as it was stated by the then Health Minister, Lord Warner, in his letter to me dated
"should moderate the future application of the RAB regime, in particular by no longer applying the RAB carry-forward rules to NHS Trusts".
That is a quite categorical, unqualified recommendation.
Last year, my three colleagues from west Kent—my right hon. Friend Miss Widdecombe and my hon. Friends the Members for Sevenoaks (Mr. Fallon) and for Tunbridge Wells (Greg Clark), both of whom are in the Chamber—and I wrote twice to urge the Secretary of State for Health to accept the Audit Commission's recommendations. So far, she has stubbornly refused to do so, so we wrote a third time on
The second issue relating to the acute hospital trust is the future of the proposed private finance initiative hospital at Pembury. The hospital, on a PFI basis, was conceived and taken forward substantially by the previous Conservative Government. The present Government have been in office for 10 years, but during that period, there has been a huge amount of delay on the hospital. Indeed, I have to say to the Minister that some of my constituents are even doubting that the Government are committed to the hospital and think that they may at the last moment rat on constructing the hospital at all.
It was for that reason that I recently tabled a question in very clear terms to the Secretary of State. I asked her:
"whether there is a firm Government commitment to have a new private finance initiative-funded hospital at Pembury; and if she will make a statement."
The reply that I received from the Minister of State, Department of Health, Andy Burnham, on
"The Department has reviewed the proposed private finance initiative scheme for Maidstone and Tunbridge Wells National Health Service Trust on value for money and affordability grounds. An announcement is expected shortly."—[ Hansard, 5 February 2007; Vol. 456, c. 724W.]
That was the end of the answer. There was no commitment and no timetable, so we are left up in the air.
I must say to the hon. Lady that this is having an extremely debilitating impact on the whole of the NHS in our area, particularly in the Maidstone hospital, where there is great uncertainty about the future of services such as accident and emergency. It really is high time that the Government made it clear that they are—hopefully—firmly committed to allowing the new Pembury hospital to go ahead.
I assure my hon. Friend that if he will allow me to make some more progress, I will give way before I finish.
I turn now to the equally important two community hospitals in my constituency, at Tonbridge and at Edenbridge, where again we have a very sorry state of affairs which is essentially of the Secretary of State's making. At both hospitals, half the beds, which were supposedly closed temporarily in January 2006 in order to reduce the primary care trust's deficit, are still closed over a year later. As the Minister knows, because she gave the answers, I recently tabled two further parliamentary questions to the Secretary of State. I shall read to the House the questions that I tabled and the answers that I received from the Minister.
I asked the Secretary of State if she would take steps to ensure that the closed beds at Tonbridge hospital and Edenbridge War Memorial hospital were reopened, and if she would make a statement. I shall read in full the reply that I received:
"This is a matter for West Kent primary care trust...NHS South East Coast has advised that the West Kent PCT is currently undertaking a review of all its community hospitals to ensure that they offer high clinical care as well as value for money. Until the review is completed, which is likely to be in the spring, all beds that are temporarily closed will remain closed. If there are any proposed changes to services in this area there will be a formal consultation with the public."—[ Hansard, 5 February 2007; Vol. 000, c. 723-4W.]
I have to say to the Minister that that answer, which was supposedly an explanation of why the beds have been closed, is—I am bound by the conventions of parliamentary language, Madam Deputy Speaker—factually an absolute travesty of the reality.
I offer the Minister my answer to my question. This is what the answer should have read: "The West Kent primary care trust has been thrown into deficit by the Secretary of State for Health's decision to make a massive transfer of funds from community hospitals to acute hospitals in order to achieve the Government's politically driven target of 18 weeks for admission to acute hospitals by the time of the next election. The West Kent PCT's deficit has been substantially increased further by the Secretary of State for Health's wholly unnecessary and financially wasteful primary care trust reorganisation of last September. However, notwithstanding her two financially calamitous decisions for the West Kent PCT, the Secretary of State agrees with the right hon. Member for Tonbridge and Malling that both Tonbridge and Edenbridge hospitals provide high standards of clinical care and excellent value for money and has instructed that the beds closed at both hospitals should be opened forthwith." Frankly, to be silent about the real causes of the deficit in the West Kent primary care trust is outrageous. It is equally outrageous to cast doubt on the standards of care at Edenbridge War Memorial hospital and Tonbridge Cottage hospital.
