(14 years, 6 months ago)
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Mr Clive Betts (in the Chair)
Let me explain the protocol to new Members in the Chamber. If a Member wants to intervene, it is up to the Member who is speaking to give way. If a Member wants to speak, they have to get prior permission from the Member whose debate it is and the Minister; I hope that they would let me know as well.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
Thank you, Mr Betts, and let me say that I am glad to serve under your chairmanship. I am pleased to have this opportunity to raise a key concern facing the people of Liverpool—namely, the urgent need to build a new Royal Liverpool University hospital. The Royal is an excellent university teaching hospital and a leading regional centre for diagnosis and treatment, deploying cutting-edge technologies such as digital histopathology, interventionist radiology and PET-CT—positron emission tomography-computed tomography—advanced scanning.
The problem is that the existing hospital, which was built in 1972, has major structural defects. Its mechanical and electrical infrastructure has major faults, it has design flaws and its internal and external fabric is failing. The trust is rated excellent for clinical services and for financial management. It has a gifted and committed staff, but that cannot overcome the problems of a deteriorating building.
In March, following years of intensive scrutiny, the then Secretary of State for Health, my right hon. Friend the Member for Leigh (Andy Burnham) visited the Royal to announce a new £45 million replacement hospital, a private finance initiative, to be built on the same site. The possibilities of refurbishment had been costed and rejected on the grounds that they offered poor value for money. The approval was confirmed in writing by the Treasury and by the Department of Health, which issued an approval letter. The trust is to fund £130 million of the £451 million capital cost, so it is planned that most of the funding should come from the private sector.
The proposal has been assessed for many years. The outlined strategic case was approved in 2006. It has been subjected to intensive scrutiny again and again locally, regionally and nationally, including by the Department of Health and the Treasury. It has met stringent tests for affordability and for value for money. That process has indeed cut costs, by about 32%, and the current proposal for 637 beds constitutes a 34% reduction in the number of beds outlined in earlier plans. Construction at the hospital, which will lessen both the hospital’s energy use and its carbon footprint, is due to start in 2012 and be completed by 2016. A competitive process to identify a suitable private sector partner is now under way. All that planning has now been thrown into doubt by this Government’s current spending review and their threatened draconian cuts.
I want to make it very clear that replacing the Royal is about providing front-line health care for the people of Liverpool and the region.
Maria Eagle (Garston and Halewood) (Lab)
I congratulate my hon. Friend on securing this debate. Does she agree with me that many people from south Liverpool also rely on the Royal Liverpool University hospital for acute health services and that a failure, at this late stage, to agree to rebuild the Royal and to let that project go forward will leave the entire city—not just the north of the city—having to obtain its health services in a deteriorating building that is no longer fit for purpose in the 21st century?
Mrs Ellman
I agree with my hon. Friend and her intervention shows why this issue is so very important.
The city has taken major steps forward in recent years, yet Liverpool remains the poorest local authority; in total, 67% of its population live in the top 10% most deprived localities in the country. Ill health is related to poverty. Industrial diseases such as asbestosis and mesothelioma, which are connected with the shipping industry of the past, cause deaths and incapacity today.
Although health standards have improved significantly during recent years, there is still an unacceptable gap in life expectancy between Liverpool people and those in the rest of the country. Women in Liverpool, Warrington and Hull have the lowest life expectancy for women in the country, at 78.8 years. Women in England as a whole can expect to live until they are 81.9 years old. The longest-living women in England are to be found in Kensington and Chelsea, reaching 88.9 years—a disparity of 10 years with women in Liverpool. Liverpool men have the fourth lowest life expectancy in the country, at 74.3 years, compared with a life expectancy of 84 years for men in Kensington and Chelsea and of 77 years for men in England as a whole.
Mortality rates are too high. The number of deaths from heart disease in Liverpool is 31% higher than the national average; the number of deaths from cancer-related diseases in Liverpool is 36% higher than the national average; deaths from causes that are amenable to health care in Liverpool are 42% higher than the national average, and deaths from conditions attributable to smoking in Liverpool are 57% higher than the national average. It is a chilling fact that for every 100 new cancers diagnosed in the rest of England, 130 new cancers are diagnosed in Liverpool.
Although that situation is related to long-term poverty, deprivation, the city’s industrial legacy and individual lifestyles, the new hospital, with its proposed high-tech facilities and single rooms, which would help to reduce the spread of infection, is essential to improving people’s health.
Despite its high incidence of cancer, Liverpool is the only major UK city without a comprehensive cancer centre. Following the Cannon and Baker report, a cancer centre linked to Liverpool university’s department of cancer studies should be built at the Royal and that project should be progressed with urgency.
