Hospital Services (North-East)

Grahame Morris Excerpts

Tuesday 27th July 2010 Westminster Hall

[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”—

[Mr Burns]

I want to reassure the hon. Gentleman, with regard to the changes made by Hansard, that there was no confusion on my behalf at all. The Hansard scribe printed it wrongly and I sought for it to be corrected. That is what happened—no confusion on my part.

--- Later in debate ---

[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?

[Mr Burns]

I am grateful to the hon. Gentleman for giving way again. Let me just clarify it for him. The figures were £5,000,033,000 and £5,000,024,000, not £5,000,240,000.

[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—

[Ian Mearns (Gateshead) (Lab)]

I have to say that the figures that the Minister has just given in his intervention on my hon. Friend seem to make the Government’s position even worse than I thought it was. What we are actually talking about is a margin of difference of £11,000—based on the figures that he has just given us here in Westminster Hall—across the 35-year operating programme. Now, I am not sure if that is actually correct. I wonder if it is a bit like the lists given out by the Secretary of State for Education; the figures and the numbers keep altering on us. But based on the figures that the Minister has just given us, we are talking about £11,000, and that is the cost of not having a brand spanking new state-of-the-art hospital to serve five constituencies: my own constituency; the constituencies of my hon. Friends the Members for Stockton North, for Hartlepool and for Sedgefield (Phil Wilson), and the constituency of the hon. Member for Stockton South (James Wharton).

[Grahame M. Morris]

There seems to be some confusion here with the figures. However, in my mind, perhaps in the minds of other Labour Members and certainly in the minds of the good people of Easington, it only shows what a bad decision it was. I do not believe that it is being made for the stated financial reasons, but instead seems to form part of some type of idelologicallybased course of action taken by the coalition Government.

It is clear now that the saving of £464 million—the figure that was widely quoted to the media at the time of the hospital’s cancellation—is completely misleading. At some point, I hope that we will also get to the bottom of the true costs to the taxpayer of cancelling and pulling the plug on this new hospital development, which, as my hon. Friend the Member for Hartlepool has indicated, has been in the planning since 2005.

On 2 May 2010, in an interview with Andrew Marr, the right hon. Member for Witney (Mr Cameron) talked passionately about how a responsible society should protect the vulnerable. This is what he said:

“The test of a good society is you look after the elderly, the frail, the vulnerable, the poorest in our society. And that test is even more important in difficult times, when difficult decisions have to be taken, than it is in better times.”

I am sure that many of my colleagues knew at the time, as I did, that that statement lacked substance.

Easington is one of the most deprived areas in the United Kingdom. Health inequalities still play a large role in Easington; there is shorter life expectancy and poorer quality of life. Life expectancy in Easington is a full two years lower than the national average. The proposed new hospital was part of a clinically led strategic reorganisation of health provision for one of the poorest areas in Britain, which would have gone some way to tackling some of the worst health outcomes in the country.

The latest figures that I have been able to access are the 2007 statistics on standardised mortality rates per 100,000 population. They show clearly that death from illness that is amenable to health care—that is, deaths that would have been preventable with health interventions—accounted for 256 deaths per 100,000 of the population in the Easington local authority area, compared to an average of only 195 across the rest of England and Wales. For all causes, the figure for Easington is 713, compared to 582 for England and Wales. For coronary heart disease, the figure is 112 per 100,000 in Easington compared to 90 per 100,000 across the rest of England and Wales. For cancer, the figure for Easington is 219 per 100,000 compared to 175 nationally.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend agree that one of the success stories in his constituency has been the local primary care trust’s anti-smoking policy—the area has seen some of the largest drops in smoking anywhere in the country? Does he also agree that the fact that that policy will be abolished too will add to the health inequalities in his constituency?

[Grahame M. Morris]

That is a very good point and the development of community health infrastructure has been integral to the proposal for the new hospital. It is key to improving health and tackling health inequalities.

I have some sympathy with the Minister, as it seems that the proposed hospital suffered at the hands of the Chief Secretary to the Treasury as he searched to save around £2 billion in June. However, regardless of the changing economic circumstances that saw Britain’s budget deficit improve by £10.4 billion from the original pre-election forecasts, I do not believe that it is too late for the Minister to give the proposed new hospital a second chance, following a reconsideration of the evidence.

[James Wharton (Stockton South) (Con)]

Will the hon. Gentleman give way?

[Grahame M. Morris]

If you do not mind, Mr Sheridan, I will not give way to the hon. Gentleman. I know that time is short, but I am almost finished and I think that the hon. Gentleman will have an opportunity later to speak. I have almost completed my contribution.

As it stands, the future of health provision in North Tees and Hartlepool is being put at serious risk. The cancellation of the hospital at Wynyard can only ever be viewed as a delay—the need for it still exists. Whether it is a delay of five years, 10 years or longer, the people of Stockton North, Stockton South, Hartlepool, Easington and Sedgefield need a new hospital. I invite the Minister to think in the long term and not to abandon a well thought-out project that would improve health care for people who have suffered a legacy of some of the worst health outcomes in Britain.

