Royal National Orthopaedic Hospital (Stanmore)

Alan Meale Excerpts

Wednesday 4th March 2015 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to serve under your chairmanship, Sir Alan, in this vital debate that is important not only locally in my constituency, but nationally. The Royal National Orthopaedic hospital in Stanmore is a national and international institution par excellence. I will use a quote that I gleaned when doing some research. The RNOH delivers

“Outstanding clinical outcomes for patients”

in premises that are

“not fit for purpose—it does not provide an adequate environment to care and treat patients.”

I and the staff of the hospital could not have put it better. That is a direct quote from the most recent inspection by the Care Quality Commission in August 2014.

The hospital premises were built during the second world war to house airmen who were defending our shores and to ensure that facilities were available to treat our brave soldiers, airmen and seafarers returning home. Sadly, we still have the same premises that existed during the second world war. I want to put on the record my tribute to the brilliant work that is done by all the medical staff, all the clerical staff and the entire team who provide facilities and services at the hospital. Many charities that are associated with the work of the hospital also operate from the site.

I wanted this debate today because I took the then shadow Secretary of State for Health to Stanmore in January 2010 to see the hospital at first hand. He gave a commitment to the board, the staff and everyone associated with the hospital that, were there to be a Conservative Government after the election in May 2010, the hospital would be rebuilt.

Just before the election, in March 2010, the then Secretary of State for Health, who is now the shadow Secretary of State for Health, announced funding for the redevelopment. It is fair to say that immediately after the election, when hon. Friends discovered there was no money left at the Treasury, I had to work very hard with civil servants and elected politicians at the Treasury to ensure that the promised funding for the rebuilding of the hospital was safeguarded in the emergency Budget that took place immediately after the election.

Here we are now, four and a half to five years on, and there has been very little progress on the rebuilding work. The trust that runs the hospital—I have worked with the board of the trust and others—has responded to every question posed by the trust development authority. It seems almost impossible to get through the positively Kafkaesque process of repeated reviews. The only beneficiaries of that process are the management consultancy firms. Patients and the medical staff have not benefited one iota.

I believe—I stand to be corrected if this is not so—that some £75 million has been spent on management consultants. It has not been spent on the consultants who treat patients, but the people who come and do management studies. I think that that is a disgrace and a waste of public money. All 13 independent reviews have concluded that the orthopaedic hospital offers excellent, high-quality, world-class care. The CQC has rated outcomes as “outstanding”, and the trust is regularly in the top 10% of all hospitals in respect of infection control and friends and family tests.

All independent reviews concerning the hospital’s geographical location have concluded that there are no better alternatives to having the hospital on the Stanmore site. All independent reviews concerning the financial risks associated with the redevelopment have concluded that the Stanmore site development offers the best value for money and that no “more affordable” option is available.

In the meantime, the future of the trust continues to be reviewed, debated and deferred. As I have said, more than £70 million of costs have been incurred, with a severe waste of money on project fees of £20 million, maintenance costs of keeping these rotten buildings going of some £15 million and the lost efficiency opportunity of some £35 million. In this modern day and age, that cannot be right.

By way of background, the hospital is a centre of international expertise in the diagnosis and treatment of neuromusculoskeletal conditions, which include acute spinal injury, bone tumour and complex joint reconstruction. This centre of expertise is not replicated anywhere else within the national health service. It has the largest spinal surgery service in Europe, with a third of UK spinal scoliosis surgery and two thirds of specialist nerve injury work being carried out on the site.

Some 95% of patients rate the care as “good” or “excellent”, and 90% of staff and patients would recommend the hospital to their friends or relatives. The hospital was the longest-standing in London with no MRSA infections in the past five years. Without question, this hospital delivers services and medical treatment that are the best in class. The clinical excellence and innovation are beyond doubt. The problem is that the buildings were built to last for a limited period, but that has stretched to 70 years. It cannot be right that we insist on brilliant medical staff operating in substandard conditions that would shame the third world.

