Royal National Orthopaedic Hospital (Stanmore)

(Limited Text - Ministerial Extracts only)

Wednesday 4th March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I will of course pass that message on, Sir Alan. It is a pleasure to serve under your chairmanship for, I think, the first time in the almost three years I have been a Minister. I heed and take note of your comments. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing this debate on an issue that is important to him and his constituents—and, more broadly, to many others. As he rightly outlined, Stanmore is a centre of national excellence in orthopaedic care. It has an international reputation. With the care it provides to its patients, it is one of the best centres in the world.

Before I address the issues my hon. Friend raised, I pay tribute to all those who work in our NHS—not just in his constituency, but right across the country—for their dedication, determination and commitment in providing first-class services to all whom they care for. I know that he made his remarks in that spirit. First-class, dedicated NHS staff need to be supported with the right facilities to provide that level of care. That is exactly why he raised the issue today, and I hope my remarks will bring him some reassurance.

One issue I wanted to pick up on was consultancy spend. I agree with my hon. Friend that hospitals spending money hand over fist in that way on consultants is completely unacceptable. I hope he will be pleased to know that the consultancy spend in the NHS has been reduced by £200 million since the previous Labour Government were in power, which is a strong step in the right direction. Many of the issues that he raised on that are historical. We have introduced new section 42 guidance for trusts that are in deficit to ensure that they are much more rigorous in how they spend their money when they want to receive additional Government cash. Looking at consultancy spend and ensuring that money is not wasted in the way that he outlined are important parts of the new criteria.

As we have heard, the RNOH is the largest orthopaedic hospital in the UK and is regarded as a leader in the field of orthopaedics in the UK and worldwide. It provides a comprehensive range of neuromusculoskeletal health care, ranging from treatment for acute spinal injuries to orthopaedic medicine and specialist rehabilitation for those who suffer from chronic back pain. The range of specialist treatments provided by the trust includes: the rehabilitation of people with life-threatening conditions, including spinal cord injuries; the innovation of new treatments, which is increasingly important, particularly in the areas of care provided by the hospital; leading-edge research and development; the manufacture of state-of-the-art prosthetics; and the training of future orthopaedic specialists. The trust is a national provider of health care: 45% of the trust’s patients live in London, a further 22% are from the remainder of the south-east, 31% are from further afield in the UK and 2% are international, which shows the hospital’s outstanding reputation.

The RNOH plays a major role in teaching. More than 20% of all UK orthopaedic surgeons receive training there, which is testament to the desire of the surgeons of tomorrow to ensure that they train and have experience of providing care at an outstanding centre of excellence. Patients benefit from a team of highly specialised consultants, many of whom are recognised for their expertise both in the UK and abroad. As my hon. Friend outlined, according to the friends and family test, Care Quality Commission inspections and many patient indicators, Stanmore is a centre of excellence and produces the very best possible care and results for patients.

The RNOH’s proposed redevelopment of the Stanmore site is key to ensuring that it can continue to improve the care it provides. I am aware that most of the buildings at Stanmore date from the 1940s, and many are no longer appropriate or fit for purpose for the high-quality care and excellent clinical outcomes that the RNOH provides for its patients. The plan is to rebuild the hospital so that it can continue to provide its specialist orthopaedic care to thousands of patients, young and old, with conditions too complicated for other larger general hospitals to handle. The new hospital will be a state-of-the-art facility that reflects and enhances the medical excellence that already exists at the RNOH. It will provide 124 beds, the majority of which will be in single rooms, thereby greatly enhancing patient privacy and dignity and helping to reduce the transference of infection, the incidence of which, as my hon. Friend outlined, is remarkably low at the trust.

Patient experience will be enhanced through a number of en-suite single rooms and modern, spacious and well-equipped communal areas. Improved facilities for staff will give them a better environment in which to work, enabling them to provide the best possible care. The RNOH is renowned worldwide for its clinical excellence, and manages to maintain high standards of outcomes despite the condition of the estate. The trust looks forward to continuing that high standard of care in the new hospital, which will provide an enhanced setting both for patients, and for support staff delivering the highest possible quality of care.