--- Later in debate ---

[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.

[Grahame M. Morris]

Will the Minister give way?

[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.]

North Tees and Hartlepool NHS Foundation Trust

Grahame Morris Excerpts

Monday 5th July 2010 Commons Chamber

[Alex Cunningham]

These issues were extensively explored with the public. There was detailed and extensive formal and informal consultation involving public meetings, leaflet drops to households and a radio campaign. The Government had promised additional funding to tackle some of the transport issues and communities across the place were in favour of the hospital.

I must outline why the new hospital should remain a priority for the new Government.

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend the Member for Stockton South— [Interruption.] I am sorry—we will get that one next time. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate. People in my constituency and the five others that were to have been served by this new hospital need to know why this project was cancelled when three other schemes elsewhere in the country were approved. The Minister is being coy in his written answers to questions, but we really need answers. The need remains. Issues of health inequality need to be addressed. I want to place it on record that south Easington, which would be served by this new hospital, is one of the most deprived communities in the United Kingdom, as identified by the indices of multiple deprivation. Health inequalities still play a significant role in determining life expectancy and quality of life. Health inequalities remain a big issue: they are inequalities not just in terms of outcomes but in access to health care resources—

[Mr Speaker]

Order. May I say very gently to new Members, whose passion for this subject I respect, that although the hon. Member for Stockton North (Alex Cunningham) is showing great forbearance there is a difference between a speech and a short intervention?

--- Later in debate ---

[Mr Burns]

If the hon. Gentleman waits, as I develop my argument I shall continue to explain the reasons for cancelling the scheme within the public spending review.

Treasury and Department of Health Ministers, myself included, decided that, overall, these factors—affordability within the changed economic climate and the foundation trust status—weighed more against the scheme for North Tees and Hartlepool than against the other three schemes for the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Epsom and St Helier University Hospitals NHS Trust and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew their support for the scheme.

If I may, I shall just answer one question that was mentioned in an intervention on the hon. Member for Stockton North. The question was, “Why North Tees and Hartlepool and not the three other schemes?” After looking into the situation, we found that, for example, the Royal Liverpool university hospital building is not compliant with fire safety regulations, and that its mechanical and engineering services are more than 30 years old and at increasing risk of failure. Some 94% of St Helier hospital’s buildings are more than 50 years old, and the 2007-08 data show that the total maintenance backlog for the Royal National Orthopaedic hospital is £53.8 million; for Epsom and St Helier it is £23.8 million; for the Royal Liverpool it is £16.3 million; and for North Tees and Hartlepool it is £3.5 million.

[Grahame M. Morris]

On the point about affordability and the Minister’s suggestion that the foundation trust look towards PFI, how would such a proposal be more affordable when the evidence suggests that PFIs are 14 to 20% more expensive to deliver? The need certainly exists, and we need to deliver quality health care, but affordability suggests that the public purse is the best way to do it.

[Mr Burns]

I am very grateful to the hon. Gentleman. Earlier today, his right hon. Friend the Member for Leigh (Andy Burnham) made the point that it would be cheaper to have a new hospital than to maintain the existing two ageing hospitals. I do not believe that that is accurate. The business case actually showed that the whole-life costs of continuing to operate and provide services from the two hospitals were very similar, but slightly lower than the whole-life of costs of operating and providing services from the proposed new facility. Over the appraisal period of 35 years, 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 defects, maintaining, operating and providing services from the two existing buildings was £5.024 billion.

However, the North East strategic health authority, Hartlepool primary care trust and Stockton-on-Tees primary care trust have pledged to continue working closely with North Tees and Hartlepool NHS Foundation Trust to plan and develop the best possible health services for the local population of Hartlepool and North Tees. I understand that the chief executive of North Tees and Hartlepool NHS Foundation Trust is currently reappraising the available options. As I have said, NHS foundation trusts have greater financial independence, which includes consideration of the private finance initiative. I am advised that the chief executive of the trust has already said that the PFI is one of the options that he is looking at, but any new proposals must be realistic, affordable and provide value for money. I cannot in any way give any guarantees that such a scheme would or would not be approved. Like all schemes, any proposals that might come forward would have to be considered on its merits and in the light of the economic climate at that time.

The local health economy is also ensuring that the wider momentum project, which involves bringing health care services closer to communities, will continue. I am delighted that on 10 May this year, the new integrated care centre known as One Life Hartlepool, located in Hartlepool town centre, opened its doors to patients. Hartlepool primary care trust has transferred a range of community services into this new £20 million facility. The PCT is working with North Tees and Hartlepool NHS Foundation Trust to agree a programme for moving a range of out-patient services into the building. In addition, work is continuing on the outline business cases for integrated care centres in Billingham and Stockton.

In conclusion, any new proposals to develop—