We need to ensure that the rebuilding takes place. I understand completely that the health service has a process for business cases and has to offer value for money. We would all support that in principle. However, as this is a specialist hospital of international renown, it has a special place within the national health service. Successive Governments and the health service have prevaricated on the future of the RNOH for decades—literally 30 years. We have to have a different, more proactive approach to resolve the problem. It is clear that the board that runs the trust will have to conclude at some stage that it can no longer offer safety to patients in the substandard conditions in which it operates.

The creditability of the Government, the national health service and everyone involved is on the line here. Political leadership is required to ensure the best interests of patients and taxpayers. I look to my hon. Friend the Minister for some suitable answers, because this has been going on publicly and privately for the past five years that I have been involved, and, before that, for the past 30 years.

So the RNOH has a track record of delivering financial and performance targets. It responds time and again, updating and revising financial plans and risk assessments and refreshing commissioner support. Every time the board responds, it appears that we do not move forward, but backward. That cannot be allowed to continue and we must reach an appropriate arrangement. We need an innovative and alternative financing option—that is not encouraged through the current NHS process—to ensure that the hospital is delivered.

We should be clear that the key to resolving this matter is the top-up of public money by capital or a loan of some £20 million. It should be understood that the board will build a private hospital alongside the NHS hospital, and that will generate income. The board will also sell off land for housing development, which the area needs, but the board takes the sensible view that it will realise the land receipts gradually as the need arises for the programme’s funding. That will maximise their value and provide a decent level of housing in the local area. Both those things have been positively embraced. The RNOH and the trust development agency have been developing the outline business case since September 2014. In March 2015, we are still waiting to see whether it will be approved and action taken, so that the redevelopment can take place.

It is time that the Department of Health acknowledged that highly specialist hospitals and providers such as the RNOH need a different approach from that taken with the generality of NHS providers. It cannot be right that a super, specialist organisation with such excellent results is denied facilities for the want of a relatively small amount of public money.

In summary, the RNOH is a vital national provider of treatment for the most complex orthopaedic conditions and the rehabilitation for people with life-threatening conditions, such as spinal cord injuries. It does vital work on the innovation of new treatments, leading-edge research and development, the manufacture of state-of-the-art prosthetics and the training of future orthopaedic specialists. The hospital has treated many famous individuals, including Lord Tebbit’s wife after the Brighton bombing and Princess Eugenie. Moreover, the RNOH recognises the financial constraints it operates within and has continuously demonstrated that mitigations to affordability risks are available. Demand for services grows every day. Major land sale receipts will be available. Planning permission is in place; there is no hold-up on that. Housing and employment for the local population will be increased by the proposal, and major private patient income will come in.

The RNOH has a track record of delivery against every target that it has ever been set. It has responded time and again to the requirements of the TDA and every other aspect of the health service. It is clear that every time there has been a step forward, there have been two steps back. Every time proposals have come forward on alternative financing options, we have just ended up spending more public money. If that £75 million had been invested in the project, we would now be looking at new hospital facilities on the site. We would have first-rate, world-class facilities for world-class medical professionals.

No one believes that anyone wants to see the facility closed down, but the reality is that the Department of Health has to move forward and instruct the TDA to abandon the position that it has adopted, so that the RNOH can move forward to development. If we do not do that, we might as well close the hospital. That would be an absolute tragedy for all the specialists, medical staff and patients. By bringing those services together, the medical professionals have developed world-class techniques and an ability to cure individuals of very serious problems. Indeed, the medical staff of the RNOH provide national and international services way beyond the bounds of the hospital. I urge the Minister to give us some good news and to ensure that we get the funding required for the hospital to be rebuilt and for facilities to be provided for the brilliant staff, who do a brilliant job for the patients.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, I want to pass a message on. Generally when debates are answered in this place, the Parliamentary Private Secretary is present. There was not a PPS in the last debate or this debate, and that might happen in the next debate, because I see the Minister for it standing by. When a PPS for the Minister is not present, it is usual for someone from the Whip’s Office to be involved. Sometimes mysterious pieces of advice appear from other places and have to be passed forward to the Minister. When those people are not present to do that, we have to rely on House of Commons staff. They have enough to do, and we should try to help them where possible. I am not saying that it is anything to do with the Minister, but I would be grateful if he could pass that expectation on to the Whips or the PPSs.