(10 years, 8 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Siobhain McDonagh (Mitcham and Morden) (Lab)
At the beginning of this month, on a crisp, cold Saturday morning, I joined a group of residents outside our local St Helier hospital to mark a sad moment in its history. For the past four years, St Helier has been adorned by a 1,000-square-feet banner, proudly saying, “Coming soon—We’re spending £219m on a major development of St Helier hospital”. The residents and I were there to see that banner taken down, and to mark the promise of a better hospital finally being taken away. The story of St Helier is a long one. I have raised it in this House on several occasions. This was a low point, but I fear that it may get lower, and the result of today’s debate does not exactly inspire confidence.
St Helier was built in the 1930s, at the same time as the St Helier housing estate that encompasses it. At that time, it was the biggest housing estate in Europe. The hospital was built there for a reason: it was where the health needs of the surrounding community were. St Helier hospital has had an interesting history. In the second world war, its bold white exterior was painted green owing to concerns that German bombers would use it for target practice or to line up their bombing missions on London. Although neighbouring buildings were destroyed by bombers, St Helier thankfully survived and has continued to serve the community ever since.
St Helier has had its troubles. In the mid-1990s, there was outrage when it was discovered that people were left to die on trolleys abandoned in the corridor. Back then, under-investment in the NHS of the John Major Government was not unusual. If it was bad on the wards, however, what was happening behind the scenes was almost as disturbing.
Even though Mitcham and Morden has always been the most deprived part of the old health area of Sutton, Merton and Surrey, it has always been the poor relation. In my almost 17 years as an MP, and for many before that, I have never known of anyone living in Mitcham and Morden to sit on the board of any NHS body. As a result, we have always had a Cinderella service. No one speaks up for our patients, and we are always first to lose out and last to gain. It was no surprise, therefore, when I discovered recently that health bosses had held secret meetings in the mid-1990s to discuss plans to close St Helier and move services to Croydon. Thankfully, once Labour came to power in 1997, this went no further, but the tone was set.
Not long afterwards, it was suggested that St Helier should merge with the hospital in Epsom. Such a merger was a little unusual, but Epsom was struggling financially, and we were persuaded that a merger would make both hospitals more resilient. The two hospitals were not a great match. People living in Epsom are relatively wealthy, and a little older. The area around St Helier is more urban, ethnically mixed, younger and has more health problems associated with poverty. Nevertheless, we accepted the advice, but it soon became clear that we had been sold a pup.
A new review, “Better Healthcare Closer to Home” was launched. This was in a time of plenty, the early 2000s, when health spending was on the rise, so a grand scheme was drawn up, in which St Helier and Epsom would both close, replaced by a new state-of-the-art hospital in Belmont, a very leafy, very wealthy community two miles south of Sutton. Aside from the terrible impact of closing St Helier, I never thought that the scheme was workable; it was too big, too unrealistic and lacked one key ingredient—any public demand for it.
Various bureaucrats argued that the site of a hospital is not important, because new community primary care services, such as GPs and local care centres, would see the patients that normally go to hospitals instead. The public never agreed, and in fact the reverse has happened: the number of people who would rather go to hospitals is rising. The public consultation at the time clearly showed that the most popular site for a hospital with an A and E was St Helier. The public knew that the people who need hospital the most are the most disadvantaged, with the worst health. They are the most likely to need A and E and the most likely to need acute maternity services.
Everyone could see that St Helier was the best location for a hospital if we wanted to reduce health inequalities, and it was backed by all the MPs in Sutton, Merton and Wandsworth. Local managers overruled us and, even though their initial assessments showed that St Helier was a 7% better option than Belmont, they voted for Belmont instead. Thankfully, in those days we had a Secretary of State for Health who was prepared to step in and stand up for the NHS. The health managers’ decision was finally called in by Labour councillors in the London borough of Merton, and the then Secretary of State decided to save St Helier, recognising that the area around St Helier had the greatest health needs in the whole catchment area and people there had up to 10 years’ less life expectancy. In contrast, Belmont is one of the wealthiest areas in the country. Indeed, people living there also made it clear they did not want a major new hospital built in their backyard. So we were all delighted when the then Government came down firmly on the side of reducing health inequalities and chose St Helier.
In early 2010, that decision was further boosted when a subsequent Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), announced the £219 million renovation. At the time, we were all very aware that the economy could no longer afford the same generous public sector funding we had in the mid-2000s. Decisions had to make financial sense and, in the case of the £219 million, the numbers stacked up. As well as improving people’s health, the scheme was shown to offer value for money. It would mean new wards, with single rooms to cut down on infections and improve patient privacy, along with various other improvements. The scheme was so well thought out that just months later it also gained the support of the new coalition Government—the Chancellor still includes the funding in the Treasury’s books—but it was not long before St Helier’s future was again at risk.
