(11 years, 9 months ago)
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Dame Joan Ruddock (Lewisham, Deptford) (Lab)
On a point of order, Mr Deputy Speaker. In his statement on 31 January, the Secretary of State for Health said that he had asked Professor Sir Bruce Keogh, the NHS medical director, to review the recommendations of the trust special administrator to replace Lewisham’s accident and emergency department with an urgent care centre. The Secretary of State then said of Sir Bruce Keogh:
“He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.”—[Official Report, 31 January 2013; Vol. 557, c. 1075.]
The serious implication of that was that lives were currently being lost. We now know that nowhere in his report to the Secretary of State did Sir Bruce mention the saving of 100 lives per annum. The Secretary of State has been made aware of the disputed facts, and I therefore wonder whether you, Mr Deputy Speaker, have had any indication that he will return to the House to explain his statement of 31 January.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I have had no such request to come to the Chamber, as the right hon. Lady would expect. She has, however, put her point of order on the record and I am sure that people will have taken note of it.
Mr Virendra Sharma (Ealing, Southall) (Lab)
I beg to move,
That this House has considered the matter of the closure of accident and emergency departments.
On behalf of all my Back-Bench colleagues who wanted time to be allocated for this important debate, may I put on record my thanks to you, Mr Deputy Speaker, and to the Backbench Business Committee for today’s scheduled parliamentary time? The closure of accident and emergency departments is a national issue and one that has profound impacts on the current and future provision of health care across the country. Concerns about the A and E closures and accompanying hospital reconfigurations have been voiced by members of all political parties including Back Benchers and Front Benchers on both sides of the House, so it is crucial that we have this debate.
Weighty decisions are being made about A and E closures across the country by NHS bureaucrats, under the guise of localism and clinically led decision making, without the democratic accountability that is vital for decisions of such importance. In order to bring these decisions to the Secretary of State for Health, local council scrutiny panels have to refer such decisions to the independent reconfiguration panel, which then reports its findings to the Secretary of State. Why are primary care trusts in their dying days making such critical decisions and not clinical commissioning groups? It is vital to have democratic accountability for these decisions and, although it is not sufficient, this debate will shine some much-needed light on these huge decisions that will have profound impacts on all our constituents. I am pleased that the Government have belatedly announced a national review of A and E services, but I am horrified that the review is planning to report by March this year. This is being done in an obscene rush, and it cannot be the considered review that we need.
There are proposed and actual A and E closures in my constituency and in those of other hon. Members. It is clear that this is an NHS-wide change that will affect every constituency in the land. The NHS needs to change and be fit for purpose in the 21st century, and I am not saying that there must be no change. Clearly, we have to provide health care in changed ways, but I am concerned about the pace of change, the impacts on the poorest and the financial drivers of the changes. The financial drivers are clear. The Nicholson challenge means that the NHS is seeking to cut spending by £20 billion by 2014-15.
Margaret Hodge (Barking) (Lab)
Does my hon. Friend agree that the care of patients must be at the heart of any changes in the NHS, and not finance? In my part of London, there is a proposal to close the A and E at King George hospital, but it would be madness to do so at a time when Queen’s hospital in Romford has far too many A and E patients and when a Care Quality Commission report has just condemned the quality of care for people who visit that A and E unit.
Mr Sharma
I thank my right hon. Friend for putting that case so strongly. I do not think anyone—inside or outside the House—would fail to agree with that suggestion.
In North West London NHS, the proposal translates into a £1 billion cut to budgets over the same time scale. The medical director of North West London NHS said that it would
“literally run out of money”
unless the closures proceeded. The scale of change driven by this financial pressure is unacceptable. It is targeting the poorest and most vulnerable, and it is unfair on the hospitals that have been financially solvent. That last point was graphically illustrated last week at Lewisham hospital, whose A and E was unjustly proposed for closure because of a neighbouring trust’s financial insolvency. That brought tens of thousands of incensed protesters on to the streets.
Sadly, this is happening in Ealing, too, whose hospital is faced with losing its A and E department, yet it is financially viable and has been for many years. It is being sacrificed on account of financial problems in other neighbouring hospital trusts. This threat of closure in Ealing exists even after the Prime Minister assured me, in a response to my question, that there was no such threat.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
Although this is a debate about the closure of A and E departments across the country, does my hon. Friend accept that it seems particularly unfair that London, with nine accident and emergency departments apparently set for closure, is being hit so hard in losing vital NHS services?
Mr Sharma
I agree with my hon. Friend, and I shall definitely cover that point later in my speech.
As in Lewisham, the people of Ealing took to the streets in huge numbers last autumn in protest at the proposals from North West London NHS whereby if the preferred option A is chosen on 19 February, it would mean the closure of four A and E departments in west London: in Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals. The campaign to save our hospitals has been broad and deep, bringing together MPs and councillors of all political parties, and organisations and individuals from all segments of society.
Martin Horwood (Cheltenham) (LD)
I am concerned about the future of the emergency department at Cheltenham general hospital. It is not exactly in the same situation as London, but it lies in reasonably close proximity to the Gloucestershire Royal hospital down the road in Gloucester. The consultants and trust management in Gloucestershire tell me that their problem is not financial but the number of consultant posts and more junior medical posts that they can fill, and that there is a national shortage in emergency medicine. Is that a factor in the hon. Gentleman’s constituency, too?
Mr Sharma
I disagree with that. The evidence shows that all these decisions are finance-led. It is not to do with the clinicians’ or consultants’ proposals. That may apply in the hon. Gentleman’s constituency, but I can assure him that it is not true of west London.
My hon. Friend the Member for Ealing North (Stephen Pound) will join us later and the hon. Member for Ealing Central and Acton (Angie Bray) will speak later, too. I thank them for their support for our campaign. I would also like to acknowledge the tremendous efforts of my hon. Friend the Member for Hammersmith (Mr Slaughter), who would be in his place here were it not for his Front-Bench duties in the Justice and Security Public Bill Committee. Back in June, when North West London NHS announced its plan to close four of our A and Es, my hon. Friend organised a public meeting, which gave rise to the Hammersmith “Save our Hospitals” campaign. He has been at the forefront of the community campaign in his own constituency and has been instrumental in organising MPs of all parties to come together for this debate. He asked me to mention particularly the threat to Charing Cross hospital, which will lose not merely its A and E but 500 in-patient beds, turning a world-class hospital into a local urgent care centre.
My hon. Friend would have reminded us that this is the second time he has defended Charing Cross from closure. He stands now with his constituents, as he did in the last century during the dark days of John Major’s Government, holding a candle for Charing Cross at its Sunday evening vigils. That light did not go out, and I am sure it will not be allowed to go out now.
Let me now raise some of my specific concerns—as well as welcoming you to the Chair, Mr Deputy Speaker. I have very grave concerns about the way in which the consultation was carried out in north-west London. It was carried out over the Olympic summer months, with an impenetrable document of 80-plus pages and a response document with leading questions that set community against community, doctor against doctor, and hospital against hospital. There were also significant parts of the consultation period when no translated materials were available for many of my constituents who speak various community languages. That was totally unsatisfactory.
Notwithstanding those difficulties, some people in Ealing were able to complete the consultation and overwhelmingly rejected the preferred option that means the closure of Ealing’s A and E, maternity, paediatric and other acute services, and the closure of Central Middlesex, Hammersmith and Charing Cross A and Es. Moreover, a majority of respondents across the whole of north-west London rejected the fundamental premise of the proposed changes—that acute services should be concentrated on fewer sites. I fear that such an inconvenient consultation response will be ignored and ridden roughshod over.
Equally, I fear that the clinical opinion of Ealing’s GPs and hospital consultants who opposed the preferred option will be ignored, despite this being one of the Government’s four tests for such reconfigurations. The clinical concerns are real and should not be brushed over. Let me address some of the key concerns.
First, the scale of change being proposed in north-west London and the associated risks of such large-scale changes is causing great concern. Taking out in one go four of nine A and Es that serve a population of 2 million—set to grow continually over the next 20 years —is a high-risk strategy. Concerns over A and E capacity are growing, as hospitals up and down the country say that their A and Es are full and that they are putting patients on divert to other hospitals. This has happened recently at Northwick Park hospital—one of the hospitals that Ealing patients are meant to be treated at if the four A and Es close. If these proposals go through, yes, there are plans for some increased investment at both Northwick Park and Hillingdon A and Es, but there are well over 40,000 patients a year using Ealing hospital’s A and E alone, in addition to those currently attending Central Middlesex, Charing Cross and Hammersmith—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I think the hon. Member was told that he had a 10-minute limit imposed on him, as applied in the previous debate. Sadly, however, his time is up. If he wants to make a concluding remark, however, I think the House would allow him to do so.
Mr Sharma
Thank you very much, Mr Deputy Speaker.
Let me finally say to the Minister that there should be a moratorium on all A and E closures until a proper, considered and full review of A and E services has been carried out, as opposed to the current rushed review. I hope that the Minister will listen.
Mr Deputy Speaker (Mr Nigel Evans)
I am extremely grateful to you, Mr Sharma, for your understanding.
From now on, Back-Bench speeches will be limited to eight minutes.
David Morris (Morecambe and Lunesdale) (Con)
Thank you for calling me, Mr Deputy Speaker. My constituents will be paying close attention to this debate.
For some weeks the press in my constituency has been awash with allegations about both maternity and accident and emergency services at our local NHS trust. What concerns me is not that the services will change, but the scare stories surrounding all this. I have received a letter from Jackie Daniels, the chief executive of the trust, confirming that it will not shut the A and E department at Royal Lancaster Infirmary. She wrote:
“‘The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster.
We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”
So the chief executive of the trust has said that not only has she no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.
Siobhain McDonagh (Mitcham and Morden) (Lab)
May I urge the hon. Gentleman to be careful about this? Most Labour Members face closures of A and E departments that serve twice that number of people.
David Morris
I shall come to that in my speech.
A concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E department is likely to close. The campaign involves press briefings, an online petition, a Facebook group, and even people walking around the centre of Morecambe with clipboards inviting people to join it. I want the e-petition to be removed from Directgov, and I have written to the Cabinet Secretary asking him to intervene. We cannot allow a dishonest campaign to be fought on Directgov e-petition platforms. If the A and E department is not under threat, it must be concluded that people are being frightened for the purpose of political advantage, which, in my view, is morally wrong.
Perhaps it is time to admit the truth: the trust is getting better under the present Government. A new and better management was introduced by the former Secretary of State. Only a few weeks ago, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) opened a new minor injuries unit in my constituency. A new health centre in Heysham, costing £20 million, was opened last year, and four new wards have just opened at Lancaster hospital. I pay tribute to my hon. Friend—for he is my hon. Friend outside the Chamber—the Member for Barrow and Furness (John Woodcock) for ensuring that maternity services in Barrow remained secure.
All that was paid for by a 2.8% increase in funding for the NHS under the present Government. This debate is part of a national campaign to scare people into believing that the NHS will be deconstructed.
David Morris
I will later.
This, I believe, started with a disingenuous story in Corby, which was used to great effect. It has now become the scare story in Lewisham and now, surprise, surprise, the scare story in Lancaster and Morecambe. Those A and Es are not under threat. They are not closing down. The public will see through this Labour campaign to start a fire and then claim to put it out, saving us all.
John Woodcock (Barrow and Furness) (Lab/Co-op)
It is a pleasure to follow the hon. Member for Morecambe and Lunesdale (David Morris), who made what I must say was a quite extraordinary speech. I realise that I may be in danger of being a little ungracious, given that he was kind enough to thank me. I shall say a little about the University Hospitals of Morecambe Bay NHS Trust, which our constituencies share. However, I must first say to him—on behalf, I think, of several Members who are present—that to suggest that the impending closure of Lewisham A and E department is a scare story from the local Labour party does an incredible disservice to the many thousands of families who are deeply alarmed and worried about what is happening in the area.
