The Future Of St Bart’s
April 17, 2002
It is nice to be here and, although there are not many hon. Members present, several interested parties are here to listen to the debate.
I am honoured to lead this brief debate this afternoon. Although the debate concerns the future of St. Bartholomew’s hospital, I will briefly dwell on its history. It was founded as long ago as 1123, and was the first hospital in what is now the United Kingdom. It received its royal charter from Henry VIII in the 1540s, and anyone who walks through West Smithfield will see his statue. Exactly 100 years ago, it became the first teaching hospital in the country. In all that time, it was endowed and supported by the local community; indeed, that local support was integral to its continued existence for centuries.
Barts, as local residents affectionately know it, is internationally renowned for its medical excellence. Institutionally, it is equally well known across the nation. I would not mind betting that if we asked people anywhere in the United Kingdom to name one hospital other than their own general hospital, Barts would be mentioned more often than any other hospital.
The National Health Service was founded in 1948. It is ironic that, today of all days, when the Chancellor of the Exchequer will extol the virtues of Labour’s health service, we must remember that St. Bartholomew’s hospital happily operated without the health service for 825 of its 879 years. I am afraid to say that it has only been in the 54 years since the nationalised health service came into being that the hospital’s future has been threatened.
I take no pride in confessing that it was my party, the Conservative party, that sought to implement the Tomlinson report when it was last in government. The report was, in my view, predicated on user figures that applied in the depths of the early-1990s recession and which were manifestly not borne out. It is a great regret that my party put in place some of the reforms that have affected Barts and which have upset not only the residential population of the City of London, but people across London and much of the UK. One thing that has become evident to me, even though I became a Member of Parliament only nine months ago, is the strength of feeling throughout the UK among people who have great reason to thank the staff at Barts or who simply see it as one of those institutions that have been undermined over the years.
The Minister and I must have an eye on the decades to come, rather than simply the past. Independent bodies have made projections about the City fringe working population. The Minister may know that the figure was 550,000 in 1999 and that is envisaged to rise to about 695,000 by 2016. A further 150,000 people are therefore expected to start working in the City fringe area in the next decade and a half.
We must also consider the residential population of the City of London; my constituents. In the past decade, the population has increased for the first time in more than two centuries. As many people will know, roughly 160,000 people lived in the City of London at the time of the first census in 1801. As of last year, the figure was 6,500 and rising. The City of London is now a very attractive place to live. The Minister will be aware of the Barbican, which is no more than a stone’s throw from the West Smithfield site, but there are other new developments. There is a thriving residential community in the City of London.
There are difficulties with congestion in central London, and Mayor Ken Livingstone is putting his congestion charge in place in the next nine months. It is only a couple of miles from the eastern fringes of the City of London down Whitechapel road to the London hospital, but the journey can take a perilously long time because of the congestion that is part and parcel of life in central London.
In several debates about London in Westminster Hall and the Chamber, I have said that we must recognise that London remains the economic powerhouse of the United Kingdom. The London Development Agency, under Ken Livingstone, recognises that. We have a crisis with our infrastructure in the capital, and that seems likely to remain for some time. Health is only one relatively minor aspect; transport, which has been much in the headlines, and other areas, particularly housing, are also part of the difficulty for central London in ensuring that highly-qualified public sector staff work here.
I work closely with several Labour Members, Liberal Democrat Members, and the cohort of 13 Conservative Members in London. There is agreement across the political divide to ensure that we avoid the idea of a zero sum game, which the Government have all too often tried to impose on London. For example, there is an idea that for Barts to get better health care, other places must suffer; the Homerton and Whittington hospitals, or others in London’s five rather large health authorities, must get fewer resources. The argument is that if more money goes to central London, the suburbs must suffer, but I entirely reject that reasoning. London remains the economic powerhouse, and it has great difficulties, which include an increasingly large residential population and a large daytime population.
The events of 11 September were a wake-up call for us all. The threat of a terrorist attack is in the forefront of people’s minds in central London. It applies not just to the City, but to Canary Wharf and this part of London ? Westminster – which is the political capital of the country.
