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Mr Iain Wright (Hartlepool) (Lab)
It is a pleasure to speak under your chairmanship, Mr Sheridan. The debate is about hospital services in the north-east, but I shall focus on services in North Tees and Hartlepool, so I welcome the fact that I can see here my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris) and for Sedgefield (Phil Wilson), as well as the hon. Member for Stockton South (James Wharton). I am also pleased to see a good north-eastern Member in the form of my hon. Friend the Member for Wansbeck (Ian Lavery). As I said, I shall focus on North Tees and Hartlepool, but I think that the hon. Member for Hexham (Guy Opperman) will wish to catch your eye, Mr Sheridan, and widen the debate so that it has a more regional perspective. I thank him for writing me a note, asking to participate in the debate.
I welcome the opportunity to discuss hospital services in North Tees and Hartlepool again. We had an important but too short debate on 5 July, initiated by my hon. Friend the Member for Stockton North, in which many hon. Members hoped to contribute so that they could express their concern about, and seek clarification on, the Conservative-Liberal Government’s decision to cancel the £464-million new hospital that was to serve the populations of Hartlepool, Stockton, Easington and Sedgefield. I am indebted to Mr Speaker, who, after discussing the matter with me, granted this longer debate so that we could discuss more thoroughly the vital issue of health care and hospital services in my area. We also had a meeting with the Minister in the week following that debate.
The decision by the new Government—one of their first decisions on coming to office—to withdraw the £500-million investment from our area throws the vital issue of health care and hospital services back into complete confusion and mayhem. My constituents and those of my hon. Friend the Member for Stockton North, as well as those of my hon. Friends the Members for Sedgefield and for Easington, are worth much more than that and deserve much better.
It is especially important that there should be excellent health care in Hartlepool and the surrounding areas because the people whom I represent experience some of the worst health inequalities in the country. Much of that is due to our legacy as a former heavy manufacturing town, with industrial diseases and injuries. Much of it is due to the deindustrialisation of the 1980s and ’90s, and the failures of Government at that time to put in place an alternative economic model. Economic inactivity and health inequality go hand in hand, and we have in the past 30 years suffered from high levels of deprivation. Much of the health inequality has to do with poor and inadequate investment in primary health care in Hartlepool in the last half-century. For example, we have had a much lower ratio of GPs per head of population than we should have had for much of the time that we have had an NHS. As a result, we have had to rely on hospitals, whereas other areas may have had suitably high levels of GPs and primary health facilities.
Frankly, much of the inequality has to do with people’s lifestyles. One third of the population of Hartlepool smoke, as opposed to 24% across England. Some wards in Hartlepool have smoking rates of 40% to 50%. The rate for smoking in pregnancy is way above the national average. The proportion of women who breastfeed their baby in Hartlepool is half what it is across the country. Hartlepool is above the national average for the proportion of people who binge-drink, although I would like to point out that it is below the average for the Teesside area as a whole. Rates of early death from heart disease, strokes and cancer are significantly worse in Hartlepool than the national average, as is life expectancy. Although the gap in life expectancy between Hartlepool and the rest of the country has narrowed in the past decade, it remains the case that a man in Stranton ward has a life expectancy some 11 years shorter than that of a similar man in a more affluent area.
All that history—the lifestyles and the poor health outcomes—means that it is vital that we have the best possible health service for my constituents. Although progress has been made, it will take more sustained help and support, and reconfiguration of services, to narrow the gap still further. We have seen more investment in Hartlepool health in the past 10 years—actually, we have seen more investment in primary health facilities in the past five years than in the previous half-century—but the people of Hartlepool still feel battered and bruised when it comes to the future of hospital services.
Since the 1990s, there has been huge uncertainty about what shape the health services will take, and where they will be located. There has been review after review after review—the Tees services review, the Darzi review, the report from the independent reconfiguration panel—and now there is the decision to scrap the hospital at Wynyard. In that time, other areas have seen a reconfiguration of hospital services; in our neighbouring area south of the Tees, one of the best hospitals in Europe—the James Cook University hospital—has been built. Those of us north of the Tees deserve something similar.
While the uncertainty has continued for my area, the hard-working staff in our local NHS have not been provided with the clear vision and leadership needed. That has compromised their ability to provide world-class health care for our area. The uncertainty has led to a loss of morale and subsequent difficulties in recruitment and retention. The trade union Unison is to be commended in my area for proudly standing up for the people who work in hospitals, but the Government’s decision, together with other reforms that they propose, is placing strain on local services and threatening jobs. We need certainty and continuing investment, and the Government, in one of their first acts in office, have provided neither.
It is fair to say that many people in my area might consider the Government’s decision to scrap the proposed new hospital to be appropriate—indeed, welcome—and might think that with a hospital not being built in Wynyard, the University hospital of Hartlepool will stay open, and that services will migrate back to it. It surely defies common sense, as I have been told by some constituents, that a town such as Hartlepool, with a population of 90,000, cannot have a fully functioning district general hospital, with all the modern services that hospitals should provide. It is argued that the decision to scrap the proposed new hospital at Wynyard presents an opportunity to provide that, and will mean that the University hospital of Hartlepool will have a secure future.