Margaret Hodge
I congratulate my hon. Friend on managing to save his A and E department, but does he not agree that money should go to where patients are? In my area, north-east London, 132,000 patients currently attend the Queen’s hospital A and E department, and 100,000 attend King George’s hospital A and E. Closing an A and E department that serves more than 100,000 patients is unfair to patients and madness in terms of funding distribution.
John Woodcock
My right hon. Friend is right to speak of the crazy situation in which heavily used accident and emergency provision across the country is under threat. I intend to say a little more about the particular challenges faced by geographically isolated regions such as mine, but first let me say how grateful I am to the Backbench Business Committee for securing the debate, and congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on a very powerful opening speech.
I want to speak briefly about the accident and emergency department at Furness General hospital in my constituency, and, in doing so, stress the importance of ensuring that A and E provision remains accessible to the high-tech, highly skilled industries in which this nation must continue to lead the world. Barrow’s A and E department is not yet under immediate threat of closure, but there is grave concern about the impending review of services throughout the Morecambe Bay area, which has been driven at least partly by the trust’s need to make significant cuts in its operating budget in the years ahead.
A trust covering 300,000 people would often be served by just one A and E department, but in the Morecambe Bay area there are two. That is due to the particularly challenging geography of the area, and, in particular, the time that it takes to travel the 50 miles from my constituency to Lancaster with only a single road connecting Barrow to the M6.
The hon. Member for Morecambe and Lunesdale directed all his fire at the local Labour party, and in doing so highlighted—probably quite helpfully for the party—the excellent work that it is doing with its campaign on the streets. I was probably more disappointed than surprised that he made no mention of his hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), who is campaigning hard to take A and E provision away from Lancaster and transfer it to Westmorland General hospital.
Let me make it crystal clear why no one should get the idea that Barrow’s A and E department could move. Not only would every single resident in the geographically isolated Furness peninsula suffer unacceptably long journey times if it were closed; its removal would be a significant blow to industry in the area, and would ultimately threaten our potential to become a national cradle for advanced manufacturing. The manufacturing companies on which our local economy depends—including shipbuilding, nuclear engineering and pharmaceutical companies—have enviable safety records, but they nevertheless carry a small but inherent risk of industrial injury. As responsible business men, local employers seek to mitigate and manage that risk, but part of their management includes access to a full accident and emergency service in the locality.
BAE employs 5,500 people in Barrow, representing the largest of the many sites in the nation’s critically important nuclear submarine supply chain. This is what the company’s submarine arm told me for today’s debate:
“BAE Systems Maritime Submarines is possibly one of the highest risk manufacturing sites in the UK with a broad spectrum of safety hazards. Although these hazards are effectively managed and the site has a strong safety record, the absence of locally provided A and E services would have serious implications for the business. The treatment administered within the first hour following incidents is critical. A number of minor incidents, particularly associated with foreign object ingress to eyes, are referred to Furness General Hospital per week. Therefore additional ambulances would be required to transfer injured personnel, significantly increasing the ambulance demand within the area. Decontamination of people would currently be provided by FGH Accident and Emergency following a major incident at the Barrow site. This may include the cleansing of chemicals or radioactive substances.”
If, God forbid, something like that were to happen, time would be of the essence. Here in Furness, as in several areas of the country, A and E closure could put at risk the lives of employees who perform a service to their country and would ultimately endanger key parts of the nation’s prized industrial base. It is vital that Ministers wake up to the full spectrum of risks posed by the approach they seem intent on imposing on our national health service.
Patrick Mercer (Newark) (Con)
I followed with interest the excellent speech of the hon. Member for Barrow and Furness (John Woodcock), and I thank the hon. Member for Ealing, Southall (Mr Sharma) for, along with a number of us, securing this debate.
I hope we can step above the confines of party politics in talking about this crucial matter, which terrifies people, especially the elderly and frail. I shall talk about Newark, of course, but I also want to talk about this matter nationally. The A and E in Newark was closed under the last Labour Government. The difficulties with Newark hospital have continued from that party’s regime into my party’s regime. I do not care about that, however. What I care about most is delivering the right service to my constituents, in particular the elderly, the frail and the vulnerable, who depend much more than other groups of people on A and Es and their substitutes.
David Morris
Does my hon. Friend agree that this issue is above party politics?
Patrick Mercer
I totally agree. I would never dream of being critical of my hon. Friend, but I do think that this is such an emotive subject that we can be distracted from the realities by the fears these proposals raise.
I hope that I will speak for everybody who lives in semi-rural and remote areas—as I do, living north of Newark—and who depends on hospitals such as Newark. Newark no longer has an A and E. We, like many other parts of the country, are now at least 20 miles away from our nearest A and Es. Our nearest ones are at Lincoln County, Grantham or—extraordinarily and disgracefully—King’s Mill, which is part of the same private finance initiative with which Newark finds itself lumbered.
Newark sits on the A1 and is adjacent to the M1, and it also sits on the crucial and very busy east coast main line railway. The sorts of incidents the hon. Member for Barrow and Furness described in the nuclear industry could also arise on the road and rail networks in and around Newark, yet Newark has no A and E, in common with many towns of the same size in similar areas.
I do not understand why there has been such confusion over my A and E, and I ask the Minister to explain. If this has happened in Newark, I have no doubt that it happens elsewhere, and that it will continue to do so. Let me explain. When I returned to my home town of Newark in 1999, we had a department called “A and E.” Only subsequently did I find out that it was not an A and E at all; it was a sort of minor injuries unit with a big notice above the door saying “A and E.” Nobody had had the political courage to say, “Take that notice down.” That was nothing to do with the Labour Government or the coalition that subsequently came to power; it was to do with the staff in charge of the local NHS, who eventually grasped the nettle and said, “No, this is no longer an A and E.” The fuss caused was disproportionate.
For 10 years, nobody had had the courage to say, “This is not right; we are lying to the people of Newark.” Why was this allowed to happen? The Minister is a fellow Nottinghamshire Member of Parliament, so she knows about what happened at Newark, but I do not understand how A and Es can continue to function like this, and how the protocols of the ambulance crews that service A and Es can cope.
Jeremy Lefroy (Stafford) (Con)
Does my hon. Friend agree that we need clear national definitions of what emergency departments do? We currently have many different types of departments that are called A and Es. Some may have major trauma, others may not. Some may do acute stroke and heart attack; others may not. The Government must put in place a classification that is recognised across the country and, as my hon. Friend says, by the ambulance services.
Patrick Mercer
My hon. Friend has clearly been reading my notes, as that is exactly the point I am going to make. If we look at the composition of the anti-tank platoon of the 1st Battalion, The Royal Anglian Regiment and the composition of the anti-tank platoon of the 3rd Battalion, The Parachute Regiment—I know that you, too, think a lot about these matters, Mr Deputy Speaker —we will see that they are identical; they have the same weapons, the same troops, the same kit and so forth. There is no difference between them. Why, therefore, do we have this byzantine set of organisations in our NHS, so that an A and E can be a sort of an A and E, perhaps, or not an A and E at all, or an MIU-plus—or have a notice outside its door that is wholly misleading?
Why do ambulance services not have a standard set of operating procedures? Why do they call them protocols? Why do protocols vary? Why are not the staff correctly, and centrally, trained to understand what an A and E delivers, so they can know when they arrive at a hospital that the casualty they are carrying will receive the sort of treatment an A and E should deliver? More to the point, why are those ambulance crews not in a position to understand that, perhaps, town X’s A and E—or MIU, or whatever—cannot cope with a certain sort of injury? As a result of all this confusion, we waste time, resources and lives. This is not the province of party politics. Party politics is not worth a damn when it comes to the lives of our constituents.
I recognise, and most people recognise—even the nay-sayers, the negatives, the people who still want a policeman in every village and the return of the home guard, and even those in Newark who do not understand that we are not going to have a general hospital there—that we are never going to have A and Es, in all their glory, returned to towns the size of Newark. However, despite asking for commonality, I ask the Minister to recognise that there has to be flexibility, although I appreciate that that sits uncomfortably with my last point. The Minister understands the country and its dreadful road systems. May we please take a flexible view of these things? Could clinical cases be assisted in places such as Newark, so that minor injury units can indeed provide other critical services than those they currently provide? We do not need to be hidebound by these things, but we do need to be regulated. We do not need to be narrow-minded, but we do need to understand that different communities have different needs, and that roads in particular impose different travelling times and different strains on ambulance services across the country.
A great deal of noise and fuss is made all the time about the A and E, the critical services and the minor injuries unit in Newark, but that is only a fraction of what our hospitals do. It was widely bruited about in Newark until recently that the hospital was going to close, and yet on Monday I helped to open a new ward there. It is not a critical ward, and it has nothing to do with the minor injuries unit or the A and E; none the less, it is an exceedingly important part of the hospital, nine-tenths of which does not deal with critical matters.
David Morris
Does my hon. Friend agree with me that the NHS is actually getting better under this Government?
Patrick Mercer
Yes, I do. In my own town, things have improved but, by golly, there is a long way to go before we get to where we need to be. There is one thing that I do not agree with my hon. Friend about. The East Midlands Ambulance Service NHS Trust has had the courage to say that it is not performing properly. I appreciate that it is not part of the NHS trust which forms part of Newark hospital. But patently, A and Es, minor injury units—whatever we are going to call them— cannot work effectively unless the communications between each are properly formulated, properly regulated and properly led.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this debate and on the fine speech he made to open it. My hon. Friend the Member for Lewisham East (Heidi Alexander) is in Committee and is unable to join us at the moment, but I know she will agree with all the remarks I am about to make.
Reconfigurations should be on the basis of clinical grounds and patient safety. That is not so in Lewisham. I should not be part of today’s debate, because the A and E at Lewisham hospital should not have been threatened. The only reason it is threatened is that the trust special administrator, acting under the unsustainable providers regime, was sent into the neighbouring South London Healthcare NHS Trust. I do not believe that the trust special administrator had the powers to take in Lewisham hospital, as part of the proposed solution to the failure of that trust; indeed, my local authority is giving consideration today to mounting a legal challenge.
I have come here today to ask the Minister again to explain Government policy, and to act as a warning to others. Lewisham Healthcare NHS Trust is solvent, highly regarded and meets all its clinical standards. The A and E is used by more than 115,000 people every year, yet the TSA proposes to close the A and E, downgrade maternity and sell off two thirds of the land to support a separate, failing trust. My colleagues and I argued that this was a back-door reconfiguration. In response to my urgent question of 8 January, the Secretary of State acknowledged just that. He said that the four tests for reconfiguration would have to apply to the Lewisham proposals. He said:
“the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.”—[Official Report, 8 January 2013; Vol. 556, c. 169.]
I can tell the House that not a single test is met in the case of Lewisham. The newly accredited GP commissioning group—created through the Government’s flagship policy, of course—is totally opposed to these recommendations, and its chair has said that she is considering her position.
The engagement process was a farce. The public questionnaire did not mention the closure of the accident and emergency department at Lewisham and the consultation document did not mention the selling off of the land. Some 25,000 people joined a protest march just a week ago, and 53,800 have signed the local petition. For “increased choice” read “massive loss of local services”. But it is the third test—the clinical evidence base—on which I wish to concentrate.
It is now clear that the Secretary of State had real concerns about these recommendations and thus he sought cover from Sir Bruce Keogh, the NHS medical director. We now have access to Sir Bruce’s advice. He said:
“The TSA must ensure there is no risk to patients by inadvertent under provision at hospitals receiving displaced Lewisham activity.”
On the proposed urgent care centre at Lewisham, he said:
“Consideration should be given to…direct admission…facilities”.
He also recommended the
“addition of senior Emergency Medicine doctors”
as a further safeguard.