The lesson of what happened in America was that hospitals in New York were close at hand to cater for the relatively few casualties; tragically, there were few casualties, but many outright deaths on that day. If we were to have a similar incident in central London, I believe it would cause utter chaos for our infrastructure. As I mentioned, the two-mile journey from the City of London to the London hospital would be an enormously difficult obstacle to overcome.
There is no necessity to build a new hospital in central London. We have the facilities, and, as many know, enormous investment less than a decade ago went into the Barts site; some £15 million was spent on six new operating theatres, many of which have been under-utilised during the past nine years. At the same time, the right hon. Member for Greenwich and Woolwich (Mr. Raynsford), the Minister for London, has written a letter to several central London Members of Parliament, which recognises:
"The NHS does not have the reserve capacity maintained for the purposes of major incident management."
He had obviously been contacted by a number of the hardworking residents’ groups that have fought a long-standing battle in relation to St. Bartholomew’s. After 11 September, they had clear concerns that difficulties could exist.
I understand that the rumours are true and that a further £18 billion or £25 billion – it depends on which paper one reads – will be injected into the National Health Service in the coming years. Even if the Government do not feel that they can bring back a fully-fledged accident and emergency unit, I should like the Department of Health to consider doing as much as it can for this unique part of central London. Could we have heralded admissions with a receiving room to take account of what I accept, as I am sure does the Minister, is the skewed daytime population of central London? Many people are aged between 18 and 45, and they have particular health needs that are different from those that apply to the suburbs or other parts of the south-east. In Scotland, where accident and emergency units have closed down in city centres, there is some authority and experience of having heralded admissions with a receiving room to take particular account of local circumstances.
I shall not go on much longer, because I should like the Minister to respond at length. The issue of Barts is not a narrow, constituency interest, although there is a growing residential population in the City of London, which has understandable concerns about the relatively long journeys in terms of time – by London standards – that they are expected to take to the Whittington, Homerton or the London. Barts is, and has been since its foundation almost 900 years ago, an asset for all Londoners who rely on the City of London services daily for their work and pleasure.
I want to salute the hard work of several people, particularly Wendy Mead, who is in the public gallery here today, as well as many members the Corporation of London, who have fought a long-standing campaign over the years. I have come to the campaign relatively recently, having been elected for the first time last June, though I was made well aware during my 18 months as a prospective candidate that the issue required significant highlighting.
Today, we understand that there will be an announcement of significant new investment in the National Health Service, which will be funded by many of those taxpayers who make up the daytime population of the City of London. I call upon the Minister to explain how he will ensure that the voice of St. Bartholomew’s hospital is allowed to express itself during the ongoing discussions concerning the expenditure of the colossal sums that we envisage being injected into the health service.
The Minister of State, Department of Health (Mr. John Hutton) : I warmly congratulate the hon. Member for Cities of London and Westminster (Mr. Field) on raising this issue, and for the spirit in which he deployed his arguments. I would never accuse the hon. Gentleman of pursuing narrow constituency self-interest, although I suppose that there is nothing wrong with that. However, he has not done so, and that will not form any part of my response to his points.
He has a perfectly legitimate concern, which he has expressed very eloquently, about the ability of the National Health Service to respond to circumstances such – heaven forbid – those which occurred in New York City on 11 September. I want to deal with the concerns that he has raised. I will explain the issues that we have addressed, or tried to, since 11 September, and how we have approached the problem and challenge of dealing with that type of emergency planning scenario in the City of London.
The hon. Gentleman made several points at the beginning of his speech about funding. He referred to a zero sum game and objected to a process that promised development and enhancement of services in some parts of the capital only at the expense of others. I should make it clear that that is not how we do things. We are not funding or securing the development of services at Barts by starving other parts of the National Health Service in London. On average, most health authorities throughout London received a cash increase of about 10 per cent. About £500 million of additional NHS capital investment is going into the city this year in addition to the £600 million of additional revenue support. It is not true to say that development in Barts, or any other part of the NHS in London, is funded only at the expense of reduced allocations to other parts of the NHS in the city.