That is an understandable stance, based on affection for the great service that Hartlepool hospital has provided down the years. The big events of life have occurred in the hospital for many thousands of Hartlepudlians, including me. I am thinking of the births of my four children, the death of my nana and the saving of my son Benjamin’s life twice—first when he contracted meningitis at the age of eight, and then at the age of 12, when he suffered a stroke. The dedication of people working in that hospital is second to none, and my family are very much testimony to that.
However, I fear that we will not see the return of hospital services to Hartlepool, and that we will have the worst of all possible worlds—hospital services will move away from Hartlepool and become more inaccessible to the people whom I serve, and we will not have a world-class facility in the borough of Hartlepool to replace them.
I fully accept and embrace the changes in health services. I welcome the technological advances that mean that whereas previously certain medical procedures required extensive stays in district general hospitals, those procedures can now be done safely and more cheaply in a local setting. Just a few years ago, high-quality internet use, for example, could be provided only by bulky and costly desktop computers; now, people can have internet access in the palm of their hand. In the same way, such advances are pushing more and more medical and surgical procedures into the community, into GPs’ surgeries and even into people’s homes. I welcome that.
We are certainly seeing that trend in Hartlepool. The Momentum programme is reconfiguring more and more services that were once the preserve of the hospital, putting them into the local clinic, closer to people. I met a man in Hartlepool recently who had had his toes amputated. Just a few years ago, that would have required an operation in a hospital and a lengthy stay there for recovery and recuperation. The man I met had had the procedure carried out in the operating theatre of his GP clinic in the Headland surgery, and he was home in a matter of hours. We shall see much more of that.
The newly opened One Life Hartlepool centre, built as part of the Momentum programme, is equipped to carry out minor skeletal surgery and will do orthodontic work that was previously the preserve of hospitals. GP surgeries increasingly take blood samples on-site rather than requiring the patient to attend hospital. Again, that is welcome.
However, we also have to admit that increases in medical specialisation, coupled with a wider and more miraculous range of things that can now be achieved through science and surgery, mean that many surgical procedures are now reserved for doctors and nurses with very specialised skills, as opposed to those in general medicine and surgery.
In preparing for this debate, I have been in contact with the Royal College of Surgeons of England, and I am grateful for its help. As part of its best clinical practice, for acute general hospitals that provide the full range of facilities, specialist staff and expertise for elective and emergency medical and surgical care, the college recommends a preferred catchment population size of between 450,000 and 500,000 people. However, the college estimates that hospitals of that size account for fewer than 10% of acute hospitals in England, and states that there is unlikely to be a significant shift to that size of hospital in the short to medium term. As it is, the majority of acute hospitals have, and are likely to continue to have, catchment populations of about 300,000. That is significantly more than the population of my constituency.
It is essential that MPs and all representatives listen to the professional advice of eminent surgeons. I do not intend to play fast and loose with patient safety and clinical excellence. As a politician, I realise that I do not know better than doctors, and I want the best possible health care for my constituents. I will fight to the last to achieve the best possible services for Hartlepool. They have to be safe and medically advisable, but if something is seen to be clinically essential by surgeons, it is right that my hon. Friends and I should listen. It is also right that Ministers should listen to eminent surgical and clinical advice, and I suggest that the cancellation of the proposed new hospital means that they did not. I hope that the Minister will do so today.
I believe that Lord Darzi’s proposals of 2005, under which Hartlepool hospital was to become a centre of excellence for women’s and children’s services, and the University hospital of North Tees was to become a centre of excellence for emergency surgery, were workable and feasible. Alas, it was not to be, as other parts of Teesside felt that they could not live with that. Although I thought that the subsequent independent reconfiguration panel review was unnecessary, I respect its decision, the quality of its evidence and its professionalism. I cannot argue with the overpowering weight of clinical advice on the matter.
In the IRP report, paragraph 4.8.5, entitled “Clinical views—the need for change”, stated:
“There was a common view across all staff that no change is not an option. Staff are keen to work with the Trust management and to embrace clinically-driven change”—
“clinically-driven change” is a hugely important phrase—
"that secures the best outcome for patients, staff and the Trust…There was widespread support for a new modern hospital, north of the Tees, concentrating on providing high quality hospital services that cannot be more appropriately provided in local communities”.
The IRP also stated:
“This is not simply a matter of recruiting additional staff. Specialist skills can only be acquired and maintained with sufficient ‘throughput’ of cases. Since safety standards can only be expected to rise in the future, the current model of service provision is unsustainable.”