Lewisham’s A and E is one of the few such departments consistently meeting its four-hour standard. The buildings were recently refurbished, at a cost of £12 million. Lewisham’s is one of the better performing intensive care units in the whole of England. It has twice-daily consultant ward rounds and access to diagnostics on Saturdays and Sundays. None the less, the Secretary of State has decided to remove the ICU, to remove consultant cover and to displace about 30,000 seriously ill patients—those who are likely to be admitted to the A and E —and take them by ambulance to another hospital. He is creating a smaller, less effective A and E, but there is no capacity at any other A and E in south-east London. Ambulances are often directed away from hospitals like King’s to come to Lewisham. Recently, a 76-year-old waited 18 hours in the A and E at the Queen Elizabeth hospital in Woolwich. The Secretary of State is just saying that he will throw £37 million at it to expand the facilities elsewhere, once he has closed down the Lewisham A and E.
All that ignores the fact that patients arrive at Lewisham hospital on foot, by private car and by bus, and of course the ambulance service is under enormous strain; people being treated in ambulances are parked up at A and E units all over London. Yet we are told that south-east London should have only four or four and a half A and E departments, not five, in order to improve clinical care.
I do not dispute the case that has been made on cardiac and stroke services, but it is not obvious that it applies in respect of other kinds of illnesses and problems. Asked to explain things, the Secretary of State said:
“That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes.”—[Official Report, 31 January 2013; Vol. 557, c. 1081.]
Dr John O’Donohue, a consultant physician at Lewisham, responded to those points in a letter to Sir Bruce Keogh. He said that there have been
“no maternal mortalities in the past 7 years. This is despite the fact that high-risk pregnancies form the majority of our maternity workload.”
He also made the point that
“UHL is in fact one of the highest performing Trusts nationally for the management of hip fractures.”
He went on to say:
“Guidance on…meningitis emphasise the speed of administration of definitive treatment and not the size of the hospital”.
He concluded:
“There is…no basis in clinical evidence for the assertion made by the Secretary of State.”
But the Secretary of State went even further, asserting that Sir Bruce
“believes that overall these proposals, as amended, could save up to 100 lives every year”.—[Official Report, 31 January 2013; Vol. 557, c. 1075.]
We now know that no such reference was made in Sir Bruce Keogh’s review. I have spoken entirely about the adult A and E facility, but there is of course also a very fine children’s A and E unit at Lewisham, which has been much neglected in these considerations.
Lewisham now faces a reconfiguration that it is not said to be a reconfiguration. It now faces having an A and E unit that is not a proper A and E, and a maternity service that no woman giving birth to her first child will be able to go to. Will the Minister explain to me today how that is improved clinical care? How is it improved patient choice? It is an absolute disgrace, it is completely unjustified and we will all fight it to the very last.
Stephen Lloyd (Eastbourne) (LD)
I thank the Backbench Business Committee for granting the debate and endorse my colleagues’ expressions of appreciation to the hon. Member for Ealing, Southall (Mr Sharma) for obtaining it. It was a pleasure to be one of his co-sponsors.
The debate is badly needed. Not a month seems to pass without another NHS trust announcing that it will close one or more hospital departments, and at least 15 NHS bodies in England are pursuing major reconfiguration plans. There is, however, increasing concern in the medical field that NHS care for emergency patients might be going wrong in too many instances. Essentially, this is a debate about specialism and generalism. Rare complex surgery, for example for brain tumours or severe multiple injuries, is clearly best done in large volumes in specialist centres. I do not dispute that—nor do the overwhelming majority of clinicians—but it is not true for the common types of emergency surgery that are best done within good time in a quality district general hospital.
Hip fractures, for instance, are very common and the results are better if surgery is done as soon as possible, preferably on the next day’s operating list, by a surgeon who has at least three years’ experience of fixing hip fractures, yet around the country hospitals are being reconfigured to provide a specialist service in a major centre, leaving, as many experienced clinicians assert, thousands of patients with delayed and worse care.
Sarah Teather (Brent Central) (LD)
As I listen to my hon. Friend, I am struck by an example from my constituency, where the likely closure of the A and E will mean that people living in Harlesden will find it almost impossible to get to Northwick Park hospital. It is important for patient experience that their relatives can visit them.
Stephen Lloyd
I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.
Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:
“Delays in surgery for the elderly are associated with poor outcomes”.
The letter to the Prime Minister also backed this view:
“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”
Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.
That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.
Jim Dowd (Lewisham West and Penge) (Lab)
How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?
Stephen Lloyd
The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.
Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.
This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.
I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.
Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.
The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.
Stephen Lloyd
I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.
Stephen Lloyd
I will continue, as I have only two and a half minutes left.
In short, either the Government’s reconfiguration tests are not being properly adhered to, or trusts and PCTs are merely using them as a smokescreen to hoodwink local communities. I do not believe for a moment that this is what the Government originally planned, so what is going wrong and why? It is clear that many very experienced and expert clinicians believe that most areas must retain emergency departments, with co-located essential core services to manage the bulk of common emergency conditions, which I spoke about earlier, or to stabilise patients prior to transfer to specialist units.
In conclusion, I am far from confident that the current process to determine whether or not reconfigurations of health services or A and E are being done in the best interests of local people is working, irrespective of the four tests that I talked about earlier. This must be addressed and that needs to be done quickly because if we get it wrong, lives could quite literally be lost unnecessarily. The NHS is our most cherished institution, often referred to as the glue which binds our society together. I pay tribute to the coalition Government for protecting NHS funding at a far higher level than was the case in any other Government Department but—and this is a “but” laden with real anxiety—I fear we may be getting the reconfiguration elements wrong. I hope the Minister will address my specific concerns about the reconfiguration element and about specialism v. generalism, to ensure that the right and the best service is provided for my and all our constituents.
Jim Dowd (Lewisham West and Penge) (Lab)
I am pleased to follow the hon. Member for Eastbourne (Stephen Lloyd). I thank him, the hon. Member for Newark (Patrick Mercer) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate and the Backbench Business Committee for agreeing to their representations.
I will return in a moment to a few things that the hon. Member for Eastbourne said, because he got to the thrust and the kernel of a lot of the problems with the four tests, although his attitude towards them is a good deal more generous than mine.
Mr Love
The four tests were invented for the reconfiguration of Chase Farm hospital, which predates everything that we are discussing today. If we look back at what happened there, it is clear that it did not matter what local opinion was, what local medical opinion was, or that everyone at Chase Farm was opposed—there was a determination to go ahead regardless. So the whole thing becomes a farce and a complete sham, and the four tests do not really add up to anything in terms of protecting local services.
Jim Dowd
My hon. Friend has it exactly. That is precisely our experience in Lewisham, which I will elaborate on in a few moments, where we have seen that the four tests are a fig leaf and entirely inconsequential, and, more than anything else, that the Secretary of State can blithely announce that he has decided that they have been met and that that is all that counts. There is no review, no appeal, no objective analysis, no consideration of alternative views: it is just a case of the Secretary of State saying yes. It is precisely as Humpty Dumpty said: “Words mean exactly what I choose them to mean, and that is it.” That is the position of the Secretary of State.
My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) went over a lot of the ground that is concerning us in Lewisham regarding the outrageous proposals by the trust special administrator appointed in South London Healthcare NHS Trust. Let me emphasise that the reason for the anger, the outrage, the fury and the sense of seething injustice in Lewisham is not that people there are particularly prone to believe scare stories—it is that they know exactly what is going on. They know that they are being punished for the failings of others at a time when Lewisham hospital has made every effort to meet the financial targets and, more particularly, the service targets, and to retain the confidence of local people.
I would therefore say this to anybody whose local trust is performing badly: fear not, for under this Government you will be rewarded. What people really need to be careful of is being anywhere near a trust that is doing badly, because even though their local trust may be doing well, the Secretary of State will appoint his henchmen—and women, for that matter—to go in there, jackboot their way around the place, spend millions of pounds of public money, and then come up with a scheme that does not do much to achieve the purpose for which they were appointed but rather deals with others who have played the game and played by the rules: and under this Government, more fool them.
Gavin Barwell (Croydon Central) (Con)
I have quite a bit of sympathy with some of the points that the hon. Gentleman is making because some of my constituents work at Lewisham hospital and have contacted me about this issue. However, he has to make his argument in a balanced way. Is it not the case that under the previous Government, when there was a problem in one PCT neighbouring PCTs were required to subsidise it, and that that, to a degree, unfair as it seems to people, is the consequence of having a national health service rather than separate individual units?
Jim Dowd
No, that is not the case.
It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.
Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.
I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.
The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.
The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.
Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.
It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
Will the hon. Gentleman give way?
Anna Soubry
Is the hon. Gentleman saying that the trust special administrator was given a brief and did not act independently? Does he recognise that he had two hospitals in PFI agreements that were losing £1 million of taxpayers’ money in those agreements—money that should have been spent on health services?
Jim Dowd
That is not true; we do not have that. That is in South London Healthcare NHS Trust. Lewisham Healthcare NHS Trust is in balance—[Interruption.] I am saying that a trust special administrator was given a remit to close Lewisham hospital. Why on earth were Lewisham Members invited to the meeting to discuss South London Healthcare back in July? This scheme has been hatched in the Department of Health, and the Minister does herself no credit by attempting to defend the indefensible.
Nick de Bois (Enfield North) (Con)
I am not sure I can keep up with the pace of the hon. Member for Lewisham West and Penge (Jim Dowd), but I am delighted to follow him and I have some sympathy with one of his points. I felt compelled to write to the NHS medical director, Sir Bruce Keogh, having seen his comments about the role of politicians.
Nick de Bois
It is true. As my hon. Friend says from a sedentary position, the Evening Standard claimed, “Nick de Bois 2, Sir Bruce Keogh 1”, so I hope I wrote on behalf of all Members. The medical profession is at the root of this issue. If it wants to win arguments based on evidence, so be it, it can win those arguments against politicians, but it also has to win the hearts and minds of the people it serves. That is why we should not be taking lectures on the role of MPs and democrats.
I would like, unapologetically, to talk about my hospital, which has been introduced briefly by my neighbour, the hon. Member for Edmonton (Mr Love). As a hospital facing threats of change—not all good by any means—Chase Farm hospital must predate almost every Member present in the Chamber, perhaps with the exception of the hon. Member for Islington North (Jeremy Corbyn). Going back to the early 1990s, it was promised the proceeds from the disposal of the Highlands hospital. As my hon. Friend the Member for Newark (Patrick Mercer) said, the story I am telling crosses more than one Government, so I will try to tell it in a non-partisan way because my interest is in getting the best for my constituents.
After my constituents were let down by the promise of investment from the sale of Highlands hospital—now a pleasant residential area—no money was forthcoming, and in 1999 an administrative merger between Barnet and Chase Farm hospitals was proposed, which we were assured would lead to no clinical changes and have advantages. The effect of the merger was that the healthy balance sheet of Chase Farm was sucked dry to support a hospital that was bleeding payments—the hon. Member for Lewisham West and Penge may identify with that. Again, my constituents were let down.
Just before May 2005 we were told that we would have £80 million investment in our district general hospital. Sadly, that investment did not materialise, and shortly afterwards, in 2006, a programme of downgrade—reconfiguration, as it is known—was started, particularly in our maternity and A and E units. That was confirmed in 2008, but judicial review by the local council held it up. Hopes were just beginning to rise, and with the change of Government those hopes were raised again from the moratorium. I have said this before on the Floor of the House but I will repeat it for the avoidance of doubt: my constituents were utterly let down by the Secretary of State when we were again downgraded.
Hon. Members will therefore understand why my constituents—I am sure this resonates with hon. Members on both sides of the House and their constituents—and the public the acute hospitals serve are so sceptical when they are on the receiving end of advice and recommendations. It is a question of trust and transparency.
Like every hon. Member, I understand the full implications of the strategic drive for, and some of the benefits of, centralisation. However, I oppose the reconfiguration because of the inconsistency in what we have been told. There has been a clinical case for change, and a clinical and safety case for change, and yet in 2011, the Care Quality Commission said that Chase Farm hospital was running up to standards.