I want to deal specifically with the points raised by the hon. Gentleman. As a Minister, I have had the good fortune to visit Barts on several occasions. In fact, I was there only last week. I agree entirely with the hon. Gentleman’s description of Barts. It is a building of exquisite beauty with an unrivalled history in the development of medical sciences in our country. I agree with him that our challenge is to secure its future. There is a very lively debate taking place in the Corporation of London and elsewhere in the hon. Gentleman’s constituency about the future of accident and emergency services. The challenge for us today is to think about how we develop the long-term future of hospital services on that site, and that is where I want to start my comments today.
The hon. Gentleman will be aware that developments at Barts will be at the centre of a huge capital scheme, worth £620 million, to build a major new teaching hospital at the Royal London hospital, Whitechapel, and secure the development of Barts as a specialist cancer and cardiac centre. I should point out the scale of that to the hon. Gentleman: it is the largest hospital development scheme in the United Kingdom today. I believe that the scheme will secure the long-term future of the hospital. It will not bring what the hon. Gentleman has described, but it is a significant moment in Barts history because it will bring major opportunities to contribute for decades to come to the health and well-being of the people of east London and the City.
Following the London review led by Sir Leslie Turnberg in 1997, Barts and the London NHS trust, together with other local NHS organisations, began to develop plans to modernise hospital services throughout the trust. In January 2000, the Department of Health gave formal approval to plans for a 10-year programme of development and improvement to health services. Since that time, the trust’s plans have been developed further, and advanced work is due to commence at St. Barts this summer. The planned development is a combination of refurbishment and new build that will increase by 100 the number of beds throughout the two sites, creating a total of around 1,285 beds, of which 900 will be at the Royal London hospital and nearly 400 at St. Bartholomew’s.
As well as modernising hospital services for east London and the City, the project will also help to regenerate the area by addressing employment, education and environmental improvements. We sometimes lose sight of the fact that the NHS employs about 150,000 people in London and contributes 6 or 7 per cent. of the capital’s gross domestic product. It is obviously a major provider of health care services, but it is also a significant partner in the economic development of the City about which the hon. Member for Cities of London and Westminster has spoken. As well as cancer and cardiac services at St. Bartholomew’s, a range of services will be provided, including diagnostic imaging, pathology and pharmacy services, as well as a patient hostel. The minor injuries unit will also remain fully functional.
The hon. Gentleman did not raise today the issue of whether an open-access chest pain clinic should be provided at St. Bartholomew’s as part of cardiac services, but he has raised it with me before. Local health services already have two chest pain clinics at Homerton hospital and Newham hospital. Those locations were chosen because their local population has the greatest need for those services. Chest pain clinics are generally regarded as general hospital clinics, and as cardiac services at St. Bartholomew’s are regarded as tertiary services, the advice that I have received is that it would not be appropriate for such a clinic to be located at St. Bartholomew’s hospital.
Mr. Mark Field : I appreciate that in the raw terms of population the decision on chest pain clinics makes sense. Clearly the population is based around the East Ham area and, indeed, Hackney. However, does the Minister not recognise – I am sure that he does and I should like to hear his comments – that there is a large daytime working population? When it comes to consideration of such clinics, Barts should be treated as a different, and in a sense unique, case. As I mentioned in my initial comments, there is a daytime population, rather than a full-time residential population, for chest pain clinics of more than 500,000 in the City and its fringes.
Mr. Hutton : I obviously accept the hon. Gentleman’s point. It is the responsibility of local NHS organisations and the new director of health and social care for the capital to keep such considerations under the most careful review. The question is not whether there should be additional services, because I am convinced that there should be and I am hopeful that we will continue to receive the investment to allow such development to take place. The difficulty in all those cases is to decide where the investment should go.