I would like to give the Minister the opportunity of dispelling any doubt that she has about the standard of care at the two hospitals. In all seriousness, I extend an invitation to her. I will scrub my diary, and I invite her to come to my constituency tomorrow, or if that is not convenient, on another date. I will meet her at Tonbridge station, and we will walk together up and down the High street, and ask the good people of Tonbridge what they think about the standard of care in Tonbridge hospital. Then I will drive her to Edenbridge, where we will walk together down the High street and ask the good people of Edenbridge what they think about the standard of care at Edenbridge War Memorial hospital.
I tell the Minister what the response will be: my constituents will be flabbergasted that that question should even be asked. They are in no doubt whatever about the excellent standard of care at both hospitals, because they know what the reality is from their own experience, and from the experience of their families. They know from the experience of their grannies and granddads, mums and dads, husbands or wives, and children. They know that when they go to the Tonbridge or Edenbridge hospital, they receive outstanding care. It is a wholly fictional justification to suggest that the review has anything to do with the standard of care at the two hospitals.
I must say to the Minister that I am appalled by a sentence in her answer. I quote it again:
"Until the review is completed...all beds that are temporarily closed will remain closed."
What an appalling position to take. They will remain closed come hell or high water, regardless of patients' needs for the beds in question. Do not the needs of patient rate, as far as the Department of Health is concerned? They should do, and they should be at the top of the Department's priorities.
I will tell the Minister what is happening in terms of patients' needs. As a result of the bed closures at those two hospitals, there is, predictably, intolerable bed blocking in the acute hospital, and I will give her an example. My constituent, Mr. Thomas Page, has given me consent to quote a letter that he has just written. He says:
"My wife has been in the hospital"— that is, Kent and Sussex hospital—
"for the past 6+ weeks and has reached the stage that she requires additional treatment for mobility and recuperative purposes. A request was made on
He goes on to say:
"The Surgeons and Doctors at Kent and Sussex Hospital saved my wife's life; The nursing staff in Intensive Care, High dependency and the surgical ward has successfully and carefully over the past 6 weeks brought her to a state of health that is a credit to their skill and ability. What a tragedy and pity that the last part of the care cannot be provided by the PCT in a Community Hospital that was built for that very purpose."
Bed blocking is happening not just in the acute hospital sector, but in hospices. Last Friday, I visited Hospice in the Weald, where I had a discussion with the chief executive, Mr. John Ashelford. He wrote to me:
"In January, we had a period with all our 12 beds full, and the need to admit four more patients. At least two of our patients could have been transferred to Tonbridge hospital, but beds were not available at the time. This resulted in us not being able to accommodate a cancer patient from Maidstone oncology centre, a patient from the cancer unit at the Kent and Sussex, and a patient at home who desperately wanted to be at the hospice. Sadly, that patient died at home, and the family were very upset about the circumstances."
Indeed, Mr. Ashelford told me that, because of bed blocking following the closure of beds in Tonbridge and Edenbridge hospitals, he has had to refuse admission to the hospice to patients vomiting blood in the terminal stages of illness. Does the Minister not agree that that is a truly shocking reflection on Government policy?
My right hon. Friend makes a powerful speech. In extending his invitation to the Minister to visit those cottage hospitals, will he ask her to visit Pembury hospital so that she can see for herself the wooden huts in which patients are treated and in which staff have to work? Will he invite her, too, to visit the Kent and Sussex hospital, where it is almost impossible to achieve the highest standards of infection control, because the building is out of date and needs to be replaced with a modern hospital at Pembury? Hopefully, the Minister will impress on her right hon. Friend the Secretary of State the need to make an immediate decision.
I am sure that my right hon. Friend is aware that the same number of beds have been closed at Sevenoaks hospital. While the standard of care has not changed, staff morale has been affected by the elongated review, which will not report until the summer. Is it not time that we were given a decision, to make sure that the future of our hospitals is safe and secure once and for all?
I entirely agree with my hon. Friend.