In the concluding remarks in the report, the chair of the IRP—a GP and the chair of an acute NHS trust in Nottingham—stated in his personal recollections that:
“The clinicians were virtually unanimous in their desire to work on one site. This was not based on their personal convenience but on clinical evidence and a belief that a real and sustainable improvement in patient care would take place.”
I want the best possible services for Hartlepool. The ideal situation if I lived in utopia would be a hospital in the very centre of Hartlepool that provided the widest possible range of specialisms. In the real world, however, I realise that the desire to see a hospital serving the people of Hartlepool, Stockton, Easington and Sedgefield was driven by clinicians, based on clinical evidence and fuelled by a belief that patient outcomes would improve and health inequalities diminish as a result.
To be fair, I think that the present Government recognise that, too. In a recent answer to my written parliamentary question on whether he would implement the recommendations of the Darzi review, the Minister replied:
“The recommendations of the Darzi review of acute health services north of the River Tees were superseded by the advice provided by the Independent Reconfiguration Panel to the then Secretary of State for Health in December 2006. This advice formed the basis of the ‘Momentum: Pathways to Healthcare programme’ which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield.”—[Official Report, 28 June 2010; Vol. 512, c. 407W.]
From that response, it seems that the Minister accepts that clinical pressures were driving and pushing this matter.
In that context, will the Minister confirm that the proposed new hospital entirely meets the criteria set out in a letter of 20 May from the NHS chief executive to Monitor—criteria that are about ensuring that all service changes are led by clinicians and patients, not driven from the top down? Taking that point further, will the Minister explain how the Secretary of State reconciles his policy of clinical-led decisions with the pledge made during the general election campaign that Hartlepool hospital would not close if a Conservative Government were elected and a Tory MP returned for the seat of Hartlepool? What clinical evidence was there to back that pledge? Is that not an example of top-down meddling by politicians, regardless of clinical evidence? Is it now Government policy for the configuration of health services to be contingent on voting behaviour, rather than clinical decisions?
Will the Minister provide further clarity about his written answer to me, to which I referred a moment ago, on whether Darzi should be implemented? If he believes that Hartlepool hospital should remain open, will he provide additional support and resources to ensure that it can remain open, and that services will return to it? However, this is not just about money; it is about the way in which services are provided and how they are linked.
Since the Adjournment debate of 5 July, and our subsequent meeting with the Minister, the NHS White Paper has been published. It rightly pledges to put patients at the heart of services and decisions regarding services. I welcome that. The phrase used in the White Paper is
“nothing about me without me”.
The White Paper also asks for an enhanced local voice; again, that is welcome. However, I would be interested to hear the Minister’s view on what should happen if there is a stark difference between what the professionals want and what the public want—if surgeons and clinical teams say that specialism requires a concentration of services on a central site, but local communities say, as they often do, that they like the status quo and that change is unwelcome? How does the Minister envisage such tension being resolved, given that such views are often polar opposites?
The Minister may say that the independent NHS board will be important when it comes to resolving tensions or contradictions, and that its decisions will be based on clinical views and free from political interference. That would be welcome, but does that mean that the NHS commissioning board will have responsibility for resource allocation? The White Paper certainly suggests so, saying that the board will
“allocate and account for NHS resources.”
In that context, I think that “resources” means revenue resources, but does it also mean capital resources? What would happen if the NHS commissioning board recommended that, for hospital services north of the Tees, it was clinically essential that the recommendations of the independent reconfiguration panel were implemented? Would the board’s decisions overrule ministerial priorities?
The Minister may respond along the lines that the independent NHS board will take decisions out of the hands of politicians, but the White Paper contradicts that. It states on page 33:
“The Secretary of State will have a statutory role as arbiter of last resort in disputes that arise between NHS commissioners and local authorities, for example in relation to major service changes.”
In other words, the reconfiguration of hospital services, which can cause bitterness and fear in many communities, as it has in mine, can still be decided by the Secretary of State. That does not take politics out of changes to hospital services at all.
I ask the Minister to address a number of other points. Does he accept that the manner in which the project was assessed within Whitehall—in both the Department of Health and the Treasury—under the Labour Government was entirely in accordance with appropriate procedures? Does he accept that the project was appraised by officials in an entirely appropriate and rigorous manner, and that that was not done a couple of weeks before the general election, but had been planned and prepared for several years? Hartlepool borough council has written to the Secretary of State on the matter. The letter was signed by the chairman of the council and the leaders of the Labour, Conservative and Liberal Democrat groups; they have yet to receive a response, so I would be grateful if the Minister could expand on what he said in the earlier debate.
Will the Minister publish the revised criteria and assessment considerations on which the project failed, so that we can see what is to be done to address the matter? Why are Hartlepool and North Tees rejected, when Liverpool and Epsom are not?
The Minister of State, Department of Health (Mr Simon Burns)
I might be able to help the hon. Gentleman on that point, so that he need not get confused. As he is a diligent Member, I need only remind him that in our debate on 5 July—in column 150 in Hansard—I went into great detail in answering that question. I am afraid that the situation has not changed since then. That was the accurate answer then, and it is the accurate answer today.