In 2011, the local NHS admitted that it had received Government instructions
“to deliver £370 million savings each year...a reduction of around 24% in their costs.”
A new body was soon set up, this time called Better Services Better Value, or BSBV— it might properly be abbreviated to just BS for all the good it has done. Its task soon became clear: to close services such as accident and emergency, and maternity units, in one or more hospital. At the same time, finally recognising that they served different demographic groups, the St Helier and Epsom hospitals started to de-merge from the trust. Both had found new trusts willing to merge with them, St Helier with St George’s Healthcare NHS Trust and Epsom with Ashford and St Peter’s Hospitals NHS Trust, but, thanks to BSBV, those new mergers soon broke down. Nobody wanted to merge with a hospital that was under threat, particularly when it was revealed that Epsom’s debts were far worse than originally thought.
Originally, BSBV would look only at south-west London, covering St Helier, Kingston, Croydon and St George’s in Tooting; one of the four would lose its accident and emergency unit. But after the de-merger fell apart, the review was extended into Surrey, and two out of five hospitals were to be downgraded—inevitably, BSBV recommended that St Helier should be one. Not only would its A and E and maternity units go, but so, too, would its intensive care unit, paediatric centre, renal unit and 390 in-patient beds.
I have always said that the sums do not add up. Some 82,000 patients go to St Helier’s A and E each year, with the NHS saying that figure will rise by 20%—100 emergency patients are admitted every day. Neighbouring hospitals are already overcrowded, and are more expensive per patient, so it was never clear how the other hospitals could meet clinical targets, let alone cut costs, if they had to treat St Helier’s patients as well as their own. Figures quoted by BSBV—that an astonishing 60% of patients would use primary care instead of A and E departments—were ridiculed by the National Clinical Advisory Team, who said:
“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.”
In fact, NCAT went a lot further than that, saying:
“Successful implementation...depends on a multitude of supporting improvements...that are not well defined in the proposals.”
Given the growing birth rate and the higher cost of giving birth in all other hospitals, closing St Helier’s maternity unit was also never going to deliver clinical targets or cut costs. Experts say that maternity units should not deliver more than 6,000 babies per year. However, if St Helier closed, the remaining hospitals would have to deliver 6,500 babies each per year, plus 2,500 in midwife units and nearly 1,000 home births. It was no surprise, therefore, that NCAT said the plans were
“based on an optimistic view of capacity.”
Everyone in my local community knew the plans were bonkers. Local campaigners such as Sally Kenny, a former deputy head and Lower Morden resident, set up local groups to fight the plans. Sally has printed thousands of “Save St Helier” posters that are currently in windows across Morden and St Helier. People cannot drive through the area without seeing the words “We Love St Helier” displayed on garden stakes.
As well as a petition signed by more than 30,000 people, thousands of local residents attended a protest picnic organised by local mums, where the leader of Merton council, Stephen Alambritis, a former football referee, waved a red card at the plans. Merton council has always shown its support. Last year, it passed a strongly worded motion backed by Labour, Liberal Democrat, Conservative and Independent councillors, saying any decision on St Helier must go to the Secretary of State. Thankfully, salvation came from an unlikely source—a clinical commissioning group in Surrey.
In Merton, the new system of CCGs has not been a great advert for the Government’s reforms. Last May, I attended one of the worst public meetings I have ever been to—and that is really saying something. Merton’s CCG was due to decide St Helier’s future, but it would allow only a handful of the hundreds of people who came to the meeting into the public gallery. The chair would not allow cameras or recordings, and the microphones did not work. Members of the CCG refused to register their personal interests, even though it was alleged that some would gain personally if St Helier were shut and services were moved to other providers such as private companies or GP surgeries. Then, just as they were due to make a decision, they suddenly walked out of the room to boos and shouts of “cowards”. Some said that they had adjourned the meeting to a quiet staircase, others that they went to the kitchen. Wherever they went, they made the decision there, in secret, without any public witnesses, to accept plans to close services at St Helier and to go to public consultation.
If Merton’s CCG was not exactly the blueprint of an open, transparent community service, thankfully others did not follow suit. Having seen the power of GPs in Lewisham, the CCG in Surrey Downs, recognised that BSBV was barking up the wrong tree and voted no. As a result, earlier this year, BSBV was wound up; it will not be mourned. However, the threat still hangs over us.
I have been shown a letter from NHS England to the CCGs complaining about their decision not to approve closures at St Helier. The letter says:
“Your approach carries significant and unacceptable risk, both financially and clinically.”