The new hospital will contribute to the alleviation of disease by building on Liverpool’s strengths in the biochemical sector, already a major contributor to the local economy, by adding £1 billion gross value added and employing 6,000 people. In doing so, the new hospital will help regenerate the city. It will enhance important diagnostic research and life sciences, with increased collaboration between the university’s leading medical school, the internationally renowned Liverpool School of Tropical Medicine and the biomedical industry.
Companies such as Eli Lilly, Novartis, MedImmune and Bristol-Myers Squibb already work with the Royal. A new biomedical campus is planned on site and it will be integrated with similar facilities, expanding research, improving diagnosis and developing new health-related products. That campus will create additional jobs in Liverpool, as Liverpool increasingly becomes a global leader in this sector. The new hospital will also make a major economic impact. Building the hospital itself will create 1,600 jobs, with the local economic benefits reaching £240 million.
It is very sad that, with the Government’s draconian spending axe hanging over us, we still await a decision on the Royal’s future. What is at stake? Primarily, the new hospital is about the well-being of the people of Liverpool and the region, too many of whom experience unacceptably poor health. Everyone, irrespective of wealth, is entitled to good health care. There has been a great deal of investment in health services in Liverpool in recent years, which is why we have seen improvements in people’s health. But the key issue of the need to replace this major hospital remains outstanding and it is acutely important. The developmental hospital is important for Liverpool’s ongoing regeneration. Liverpool is a city transformed, but too many of its citizens have not yet reaped the benefits. And now, in this fraught economic climate, new challenges have emerged.
A rebuilt Royal will bring all the people of Liverpool essential state-of-the-art health care, fit for the 21st century. Linked with primary care, it will make a real difference. The current proposal is mainly private finance initiative-funded. It does not lean heavily on the public purse. It has been subject to stringent scrutiny, ensuring value for money, and that process is continuing.
The city council has already made strong representations and I want to praise Councillor Joe Anderson, the leader of the council, and Councillor Paul Brant, an executive member of the council, who have taken the lead in speaking up for the health needs of the city. Any delays, cutbacks or cancellation would deal a major blow to the people of Liverpool, with consequences for the whole region.
On 31 March 2010, the Liverpool Daily Post reported statements made by the then shadow Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley). Following some general comments that he made about the proposed scheme at the Royal, the Liverpool Daily Post said:
“And he turned the tables on Labour, by insisting the Tories were committed to protecting NHS budgets, while the Government”—
that is, the Government at that time—
“was plotting to slash capital spending by half.”
Asked about the Royal development, the right hon. Gentleman, now the Secretary of State, replied:
“The Conservatives have been clear about the need to protect NHS budgets, including capital spending, so we can support this project.”
I ask the Minister to confirm that that pledge remains real. I also ask him to implement it without delay, give this front-line service the green light and enable the people of Liverpool to benefit from the first-class health facilities that are so important for their future.
The Minister of State, Department of Health (Mr Simon Burns)
I begin by congratulating the hon. Member for Liverpool, Riverside (Mrs Ellman) on securing this debate on the future of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. I know of her long-standing support for the rebuilding of the Royal Liverpool hospital and it is apparent, just from looking at the number of Labour Members from Liverpool who are here today, that they are showing their interest in and concern about the provision of health care services in their constituencies and in the broader area of Liverpool and the Wirral.
I also pay tribute to the NHS staff across the whole of Liverpool, who do such an incredible job of caring for hon. Members’ constituents throughout the city and the surrounding area. Those members of staff do a fantastic job, day in and day out, with little recognition or thanks from people. I want to place on record my gratitude for their tremendous work and that of NHS staff in the rest of the country.
Before I come to the specifics about the Royal Liverpool hospital, I would like to set out the Government’s approach to the reconfiguration of local NHS services mentioned by the hon. Lady as part of her argument. I believe passionately that local decision making is essential to improving outcomes for patients and driving up quality. This Government will do more than just talk about pushing power to the local level; we will actually do it.
My right hon. Friend the Secretary of State has identified four crucial tests that all reconfigurations must pass. First, they must have the support of GP commissioners. Secondly, arrangements for engaging patients and the public, including local authorities, must be further strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice. To be clear, that means that forced hospital closures that do not have the support of GPs, local clinicians, patients and the local community should not occur.
Mrs Ellman
I am interested to hear the Minister’s enunciation of Government policy, but does he agree that in this instance we are discussing the much-needed replacement of an existing hospital that is required by practitioners and the local authority?
Mr Burns
The hon. Lady can rest assured that I will come to that in due course, during the latter part of my speech. In light of some of her comments, particularly about cancer services, I wanted to show the setting for reconfiguration in so far as it might affect that site and other parts of Liverpool’s health care provision.