At that point, the PFI situation emerged. The PFI deal sealed for North Middlesex hospital—a neighbouring hospital in the south of the constituency—meant an investment of £129 million over 31 years, meaning a total repayment of £640 million. That £2 million a month comes off the operational budget. On 22 November, the then Secretary of State was quoted in the very reliable Daily Mail as saying that the recent downgrade was partly because of unsustainable PFI debt.
One reason often cited for the proposed downgrade of my hospital is that GPs support it. Three hospitals—Barnet, North Middlesex and Chase Farm—were part of the downgrade plan, and GPs from Haringey, Barnet and Enfield were asked about the proposals. The vote was organised like a communist meeting. If we ask people in Haringey or Barnet whether they have a problem with the downgrade in Chase Farm, I suspect they will say no if it benefits their hospital. The figures show that only 44% of Enfield GPs approved, but of 129 GPs asked, only 48 responded, so only a positive 16% recorded their support. I hope the Minister asks her officials to reflect on that point.
I oppose the reconfiguration but recognise that I need to fight for the best possible deal for Enfield. It is therefore important to examine the so-called pre-conditions of implementation of the strategy that we were promised —we were guaranteed that they would be put in place.
Mr Burrowes
I commend my hon. Friend for his continuous efforts, although perhaps he should take his seat since he has given way.
Mr Deputy Speaker (Mr Nigel Evans)
That is my job, not the hon. Gentleman’s.
Mr Burrowes
My hon. Friend has continuously stood up, not just in the House but in his constituency, against the closure of the A and E in Chase Farm and for securing health improvement in Enfield. He has secured a cross-party delegation meeting with the Secretary of State, at which we want an assurance that the £10.6 million being invested in primary care in Enfield ensures we get effective primary care improvements before the reconfiguration.
Nick de Bois
That goes back to my point—it is a question of trust. It is vital that that promise is delivered, but it is already some four years since the change was envisaged, and very little has been put in. It is therefore right that we press the case for implementation and delivery on the ground if the strategic review goes ahead.
I welcome the opportunity to meet the Secretary of State—I hasten to add that a cross-party delegation will meet him—but I have some questions to put to the Minister on the Floor of the House. Is she aware of the growing health inequalities in the borough, which have increased since the original 2008 assessment? According to the latest census, the population is far removed from the original assessment—there are 40,000 more people.
Angie Bray (Ealing Central and Acton) (Con)
I am listening carefully to my hon. Friend’s remarks. Does he feel at this stage that he is pushing at an open door or a closed door?
Nick de Bois
I am sitting next to my hon. Friend, who shares a great interest in this subject, and I think she has been reading my notes. With a new Secretary of State and with such interest across the country, Chase Farm does not feel as if it is alone any more. There is a momentum and an opportunity to examine new issues, so I hope I am pushing at an open door. On cost and on how we treat patients, we need to be bold and innovative. For example, we should be examining the impact of telehealth care on our acute centres. Such things will drive not just costs, but better health care. Can they have an impact on whether we retain more services at our acute centre in A and E, while more people are being treated in the primary sector?
I think that my constituents look at the Lewisham solution almost with envy. We should be able to at least guarantee to our constituents—[Interruption.] Bear with me here. As a minimum in Enfield, we would like to see 24/7 access to a doctor because the proposal for our urgent care centre is 12 hours. I think people need that comfort. I am not playing politics with Lewisham and I am not saying that the situation there is satisfactory—the hon. Member for Lewisham East (Heidi Alexander) knows well my position on that. However, I am saying how we look at it from Enfield. I hope the Minister will consider innovative ways, looking for providers be they from clinical commissioning groups or with direction from the centre, in which we can offer 24/7 doctor-led care to my constituents after years and years of frustration.
Mike Gapes (Ilford South) (Lab/Co-op)
It is a pleasure to follow the hon. Member for Enfield North (Nick de Bois). He and I have something in common. He said that he had been let down by the Secretary of State after 2010. Sadly, I have to say that my constituents and I, and my neighbour, the hon. Member for Ilford North (Mr Scott)—unfortunately, he cannot be here today, but he asked me to mention the fact that he has been in Committee—also felt let down because of a decision that was taken. Eight Members of Parliament from north-east London campaigned together on a cross-party basis to save the A and E at King George hospital, yet in 2011 the Government announced that, after the previous decision, they were going to go ahead with a recommendation to close the A and E and the maternity unit at King George hospital in Ilford. There will be no more births there at the end of March. We will no longer have children born in Ilford, unless they are born in the back of taxis or cars that are trying to get through traffic jams to take them to Queen’s hospital Romford. However, I want to concentrate on the A and E.
This afternoon, a risk summit is being held between Barking, Havering and Redbridge University Hospitals NHS Trust and the commissioners to consider the implications of the absolutely damning Care Quality Commission inspection, one of a series of inspections of Queen’s hospital, which was published on 30 January, which is last Wednesday. Among other things, the report stated:
“The accident and emergency department…has not met most of the national quality indicators as a result of extensive delays in the care of patients. Five percent of patients who need to be admitted to the hospital are waiting for more than 11 hours in the department. The Trust should be aiming to transfer 95% of patients who are being admitted to wards within four hours of their arrival.”
Many patients are waiting much longer than four hours, and 5% are waiting for more than 11 hours. That was from an inspection in December. The report also says that there is
“poor care for patients in the ‘Majors’ area”
and that the
“environment is unsuitable for patients to be nursed in for long periods of time,”
because of a
“lack of privacy/dignity, no washing facilities, no storage space for personal belongings and no bedside tables.”
I could go on—there are complaints about other A and E services and facilities at Queen’s hospital.
Queen’s is a new, PFI-built hospital that was designed for 90,000 admissions. Last year it had 132,000, as my right hon. Friend the Member for Barking (Margaret Hodge) mentioned in an intervention. It is in a joint trust with the King George hospital in Ilford, which has fewer admissions, but there was a proposal—the then Secretary of State and his Health Minister said this was the intention—to close the A and E at King George hospital in about two years from October 2011. Patients would then have had to go to the A and E at the already over-pressed and stressed Queen’s hospital. Frankly, that policy was always insane and foolish. We fought against the first such proposals in 2006—the misnamed “Fit for the Future” proposals—right the way through, in cross-party unity with neighbouring MPs, under the last Government. We managed to get implementation halted for reconsideration and review, but sadly this Government have given the go-ahead to closure of the King George A and E unit.
Nick de Bois
I hope the hon. Gentleman will benefit from the time he gains by giving way to me. He is right about the documents—as he will recall, we had “Healthy hospitals”, which was the last thing being sought. Let me remind him that we have another thing in common: the merry-go-round of chief executives, from my former chief executive to his hospital’s chief executive. It worries me that the administrators are in control, not the people or the politicians.
Mike Gapes
I do not personally blame Averil Dongworth, the new chief executive at Barking, Havering and Redbridge University Hospitals NHS Trust, for the current situation. She has not been there long enough. There are a number of predecessors who were party to the proposal. I also blame Ruth Carnall and the people in NHS London who were behind the original proposals. They and Heather Mullin, along with others in the NHS in London, have been determined for six or seven years to close the A and E unit at King George regardless of the petitions, the protests or the fact that the public overwhelmingly rejected their proposal, even in their rigged consultation.
Jim Dowd
On the malign influence of NHS London, let me tell my hon. Friend that its policy director—one Hannah Farrar—was appointed as number two and chief assistant to the special administrator of South London Healthcare NHS Trust, precisely to achieve what had always been wanted: the closures at Lewisham.
Mike Gapes
Where are we now? Last year saw a 22% increase from 2011, with 26,859 additional attendances in the A and E unit at Queen’s hospital. In addition, there were 73 patients a day more than in the previous year, with 23 days on which there were more than 470 compared with only three days in the previous year. The pressure on Queen’s hospital today is getting bigger and bigger, yet the plan is still to close the A and E unit at King George hospital. Where are all the patients supposed to go? Presumably not to Queen’s hospital, because it cannot cope. What is already happening? Although the figures are not being made public, I am told that on a number of occasions over recent weeks, in December and January, ambulances have been diverted to other hospitals from Queen’s hospital, including Whipps Cross hospital, which is part of the Barts Health NHS Trust—and it has its own problems. We are facing a real crisis.
I also understand that performance at Queen’s hospital has fallen off drastically. Only 65% of patients have been seen within four hours since the end of last year. The figure at King George hospital was much better, yet it is King George—the better-performing hospital in this trust—that is supposed to be run down. I spoke to the Care Quality Commission this afternoon, which is now proposing a potential cap on the numbers of patients in the “majors” area at Queen’s, because of the problems and lack of safety that will arise.
This is not just a question of resources. It is also, of course, a question of management, but ultimately it is not possible to get a gallon into a quart pot, which is what we face in north-east London. The trust’s board meeting on 9 January looked at these issues in detail. It has already got McKinsey in and it already has the so-called reset programme running. It also says that it has been making improvements for the past few months. Well, it made big improvements on maternity, but it has failed on A and E.
There is a real problem as long as the proposal to close A and E at King George is on the agenda. There is a problem of morale, motivation and, potentially, recruitment. The CQC report is absolutely damning about the shortage of consultants, the reliance on temporary locum staff and many other issues that are part of a fundamental problem in the trust’s culture that has been going on for a long time.
It is not very easy for my constituents to go to other hospitals. If the problems at Queen’s continue, it would be insane to go ahead with the proposals to close King George’s A and E. Last month I asked the new Secretary of State to reverse his predecessor’s decision; unfortunately he refused, but please will the Minister give me that commitment today?
Mr Speaker
Order. The limit on Back-Bench speeches will have now to be reduced to seven minutes, with immediate effect.
Sir Tony Baldry (Banbury) (Con)
Our lives are measured out in minutes, Mr Speaker.
In paragraph 1.25 of his report, which was published yesterday, Robert Francis said:
“MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.”
I am not sure how many Members of Parliament Robert Francis QC spoke to before writing that particular paragraph, but I suspect that every MP seeks to be a champion for their local hospital and for the NHS in their own area.
I have left instructions for my body to be given to Oxford university’s anatomy department, for various reasons: there is quite a lot of it and I certainly think that the liver of anyone who has been an MP for more than 30 years is worthy of anatomical examination. Most important, however, I want to ensure that when they open me up they will find inscribed on my heart the words, “Keep the Horton General”. Throughout my 30 years as an MP for north Oxfordshire, the one thing that has been of greatest importance to me, practically above all else, is ensuring that the Horton hospital in Banbury remains a general hospital—that is, one with consultant-led maternity and children’s services, 24/7 A and E services, and a facility for people to see doctors on a 24/7 basis.
I also readily recognise, however, that certain specialist trauma services cannot be provided at hospitals such as the Horton, and that they are best provided at hospitals such as the John Radcliffe in Oxford. That was best demonstrated to me by a constituent, a friend of mine, whom I met the other day. He had suffered a ruptured aorta. My paternal grandmother died of a ruptured aorta, but this constituent survived. I said to him, “You were jolly unlucky to have a ruptured aorta, but you were fantastically lucky to live.” He told me that the only reason he had survived was that the ambulance had taken him from Banbury directly to the John Radcliffe in Oxford, where he received the specialist treatment that he needed.
I echo the point that has been made by several hon. Members that we need total clarity about what people can expect from major trauma units, and what is meant by the terms “accident and emergency department”, “urgent care centre” and “major injuries unit”. We need national standards so that we can all be confident that we are comparing like with like. We could then be confident about the protocols that the ambulance services use—when they are dealing with major road accidents on the M40, for example—and patients, GPs and people generally in my constituency would know what to expect from the accident and emergency services in Banbury, and when it would be more appropriate for them to be directed to the major trauma unit at the JR in Oxford. People would also be clearer about when they ought not to be bothering the accident and emergency department at the Horton at all but should really be going to see their GP. All too often people tend to treat the accident and emergency department as an out-of-hours GP service, but it was not intended for that purpose.