Mr Wright
I thank the Minister for that clarification. Some of my hon. Friends might probe him a bit further on that point, because we are unclear about a number of aspects. Let me return to the point about the appropriate and rigorous procedure that took place in Whitehall. My recollection might be incorrect, so the Minister may have to provide further clarification. Will he confirm whether a letter of direction, which would be needed if the permanent secretary was unhappy with the decision taken by the Secretary of State, was needed for the proposed new hospital? The decision has left Hartlepool and the surrounding communities high and dry. There will be no new world-class hospital, the plans for which were based on clinical decisions, and no money to upgrade existing facilities. I fear that we will soon have one hospital serving the people of my constituency, and that hospital will be in North Tees. That is completely unsuitable for the task, and for the people of Hartlepool, who will find it appallingly hard to travel to.
We have no clear direction from the Government on the future of hospital services; there is only a vague sense of having been told, “You are on your own; you can do what you like.” That is part of a worrying pattern emerging in the north-east. First, there was the future jobs fund, then the working neighbourhoods fund, then the decision on the hospital, and then the scrapping of Building Schools for the Future. The people of Hartlepool and the surrounding areas are worth more than that and deserve better. I hope that the Minister will acknowledge that this afternoon and clarify how we will provide help, support and additional resources to improve hospital services in North Tees and Hartlepool.
Grahame M. Morris (Easington) (Lab)
I am pleased to serve under your chairmanship, Mr Sheridan, in this important debate. I congratulate my hon. Friend the Member for Hartlepool (Mr Wright) on securing this debate on hospital services in the north-east. In my remarks, I intend to focus on the future of hospital services for my constituents in the south of Easington who, until June of this year, were looking forward to the benefits of a new acute hospital at Wynyard, which would have served local people in five parliamentary constituencies: Stockton North, Stockton South, Hartlepool, Easington and Sedgefield. This state-of-the-art hospital costing £464 million was granted approval in March following many years of preparation and consultation, with health professionals and clinicians working on the ground. The original concept for the new hospital was set out by Professor Sir Ara Darzi, and proposals by an independent reconfiguration panel were clear in recommending a new hospital to replace the existing provision spread across two sites, 14 miles apart.
It is evident that the North Tees and Hartlepool NHS Foundation Trust will struggle to continue to provide high-quality health care as we move forward into the future with the existing, ageing configuration. I commend the work of health care professionals and ancillary support staff at the University hospital of North Tees and the University hospital of Hartlepool, without whose dedication and commitment our health service could not function.
North Tees and Hartlepool NHS Foundation Trust has worked hard to meet key targets—Labour’s targets—to ensure a high quality and universal standard of health care for all the people in its catchment area. More than 90% of outpatients and 85% of inpatients wait no more than 18 weeks from being referred by their GP to receiving their first treatment in hospital, which is no mean achievement. The trust has also consistently managed to see, treat, admit or discharge 98% of patients within four hours of arriving in accident and emergency. Like services across England and Wales, the North Tees and Hartlepool NHS Foundation Trust guarantees to see patients within two weeks if a GP thinks that they may have cancer. That final target, the cancer guarantee, has been kept by the Minister, although my right hon. Friend the Member for Leigh (Andy Burnham) had to work hard for that victory. If the proposed hospital at Wynyard does not go ahead and our services must continue to be delivered from inadequate and increasingly outdated hospital buildings, I have a real concern that patients will suffer. Within the context of the proposed new hospital, I want to touch briefly on NHS targets. The Government’s principal argument against targets has been eroded since they accepted the two-week cancer guarantee, so why can they not admit that targets are important to ensure a universal quality of health care?
Hospital services in the north-east have offered high-quality standardised care during the past decade. As I have mentioned, my concern is that, if North Tees and Hartlepool NHS Foundation Trust is forced to deliver care to patients from two existing and increasingly outdated hospital buildings, the removal of targets that would have guaranteed a certain level of patient care will put patient care at risk. It is possible to foresee a scenario whereby, in comparison with those areas where the Government have allowed the construction of new hospital buildings to go ahead, the services provided in North Tees and Hartlepool—in much more challenging circumstances—could fall behind the standard of care offered by the new hospitals elsewhere in the country.
I remember that the Minister had some difficulty over the figures that were quoted when he responded to my hon. Friend the Member for Stockton North (Alex Cunningham) on 5 July, as has already been mentioned; perhaps there was some confusion over the figures. I would appreciate it if the Minister could clarify this point, because the record was corrected and I am taking these comments from Hansard, concerning the evaluation of the relative costs of providing health care with and without the new hospital. The corrected version of Hansard reads as follows:
“Over the appraisal period of 35 years”—
that is, the life span of the hospital—
“the total net present cost—that is, the whole-life cost—of building, maintaining and operating the new facility was £5.033 billion, but the cost of repairing”—
Grahame M. Morris
I want to continue on this point, because the Minister is reinforcing my point in relation to the costs. He said on 5 July that the cost of “operating the new facility” was £5.035 billion over the 35-year period that is the hospital’s life span. He continued:
“but the cost of repairing defects, maintaining, operating and providing services from the two existing buildings was £5.24 billion.”—[Official Report, 5 July 2010; Vol. 513, c. 150.]