Where local NHS organisations have already started to consider changing services, they will need to consider again whether their plans meet the criteria before continuing. It will be an opportunity for patients, local GPs and clinicians, and local councils to play a far greater role in how services are shaped and to ensure that the changes will lead to the best outcomes for patients.
The hon. Lady mentioned in an intervention the rebuilding of the Royal Liverpool. That will be reviewed in the light of the Secretary of State’s four tests. As she said in her speech, it is widely recognised that the hospital has a number of issues. Most significantly, the fabric of the building is deteriorating due to a serious case of concrete rot. The building’s condition contributes to high maintenance costs and a significantly poorer patient experience. The building is also inflexible, making it increasingly difficult for the trust to deliver modern, high-quality services.
Maria Eagle
I welcome the hon. Gentleman to his role. He is a reasonable man, and I am happy to see him in this job. Can he give all the Liverpool MPs here today some time scale within which the Government will take the decision on the review? We would be grateful for an approximate date.
Mr Burns
I thank the hon. Lady for her kind comments, which are greatly appreciated. I return the compliment by saying that when our roles were reversed, I found her an extremely helpful and sympathetic Minister when I brought problems to her concerning Chelmsford prison. She has anticipated me in her direct question. I assure her—I am choosing my words carefully, as she will discover—that I will answer her question later in my speech.
The programme to address the issues within the trust has been ongoing for some time, as all hon. Members present will know and appreciate. For the benefit of those hon. Members not present who will read the report of the debate, I shall set out the timeline of events.
Due to the sorry state of the buildings and the high cost of refurbishment, the trust decided fully to rebuild the Royal Liverpool and Broadgreen University Hospitals NHS Trust while refurbishing the site at Broadgreen. In July 2004, the Department of Health agreed the project’s strategic business case, enabling work to start on the outline business case and the process of obtaining planning permission from Liverpool city council. In March 2008, planning permission was granted. In September 2009, the strategic health authority, NHS North West, approved the outline business case. Then, in March this year, the project was approved by the Department of Health and the Treasury. On 14 April, an advertisement to tender for the project was placed in the Official Journal of the European Union. That is the scheme’s current position.
However, it is important to understand the changed context within which we now find ourselves. The most urgent task facing the Government is to tackle our record debt. As part of that, the Treasury is reviewing every significant spending decision made between 1 January 2010 and the general election on 6 May. As the hon. Member for Liverpool, Riverside herself said, the final approvals were given on 29 March—two weeks to the day before the general election was announced. As a result, the project has been included in the Treasury review of public spending commitments made by the previous Government.
I hasten to add, as delicately as I can, that we, as a nation, face tremendous difficulties due to the staggering debt left to this Government. My right hon. Friends have rightly decided that we must get to grips with the economic situation that we inherited, and the primary problem that we face in the immediate future is the debt.
Mrs Ellman
We all understand the problems of debt, but, as the Minister himself said, the replacement of this particular hospital has a long history. It has been scrutinised many times at many different levels—locally, regionally and nationally. It is a majority private finance initiative scheme funded mainly by the private sector. Is he suggesting either that the scrutiny has not been proper or that the hospital is not needed to meet the health needs of the people of Liverpool?
Mr Burns
I am not quite sure how the hon. Lady could reach either of those conclusions, and I can tell her with all clarity that my answer to both questions is no. I do not think either of those things—that is, that proper scrutiny has not been carried out or that changes to the existing system are not needed. I can reassure her on those points, but the problem is that the final decision was taken after 1 January—very close to the calling of the general election. Because the review commences from 1 January, the project falls within its scope and must be reviewed, in these changed circumstances, to help to meet our pressing economic problems and deal with the debt that we have inherited. The project received Treasury approval only in March. As a result, it is caught up in the review, as are many other projects.
The issue comes down to the simple fact that this country faces crippling debts. A huge amount of work is involved in the Treasury review. As I hope hon. Members will appreciate, I cannot give an exact timetable for the decision, but to be as helpful as I can and, I hope, live up to the kind words of the hon. Member for Garston and Halewood, I anticipate a decision being taken by the spending review in the autumn. I appreciate that that might be frustrating for hon. Members and their constituents, but it is the best I can do. I hope that that answer moves towards their concept of helpfulness. I am afraid that, until then, I cannot comment further on the future of the development. If hon. Members were in the position in which my Government and I find ourselves, I am sure that they would do the same.