We must also recognise that medicine is constantly changing. The general hospital in Buckinghamshire at which my mother was a sister tutor, and whose accident and emergency department I visited as a child, has long since closed. The general hospital at which my father was a consultant has now merged with St Peter’s hospital in Chertsey. There has been evolution in health care for a long time. The Horton hospital is changing in that medical technology is improving the pace at which patients can be treated. In the past, women who had hysterectomies might have had to stay in hospital for 10 days, but that procedure can now be done as day surgery with an overnight stay.
Changes are also resulting from the fact that we have a much larger older population, many of whom have age-related dementia issues, who need to stay in hospital much longer. We have to reconcile those two growing areas of change within one general hospital. We have to recognise that medicine and service provision will not remain static. We cannot apply a single model throughout the system. We need integrity and honesty about what services are being provided and where, and an acknowledgement that it is not always in the best interest of patients to have a single stand-alone hospital providing every service to every patient. That is not necessarily in the best interests of patient safety.
As this debate has demonstrated, we will all fight tenaciously to ensure that the national health service continues to provide the very best service for patients. The Mid Staffordshire report yesterday was a wake-up call to us all. We all love our NHS and see it as a representative of our national integrity and of the cohesion of citizens and society, but we must also acknowledge that it faces real challenges and that we must all contribute to tackling them.
Siobhain McDonagh (Mitcham and Morden) (Lab)
I join this debate as another Member whose A and E is targeted for closure. My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.
Last summer, the bad news came that it would be my local hospital, St Helier, that would lose its A and E, maternity, intensive care unit, children’s unit, renal unit and 390 in-patient beds. To be honest, it has all been a bit of a shambles. NHS South West London was due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed. Then, in September, it proudly press released that a decision was imminent and that the public consultation would start on 1 October. One doctor was quoted as being
“excited by the huge potential of the BSBV programme.”
The decision was put off. I would love to say that it was because of what local residents had to say, but actually it was because of a scathing national clinical advisory team report on the plans, which mocked BSBV’s claim that an astonishing 60% of emergency patients would use primary care instead of A and E, saying:
“The Assumption that 60%...can be managed by clinicians from primary care demands…local analysis. Elsewhere in the UK a consistent finding is…far lower, usually…15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”
What really put a block on the plans was the sudden collapse of another nearby hospital. Epsom hospital has long had financial troubles. In the 1990s, they were so bad that it was forced to merge with the more financially viable St Helier to form the Epsom and St Helier University Hospitals NHS Trust. The merger was never ideal, as Epsom has more in common with other Surrey hospitals than with St Helier. In 2011, it was finally decided that the Epsom and St Helier should de-merge and that Epsom should merge with a hospital in Surrey—Ashford and St Peter’s hospital.
All was going well until last year, when it was revealed that Epsom’s debts were far worse than originally thought. The merger deal with Ashford and St Peter’s collapsed, and Epsom was left out in the cold. This made Surrey panic about what BSBV was planning. After all, if St Helier lost its A and E and Epsom collapsed, there might be no hospital between Tooting and Guildford—so BSBV was put on hold again. In retrospect, that only made matters worse. Instead of closing one A and E out of four hospitals, the local NHS has just decided to close two out of five. That will be catastrophic.
We all know that Epsom, with its MP in the Cabinet and its wealthy population who can afford a judicial review, will put up a big fight, so the consequences for south-west London will be disastrous. There are parallels with what happened in Lewisham. Patients will suffer because of the financial problems of a hospital miles away. We thought things were bleak before; they are even bleaker now. With St Helier singled out for service closures even before this latest development, it is going to be even more difficult for our community than ever before. The argument remains the same, and my local community will not stop arguing. Closing services at St Helier is a false economy, as 200,000 people will have further to go in an emergency.
If things were bad enough even before Epsom’s problems were thrown into the mix, we will now find that an A and E will close, even though A and E visits are due to go up 20% in the next five years, and a maternity unit will close, with thousands of patients giving birth further from home, even though birth rates will go up 10%. Even when just St Helier was under threat, the National Clinical Advisory Team said:
“Successful implementation…depends on a multitude of supporting improvements”
and these
“are not well defined in the proposals.”
It concluded:
“The reconfigurations are based on an optimistic view of capacity”.
Next Monday, I will host a meeting for my local constituents to try to update them about what is going on. Obviously, the fight goes on.
The NHS admits it must save £370 million in my part of London alone. The UK Statistics Authority has made it clear that the Prime Minister has broken his electoral pledge to increase health spending. Demand for A and E is up, and the birth rate is up; but instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. If St Helier goes the way of Lewisham or worse, and loses its A and E and countless other services, my constituents will know why. My constituents are very angry: they know this will not work, and they want to hear from the Minister today that it will be stopped.
Angie Bray (Ealing Central and Acton) (Con)
I sympathise with the problems described by the hon. Member for Mitcham and Morden (Siobhain McDonagh).
It seems a long time since NHS North West London presented its “Shaping a healthier future” proposals and Members from across west London first came together to debate them. On that occasion, I explained why I opposed the plans, and put on record my fear that they would have a serious and negative impact on my constituents. Downgrading the four nearest A and E departments—at Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals—would be completely disproportionate, and would leave the people of Ealing and Acton slap bang in the middle of an emergency care black hole.
Since that debate, a cross-party coalition—including the hon. Member for Ealing, Southall (Mr Sharma), who opened the debate, and the hon. Member for Hammersmith (Mr Slaughter), who is also present—embarked on fighting the plans. We have organised rallies, marches, petitions and leaflets, and pages and pages of coverage have appeared in the local as well as the national press. I am not a natural marcher, but I did attend the big rally on Ealing Common to oppose the plans, along with other local Conservatives.
We felt that the most constructive use of our time would be to encourage as many people as possible to fill in the consultation document provided by NHS North West London. We offered guidance on how best to navigate the bewildering and unnecessarily lengthy set of questions, and we helped about 600 people to register their views. That was a large contribution in a borough which returned the highest number of responses to the consultation, almost all of which opposed the plans, and it demonstrates the level of worry that exists in Ealing and Acton.
Mr Andy Slaughter (Hammersmith) (Lab)
Despite the biased nature of the questionnaire, efforts were made to fill it in, and a few thousand people did so. However, 80,000 people signed petitions which were then studiously ignored. Only the responses to the questionnaire were taken into consideration. Perhaps the hon. Lady would like to comment on that.
Angie Bray
I certainly think that a petition of that size cannot be easily ignored. However, as we pointed out when we encouraged people to take part in what was a massive and time-consuming process, I suspect that, technically and legally, the authority is obliged to register only the responses to the consultation.
Beyond what I have described, my role has been to make my objections, and those of my constituents, fully known to and understood by as wide an audience as possible in Government. After doing the rounds of meetings with the previous team at the Department of Health, I held meetings with the new ministerial team and the Health Secretary after last autumn’s reshuffle. I followed that up with a meeting with the Prime Minister, whom I left in no doubt that this issue was of the utmost importance to my constituents.
We all believe that the closure plan must be reviewed. None of us can believe that it is anything other than reckless. We wonder how the A and E departments that are left standing will be able to cope with all the extra pressure that will result from the closure programme. I explained to the Prime Minister in detail why the extra travel time to A and E departments further afield would be unacceptable. He listened carefully, asked a number of detailed questions, and told me that he would certainly discuss the issue this with Health Ministers.
Much of our campaigning has focused on the baffling way in which NHS North West London has chosen to present the proposals as a virtual fait accompli, without adequately explaining quite how they will work in practice. We are told that new “urgent care centres” will cater for everyone’s needs, but we have also learnt that there is a lengthy list of conditions, and that there are a number of possible problems with which they will not actually deal.
Steve Baker (Wycombe) (Con)
It is, in a sense, reassuring to hear that my hon. Friend is experiencing exactly the same problems as we are experiencing in Buckinghamshire. It is always made to sound so good, and then it is so awful. I hope that the Minister will be able to explain how things can change, so that instead of standing here complaining on behalf of our constituents we can actually make a difference.
Angie Bray
I entirely agree. The issue of trust is so important, but I suspect that we shall have to do a lot of work if we are to build that trust.
What I have just said about urgent care centres will not be at all reassuring for my many constituents who use the local A and Es. We must not forget that Ealing hospital’s A and E sees at least 100,000 people every year. Nobody is suggesting that we do not need to make long-term improvements to our health service and the way services are delivered, but we need better guarantees that the planned changes will provide an acceptable replacement for what we have at present.
It is unreasonable to expect my constituents to support the closure of their local much-cherished A and Es without any certainty that what they are told will be put in place will materialise. In the meantime, there is the practical question that everybody is asking: if the A and Es are closing at four hospitals, what will happen to the queues at the A and Es that are left open?
No one is under the impression that everything is rosy and that the way health care is delivered in north-west London is absolutely perfect. Clearly, in the longer term we will need to encourage more people to sign up to local GPs rather than depending on A and Es for all their health care needs, but that requires time and organisation. We cannot just close the A and E and expect people to cope. Looking forward, we clearly need to make sensible decisions on how we fund health care provision locally, to ensure money is available to meet all the rising costs associated with people living longer, new medicines coming on-stream and new costly treatments, but we have to take people with us as we approach change.
Understandably, people have an emotional attachment to their local hospitals and they need to be persuaded of the case for change. Given that the health reforms are about to put GPs in charge of local health provision, why are we not waiting to see what decisions they think would be appropriate, rather than pushing these decisions through now? The whole approach has been too rushed. Local GPs have hardly been queuing up, in public at least, to support these proposals. The impression my constituents have been left with is that the consultation was little more than an attempt to channel their views towards the preferred option, in what was a box-ticking exercise by NHS North West London.
There are too many questions left unanswered, and too much of the information provided in the consultation was too questionable. For all these reasons, I can only hope that if NHS North West London decides on 19 February to proceed as it currently intends, the Secretary of State will ensure that that is reviewed in its entirety. My constituents are deeply concerned.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
I greatly enjoyed the speech of the hon. Member for Ealing Central and Acton (Angie Bray) and share many of her sentiments, but I hope she will forgive me for saying that her contribution lacked a sense of regional and national context. Despite the pretence of a national review, to which my hon. Friend the Member for Ealing, Southall (Mr Sharma) alluded, closing substantial numbers of A and E units is clearly now Government policy. Professor Matthew Cooke has been advising the Department of Health on A and E issues—he did so last year, at least. He has spoken to NHS North West London, supporting its plans to close four of our nine A and E departments, and he was reported in the Daily Mail as saying that those plans were in line with national Government policy.
At the 2010 general election, the Conservative party manifesto promised to stop the closure of A and E departments. Indeed, I think the Prime Minister insisted there would be a moratorium to stop further A and E closures. If I remember rightly, during the election campaign the Prime Minister visited Chase Farm A and E department in London and Queen Mary’s A and E department in Sidcup, promising to stop their closure.
Mr Thomas
Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.
My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.
We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.
Heidi Alexander (Lewisham East) (Lab)
My hon. Friend mentioned the hospitals the Prime Minister visited before the election whose A and Es he promised to retain. Of course, in 2007 he also said that he would get into a bare-knuckle fight over the future of Lewisham hospital. Does my hon. Friend agree that the Government’s A and E policy seems somewhat hypocritical?
Mr Thomas
There certainly seems to be little obvious sign of any bare-knuckle fighting on the Prime Minister’s part to stop the closure of Lewisham A and E or, indeed, the other eight departments set for closure in London.