Therefore, although it was not immediately clear, is that incorrect?
Grahame M. Morris
Okay, thanks. The cost difference is very marginal, when we factor in things such as NHS inflation and so on. The Minister has already given some clarification, but my point is that by not continuing with the proposed new hospital the cost of delivering health care may in fact—
Diana R. Johnson (Kingston upon Hull North) (Lab)
I congratulate my hon. Friend the Member for Hartlepool (Mr Wright) on securing the debate this afternoon. He is a worthy champion of his constituency and the region, with respect to a range of matters including health, education and economic regeneration. He spoke passionately about the need to deal with the health inequalities that blight this country, and the problems in his constituency in particular, as well as the need for excellence in health care in the north-east, including the new hospital that is at the heart of the debate.
Like all hon. Members who have spoken, I pay tribute to the staff of the NHS, whose work for and commitment to the people of the north-east and the rest of the country is excellent. It was striking to hear the personal experience that my hon. Friend the Member for Hartlepool had in his local hospital, and what excellent care he and his family received. I pay tribute to all hon. Members who are present today, including my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris), for Wansbeck (Ian Lavery), for Sedgefield (Phil Wilson), for North Tyneside (Mrs Glindon), and for North Durham (Mr Jones). I know that they all feel strongly and passionately about the issue.
I want to comment on the remarks of my hon. Friend the Member for Easington. He put patient care and safety, which is what the debate is really about, at the centre of his remarks. He set out his concerns about what will happen to patients who are left with the two hospitals, where they will now be treated. Will the abolition of targets affect care and safety? That is an important issue, which I hope the Minister will deal with. My hon. Friend also raised the important issue of finances and how they stack up. I would like to know in particular whether the difference in cost between building a new hospital and repairing and maintaining the two is £11,000 or £11 million. I am sure that the Minister will clarify that.
Mr Burns
If it will help the shadow Minister I shall clarify the point yet again. The reason the question ever came into the public domain was that on the morning of the previous debate the right hon. Member for Leigh (Andy Burnham) incorrectly put out a press statement saying that the building of a new hospital would be cheaper than the maintenance and upkeep of the two existing hospitals, over a 35-year period. The figures, which Hansard originally printed wrongly—hence the correction—showed a difference of £11 million. It was cheaper by £11 million to keep the two existing hospitals. The point was merely to show that the right hon. Gentleman was factually incorrect.
Diana R. Johnson
I am grateful to the Minister for correcting what he said earlier, when he talked about the figure of £11,000. We understand that the figure is £11 million. I suggest that in the great scheme of things, if the difference in cost between maintaining and repairing two hospitals and building a state-of-the-art new one is £11 million, Labour Members might think that it is £11 million that should be spent.
Diana R. Johnson
My hon. Friend makes an important point about the cost over 35 years.
My hon. Friend the Member for Stockton North, who I understand is a former non-executive director of the North Tees and Hartlepool NHS Foundation Trust, spoke clearly about the need for a new hospital. I know that he also tabled early-day motion 273, which attracted a great deal of support, to request a review of the coalition decision about the hospital. He, too, made an important case about health inequalities and why the hospital is needed. He also pointed out that structural upheaval in the NHS at a time when we are facing such financial problems is a recipe for chaos. What is the future for the people represented by him and our hon. Friends? Again, I look to the Minister to explain the coalition Government’s thinking about what will happen to the needs of communities in the north-east.
I do not wish to rehearse the history of this £464 million hospital project—my right hon. Friend the former Secretary of State made it clear that it was a top priority for the NHS, and agreed in March this year that it should go ahead—but it had been in planning for a long time. It was not just signed off close to a general election. As we have heard, the coalition Government decided to cancel the hospital project within the first few weeks of taking up their position in Government. It is clear that the Treasury and other Departments reviewed every significant spending decision made between 1 January and the general election on 6 May. The proposal for the new hospital scheme, which received Government approval only in March, was considered properly during that review, but there are questions about why that particular hospital project was cancelled and others were allowed to proceed when my right hon. Friend had made it clear that the hospital was a top priority for the NHS.
Diana R. Johnson
The Minister will be pleased to know that I took great pleasure in reading his response to that debate, but I am still not satisfied with the explanation given. There is room for further explanation why that particular hospital was chosen.
