Royal National Orthopaedic Hospital: Redevelopment

Baroness Ludford Excerpts

Thursday 17th March 2016 Grand Committee

[Baroness Ludford (LD)]

My Lords, I, too, thank the noble Baroness, Lady Dean for this vital and timely debate. I am pleased to speak in the presence of the chairman and the chief executive. I am very glad to count myself among the friends of the RNOH. I have absolutely no experience or knowledge of the NHS, but I am speaking out of gratitude because my husband is a very appreciative patient at the royal national hospital, so I am in a similar position to the noble Lord, Lord Tebbit.

My husband has an NHS position, which I should mention: he is chair of Whittington Health, a trust in north London which consists of a hospital and community services. He was initially treated at the Whittington last autumn for a very serious, life-threatening infection and received the most marvellous and dedicated care from the medics there, whom he and I cannot thank enough. Thanks to them and his own fighting spirit, he pulled through, but his leg had to be amputated, so he passed into the care of the royal national hospital, Stanmore, initially as an in-patient for five days. To be frank, my only personal experience derives from being a visitor there for those few days.

I was, it is fair to say, aghast when I first saw the hospital. “It’s a bunch of Nissen huts”, I exclaimed, which is, of course, precisely what much of it is. I did not see the whole estate, but as it was built in the 1940s, I think that that was fair comment. We went in through a heavy, plastic door, which was all that kept the winter winds from the ward into which we entered directly. So my second thought on arrival was, “What on earth are the heating bills?”. My third thought was that, on a dark winter night, having to find the visitors’ loo outside, across the road and down some steps was less than congenial.

So my first point is that this is no way to treat a national, indeed, an international, centre of excellence. The staff are first class and deliver excellent care, as recognised by the “outstanding” rating given to the hospital by the Care Quality Commission in 2014 for its medical care, which includes the rehabilitation from which my husband is benefiting. However, the staff, the patients, their families and the community are being horribly let down by the appallingly bad, old and decrepit physical conditions. The CQC said the hospital’s premises were,

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

which is, no doubt, why the ratings for out-patients and children’s services were, “requires improvement”. I did not see the children’s wards but I am told that they are the worst of all.

What is it doing to staff morale and the ability to attract the brightest and the best that the powers that be are stalling over the green light for desperately needed redevelopment? With the best will in the world, the morale of patients and their families, at a time when they may be very vulnerable, whether after an amputation or for another reason, will not be increased by such grotty surroundings.

Secondly, I want to express deep frustration at the delay in getting the go-ahead from the NHS Trust Development Authority. This unelected quango— I use that term not to be abusive but as a statement of fact—seems to be the body on which everything now depends. It approved the outline business case a year ago, and I do not understand why it takes so much to get to the final sign-off and permission to borrow.

When the local MP, Bob Blackman, with whom I have been fortunate to have a word, initiated a short but very valuable debate a year ago, the Minister, Dr Daniel Poulter, rightly said of the RNOH:

“With the care it provides to its patients, it is one of the best centres in the world … a leader in the field of orthopaedics in the UK and worldwide”—

including through training and research, and—

“produces the very best possible care and results for patients … The RNOH is renowned worldwide for its clinical excellence”,

He said:

“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”.

He agreed:

“The RNOH’s proposed redevelopment of the Stanmore site is key to ensuring that it can continue to improve the care it provides”.

I was a little worried by his comment that the RNOH,

“manages to maintain high standards of outcomes despite the condition of the estate ”.—[Official Report, Commons, 4/3/15; cols. 350-51WH.]

That is only through the heroic efforts of its staff, which no doubt cannot be taken indefinitely for granted. If they are being heroic about rising above their surroundings, I would prefer their heroic efforts to go into patient care.

Dr Poulter acknowledged the frustration at the delays, saying that due diligence was necessary to ensure financial viability. That is understandable, but the TDA has been on the case for three years, asking for more and more information. As we have heard, the deliberations have gone on for 30 years. Planning permission was received three years ago, which was, of course, the result of a transparent and democratic process by the London Borough of Harrow.

Given the high degree of centralisation of the NHS, I am bemused by the gap between expressed ministerial support and the lack of speedy output from the TDA. Surely the Government cannot be saying that they have no levers to encourage the TDA to get on with it. The medical case for a modern, state-of-the-art hospital seems unanswerable, and it seems that the financial case is equally sound and straightforward. It was given by the noble Baroness. The debate that Bob Blackman MP held was followed five days later by TDA approval of the outline business case. Let us hope that we, through this debate, thanks to the noble Baroness, Lady Dean, might have a similar catalytic effect on its final decision. I look forward to hearing from the Minister that this will indeed be the case.