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Mr. Michael Jack (Fylde): Thank you, Mrs. Adams, for calling me to put the case for an additional computed tomography scanner at the three-star Blackpool Victoria hospital. May I say at the outset how delighted I am to see the hon. Members for Blackpool, South (Mr. Marsden) and for Blackpool, North and Fleetwood (Mrs. Humble)? I thank them for their support for this initiative.
However, in spite of Herculean efforts by the clinical staff, there is tremendous pressure on the existing scanner facilities. I hope that the debate will make a case on their behalf to ensure that the current capacity is increased.
Mrs. Joan Humble (Blackpool, North and Fleetwood): I thank the right hon. Gentleman for giving way so early in his contribution to this important debate. Is he aware that the Department of Health has not yet determined the criteria for allocating new scanners through the renewal programme? Does he agree that the Blackpool Victoria trust must develop the case-of-need document that it has to submit to the Government and outline how vital additional scanning facilities are for my constituents, his constituents and those of my hon. Friend the Member for Blackpool, South?
Mr. Jack : The hon. Lady makes a valid and relevant point. I shall develop that theme later in my remarks. The purpose of the debate is to accelerate the process that she has carefully described, because the pressures exist now and must be addressed.
The hospital has one CT scanner and one magnetic resonance imaging scanner, both bought as a result of public subscription. There is strong feeling in the area that the time has come for capacity to be expanded, but not by public subscription out of public funds.
I want to put on record my appreciation of the help given to me in preparing for this debate by Dr. Neil Flanagan, the senior radiologist at the hospital, who first drew my attention to this matter, as well as to Mark Lambert, one of the consultant surgeons, Dr. Graham Hoadly, the clinical director for radiology, David Gill, the chief executive, and to my own researcher, Caroline Evans. All of them have managed to put together what I believe is a very good case for the development of scanning facilities at the Blackpool Victoria hospital. The hospital, local Members of Parliament and patient groups are at one in arguing for this case.
How have we reached the point of having to raise this matter in Parliament? In the national cancer plan, the Government have rightly reduced the time between the initial request by a patient to see his or her general practitioner and the granting of an out-patient appointment to a minimum of two weeks. As the consultant radiologist told me, one problem that has arisen, as people come forward more quickly for their out-patient appointment, is that the demands on them
Urgent action is needed on this matter because an implication of the national cancer plan is, as I understand it, that by 2005 there should be a two-week time frame for urgent CT scans. Other developments, such as the National Institute for Clinical Excellence and the national service framework for older people, require all patients admitted to hospital with a suspected stroke to receive a CT brain scan within 48 hours by April 2004. That illustrates the pressures building up on scanning facilities at the Victoria hospital. To return to the intervention of the hon. Member for Blackpool, North and Fleetwood, if action is not taken now, we will not have sufficient scanning capacity to meet those very important new requirements and criteria.
Mr. Gordon Marsden (Blackpool, South): I am grateful to the right hon. Gentleman for giving way, and for securing the debate. Although it concerns the hospital in my constituency, it affects all on the Fylde. My hon. Friend the Member for Blackpool, North and Fleetwood referred to the criteria allocation. Does the hon. Gentleman share my concern that, in deciding the database for allocation in the region, sufficient attention should be given to the peculiar and specific circumstances of the Blackpool Victoria hospital? It treats a large number of visitors and tourists, and the Department of Health is not sufficiently addressing those criteria.
Mr. Jack : The hon. Gentleman raises an important dimension of the work of the Blackpool Victoria hospital, which is not always recognised in formulas for funding and resource allocation. He makes a valid point about the pressure on the hospital, which I am sure the Minister will want to acknowledge when she winds up the debate.
Looking at the matter from the patients' standpoint, I was struck by a letter from the Lymphoma Association. The regional co-ordinator of that association and a patient, Mr. Philip McIntyre, wrote that he was diagnosed four years ago with non-Hodgkin's lymphoma. He said:
As you already are aware, the cancer workload at Preston and Chorley hospitals is similar to Blackpool. They have three scanners and Blackpool Victoria hospital has only one, this being provided from charitable donations...To be told you have cancer can be devastating both to the patient and the whole family, to have to wait upwards of 8 weeks for a scan is totally unacceptable.