Diana R. Johnson
I am particularly concerned—I think that my hon. Friend the Member for Hartlepool mentioned this—about the clear view of all the clinical professionals—[Interruption.] I do not have the speech in front of me, but considering that the Secretary of State for Health talks continually about the need for doctors and clinicians to be in the driving seat when decisions are made in the NHS, and considering that, as my hon. Friend said, it is clear that the clinicians and health professionals involved were very centred on having that one hospital, why have those views been suddenly pushed to one side? Will the Minister explain that, given the coalition Government’s new approach of saying that clinicians are at the centre of decision making? If so, I will be pleased.
Also, on the cost of cancelling the project, how much money was spent getting to the point of preparing to proceed? What yearly maintenance and repair bill does the Minister think will now have to be paid for the two hospitals? What is the coalition Government’s plan for in-patient health facilities for that community? What does he see as the future for either a new hospital or a different style of health service provision in the area? What is his thinking? It is certainly not clear.
The Office for Budget Responsibility’s projections, to which one of my hon. Friends referred, show that the actual deficit was lower than was projected before the general election. We have also seen higher-than-expected growth figures this week, which hon. Members might find surprising. I ask the Minister to reconsider the economic impact of refusing to follow through on the decision to build the hospital, taking into account what my hon. Friend the Member for Sedgefield said about the potential for the hospital to be an anchor tenant to attract important private sector businesses and jobs. I know that the coalition Government are committed to helping the private sector grow us out of our present financial situation, so will the Minister reconsider? The range of Members present in the Chamber shows a clear commitment to ensuring that the people of the north-east get their fair share of resources and the kind of hospital service that they so richly deserve.
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the hon. Member for Hartlepool (Mr Wright) on securing this debate. As he and his hon. Friends will know—as the shadow Minister rightly said, they are here in force—we have had a briefer debate on this subject, and I have had the pleasure of welcoming most of the Opposition Members present to a meeting at my Department, where we had a useful exchange of views.
Before I address the main thrust of most of the contributions, which is North Tees and Hartlepool, I will give a brief overview of the health situation in the north-east and will refer to some of the comments made by my hon. Friend the Member for Hexham (Guy Opperman).
Earlier this month, as hon. Members know, we published our vision for the national health service in the White Paper “Equity and excellence: Liberating the NHS”, which signals the beginning of the most profound reform in the NHS’s 62-year history. By taking power away from Ministers and civil servants in Whitehall and handing it to patients and clinicians, we shall transform the health service from the ground up.
Diana R. Johnson
I am intrigued. I read carefully the coalition agreement, which said that there would be no top-down reorganisation of the NHS and mentioned having elected representation on primary care trust boards, which I understand are now to be scrapped. Will he explain why, in a few weeks, the Government have completely ditched that proposal, which was in the coalition agreement?
Mr Burns
I will certainly explain that when I get on to the specific point about Hartlepool because, unfortunately, as will be unveiled to the shadow Minister and the hon. Member for Hartlepool, their comments today are based on a false premise and show that they do not fully understand the previous speeches on the issue, or the meeting we had at the Department of Health. All will be unveiled shortly, and I hope that the shadow Minister will understand the reasoning behind the decision taken.
As I was saying, as part of the vision, and the moving forward on the White Paper, we want every hospital trust in the country to become a foundation trust. We want to direct every aspect of the national health service at delivering clinical outcomes that are as good as, or better than, any in the world. The north-east is already ahead of the game in many respects. In November 2009, it became the first and only region in England to have all of its NHS hospital and mental health trusts awarded foundation trust status. When the Care Quality Commission reviewed hospital services in the region last year, every single hospital trust and every ambulance service was rated either good or excellent for the quality of their services. That gave the north-east the highest score in England for the third year running.
Among those hospital trusts, Gateshead Health NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust all received double excellent scores for both quality of services and the use of resources. The high quality of services across the north-east is down to the skill, dedication, creativity and sheer hard work of the thousands of NHS staff across the region. I want to take this opportunity to pay tribute to them and wish them well in their continued success in providing first-class care and services to the people of the north-east.
Alex Cunningham
Would the Minister care to help us get a hat trick, and to go from double to triple excellence, by having a brand new hospital for the people of North Tees and Hartlepool?
Mr Burns
I admire the hon. Gentleman for his persistence. If he could have a little patience, I shall talk about the points made by my hon. Friend the Member for Hexham, and will then come on to the hospital that has so dominated the debate.
My hon. Friend mentioned Northumbria Healthcare NHS Foundation Trust and its proposal to build a £75-million emergency care hospital in Cramlington. I am advised that planning permission is currently being sought for the proposed site and that further development work is under way. I hope that that goes some way to answering the point that he raised. I will make sure that I write to him during the next week or so on the other points that he mentioned to explain all the outstanding issues.