On those issues, I hope that the hon. Gentleman understands that we in the Department of Health always try to act on the best clinical and medical advice. It is very important that that remains so because that is the proper discharge of Ministers’ responsibilities. He and other Opposition Members frequently criticise us for meddling in the affairs of the NHS, and I would take issue with him on that, although not on this occasion. Generally speaking, such decisions need to be informed by the best medical, clinical and scientific advice, and we act on that. If any such advice were different from that that I have received it would be a factor to which I should pay the most careful attention.
Returning to the developments at Barts, the first stage is the £21 million upgrade of the west wing and Kenton and Lucas block using public as well as charitable funds. As the hon. Gentleman will know, the west wing is a grade 1 listed building currently accommodating out-patient clinics and support offices. The greatest care will be taken to maintain historic features while adapting the space for new clinical use. Work is due to commence this summer, and we hope that it will be completed by the end of 2003. Once refurbishment is completed, the breast care unit will be located in the west wing, allowing all those facilities to be centralised together in a new, modern environment.
Refurbishment work at Kenton and Lucas block, a grade 2 listed building, will begin this summer and once completed in 2004, slightly later, will accommodate an integrated rehabilitation unit, sexual health clinic and fertility clinic. Other moves that have already taken place at Barts include the provision of better nursing accommodation for nurses previously housed in Queen Mary wing, which will now be redeveloped to make best use of the space for clinical services. The remainder of the developments at Barts will progress alongside the developments at the Royal London hospital.
In February this year, I announced approval for Barts and the London NHS trust to seek private finance partners to implement the development proposals. The trust advertised in the Official Journal of the European Community in February 2002. It is expected that work will begin on that scheme in 2004.
I want to say a few words about whether full accident and emergency services should be provided at Barts, which I think is the main theme of the hon. Gentleman’s remarks. He has raised with me before his concern that the reviews informing the decision to close the accident and emergency department at Barts were based on old data and that in the climate following 11 September workers in the City need to be reassured that there is emergency provision nearby. I fully understand that. He has asked me to reconsider the decision taken in 1993 to close the accident and emergency department at Barts.
When I last met the hon. Gentleman to discuss those issues, in October, I explained that the decision to close that department would not be revisited. That remains the Government’s position. The decision was based on the best clinical advice from the royal colleges and I am not aware of any convincing new evidence, since the decision was made, that would lead me to conclude that it should be reconsidered.
The closure of the accident and emergency department at Barts was supported in the Tomlinson report back in 1992 on the ground that accident and emergency services at Homerton, Guy’s and St. Thomas’s, the Royal London and University College hospitals were all within easy travelling distance of the population local to Barts and accessible in the event of a major incident. Those services remain in place and continue to be accessible.
Mr. Mark Field : As I understand it, one difficulty in looking at the 1992 Tomlinson report is that the projected figures for daytime population were drawn up at the absolute depths of the last recession, as I mentioned in my initial comments. Even in the seven or eight years since then, we have seen an explosion of the daytime population in London. We envisage that that will continue, in a fairly uniform way, for the next decade and a half. Some of the basic statistical premises made to justify the closing down of the accident and emergency department in 1993 seem, therefore, to be faulty, if not entirely out of place.
Mr. Hutton : I perfectly understand the point that the hon. Gentleman makes, and was hoping to come on to it in a few moments. I do not dispute for a second that matters have changed since 1992. They clearly have. I am on this side of the Chamber and the hon. Gentleman is on the other. That is one change, one of the more welcome ones, but that is not a theme for today.
I do not dispute the hon. Gentleman’s fundamental point that accident and emergency services in London and elsewhere might need to expand as the population grows and as the working population in parts of the country expands. It is the responsibility of the National Health Service to make plans for that. Clearly, if the population increases, we will need more beds in hospitals and more nurses and doctors. That is axiomatic. The argument, in relation to the points about Barts and the wider points that the hon. Gentleman has made, is about where those extra services, if they are needed, should be located. I shall return to that point in a second.