I want to concentrate the rest of my speech on the plans at North West London Hospitals NHS Trust. As the hon. Member for Ealing Central and Acton said, there are plans to shut Ealing, Charing Cross, Hammersmith—it is good to see my hon. Friend the Member for Hammersmith (Mr Slaughter) here—and Central Middlesex A and E departments. My constituency is served by Northwick Park hospital A and E department, and my constituents are worried about the pressure that the closure of the four other A and E departments in the area will put on Northwick Park when all the extra people turn up there needing treatment.
Clinical teams at the north-west London trust have noted that the strategy behind the proposed closure of the four A and E departments assumes that thousands of people can be persuaded not to go to A and E but instead to use their GPs and other community services. I am a little sceptical about the idea that that will work, not least because the numbers using Northwick Park A and E are already significantly greater than before the 2010 election.
One element of the strategy, to prevent the possibility of patients who shift to Northwick Park not getting the services they need, is, as I said, to use community services. The decision to downgrade the Alexandra Avenue polyclinic, a walk-in service open 8 am to 8 pm, 365 days a year in the south Harrow part of my constituency, to just Saturday and Sunday opening, 9 am to 3 pm, has led to greater use of Northwick Park hospital A and E, as a number of doctors have said. So the decision to close that polyclinic, supported, incidentally, by the Conservative party in Harrow, seems particularly surprising, given the appetite for community services to solve the problem of lots of people potentially going to Northwick Park A and E.
Nick de Bois
To put this in context, it is clear, having read Hansard, that both this Government and the previous Government supported reconfiguration on the basis of more people being served in the community, and that is probably not a bad thing. However, it is not just a question of having the infrastructure, the buildings and the clinical staff, but of imploring people to make a cultural change. One cannot do that easily and quickly, particularly between generations. So although both this and the previous Government agree that reconfiguration is important, my concern is that they have not taken the people with them.
Mr Thomas
On that very specific point, I agree with the hon. Gentleman. What feels different about the context in which we are having this debate is the sheer number of A and E departments whose closure is envisaged.
If the hon. Gentleman and others will forgive me, I will return to the issue of Alexandra Avenue polyclinic and how it helped to divert people from using the A and E department at Northwick Park. I urge the new Harrow clinical commissioning group to reopen Alexandra Avenue as a proper walk-in service, or to find an alternative site for such a facility in order to reduce the pressure on Northwick Park. The last figures that I saw showed that in fewer than 12 months, from April 2011 to February 2012, the number of people waiting more than four hours at Northwick Park and Central Middlesex hospitals’ A and E departments had risen to more than 9,000. A total of 9,137 people in that 10-month period had waited more than four hours for treatment. What is far from clear is whether there is a clear clinical strategy across London that has the confidence of doctors and of the public—that point was raised by the hon. Member for Enfield North (Nick de Bois)—to really drive down the pressure on A and E departments in the future.
Already, too many people in London have had to wait in ambulances for longer than 30 minutes; that happened to 42,248 people in 2011-12, a rise of almost 50% on the previous year. Some 10,000 people had to wait more than 45 minutes to get into the A and E departments across London; they were sitting in the ambulance waiting. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said, the UK Statistics Authority has pointed out that the Prime Minister has broken his promise to protect NHS spending. It is clear that the NHS in London is under unprecedented pressure, because of the Conservative party’s squeeze on NHS funding. A Prime Minister who once promised to stop A and E closures is allowing nine to go ahead across London. Once again, that old adage is being proved true, “Same old Conservatives. You can’t trust the Tories with the NHS.”
Mr Speaker
Order. We are extremely grateful to the hon. Gentleman for his contribution. The next speaker, to whom, unfortunately, a six-minute limit will have to apply, a fact of which I was about to notify him, is Mr Gavin Barwell.
Gavin Barwell (Croydon Central) (Con)
For the second time this week I have reason to thank you, Mr Speaker. Six minutes seems like an eternity compared with four. A number of colleagues kindly commented positively about my speech on Tuesday, but this one is going to be much less popular, particularly with the hon. Member for Mitcham and Morden (Siobhain McDonagh), and I apologise to her at the outset for that. I am going to strike a slightly different tone from that of many of the people who have spoken in the debate.
The hon. Lady mentioned the “Better Services, Better Value” review, which has been commissioned for health services across south-west London. In the final clinical report’s introduction, the clinicians involved in the review found that
“health services in south west London are not sustainable in their current configuration. In the opinion of the clinicians leading the review, no change is not an option.”
A number of points made in the review are specifically relevant to A and E departments and I wish to draw the House’s attention to them.
The review looked at the number of full-time equivalent emergency medicine consultants in each of the four A and E departments in the area and compared that with the recommended minimum number to achieve cover for 16 hours a day, seven days a week. Croydon Health Services NHS Trust should have 16 whole-time equivalent consultants, but it has 4.9. The figures for St Helier show that it should have 12 but actually has 4.5. Kingston Hospital NHS Trust should have 16 but it has 10. St George’s should have at least 16 but it has 21. So that provides clear evidence that the departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended minimum level of consultant cover.
The review says specifically:
“In London, data shows that the probability of dying as a result of many emergency conditions is significantly higher if the admission is at the weekend, compared to a weekday.”
That is because of that low level of consultant cover. It continues:
“Each year, there are around 25,000 deaths following emergency admission to London’s hospitals. If the weekend mortality rate in London was the same as the weekday rate there would be a minimum of 500 fewer deaths a year.”
Heidi Alexander (Lewisham East) (Lab)
How does the hon. Gentleman know that those different mortality rates that he cites are down to less consultant cover at weekends and are not, for example, the result of a sicker population entering A and E at weekends?
Gavin Barwell
The honest answer to the hon. Lady’s question is that I do not know. I am simply relying on the report, which is suggesting that that analysis points to 500 as the number of deaths that are purely due to the timing of the week. We could argue about the figure, but I hope that she would agree on the point of principle that having fewer consultants on at the weekend must impose some level of risk.
The report also says:
“The Royal College of Surgeons state that a critical population mass is required in order to provide an efficient and effective emergency service. This is supported by literature that suggests that surgeons who perform a high volume of procedures tend to have better outcomes. The preferred catchment population size for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency surgical cases would be 450,000-500,000.”
We have a problem. We have a large number of hospitals in London with accident and emergency departments and they do not have the recommended level of full-time equivalent consultant cover to provide the best medical outcomes. Every single Member of this House will defend their local hospital, as that is where their constituents go for treatment. If I was in the same position as the hon. Member for Mitcham and Morden, I would be doing exactly the same.
Gavin Barwell
I shall give way to my hon. Friend, because I promised that I would.
Mr Charles Walker
The problem in north London—and in Broxbourne on the edge of north London—is that Chase Farm is serving a growing population. I do not want to keep Chase Farm A and E open because of any emotional attachment to it, but because we have a population that is due to grow by another 40,000 over the next few years.
Gavin Barwell
My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.
The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.
Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:
“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”
The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.
There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.
Siobhain McDonagh
Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.
Gavin Barwell
I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that
“there is no firm evidence”
to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.
Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.
Gavin Barwell
I am afraid I cannot take any more interventions.
The hon. Member for Lewisham West and Penge was wrong to state that that has only started to happen under this Government. In my part of London in the past things have gone wrong in neighbouring boroughs and Croydon PCT has had to help them out. In the past two years Croydon PCT has got into trouble and neighbouring boroughs have helped us out. That does not mean that what is happening is right. I am not making a judgment on it. I am just saying that it is not fair to suggest that the present situation is a wholly new departure.
Hon. Members have made powerful arguments for their local hospitals, but there is a balance to be struck between convenience of locality and ensuring sufficient acute cover. I completely understand the point made by the hon. Member for Mitcham and Morden (Siobhain McDonagh) in relation to St Helier, but as a Croydon MP I have to say that there must a solution that gets us to the recommended minimum level of consultant cover in our hospital, and I will continue to fight for that.
Mr David Lammy (Tottenham) (Lab)
Twelve years ago I sat where the Minister is sitting, when I was the Under-Secretary of State for Health. I had responsibility for accident and emergency services in particular, and I want to impress on her that she has power to respond to what is being said in the House today.
All Members will understand that the NHS does not stand still. Reconfigurations are necessary. Changes are necessary. I was born in a constituency that had a wonderful hospital called the Prince of Wales; it no longer exists. In the Roehampton part of London, there was a hospital; it no longer exists. Things change. In London we have seen changes to stroke services. It is possible that someone in an ambulance, having been unfortunate enough to have a stroke, will drive past a hospital to get to another hospital, a centre of excellence. That was a configuration that was carried out with great consensus across London. I pay tribute to Richard Sumray, who was chair of the primary care trust in Haringey and led the consultation on changing stroke services in London.
The Minister has heard deep concerns expressed about the changes proposed in every area of our capital city—deep concerns about King George hospital in the east and about the much loved hospital in Lewisham in the south. No one can understand why Lewisham should pay for problems in an adjoining area, as currently proposed. We raised concerns about the problems in the north. I will refer briefly to the Whittington, although my hon. Friend the Member for Islington North (Jeremy Corbyn) is in his seat and will major on that. We have heard about Chase Farm and about pressures deep in the south, in St Helier and the Croydon area, which were described by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). We have also heard about concerns in the west of London around Ealing. That is unprecedented.
Jeremy Corbyn (Islington North) (Lab)
Does my right hon. Friend accept that one problem is that London’s population is rising, health inequalities are rising, and health demands are rising among poorer people? Although I understand all the arguments about putting services in the community, if hospitals are closed, many desperately poor and ill people will not be properly served.
Mr Lammy
My hon. Friend makes the point beautifully. Let us look at the demographics of London. The Mayor’s London plan estimated London’s population to be 7.8 million. The census later showed us that it was 8.17 million at least. The London plan assumed that the population would break 8.5 million in 2027. We now believe that it will exceed that figure in 2016. By 2031 there will be 9.5 million people living in our capital city. The areas marked for growth are the upper Lea valley—Chase Farm; the Metropolitan line corridor, with nine A and E units now turning into five; and the south-east of London, where Lewisham is based. There will be 9.5 million people using services that the Health Secretary is seeing shut down. There are huge concerns.
I sat in the Minister’s seat. That was after the terrible winter flu epidemics in the late 1990s. At that point the Whittington hospital in north London was at the epicentre of a public storm because of the bed waits and other long waits. My job, set by the former Member for Darlington who was then Secretary of State for Health, was to ensure that that four-hour wait was a reality across our country. I would sit with chief execs and we would go through the so-called sitreps to ensure that those hospitals were meeting the four-hour waiting target. That was the key element of my job.
I decided to look at the sitrep for the past four weeks across London. There is a target, and if hospitals are doing badly they are flagged as red, while if they are doing well and meeting the target, they are marked as green. I was startled. Ealing, Hillingdon, Imperial, North West London Hospitals, West Middlesex, Barnet and Chase, Whittington, Barking, Guy’s and St Thomas’, King’s College, Lewisham, South London, Epsom and St Helier, Kingston, Croydon and St George all currently fail. Yet it is proposed that we can lose many of our A and E departments—eight across London—at this time. It does not make sense.
This is a health service in London that we look to when a helicopter falls out of the sky or when bombs go off in Canary Wharf or on the underground. This is an A and E service that we look to following riots. I remember the A and E serving our police officers on the first night of riots in my constituency. Londoners will be very concerned indeed that this debate is being framed and structured in this way at this time, with the lack of consultation described so well by my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock).
I was staggered when I found out about the proposed changes to Whittington hospital in Camden New Journal. In November, I had a meeting with the chair and the chief executive, with other Members of Parliament, and we found out that a third of the hospital was to be sold off, that it was apparently to be totally reliant on community services, that it was to lose 500 jobs, and that the people of north London would again have to fight to retain the hospital that they loved—a hospital in my constituency in which my two sons and I were born, and which has been served particularly by nurses from the Caribbean.
Londoners are concerned and Londoners will fight. The Minister has the power to act to put an end to the disarray that we are now seeing across London, and I ask her to do so.
