Acute NHS Care: South-west Hertfordshire

(Limited Text - Ministerial Extracts only)

Wednesday 13th March 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Sir David, and to respond to my right hon. Friend. I want to say at the outset that one thing we absolutely agree on is what he said in his opening remarks. He expressed, in bringing forward this important matter for debate on behalf of his constituents, recognition of and admiration for the frontline staff. Even though I do not know the frontline staff in his area, I know from my visits in my short time as Minister and from my constituency experience that the professional care they deliver is admirable and extraordinary. We should never forget the effort they put in, and my right hon. Friend is right to acknowledge that.

Before I address specifics, and before what I suspect will be an iterative debate, I want to deal with two fundamental points, which I know my right hon. Friend knows, but are worth putting on the record. First, any service change in the NHS must clearly be based on clear evidence. Secondly, before any substantive change is made, patients and the public should be consulted. My right hon. Friend raised two interesting subjects on which we could have a debate of an hour and a half, or probably even three hours. One was local accountability in the NHS, in its wider sense and form, and how he is accountable as the Member of Parliament. The other was funding criteria.

My right hon. Friend has, I think, addressed two other Ministers on his passion for the longstanding need to improve the quality of hospital infrastructure in west Hertfordshire. That has been a stated aim of the Hertfordshire and West Essex sustainability and transformation plan since its inception. I know it is engaging in the process of looking at how a redevelopment and redesign of the hospital provision in west Hertfordshire can be achieved, working alongside NHS England and NHS Improvement.

I recognise that my right hon. Friend has real concerns and real scepticism about the work of the CCG. I hope he will recognise the work that the sustainability and transformation partnership is involved in in the hospital development process, and the fact that the director of strategy took part in a process and evaluation meeting in February 2019, at which a shortlist of our options was discussed. The STP is also due to take part in the next evaluation event.

I understand what my right hon. Friend says about the capital. I hear his criticism and scepticism of the West Hertfordshire hospitals trust, but it has been taking the lead in developing the strategic outline case for change. I understand that it and NHS Improvement had dialogue, and feedback was provided on the strategic outline case for the acute hospital redesign submitted by the trust. I also understand, as he will, that the feedback made two key points: it was clear, first, about the need for funding, and secondly, that the overall public money for hospital redevelopment is relatively limited.

My right hon. Friend has raised the issue of the £350 million; he knows that the turnover figure is a key criterion and a key threshold for capital investment, and that any options that significantly exceed the £350 million capital cost have been excluded from the current shortlist. He is obviously aware of a £750 million figure being used locally, but I must confess I am not aware of that figure. I would be delighted to offer him a chance to sit down and try to work out with me where that figure came in—recognising, as he rightly points out, that it will not be a Minister who makes any decision. If it is helpful to him, I am happy to have that discussion.

[Sir Mike Penning]

I had that discussion with the Secretary of State, a couple of days after he was appointed. It is not just Ministers that I pick on—Secretaries of State get it in the ear as well. There are two points I would like to touch on. First, how can it be fair to a community that, if it is just based on the turnover of a trust and that trust happens to be a very small one, the provision we get locally is second class? We cannot even go to that territory. Secondly, on the £750 million, I will ask the Minister to step in, because that is the figure being used locally to rule out the greenfield site. There was an evaluation panel, and members of the panel asked for the greenfield site to be put in, and fundamentally, it appears to me, they have been completely ignored.

[Stephen Hammond]

I made the point a moment ago that, because the cost of that greenfield site exceeds the £350 million threshold, it has currently been dropped from the shortlist of options. My right hon. Friend repeats a point that he made during his speech, questioning the criteria; he will know that I have heard what he has said. As he has just informed me, he has made a representation to the Secretary of State about that figure, and I have offered to have a meeting with him so that we can both explore it.

I do not think that, in the relatively short time available, I should get into the debate about the loan criteria, as I said at the beginning. We can have that debate at some other stage if my right hon. Friend wishes to put it forward, but he knows that at the moment the key threshold for capital investment would be the turnover, and therefore options that significantly exceed a £350 million capital cost have been excluded. As part of the option appraisal process, senior leaders and clinicians, as well as expert analysts, were involved in information gathering to put together the option evaluation. He will know that that included demand and capacity analysis based on population, hospital activity and operational planning.

With regard to reviewing that process, my right hon. Friend, as he said, wrote to both NHS England and NHS Improvement concerning the approval process. As he referenced in his speech, he forwarded to them an email from Professor Ron Glatter of the New Hospital Campaign. I understand that in that email, the professor requested a full statement of the outcomes of NHS Improvement’s review of the trust’s acute transformation strategic outline case.

In its answer, NHS Improvement has so far said that it has not started its formal review because the Treasury and the Department have not yet decided whether the proposal represents a scheme that can in principle be supported by central Government. I recognise the strength and effort of the campaigning for the new hospital option and I acknowledge the expert views that have been sought. While it is obviously not right for me to prejudge the answer from NHS Improvement, I know my right hon. Friend will recognise that I and the Department must take a wider view and that decisions made on capital funding must be the same for everyone across the country.

There has clearly been a huge amount of public engagement throughout the process, and I understand that further public engagement is planned for this month. Notwithstanding my right hon. Friend’s scepticism, I understand that the results of those consultations, in terms of the preferred way forward, will be taken to the trust board and the CCG in June 2019.

I recognise my right hon. Friend’s commitment to improving services; I assure him that the information provided by the New Hospital Campaign is being considered and will be considered as part of the review. As I said, it is not appropriate for Ministers to comment on specific decisions but, as he knows, the Government are determined to encourage innovation and to ensure that all patients have access to high-quality services. The updated proposal will clearly help to inform both the Department and the Treasury about capital allocations in the next spending review. I will not rehearse the arguments about the extra £33.9 billion of cash to support the NHS, or the additional capital and the bid we are putting forward in the comprehensive spending review.

[Sir Mike Penning]

If we accept that the rules at the moment are that any bid cannot be over the revenue income, which is the £350 million, can the Minister explain to me why, in Birmingham, the new build for 750,000 people cost between £300 million and £350 million, which we know because of the Carillion contract that collapsed, and the Royal Liverpool cost £335 million, yet we have been ruled out of having any new build on land that is actually owned by us—one of the sites is on Crown Estate land, public land—because it would exceed £350 million? I know he probably will not have the ability to answer that this second, but a letter in the next few weeks would be very helpful.

[Stephen Hammond]

As my right hon. Friend knows, all Ministers can make an attempt at an answer, but I am sure he would prefer a detailed answer. Therefore, I will make that detailed response to him, as he has asked, in a letter. I also know that he would like me to commit to the spending now, but he will know that I am unable to do so at this stage. I have listened carefully to his points about what might be the cost of the redevelopment that he believes should happen, and he will know that I have heard that. He will also know that I have heard the differences that he has pointed out between the supposed or quoted cost and the cost of build in other areas. He knows that I will have taken that on board.

At this stage, with just 30 seconds to go, I thank my right hon. Friend for bringing this matter to the Chamber and for making the case yet again for his constituents. He should know that the Minister and the Department have listened, and I will respond to him and have that meeting with him.

[Sir Mike Penning]

rose—