Since the accident and emergency department at Barts closed, the number of accident and emergency attendances at the four hospitals to which I just referred has risen as capacity has increased. In particular, attendances in accident and emergency at Homerton hospital have increased by a little more than one third. That lends support to the view that there is adequate accident and emergency capacity available for the people of east London and the City. Patients are being attended to in those departments well within the time limits that we have set as national targets.
If there were a mismatch between capacity and demand, the length of waiting times in those four accident and emergency departments would be rising significantly. They would certainly not be beating our target of 75 per cent. of patients being treated and discharged or admitted within four hours. Throughout those four departments, more than 90 per cent. of patients are admitted, transferred or discharged within that four-hour target.
The hon. Gentleman will be aware that the accident and emergency department closed in March 1995, and the minor injuries unit opened at exactly the same time. In 1997, as part of the London review, Sir Leslie Turnberg re-examined the St. Barts hospital closure and considered views from as wide a spectrum as possible. That will continue to be our approach.
The hon. Gentleman asked how the people of east London and the City will be able to have a say in decisions that affect health service provision. We certainly need to improve the way in which we communicate with, consult and involve patients and the public in all areas of decision making. I hope that the new primary care trusts, supported by the strategic health authorities, will be able to do that. New legislation in the National Health Service Reform and Health Care Professions Bill will take patient and public involvement in the NHS to a new level.
We are actively trying to encourage a climate in which decision making is as open and informed as possible. I certainly do not take the view that has been put to me on occasions by other right hon. and hon. Members that the NHS operates as a secret society. I understand why the criticism is sometimes made, but it is profoundly damaging to the NHS if such allegations have any legs. It is the people’s service, and the people must be fully involved in the decisions. They may not always agree (that is the problem) but I certainly share with the hon. Gentleman a very strong desire to involve them fully. It happened on this occasion, and we will ensure that it does in the future.
The previous Conservative Administration’s decision to close St. Barts was overturned by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) when he was Secretary of State for Health, but he upheld the decision in relation to the accident and emergency department. It was and remains the right decision.
At the Royal London hospital in Whitechapel, the trust has a comprehensive major incident plan that centres on accident and emergency services. Following events on 11 September, the plan has been updated and was tested as recently as February. The London Ambulance Service co-ordinates a well-rehearsed plan for the transport of patients to several receiving hospitals in the capital in the event of a major incident. The trust’s day-to-day accident and emergency service is run from the Royal London hospital, which has a trauma centre and a dedicated children’s accident and emergency department. A 24-hour comprehensive emergency service is provided seven days a week, including on-site senior accident and emergency staff. In fact, the accident and emergency department at the Royal London hospital is unique within London and the United Kingdom in its provision of a resident accident and emergency consultant 24 hours a day, Monday to Friday. That is not the case anywhere else. It has some of the best clinical outcomes in the UK for patients who undergo surgery following emergency admission.
The minor injuries unit continues to operate at St. Barts. It is open from 8 am to 8 pm, Monday to Friday, and will be retained as part of the new development. There is no prospect of its disappearing. In the event of a major incident in the City, which is the hon. Gentleman’s concern and should be a concern of us all, there is an escalation plan for the walking wounded who might arrive at St. Barts, but the hospital would not receive any patients directly from the London Ambulance Service. That is a clear protocol.
Two new walk-in centres were developed at the Newham and Royal London hospitals during 2000. They will offer fast and convenient access to local NHS advice, information and treatment seven days a week without an appointment.
The hon. Gentleman rightly raised the question of the future of St. Bartholomew’s hospital. The Government are committed to modernising health services and ensuring that patients receive treatment of the highest quality that is fit for the 21st century. The development of St. Bartholomew’s and the Royal London is part of the commitment and will modernise services for patients and staff in east London and the City. After years of deliberation, the future of the hospitals in those areas is now clear, as the modernisation and rebuilding plans for both sites reach the final approval stages. I say to the hon. Gentleman with the greatest respect that the debate needs to move on, so that we can focus on ensuring the success of the exciting plans to redevelop the NHS in east London and the City.