Like the hon. Member for Liverpool, Riverside, I and everyone in the country share a vision of and want a high-quality NHS—accountable to patients, led by GPs and controlled locally. As a party, we were elected on a platform of real-terms increases in the NHS budget for every year of this five-year Parliament. It is a protected budget, so there will be no cuts, but there will be real-terms increases year after year, as long as this Parliament remains, which I anticipate will be five years. In that respect, there is stability and commitment, and an understanding of the financial commitments to the NHS. That, I hope, will give some stability to the overall decision-making process and the decisions that the NHS will have to take beyond simple capital projects.
Steve Rotheram (Liverpool, Walton) (Lab)
Does the Minister agree that our city and its citizens deserve not only a new hospital built on the Royal Liverpool site, but the state-of-the-art facilities outlined by my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman)? Does he also agree that the jobs created during the construction phase, similar to those that the Prime Minister spoke of in the Chamber this afternoon, would boost the local economy at a time of economic uncertainty? From what the Minister has said, the project appears to meet the Chancellor’s tests under the Treasury review because it is primarily financed under the private finance initiative.
Mr Burns
The hon. Gentleman makes a valid point, but everything has to be taken in the context of the changed circumstances—a change of Government and our overriding need to get the debt and the deficit under control. The context for that and the engine driving it is the review of all public spending commitments across the board. We are talking about not simply the health service, but commitments made across Government since 1 January. I cannot anticipate the outcome of any review, and I am sure that hon. Members would not expect me to. I can tell them that decisions will be taken by the spending review in the autumn, and I hope that hon. Members consider that helpful.
Maria Eagle
The Minister is being extremely generous in giving way and I am grateful. I understand the position that he is in—believe me. He gave an endpoint to the deliberative process, but the time scale he suggested might put the development at risk. Uncertainty can create difficulties with the funding arrangements for a PFI project, such that it is no longer workable or cannot be put together properly if the delay is too extensive because the private sector needs to raise money through the markets and in other ways.
Will the Minister undertake to do the usual thing that Ministers do, which is talk behind the scenes to his Treasury colleagues, as he will have to do anyway? Will he ensure, as far as he can, that the project is at the front rather than the back of the queue? The delay he indicated—through to the spending review in the autumn—could put the viability of the scheme at risk, whether or not the Government reaffirm the commitment made by the previous Government. For that reason, I urge him to do us a favour and discuss with the Treasury behind the scenes, as Ministers do, the urgent need to deal with this scheme as soon as possible.
Mr Burns
I respect the hon. Lady’s ingenuity and I can see where she is hoping I will go. I do not want to disappoint, but I understand the situation and all I can do is reiterate that the project will be reviewed, as a lot of other projects across Government will be reviewed, in line with the Treasury guidelines for the review of projects from 1 January.
A decision will be taken by or at the time of the spending review in the autumn. I cannot go further than that. However frustrating it is for the hon. Lady, I know that in her heart of hearts she understands what I am saying. If the roles were reversed, she would probably say the same thing. It would be wrong and irresponsible, and potentially misleading, to go any further.
Stephen Twigg
I am grateful to the Minister for giving way and I join in the congratulations to him on his well deserved appointment to the Department of Health. I understand that he cannot go further on timing, but can he tell us more about the nature of the review? Is it likely that his Department will say that certain projects will go ahead as planned and others will not, or will it ask projects to look again at the cost, to achieve more projects at the lowest cost to the taxpayer?
Mr Burns
I thank the hon. Gentleman for his kind and gracious comments, which I greatly appreciate. I also pay tribute to his experience in coming at the question from a different angle. I do not want to, but I am afraid that I must disappoint him. I will not go down the route he suggests because it could be open to misinterpretation. I can only repeat what will happen: all spending projects from 1 January are being reviewed. Decisions will be taken by the time of the spending review.
I return to the reconfiguration of cancer treatments in the area, which the hon. Member for Liverpool, Riverside raised, to give her a brief explanation of the current position, because that will put it in context and, I hope, be of help to her. Local health organisations in Cheshire and Merseyside are working together to ensure better cancer facilities for the local population. However, I am advised that the primary care trusts plan to review the first facility at the University Hospitals Aintree site before committing to further facilities at the Royal Liverpool. As the hon. Lady will appreciate, that is a local decision and it would not be appropriate for Ministers, at this stage, to compromise the processes, intervene or comment. There are local procedures to be gone through before final decisions are taken.
I welcome the opportunity to discuss the future of Liverpool Royal University hospital and fully appreciate how important it is to all hon. Members present and their constituents. We will have to wait until the spending review is concluded in the autumn for a decision. In the nicest possible way, I urge hon. Members, however difficult it is, to be patient and wait. If I were a constituency MP in Liverpool, I would be in the same position as them.
Question put and agreed to.