Kate Green (Stretford and Urmston) (Lab)
I want to speak about changes to the A and E department at Trafford General hospital in my constituency.
Over the years, Trafford General has experienced financial and management problems, and last year it was absorbed into Central Manchester University Hospitals NHS Foundation Trust. We all expected that there would be a reconfiguration of services following that acquisition, and that is what happened. Last month, following public consultation on the so-called new health deal for Trafford, NHS Greater Manchester announced its intention to proceed with a downgrade of the A and E at Trafford General, first to an urgent care centre open from 8 am until midnight, and in due course to a nurse-led minor injuries unit, alongside other changes to services. I expect those changes now to be referred to the Secretary of State for decision.
Nobody in Trafford is opposed to change that can improve clinical care. Already, major trauma cases are diverted away from Trafford General, while serious stroke and cardiac cases go not to Trafford but to centres of excellence at Salford Royal, University Hospital of South Manchester and Manchester Royal Infirmary. That approach is widely understood and accepted by the public. Equally, plans to develop a model of integrated care locally are popular, and it is recognised that they could help to keep people out of hospital for longer.
However, there are consequences to the reconfigurations that have already taken place and to what is now proposed. More than half of Trafford residents now attend an A and E other than Trafford General, partly because more specialist and complex cases are rightly diverted to other centres, partly because local people are choosing to attend other nearby hospitals that offer them greater convenience or the kind of care they want, partly because it is widely believed that ambulances will not take people to Trafford General unless they specifically instruct them to do so, and partly because the whole downward spiral in activity is reinforcing public behaviour so that they are increasingly even less likely to decide to go to Trafford General. In other words, reducing activity levels are, to a degree, a self-fulfilling prophecy.
There are concerns about the capacity at neighbouring hospitals. My right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has been raising concerns about capacity at the University hospital of South Manchester in Wythenshawe since we first knew about the proposals last summer. Its A and E is already coping with tens of thousands more admissions than the 70,000 for which it was designed. It simply cannot absorb more patients from Trafford without additional investment.
Commissioners assure me that there is progress in the development of integrated care, but that is pretty well invisible to local people. Recovering patients report long waits and great difficulty in getting rehabilitative care and support at home. In the meantime, many of the admissions to our A and E are elderly and frail patients, which is undoubtedly in part the result of the gulf between the ambition for integrated preventive services in the community and the reality.
There are concerns about the capacity of the North West ambulance service. If there is a reduction in hours and capacity at Trafford general, there will clearly be more patient journeys to other hospitals. There are also worries about what will happen if mental health patients present at Trafford general’s urgent care centre and it does not have the capacity to care for them.
All of that is taking place against the backdrop of a wider planned reconfiguration across Greater Manchester. Last year, in the middle of the consultation on the changes at Trafford, we learned about Healthier Together, a major redrawing of health care provision across Greater Manchester, including A and E provision. If, as is likely, that leads to further closures and reductions in A and E services across Manchester, there will be further capacity questions that will have a significant effect on Trafford. We are in an invidious position. It has been said that the new health deal for Trafford offers the best hope of a secure future for Trafford general, but we are planning in a vacuum. We know for sure that change is coming, but we have no idea what it will look like.
Late last year, my right hon. Friend the Member for Leigh (Andy Burnham) wrote to the Secretary of State asking him to halt the reconfiguration at Trafford and to consider it within the wider Healthier Together review. The Secretary of State refused to do that, but he has offered no guarantees or reassurances regarding the impact of Healthier Together on Trafford general.
There is now a broader context still with Sir Bruce Keogh’s review of emergency services. I hope that the Minister will reassure me that decisions about the future of services at Trafford will not pre-empt Sir Bruce’s review. Sir Bruce has made it clear that it is vital that new services are in place before existing services are closed. In The Guardian on 24 January, he was quoted as saying:
“I don’t think we can change the system until we know we have a solution that is OK.”
He specifically highlighted concerns about
“the idea of some poor mum having to travel to A&E on two buses because we closed an A&E down and she doesn’t have confidence that what is left is good enough”.
That is precisely our fear in Trafford.
I have no doubt about the good intentions and efforts of local NHS managers and commissioners, but they are being constrained by financial pressures and limited, as has become clear this afternoon, by a lack of overall vision and strategy from the Government. Local people cannot be expected to sign up to changes that they do not know have been future-proofed against changes that we know are imminent.
Last month, my right hon. Friend the Member for Leigh set out a vision for the future of district general hospitals such as Trafford general, which offered a different kind of future and a secure one. I agree with the hon. Member for Croydon Central (Gavin Barwell) that it is important to strike the right balance between quality and convenience, but process and trust are also important. Today, I have to inform the Minister that people do not feel that trust in relation to the plans for Trafford.
Mr Iain Wright (Hartlepool) (Lab)
The A and E department at the University hospital of Hartlepool closed in August 2011. I want to raise five points relating to the experience of the 18 months since.
First, clinical safety is paramount in all health reconfigurations. There was clear consensus among senior medical staff that there were significant safety issues with the A and E at Hartlepool. The number of medical staff was insufficient to cover two rotas at Stockton and Hartlepool, and the supervision of junior medical staff was inadequate and did not meet modern guidance criteria. When senior clinical staff say that lives will be saved if changes are made, it is irresponsible for anybody, whether elected representatives or others, not to listen to those expert voices.
Despite the paramount importance of clinical safety, however, it is clear that the people of Hartlepool did not and do not want the closure of their A and E department—no community does. More provision can be made outside the hospital setting and in the local community to make services closer and more convenient to where people live. A One Life centre—a minor injury unit—has been built in the heart of the town centre and should be more easily accessible to a greater number of the town’s population. That is a welcome step. During a debate on A and E in September 2010, I said:
“Moving more serious cases to North Tees is very unwelcome as it is detrimental to my constituents”.—[Official Report, 14 September 2010; Vol. 515, c. 202WH.]
I stand by that.
My area has seen bitter disputes about the reconfiguration of acute services for the best part of 20 years. There is real tension between the views of professionals, who are best placed to consider the safest and most clinically effective means of providing a service, including in specialist concentrated centres, and the general public who will be the recipients and beneficiaries of that service, and who will pay for it through general taxation, even though they may often disagree with the means and location of that service. Successive Governments over two or three decades have failed to reconcile that basic tension. The concept of “No decision about me, without me” and the four tests of reconfiguration that are often bandied about are a fallacy. It is an understatement to say that Hartlepool would have preferred to maintain a full A and E service. People do not feel as if they have had a proper say in the matter.
Safety, changing medical practices and, increasingly, financial considerations, will play the decisive role in where A and E and other health services are located, and invariably it will be against the general wishes of the local population. I would be interested in the Minister’s views about how that tension between clinicians and the public can best be resolved.
That was my second point. My third point concerns communication about where a patient should go. If a child bangs his or head in Hartlepool tonight, where should their parent take them? Previously, it was a relatively simple choice—they went to A and E. Now, a parent is confronted with going perhaps to the A and E at North Tees hospital, perhaps the One Life minor injuries unit and urgent care centre, or even the university hospital of Hartlepool. The new arrangement seems more complex and fragmented, and surely if the system contains greater complexity and fragmentation, there is greater risk.
Some 18 months after the A and E closure, the system is bedding down; it was not perfect from day one, although that is another matter. However, I am not convinced that the risk is being adequately managed. There is inadequate communication and subsequent misdiagnosis, leading to obvious and understandable alarm among my constituents. What will the Minister do about that?
My fourth point concerns the pressing and persistent need to link reconfiguration of health services with transport policy. Such a link is just not there at the moment. How on earth will my constituents be able to travel to North Tees hospital 13 miles away? The hospital is a long way from many of them and difficult to get to. Hartlepool has low rates of car ownership and poor public transport links, and bus services are virtually non-existent, certainly at weekends and evenings. I would not have thought that the Government or local NHS trust wanted the public to rely solely on ambulance services. The point I wish to stress, and which I hope the Minister will address, is that any reconfiguration of services requires transport and accessibility at its heart. At the moment, transport policy is merely being paid lip service. What will the Minister do about that?
My final point is about the wider reconfiguration of health services north of the Tees. Although, as I said earlier, much of the decision to close Hartlepool A and E was based on immediate clinical safety grounds, it is fair to see that decision in the context of the Momentum programme, which is designed to move health services out of the hospital setting and into the community. The Momentum programme culminates in the building and opening of a new hospital in Wynyard, which is designed to incorporate the most advanced equipment and medical and surgical practices and serve the acute health needs of the populations of Hartlepool, Stockton, Sedgefield and Easington. The original plan was for construction to start last year and for the first patients to be admitted by 2014-15. Soon after taking office, however, the Government withdrew public funding for that hospital, and despite warm words and a series of announcements from the Foundation Trust Network, no alternative source of private funding has been approved. We do not appear to be any further forward.
Two procedures are running dangerously out of parallel. We have the Momentum programme, with the reconfiguration of services, and the funding programme for the new hospital. That is now three years out of date and there is no concrete indication that private funding is on the table. Services have been moved without any clarification about the endgame. My big fear is that my constituents will have the worst of all possible worlds with services moving to North Tees and no new hospital. Something must be done.
Jeremy Corbyn (Islington North) (Lab)
I will try to be as brief as possible so that the debate can be properly concluded.
This debate goes to the heart of what the NHS is about. Many Members of Parliament are deeply frustrated about health plans being hatched in their constituencies, but they have very little power to influence events. The health service is being atomised by a large number of private interests through private finance initiatives, and by a large number of trusts with competing interests. We need a properly planned health service rather than the internal market and competition, which are at the heart of so many of our problems.
If the hon. Member for Enfield North (Nick de Bois) were still in his place, I could tell him something that would make him even more depressed about the future of Chase Farm hospital. As a former member of the late Enfield and Haringey area health authority in the 1970s, I recall debates on whether Chase Farm should be closed. There are agendas—colleagues will recognise such agendas all over the country—that live on beyond past directors, trusts and reconfigurations: somebody always has an aspiration to close something and centralise something else. If hon. Members think politics in the House of Commons is robust, they should try NHS politics, which is far more robust and nastier than anything we experience here.
I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on opening and securing this debate, and on the campaign he is running on behalf of the people of his constituency. Many Members are involved in that campaign in west London and the one in south London. What is going on in London is outrageous. I ask the House to consider what my right hon. Friend the Member for Tottenham (Mr Lammy) said. London has a fast growing population, great health inequalities and poverty, and a fast growing number of people in the daytime: the population of central London goes up phenomenally during the day because of people commuting to work, going to cultural or sporting events, or simply passing through the capital city. If we start closing A and E departments and saying that everything should go out into the community, and thus that hospitals can be reduced and closed, we are making the future very dangerous for our communities.
As the House is well aware, I represent Islington North. The Whittington hospital is in my constituency. Anything I say about the hospital is not a criticism of it or its wonderful staff—I absolutely support them and their work. Some three years ago, we discovered that the A and E department was due to be closed. As ever, there were denials all over the place. I tell the hon. Member for Morecambe and Lunesdale (David Morris) to be ever so sceptical when told that an A and E department is not closing, because closure is probably in a plan somewhere.
We exposed the plan to close the Whittington A and E and eventually had the most bizarre general election rally ever in 2010, when the right hon. Member for South Cambridgeshire (Mr Lansley), the hon. Members for North Norfolk (Norman Lamb) and for Hornsey and Wood Green (Lynne Featherstone), my right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Tottenham, and my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) and I were on a platform pledging to save the A and E department, which was duly saved. However, time moves on. The hospital wants to become a trust and has begun putting together a financial package, to which my right hon. Friend the Member for Tottenham referred. The package involves the sale of a quarter of the site—apparently, £17 million is to be made from that—the loss of 500 jobs and a reduction in the number of beds in the hospital to 177, which is about half what it was five years ago.