Four years have gone by, if I was being diagnosed today and having to wait 8 weeks for a CT scan due to only one scanner being available, my outcome does not bear thinking about."
The hospital has not taken the current pressures lying down. On 31 March 2001, the health authority agreed to provide £150,000, and a further £300,000 will be available from 1 April 2002 to increase scanning capacity. I want to put on record my appreciation of the efforts of Dr. Rodger Berry at the hospital. Despite personal injury and illness, he came in to try to help with the work being done to increase the existing system's throughput. Extra scanning sessions have been arranged, some of the work has been moved from the CT scanner to the MRI scanner and work has been undertaken at weekends.
The additional permanent scanning hours have funded much additional work, but have put tremendous pressure on the clinicians and their support staff. There are two vacancies for radiography posts in Blackpool. As the hospital put it to me, there is little chance of bringing more people in despite the fact that those currently there are being worked to the limit.
Mr. Marsden : On that point, I too pay tribute to the diligence of the hospital staff in extending those hours. I raised the issue at the end of last year in correspondence with my noble Friend Lord Hunt and received the response that weekend that extra hours were being worked. Does the right hon. Gentleman share my concern that that inevitably puts pressure on those facilities and that if, God forbid, there were to be problems regarding the overuse of that scanner, it would make the situation at Blackpool Victoria even more urgent and perilous?
While we are looking at the question of patients, I received a copy of a letter from a constituent of the hon. Member for Blackpool, North and Fleetwoodalthough, looking at the address on the letter, he may be a constituent of the hon. Member for Blackpool, Southwho commented on the pressure on patients. He has an orthopaedic problem, but because an X-ray failed to show damage he was told that he must wait 15 to 16 months for a scan. Officially, there is a four-week wait for urgent CT and MRI scans, but more tellingly there is a 10-month wait for routine CT scans and a 15 to 16-month wait for MRI scans.
A local primary care group attempted to introduce direct GP referrals to a hospital in Liverpool to get round those roadblocks. Unfortunately, that did not work out as the GPs had hoped, but the Blackpool Victoria trust took up some of that capacity by moving 500 cases to Liverpool. We have not seen the benefit of the extra hours that are being worked because the more difficult cases reside in Blackpool. That has affected the productivity of the scanning facilities and illustrated the pressures on capacity. The Chorley and South Ribble and Preston Acute Hospitals NHS trust have one scanner per 300 acute beds; Southport, a place similar to Blackpool, has one scanner per 456 acute beds; Blackpool has one scanner per 658 acute beds, which makes it the 11th worst acute hospital trust in the United Kingdom for scanner capacity. That figure is telling.
There is a good business case for why we should have a new scanner. The question of upgrading the existing scanner was looked at, but there were significant disadvantages, especially from the radiographers' point of view because they feel that this would provide insufficient throughput to meet the forward demands of the new national cancer plan, and the NICE and national service framework recommendations. A second CT scanner would double patient throughput, reduce patient waiting times, provide a better response to in-patient requests, facilitate better training opportunities for staff, allow the department to acquire a modern scanner capable of enhanced functions that are currently not available, provide extra cover in the event of the other machine breaking down, allow additional capacity to be phased in on a sessional basis and, most importantly, anticipate future demand.
The Minister may, rightly, mention the question of resources. I am advised that what is required is capital investment of between £0.5 million and £0.75 million, with additional investment for new radiographers and the associated team. That is a relatively small price to pay in relation to overall expenditure on the health service, bearing in mind that the good people of the Fylde coast have already made their contribution by purchasing the existing CT and MRI scanners by public subscription.
Mr. Marsden : On that point, does the right hon. Gentleman agree that the Government have made an entirely laudable commitment to replacing scanners and to upgrading generally, and that it is important that the case for an additional scanner at Blackpool Victoria hospital is not downplayed purely and simply because we have had the good fortune to raise the funding for the initial scanner by public subscription, so that it is not one of the older scanners that might be automatically replaced?