I shall now turn to the review of the hospital in North Tees and Hartlepool. The hon. Member for Hartlepool specifically raised the Government’s decision to cancel North Tees and Hartlepool NHS Foundation Trust’s proposal for a new hospital building. As I stated in the House in our last debate on this matter on 5 July, the original proposal for a publicly funded capital scheme received Treasury approval in March this year, in the run-up to the general election. In view of the shocking state of the public finances and the desperate need to reduce the £155 billion deficit, which I need not remind Labour Members was left to us by their Government, the Treasury and other Departments reviewed every significant spending decision made under the previous Government between 1 January 2010 and the general election on 6 May.
Mr Iain Wright
I appreciate the Minister’s explanation and analysis, but if the Conservative-Liberal coalition Government are concerned about the state of the public finances and want to help drive down the debt quicker, why was there not a moratorium on all capital spend in the NHS, similar to that which the Secretary of State for Education put in place with regard to Building Schools for the Future?
Mr Burns
Because, as I will again explain—this is similar to what I said on 5 July—there were a range of criteria determined and, as the hon. Gentleman is aware, we took the decision on the hospital on the grounds of affordability and the foundation trust status of the hospital. If he will bear with me, I will explain that again, so that even if he does not accept the decision, he will, I hope, come to understand the reasoning behind it.
On 17 June, the Chief Secretary to the Treasury, my right hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), announced to the House the decisions made following the Government’s review of spending commitments. The review cancelled 12 projects, including the proposed new hospital at North Tees and Hartlepool.
The aim of granting foundation trust status is to give bodies, such as the trust in the area represented by the hon. Member for Hartlepool, greater financial independence. As well as being able to keep any internally generated resources, foundation trusts also have greater freedom to borrow from either the public or the private sector. As the proposals required an allocation of public dividend capital from the Department of Health of more than £400 million, they were not consistent with that financial independence. Treasury and Department of Health Ministers, including me, decided that, overall, those factors—affordability within the changed economic climate and the hospital’s foundation trust status—weighed against the £458-million scheme for North Tees and Hartlepool more than they did against the other three schemes at Liverpool, Epsom and St Helier, and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew support for the scheme.
Following our previous debate, I was pleased to meet, on 8 July, Paul Garvin—the chair and non-executive director of North Tees and Hartlepool NHS Foundation Trust—together with the hon. Member for Hartlepool and many of his hon. Friends now present. At that meeting, we discussed the possibility of the trust putting forward a new proposal under the private finance initiative. As I have said repeatedly, I cannot in any way give any guarantees that such a scheme would, or would not, be approved. Like any proposal, it would have to be considered on its merits and in the light of the economic climate at the time it was put forward for consideration and possible approval.
However, the advice I would offer the foundation trust is the same advice I would offer any organisation putting forward such a proposal. Any scheme must reflect the changed realities of the national health service, as set out in the White Paper. It would clearly have to demonstrate that it passed the four tests for reconfigurations set out by my right hon. Friend the Secretary of State. That is, it has to have the support of GP commissioners; arrangements for public and patient engagement, including with local authorities, must be strengthened; there must be clear clinical evidence underpinning any proposal; and it must develop and support patient choice.
The economic and policy circumstances have changed since the original proposals were put forward. It would be advisable for the foundation trust to make sure that any revised proposals reflect those changes, and can demonstrate that they have the full support of GPs, the public and the local authority. Any new proposal must be realistic, affordable and provide value for money.
Grahame M. Morris
On the point about providing value for money, and the elephant in the room, which is the implied advice that the appropriate route for a foundation trust is a PFI initiative, does the Minister accept that the evidence suggests that over the 35-year write-off time, or life of a hospital, there would be an estimated additional cost to the pubic purse of £5 million a year as a result of going down the PFI route? That would cost the public purse an additional £175 million over the lifetime of the hospital—money that would otherwise go into patient care.
Mr Burns
I have to say, in the kindest, gentlest way possible, that I fear we are beginning to go around in circles. I have given the corrected figures; confusion was caused by what Hansard originally printed in the last debate on the subject, when I talked about the comparable costs of maintaining the two hospitals that exist and building a new one. There was a marginal £11 million difference.
Mr Burns
The hon. Gentleman must wait a minute, because I have only 10 minutes in which to answer the questions that the hon. Member for Hartlepool asked. The fact is that the decision was taken on affordability and on the fact that the trust was a foundation trust and so was free to seek other means by which to finance the project, rather than going to the Department for capital funding. Those decisions were taken because of the tough economic situation we inherited after 6 May and the massive deficit the country was left with. My right hon. Friend the Chancellor of the Exchequer rightly believes that the No. 1 priority for sorting out the economy is to get rid of the deficit as quickly as possible. Regrettably, tough decisions have to be taken in the light of the dire economic situation.
I must tell the hon. Members for Hartlepool and for Kingston upon Hull North (Diana R. Johnson) in the nicest terms possible, that it was their party’s mismanagement of the economy and deficit that put us in the current situation. We will have to take tough decisions if we are to have a buoyant, vibrant economy again. [Interruption.] If I might continue—[Interruption.]