We asked whether an A and E department with a hospital of only 177 beds behind it was viable. Is that not a plan to remove the Whittington as an overall local district general hospital with an A and E department in future? The Camden New Journal and Islington Tribune reported on this with great alacrity last week. I congratulate Tom Foot and all those who put the story together, because I suspect the issue would not otherwise have reached the light of day. At a public meeting next Tuesday, friends, neighbouring MPs and many others from the local community will be questioning the chief executive and others from the hospital, and taking part in a big campaign to protect our hospital.
We all face issues of health care. I think there is a consensus that we all respect and value the principles of the national health service, but if we allow buildings to be sold off and A and E departments to close, we will end up with the health service becoming a service of last resort and with the promotion of private medicine at the expense of the NHS. We will end up with much poorer societies and much greater health inequalities, and that is in nobody’s interest. Let us get control of this in a democratic way, so that we can control what goes on in the health service in our name.
Mr Andy Slaughter (Hammersmith) (Lab)
May I first thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for picking up the baton and sponsoring the debate? It was first proposed to the Backbench Business Committee before Christmas by me and colleagues from other parties as a London debate, and it has had the feel of a London debate. However, colleagues from elsewhere in the country should not feel excluded, because a lot of what is being tried out in London will soon be spreading to the rest of the country if they are not careful.
I had to attend the Justice and Security Public Bill Committee, which meant that I was not here at the beginning of the debate, but I am grateful for the opportunity to speak. Balancing whether to oppose the Government’s attacks on civil liberties or the Government’s attack on the health service is difficult, so it is nice to be able to deal with both in one day.
I will not get involved in a hierarchy of misery. Many Members have spoken passionately about their own experiences, but I will say that both the A and E departments at the world-class hospitals—Hammersmith and Charing Cross—in my constituency are marked for closure. Charing Cross hospital, which in many ways has the best site and some of the best facilities in north-west London, is marked for almost complete closure. All 500 beds will go, the A and E will go and the specialist services will go, leaving an urgent care centre and other services high and dry, such as the Maggie’s cancer centre and the mental health services. To its shame, Imperial College Healthcare NHS Trust is supporting those closures because it will provide a very valuable piece of real estate for it to sell and thus improve other campuses.
As my hon. Friend the Member for Harrow West (Mr Thomas) said, it is not the case that community services have been improved before these closures will take place. Indeed, the White City collaborative care centre, which should have been the first polyclinic in the country is, thanks to a Conservative council, six years late and with a fraction of the services it should have. It is still not open and will not adequately replace any of those services.
What is happening in north-west London flies in the face of the facts. Most hospitals in the area do not meet the four-hour target, owing to the demand on their services. Ambulances are less safe and effective than A and E care. For patients, it is clearly better to be in A and E than in an ambulance. Longer journeys and journey times need to be avoided. There is no evidence that when a good A and E closes most cases get dealt with better via centralisation. There are good data suggesting the opposite is true, as local A and Es have the capability to select patients who require more specialised care, easing the pressure on large units, and to stabilise those patients in the critical intermediate period.
In a nutshell, my constituents are being offered a second-class service. There is no clear demarcation. The health service itself cannot tell us which conditions should go to an urgent care centre and which should go to an A and E. The majority of my constituents will have a worse health service, and that particularly applies to poorer constituents who do not have access to private transport.
Let us look briefly at the process we have gone through, which has been utterly scandalous. As soon as the coalition Government came in they started preparing these closures. They gave millions of pounds to McKinsey to draw up the plans, yet when I asked it about those plans I was lied to about the fact that hospital closures were being prepared and was even told that I had been consulted when I had not. We have heard already about the phoney consultation, the 80,000 signatures that were ignored and the 3,000 or 4,000—
Mr Speaker
Order. I am sure the hon. Gentleman was not suggesting for one moment that he was lied to in the House of Commons.
Mr Slaughter
Absolutely not. As part of the consultation process that was undertaken, it is on the record in the documentation that I was consulted. I was not consulted on those matters.
Mr Slaughter
I am sorry; although I would love to give way, I have been asked not to.
That consultation was ignored. The body taking the decision has no stake in these matters whatever. The joint PCT council, NHS North West London, will not exist. The bodies that do have a stake, namely the clinical commissioning groups that are taking over—the puppet masters, as it were—have too much influence in my view and too much to gain personally. I wish I had time to go through the declarations of interest that members of the CCGs have made. They show that most hold shares in Harmoni, Care UK or other private interests that might benefit from the commissioning powers that the CCGs are about to get. I have not received proper answers from the health service about what those interests are or what they remain.
To conclude, the decision for north-west London will be taken on 19 February, so this debate is very apposite. I have no doubt that the decision will be taken to go ahead with most or all of the proposed closures, but the protests that have taken place—the demonstrations, marches and petitioning—will continue, because this now becomes a political decision for the Secretary of State. In the early-day motion that I tabled last June, I referred to the fact that the health service locally was saying it would run out of money if it did not make these cuts. Services are already being run down by sleight of hand. The buck stops with the Secretary of State and the Government. The ball is in their court. I hope the decision will be taken, first, by the independent panel and, secondly, by the Secretary of State. The Government cannot dodge this issue. This is about cuts, as it was in the 1990s, and the denigration of our local health service. The buck cannot be passed beyond this point. I call on the Minister in her reply to say how she intends to preserve the local health service in north-west London.
Mr Jamie Reed (Copeland) (Lab)
First, let me commend my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Members for Newark (Patrick Mercer) and for Eastbourne (Stephen Lloyd) for initiating this debate and the Backbench Business Committee for agreeing to it. As we have heard, given the geographical spread of concerns, this will clearly be the first of many such debates.
The recent events in south-east London have demonstrated just how timely this debate is. Members from all parts of the House have made compelling cases and shown the depth of feeling on this issue, which cannot be approached easily or without extremely strong emotion. I have always fought for the services provided by West Cumberland hospital in my constituency and I always will. I know just how Members feel about the issues facing their hospitals and I am sure the Minister does too. Indeed, I am sure we have all faced them.
The needs and best interests of patients were at the centre of the inspiration to create the national health service, almost 65 years ago, from the ashes of the second world war. The needs and best interests of the patient must remain at the centre of any discussion about health services today. This is the crux of the issue. With that in mind, the recent decision that the Secretary of State for Health took on the A and E department at Lewisham has set the NHS on a dangerous path whereby the core principle underpinning and shaping the design and delivery of hospital services—that which is in the best interests of patients—now looks set to be redefined. This Government have introduced a new basis on which to take decisions—namely, that financial considerations should take precedence over clinical considerations. Any A and E department in the country is vulnerable to change on that basis.
Those two fundamental points—financial considerations taking precedence over clinical considerations and the Government allowing the reorganisation of well functioning hospitals on that basis—create a toxic mix that could have consequences for patient care and well-being. As we have seen—today’s debate is testament to this—the new emerging principle has consequences for the legitimacy of the decision-making process for reconfiguration and the accountability of those behind such processes. We must return to the first principles of health care provision. The patient comes first. Their health care and well-being are paramount. The needs of the patient must always take priority over the needs of any other interest in the system. Services should reflect that, as should their design and delivery.
If a clinical case and clinical evidence suggest that services and, most importantly, patient care can be improved by reconfiguration, we have a duty to support those arguments in the interests of the patient. Where a reconfiguration is shown to improve patient care and ultimately save lives, we cannot and must not stand in the way. Where services can be better provided to those who use them, changes cannot and should not be opposed simply for the sake of opposition.
My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, has made clear the massive challenges facing our health-care system. It is a 20th-century system struggling to answer the questions asked of it by a 21st-century society. There is a huge sustainability challenge characterised by an era of economic austerity, for which there is no line on the horizon, and rapidly rising demand. However, any community that is experiencing reconfiguration without clinical evidence should know that the Opposition will be by its side fighting with it every step of the way. The NHS is our greatest achievement and we guard it jealously.
There are important progressive principles at stake. First, every penny of taxpayers’ money should be spent to its maximum effect, even more so in austere times. As arguably the nation’s most valued public service, the first duty of the NHS is to the patients and public of our country, not to public servants.
Last week, we published a report on the state and condition of A and E services throughout the country. The scale of demand and the pressures on the system are frightening. In the financial year to date about 100,000 more patients are being left to wait for more than four hours in A and E waiting rooms before being seen. That does not show the full scale of the pressure, as an extra 23,000 patients were left waiting on trolleys for more than four hours after being seen and before being admitted to A and E. The pressure then backs up through the ambulance services and, because of the lack of capacity in A and E, patients are being left waiting in the back of ambulances for, in some cases, many hours. This is an issue of capacity or, to be more accurate, lack of capacity. It shows that the system is creaking under the pressure, so reconfigurations based purely on financial considerations are simply unacceptable.
The distinction between the different forms of reconfiguration is important. If a change in services is supported and motivated by clinical evidence, it can offer real improvements to patient satisfaction and to overall levels of care; but if a closure is motivated purely by financial reasons—and if it is taken in the absence of clinical evidence or consultation—that is simply a cut to services hidden beneath the label of reconfiguration, and that is not acceptable.
There are always genuinely hard choices to be made in the national health service, but I would never accept a reconfiguration of hospital services in my constituency based on non-clinical considerations. I am sure that the Minister would not either, and I am convinced that no Member of this House would accept reconfiguration on that basis.
Lewisham A and E was not downgraded because it performed badly or because the level of care for local residents could be improved by focusing services elsewhere; it was downgraded because of financial problems in neighbouring trusts, and that is wrong.
The figures that I have quoted show a system that is on the brink. Further increasing pressures by reducing capacity without clinical reasons has the potential for truly dangerous consequences. Closing without clinical evidence an A and E department that is relied upon can be damaging to local patients and a community, but it also has wider implications for the health care system as a whole. Performance in A and E departments is a barometer of how the wider NHS is performing. Patients on trolleys indicate lack of capacity on wards, and the increased number of delayed discharges shows that patients are being kept in hospitals when they could be receiving care in their communities, but there are clear gaps in primary care provision. A and E departments are under immense strain. Department of Health figures show as much and there is simply no justification for the financially driven closure of services or the downgrading of facilities.
At the heart of the health care service is patient need, and ensuring the right provision of health care services can only be done by speaking with patients and clinicians. That is why it is crucial that consultation is undertaken at every level in any process relating to reconfiguration. A and E services should first of all be about people and not pound signs. Those of us who care about the national health service must guarantee that people are engaged at every possible juncture in the decision-making process. That will ensure that they have a stake in the future design of services, that, crucially, they have the services they need and that they are not subject to back-door, cherry-picked reconfigurations, such as that in Lewisham.
Pressures in A and E departments are felt across the whole health economy of a local health service. Removing an A and E department without clinical support or evidence is hugely disruptive and will have a profound effect on the provision, level, quality and type of every associated service in any and every local health economy. A reconfiguration of emergency services without sound clinical guidance is not a reconfiguration— it is a cut. It is a cut in services and in provision that will be detrimental to the people who rely on those services. In real terms, national health service spending has been cut, and £3.5 billion has been wasted on a reconfiguration that was not voted for by anyone at the last general election. It is not wanted by anyone in this country, including medical professionals, and it has caused chaos in the NHS and in the delivery of its key services.
Opposition Members will never accept purely financially driven reconfigurations. I call on the Minister to commit unequivocally to that principle, and to intervene without delay on reconfigurations that are being driven not by clinical need but by financial pressures. I can only echo the powerful invitation made to the Minister by my right hon. Friend the Member for Tottenham (Mr Lammy), and remind her that she has the power to intervene and stop this happening. I look forward to her doing so.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.
I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.
Anna Soubry
I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.
Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:
“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]
In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.
I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.
Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.
I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.
Anna Soubry
I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.
As part of the review’s work, it needs to consider public understanding of the best place to go for care.
Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.
I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.
My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.
I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.
I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.
Mr Virendra Sharma
How disappointed I am that the Minister failed—utterly failed—to address the issue—