Mr. Jack : I entirely agree with the hon. Gentleman. My purpose in initiating the debate was not to bash the Government, because in fairness they recognise the problem. The case that all three Members for the Fylde coast want to underscore is that, if we go by the timetable given to me by the Minister's Department in parliamentary questions, then before we can even look at the criteria for the allocation of a new scanner we will have to wait for the programme to replace scanners that are more than 10 years old, and with every day that goes by we shall fall behind in our ability to meet the demands on scanning capacity.
The hon. Member for Blackpool, South is right to draw attention to the worry that the criteria that will be used to determine the allocation of the extra 50 CT scanners are not yet in the public domain. Some people inside the NHS say quietly and privately that there is a nasty smell suggesting that this might be a done deal; that words may have been exchanged behind closed doors about where in general the new scanners are supposed to go, and that any public consultation exercise to determine the criteria will be a sham. As the hon. Member for Blackpool, North and Fleetwood said in her telling intervention, that would deny us the opportunity fully to air the arguments for Blackpool to be a beneficiary of one of the new machines.
I want to close with a paragraph from the consultant haematologist, Dr. Flanagan, whom I earlier accused of being a radiologist. He made some telling comments in a letter to me dated 23 February last year:
Blackpool was battered by storms yesterday. I hope that calm will descend on the hospital after the Minister responds to the well-reasoned, moderate, sensible and widely-supported argument that we should press the fast forward button to allow one of the new scanner facilities to be granted to us at the earliest possible opportunity.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate the right hon. Member for Fylde (Mr. Jack) on his success in securing this Adjournment debate on scanning facilities at the Blackpool Victoria hospital and I welcome the comments and support of my hon. Friends the Members for Blackpool, South (Mr. Marsden) and for Blackpool, North and Fleetwood (Mrs. Humble).
The scanning facilities at Blackpool Victoria hospital are a matter of strong feeling on the part of the local Members and their constituents. I welcome the strong support that they have shown for local health services and their improvement. I will try to respond to their points.
Blackpool Victoria hospital is a large acute hospital serving around 350,000 people on the Lancashire coast. That includes those in urban and rural communities, affluent neighbourhoods and areas of social deprivation. As my hon. Friend the Member for Blackpool, South pointed out, the hospital must serve the resident population and millions of holidaymakers every year, placing additional demands on health services. The trust was awarded three stars in September's performance tables, achieving all but one of the nine key targets. Such quality indicators matter to patients and their relatives. Blackpool's star rating is a tribute to everyone who works in the hospital and they deserve our congratulations.
My hon. Friend the Minister of State for Health has been invited to Blackpool on Friday to open formally phase 5 of the Victoria hospital. That is a major new development, consisting of expanded accident and emergency and critical care facilities, a medical admissions unit, coronary care unit, seven acute medical wards and a cardiology ward.
The right hon. Member for Fylde focused on the need for additional scanning capacity. At present, the hospital has two scanners: one computed tomography, or CT, scanner and one magnetic resonance imaging, or MRI, machine. Both were installed comparatively recently, so neither is due for replacement in the near future. By 2004, we are committed to phasing out all machines used in the diagnosis of cancer that are more than ten years old.
A year ago, waiting times for urgent and routine CT and MRI scans at Blackpool Victoria hospital had risen to what were considered to be unacceptable levels. Consequently, the trust submitted a business case to North West Lancashire health authority, suggesting three alternative strategies to increase capacity. After negotiations with trust management and radiology staff, the health authority agreed to release additional funding for 2001-02 and 2002-03 to pay for additional scanning sessions. That enabled the trust to arrange extra scanning time at weekends, which it hopes will add about 700 scans to the annual total by the end of 2001-02.
Last month, the trust introduced another 10 hours scanning time each week on each machine. That is a permanent arrangement, but its full implementation is conditional on the hospital's successfully recruiting more radiologists. Over a 12-month period, extra operating hours should deliver more than 2,000 CT and MRI scans.
The trust will address staffing in a number of ways. It is reviewing staffing roles and responsibilities, so that radiographers can be trained to carry out certain tasks in place of radiologists. It will recruit a specialist registrar to the radiology team, and promote Blackpool as an attractive location for consultants. The introduction of a booked admissions approach should deliver service planning advantages.