Mr Burns
I will now answer some of the Opposition Members’ questions. The hon. Member for Hartlepool asked whether there was an optimal population size for a hospital. I have consulted my officials, who tell me that they are unaware of whether there is an official optimal population size for hospitals, so I will look into the matter and write to him with a satisfactory answer as soon as possible, giving him any information we have.
I have already explained, including on 5 and 8 July, the decision that governed the withdrawal of approval for the hospital. On the hon. Gentleman’s question about the future of Hartlepool hospital, there are currently no plans to close it, and that will remain the case unless the strategic health authority and the PCT propose closure. There are no such proposals at present, as far as I am aware.
Mr Iain Wright
I thank the Minister for that clarity. Given the proposals to abolish SHAs and PCTs, what will happen after that?
Mr Burns
It is perfectly reasonable for the hon. Gentleman to express concern about and an interest in finding out what would happen. The answer is that that will depend on a combination of factors, including the national commissioning board that will be created, the GP commissioners and the decision of the local health community. If a local health community put forward any proposals to reconfigure health patterns in its area, it would have to go through all the procedures that are currently in place, and there will also be the changes that my right hon. Friend the Secretary of State will put in place to strengthen the community’s input into any proposed reconfiguration. The views and support of clinicians and GPs will be sought, and the focus will be on improving outcomes and affordability, and including the views of local populations.
The hon. Gentleman will know from reading the White Paper and the five related documents that have so far been published, which flesh out the details, that local authorities will have a greatly enhanced role in the provision of health services and the maintenance of health care standards in the local community, and will not be restricted solely to their current role in public health.
The hon. Gentleman asked whether the Government will implement the recommendations of the Darzi review on acute health services north of the River Tees. The recommendations of that review were superseded by advice provided by the independent reconfiguration panel to the then Secretary of State for Health in December 2006. That advice formed the basis of the “Momentum: Pathways to Healthcare” programme, which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield. We understand that NHS Hartlepool and NHS Stockton-on-Tees will continue to work closely with North Tees and Hartlepool NHS Foundation Trust on delivering the wider Momentum programme, and will be discussing the options available with the trust. I hope that that goes some way towards satisfying the hon. Gentleman.
The hon. Member for Kingston upon Hull North mentioned the generality of the provision of health care, and new health care facilities, in the region, and I can reassure her by mentioning a number of initiatives that have taken place in the Stockton-on-Tees area in recent years.
Mr Burns
Yes, in recent years—there is no point in the hon. Lady sitting there and saying that because, to be frank, anyone who takes a sensible approach to such matters will not try to score cheap party political points. I recognise that for the past 13 years we have had not a Conservative but a Labour Government, and I am mature enough and comfortable enough within myself to recognise that during those years advances in health care were made. I am not one of those narrow politicians who say that, because there was not a Tory Government, everything was awful, or that everything done by a Tory Government is wonderful; it is a mixture of the two. One has to be mature enough to recognise that, as I do. The initiatives I will refer to took place in the past few years, so they were under a Labour Government.
As the hon. Lady will know, 26 of the 46 Momentum business service change projects are under way as part of the “Momentum: Pathway to Healthcare” programme. They consist of detailed service reviews, a revised pathway based on a map of medicine, a value impact assessment and a service implementation plan. Examples of pathways reviewed to date include those on diabetes, respirology, cardiology and haematology. There are also cross-cutting business service change projects under way in the areas of work force and education, IT, and communications and engagement. There is also an integrated care centre at Hartlepool, with which the hon. Member for Hartlepool will be familiar, and an integrated care centre at Billingham, which I expect the hon. Member for Stockton North (Alex Cunningham) and my hon. Friend the Member for Stockton South (James Wharton) will know.
Diana R. Johnson
I am pleased that the Minister has read out a list of initiatives introduced under a Labour Government, but I am interested in the coalition Government’s thinking on health service provision in the north-east. What initiatives do they have planned for dealing with the health inequalities that have been mentioned by Members today?
Mr Burns
I thank the hon. Lady for giving me the opportunity once again to tell her that those are all contained in the vision outlined by my right hon. Friend the Secretary of State in the White Paper that was published last week. It is a vision that puts patients at the heart of health care, so that they can have the best health care of the highest quality. It is based on the premise that there should be a local, bottom-up system, rather than one in which politicians and bureaucrats in Whitehall issue diktats and tell local communities with which they are unfamiliar what they should and should not do. That is the way forward for enhancing health care.
Our vision is based not on processes that are distorted for party political purposes, but on the need to improve outcomes so that people get better health care. The patient experience, whether in a hospital setting or when a patient visits their GP, should be tailored to their needs, rather than to what the state tells them that they should have. That move will be spearheaded by GPs, through GP consortiums, as it is they who are closest to patients, know the health care that they need, and know how patients can best access it. That will all be determined by improving outcomes and the patient experience in order to give the finest quality care that the country can provide—the highest in the world. That is the answer to the hon. Lady’s question.