I appreciate the concerns that have been expressed. My hon. Friend called some of the challenges Kafkaesque, and I share his frustration at the difficulties experienced in developing and improving the facilities at the trust. It has taken a long time to get the proposed redevelopment to this point. Nevertheless, it is important that the business case is affordable. We know some of the historical dangers and challenges of unaffordable private finance initiative deals. In fact, a PFI deal crippled the South London Healthcare NHS Trust; that serves as a reminder to us all of the challenges that hospitals will face in achieving sustainability and delivering high-quality patient care if they take on unsustainable and unaffordable PFI deals.

I know that it has been frustrating, but we must ensure that the financial arrangements for the loan, as well as those underpinning the new development package, are sustainable, in order to ensure that the future provision of services is not jeopardised by a rush into an imprudent financial arrangement. It is in that spirit that there has been a lot of due diligence, although I accept that it has been frustrating.

In April 2013, the NHS Trust Development Authority took over responsibility for approving business cases for estate redevelopment. Between April and December 2013, the TDA worked with the trust to address the additional assurances required on the draft appointment business case. Both the trust and the TDA are clear that the right solution must enable the provision of excellent services to patients, be affordable, and offer value for money.

In December 2013, the RNOH trust board determined that it was unable to give its continued support for the draft appointment business case, because the trust concluded that the risks to affordability and flexibility associated with continuing with the scheme as then proposed were not sustainable. At that point, recognising the importance of the proposed redevelopment, the TDA committed to supporting the trust in working up alternative options for funding. The TDA has been supporting the RNOH to develop a business case that offers value for money and stands a good chance of securing the necessary funding to enable important improvements to be made for the benefit of patients. Serious consideration must also be given to the impact on the long-term sustainability of the trust.

In January 2014, when the financial modelling was complete, the trust concluded that a PFI scheme was unaffordable and that it wished to pursue an alternative scheme. In May 2014, the trust presented to the TDA an outline of its new preferred option for the redevelopment of the Stanmore site. It is a smaller-scale capital redevelopment, costed at around £40 million, as my hon. Friend said. The cost is to be met jointly through public funds and the proceeds from land sales.

Hospitals and trusts sometimes have surplus land that is not used for patient care, and that it costs them money to maintain—money that does not go to front-line patient care. It is of course right that, if they would like to redevelop facilities for the benefit of patients, they should use some of the capital receipts from the sale of that land to contribute to any planned redevelopment. It is in that spirit that the new package was put together. Indeed, it is in that spirit that the section 42 guidance for trusts in deficit that require finance, which I outlined earlier, was drawn up. Where trusts have surplus land that they could release because it is not required for patient care, that land can be freed up in order to provide affordable homes for local people, support the construction industry and, of course, reduce the overall cost of running a trust’s estate. That is a win-win situation for the NHS, as well as for the local economy and, often, young families in the area. I am sure that that will be a benefit of the proposed new scheme, as my hon. Friend said.

The TDA supports the approach that has been put together as part of the £40 million package, and will advise and support the trust on the development and submission of its application for public funding and its business case for the sale of land.

Looking to the future, I understand that the TDA received the trust’s revised outline business case on 29 January. The TDA is now assessing the business case with the aim of making a decision at the earliest opportunity; its board meeting will be held on 19 March—in less than three weeks’ time. This morning, I spoke positively to the TDA about the business case. I have every hope that the outline business case will be strongly supported. We must obviously wait for the outcome of the meeting, but I hope that my hon. Friend and his constituents will hear good news later this month.

The TDA recognises the unarguably poor quality of the Stanmore estate, and the great challenges that that presents to the delivery of high-quality health care and a positive patient experience in the months and years ahead. It is mindful of the need to make a swift decision, so it is committed to working alongside the trust to agree a business case for clinical quality reasons. It is vital that that is done in a way that safeguards important services for patients. Now that the TDA has received a formal business case to review, the process will continue at pace. Once the business case is approved, the TDA will support the trust in developing a full business case and finalising any outstanding assurances that might be required, in the shortest time possible.

I hope that my hon. Friend is reassured that a very active process is now in play, with the Trust Development Authority proactively supporting the trust to progress its business case, which I am optimistic will be approved in its outline form later this month. I hope that my hon. Friend’s constituents will then receive some very good news that will be welcomed not only at Stanmore and by his constituents, but by orthopaedic patients in this country and elsewhere in the world who receive the best possible care from the trust.