I apologise to the Minister, because we have eaten into a few minutes of her time. In reality, she can make a short reply. She can make a one-minute contribution, in which she accepts that the Maidstone and Tunbridge Wells NHS Trust will not have to pay off the £16.9 million deficit a second time. She can say that yes, the Government are committed to the new hospital at Pembury, and construction will start this year. She can say that the beds in Tonbridge and Edenbridge hospitals, and in the hospital of my hon. Friend the Member for Sevenoaks, will be reopened forthwith, and will remain open.
I congratulate Sir John Stanley on securing this debate on hospitals in west Kent. He is joined by his hon. Friends the Members for Sevenoaks (Mr. Fallon) and for Tunbridge Wells (Greg Clark), and I wish to welcome, too, my hon. Friend Jonathan Shaw.
I wish to take the opportunity to congratulate NHS staff in Kent on the hard work that they have put into improving services and performance, as it is right to do so. Millions of people receive high-quality and safe services every day in Kent, as in other parts of England. The best of the NHS is among the best health care in the world, and we should all be proud of its achievements. We are halfway through the 10-year NHS plan and the achievements are tremendous. The waiting time for in-patient treatment has fallen to 26 weeks, compared with 18 months or more in 1997; the maximum waiting time for an out-patient appointment with a consultant has been halved to only 13 weeks; and 98.5 per cent. of patients are seen, diagnosed and treated within four hours of arriving at an accident and emergency department. Those of us with longer memories can see the difference, but others may not recognise the advances that have been made in our national health service.
The right hon. Gentleman's local NHS organisations, West Kent primary care trust and Maidstone and Tunbridge Wells NHS Trust, helped to meet those targets, but the quality of service delivered by the NHS does not just mean meeting targets; it also means thinking about the future, and about how we can provide services in the right locations, in buildings fit for the 21st century. We have embarked on a major hospital rebuilding programme over the past 10 years, because development was abandoned under previous Administrations. I believe that it is the largest hospital building programme that there has ever been. In 1997 at least 50 per cent. of NHS buildings predated the formation of the national health service, and dealing with that takes time, money and commitment.
The White Paper "Our health, our care, our say" committed the NHS to shifting more care into community settings because that is what people said they wanted. In June 2006, we announced that up to £750 million would be available over the next five years to develop a range of different models. In some cases, that could mean new community hospitals; in others, it could mean refurbishment, enhancement of services or community-based services, delivered in a person's home or through a general practice. The aim was to recognise the important elements of delivering a health service that would meet the needs of our communities.
West Kent PCT has been reviewing its community hospitals, as the right hon. Gentleman and his colleagues know only too well. It intends to deliver not just a cost-effective service but a more diverse range of services. I appreciate the right hon. Gentleman's concern about the reduction in bed numbers at community hospitals, but the PCT is focusing on how it can treat more patients in community hospitals—for example, day-case surgery patients—while reducing the number of in-patients who are admitted.
For some people the provision of services enabling them to be looked after at home, or simply to be at home, is an important part of what they want from the NHS; others may need to recuperate in a community hospital after being in an acute hospital. Many more people can now be treated in their homes for long-term conditions such as chronic obstructive pulmonary disease, heart disease and diabetes by, for instance, community matrons. I shadowed two community matrons in my constituency last year, and observed the impact of the service both in preventing too many admissions through accident and emergency units and in ensuring that those who were admitted could subsequently be cared for at home, perhaps by district nurses or with the support of social services departments.
The Livingstone hospital rehabilitation unit in Dartford has only 38 beds serving a population of about 250,000, but problems involving delayed transfers of care are minimal. West Kent PCT remains committed to community-based services, and aims to use the commended model at Livingstone hospital as a basis for the most effective, efficient and patient-focused delivery of services.
I understand that the reduction in services at Sevenoaks, Edenbridge, Tonbridge and Hawkhurst hospitals was decided in consultation with the permanent nursing staff. The number of beds was reduced in a phased approach, as patients were discharged from the community hospitals. No patients in need of care at any of the community hospitals were moved to another hospital as a result of the reduction.
The right hon. Gentleman raised the case of someone being kept in an acute hospital and not being able either to move to a community hospital or to receive support at home. I noted what he said, and will pass it on.