The chief executive, Mr. David Gill, wrote to hon. Members in November, detailing the current position and the actions that had already been taken to alleviate long waits. He outlined the measures proposed for the future, and I am pleased to say that the situation has improved since then.
The latest figures that I have seen are for 10 January, when urgent waiting times stood at three weeks for both types of scan. As that is a week less than in mid-November, some progress is being made. Routine waiting times are 10 months for CT, 16 months for MRI, and five months for brain scans. Provided the necessary staff can be identified, more sessions are planned from 1 April when the 2002-03 money becomes available.
Yvette Cooper : Clearly, the right hon. Gentleman is right. There are concerns about long waits for routine scans and we must speed up access to those scans across the board. The evidence of progress is welcome, but hon. Members are right to say that there is still some distance to go before a breakthrough can be achieved. The projected levels calculated by the trust suggest that although the improvements will restrict the rate of increase, they do not amount to a long-term solution.
From April 2004, we expect all patients who are admitted to hospital with suspected strokes to receive a CT brain scan within 48 hours. Hospitals such as the Blackpool Victoria should have plans in place by April this year to meet the new standard.
From David Gill's letter, it is clear that the trust has researched the subject carefully. He correctly says that the north-west as a whole has above average access rates to scanners on a per capita basis, but it is equally correct that overall distribution is patchy with some localities undeniably served better than others. In recognition of that situation, which we inherited, not just in the north-west but throughout the country, we have introduced a series of initiatives aimed at levelling up provision throughout the country to reduce access times and to ensure that patients are not faced with long journeys from home to add to their anxiety. Hon. Members will understand that years of under-investment cannot be put right overnight. It takes time to manufacture and install equipment.
Additional replacement scanners have been or are being delivered through the new opportunities fund, the cancer capital modernisation fund and the NHS and cancer plans, but demand still exceeds supply. The Department's cancer services team, in conjunction with cancer networks throughout England, is drawing up criteria for allocating new machines as equitably as possible, taking account of relevant factors such as existing provision. Any bids presented by the Blackpool Victoria will be evaluated with those from elsewhere in the country against a common set of criteria. That is the fairest way of determining where top priorities lie. Since April 2000, 27 new MRI scanners and 63 CT scanners have been installed and by the end of 2004, a further 123 CT scanners will be delivered as well as additional equipment.
Hon. Members are right to say that discussions are still taking place about allocation of the 50 additional CT scanners and the 50 additional MRI scanners identified in the cancer plan. The cancer networks and
We are seeing a gradual increase in the number and quality of scanners as old equipment is replaced and new machines are delivered. Geographical coverage is also improving. Hon. Members will understand that I cannot make commitments about individual bids at this stage and the case will need to be considered against the cases made by other areas that also face need.
We must ensure that available scanners and equipment are used in the best possible way. I know that the local trust has done a lot in that context, but we need to do more throughout the country. I note that two out of 10 local consultant radiologist posts are vacant when candidates are in short supply nationwide. The supply of skilled radiographers is also an issue if we are to ensure that we are using existing scanners and equipment to full capacity. Nationally, we are working with the Society of Radiographers and bodies such as the Royal College of Radiologists to improve the radiography work force, including an increase in the number of radiography training places, which have increased by 20 per cent. in the past year and will increase by 55 per cent. by April 2002, extending the careers of radiotherapy staff who are currently working in the NHS and developing new ways of working in radiotherapy to allow staff to develop and extend their roles in the profession.
There is scope for innovative solutions and the right hon. Member for Fylde said that some patients have had knee scans in Merseyside under a pilot scheme agreed between the health authority and the Royal Liverpool university hospital. More innovative solutions will need to be considered throughout the country to deal with capacity problems.
In Blackpool, as in other parts of the country, the conclusion is clear. Yes, we need more scanners. Yes, we need more investment in the NHS. That is already happening, but it must continue fairly throughout the country. We also need reform and modernisation to ensure that we make the best use of facilities in the fairest possible way to improve access and care for local patients.