Does the Minister not agree that when patients are clearly in clinical need and beds are available in community hospitals such as Tonbridge and Edenbridge, it is indefensible to say that those beds must be closed, come hell or high water, until some review finishes?
It was indefensible for such people to wait 18 months for an operation—a situation that we tackled and stopped. It is difficult for me to comment from the Dispatch Box. These are issues that must be decided locally. Patient safety and clinical need must be the priority. I do not know the details of the cases that the right hon. Gentleman mentioned, but if he wants to provide further details of the particular case I will bring it to the attention of the local PCT so that it can be looked into.
A number of other points were raised, including the proposed Pembury PFI scheme, which would provide a full range of services, including planned and emergency surgery, orthopaedics and outpatient services, in a state of the art setting. I appreciate the concerns that have been expressed locally about delays to the project. We must ensure, though, that every PFI scheme offers value for money and is sustainable. That is why we asked strategic health authorities to reassess their major schemes, and submit their conclusions to the Department for ratification. I want to reassure the right hon. Gentleman and his hon. Friends that decisions from the review will be announced shortly. In the meantime, the trust has continued to develop the scheme and is working with a preferred bidder on the business case process.
That word "shortly" has appeared again. The word "shortly" was used by the Prime Minister in response to my question to him in July about when we might expect a decision. A period running from July until February is a strange use of the word "shortly". Will the Minister define what she means by "shortly"?
I understand that the proposal had to be resubmitted to be checked and re-evaluated. I cannot define precisely what "shortly" means, but the hon. Gentleman should accept that we are trying to expedite the matter, because we recognise the concerns locally.
The NHS as a whole is in receipt of record resources because of our policy of funding the NHS. In the earlier debate I was accused of being too political, but the fact is that the Conservatives—possibly not one of the newer Members present—voted against the Government's increase in funding for the NHS. Nationally, the latest round of allocations covering the period 2006-07 to 2007-08 represents an investment of £135 billion in the NHS, with £64 billion allocated to primary care trusts in 2006-07 and £70 billion in 2007-08.
The current financial situation at Maidstone and Tunbridge Wells NHS Trust cannot be attributed to lack of funding. In fact, West Kent primary care trust received an allocation of £740.5 million for this financial year. However, I note the concerns that have been expressed today and in correspondence from the right hon. Gentleman regarding debts accumulated by the trust under the resource accounting and budgeting system known as RAB.
In the NHS operating framework for 2007-08, the Department set out the initial response to the Audit Commission's review of the NHS financial management and accounting regime. The issues are being reviewed and a decision will be announced once our considerations are complete. So we are actively looking into the matter and recognise some of the problems that have arisen from the RAB system. However, until the review is completed, all NHS organisations must comply with all current statutory and financial duties, and ensure that they achieve financial balance.
Maidstone hospital was mentioned in the debate. I understand that concern has been expressed locally that the recent consultation on orthopaedic and surgical services at the planned PFI hospital at Pembury represents a lack of commitment to Maidstone hospital. The bulk of improvements made by the trust in recent years have taken place at Maidstone, with £70 million spent since 2003 on improvements. The trust wants to ensure that Maidstone hospital is capable of meeting the state of the art services that the new Pembury hospital will provide.
New facilities at Maidstone hospital include a day surgery, an endoscopy unit, a digital radiology unit and a breast screening and outpatient department—another example of innovation and new and better services being provided for local communities. The additional investment and development of services has been supported by the creation of 29 new consultant posts at Maidstone hospital since 2000. That accounts for 76 per cent. of the total new consultant posts created at the trust in the past six years. I hope that that indicates that there is no attempt to run down services at Maidstone hospital, and that they are being built up.
As the right hon. Gentleman is aware, NHS South East Coast is reviewing how its services are delivered across the region. The "creating an NHS fit for the future" review aims to ensure that modern health care services that are of high quality and safe, as well as being clinically and financially sustainable, are delivered to patients. In west Kent, the review led by the local PCT and the NHS is engaging in an extensive programme of discussion with stakeholders, clinicians and the public. The current review of community hospitals, the recent consultation on surgical and orthopaedic services at Maidstone hospital—
The motion having been made at Six o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at half-past Six o'clock.