Castigating the CCGs for their decision, it goes on:
“We consider your proposed approach would make it difficult for South West London CCGs to formulate a coherent strategic plan.”
According to NHS England, the decision
“carries unacceptable risks to your ability to develop and deliver a strategic plan. We also believe the approach carries significant operational risks. Firstly that your providers will not be able to meet the London Quality Standards...Secondly, that providers will not be able to recover their costs against income and therefore...will be unable to become Foundation Trusts.”
Most damning of all, it says:
“This could be interpreted as commissioners planning for clinical and financial failure in some of its providers.”
That letter is very revealing. It proves that those in charge still cannot bring themselves to rule out the possibility of St Helier closing. They are planning to fail, and if they do not fail, they will not allow St Helier to become a foundation trust anyway. Either way, the hospital will fail. That indicates that the announcement not to close St Helier is not real. As if we needed more evidence that the Government are not committed to St Helier, we heard, just a few weeks later, that the £219 million had been withdrawn. After I had repeatedly asked about the lack of progress, the head of Merton’s CCG finally conceded the truth. Ruefully, she admitted that the work was now “probably unaffordable” and no longer featured as
“one of the...scenarios being worked up by the Trust at this stage.”
The whole community knows what is going on. St Helier is not “safe”. It does not have the Government’s backing. If the Government truly still supported St Helier, why is it not full steam ahead with a scheme that has funding from the Treasury and that has proven its clinical value? They are failing to plan, and planning to fail. All this ends in one place: the demise of St Helier. If St Helier loses emergency services, 200,000 people will face longer journeys in an emergency. A and Es across south London will struggle to cope with the extra workload, and that will affect millions of patients, including the Minister’s constituents.
The Minister has a chance today to offer some hope. She is a significant person. A word from her could make all the difference. All she has to say is that St Helier will stay open and that she will not allow it to lose its A and E, its maternity unit or any of its other services. She can say today that the £219 million must be spent. When that money was announced four years ago, construction was due to begin in 2012. Nothing has happened, but this evening she can turn nothing into something with just a word. She will probably say it is for others to decide, but that is her decision. A decision not to act is just as much a decision as any other. What she should do is show leadership, because leaders decide. Without ministerial commitment to St Helier, it is clear where this will end. They are planning to fail, and that is why the fight goes on.
All the while, the population in south London is rising, demand for hospital services is increasing, demand for A and E is going up by 20%, and the birth rate is rocketing. Doctors oppose the closure of services, Merton council unambiguously opposes any closure, and all parties want to save St Helier. We thought things were bleak before; they are just as bleak now.
All the while, instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. The UK Statistics Authority has made it clear that the Prime Minister has broken his election pledge to increase health spending. If St Helier loses its A and E or countless other services, my constituents will know why. They are angry. In Mitcham and Morden we demand nothing less than a moratorium on A and E closures. We want our hospital, St Helier, to continue. The German bombers never destroyed it, nor should this Government. The Minister needs to say, “Yes, the £219 million is still there, and yes, the building work will start now.”
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her some assurance about the potential for the future, if not about some of the specific points that she asked me to address.
Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.
As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.
I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.
At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.
As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.
The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.
The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.
Siobhain McDonagh
It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.
Jane Ellison
The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.
Paul Burstow (Sutton and Cheam) (LD)
I am grateful to the hon. Member for Mitcham and Morden (Siobhain McDonagh) for calling for this debate. Will the Minister use her good offices to ask the trust to set out very clearly to all hon. Members representing constituencies with an interest in St Helier its plans and the timeline for this capital investment?
Jane Ellison
That is an entirely reasonable request and I will, of course, convey it to the trust following this debate.
The local CCGs have listened to feedback from local people and they have now told us that they want to look at local health services in a more holistic way. Although they have decided against proceeding with BSBV, the local CCGs have unanimously supported the clinical case for change in south-west London and propose to use the detailed analysis provided by that exercise to plan their future strategy. I accept that that is a broad-brush explanation and that we have yet to see the detail, but that is essentially the direction of travel. Obviously we are not as far forward as we would have wanted to be after all the consideration given to the issue over the past few years.
The CCGs have also made it clear that if they do not address the challenges identified under BSBV or, at a national level, those in NHS England’s “Call to Action”, local services might decline in quality and not be able to meet the required safety standards. The CCGs have agreed that all future hospital services should be commissioned against the London quality standards and that all hospitals must provide seven-day-a-week, consultant-led services.
I referred earlier to events overtaking the BSBV programme, and the CCGs need to take into consideration some of the more recent developments, not least Sir Bruce Keogh’s review of urgent and emergency care. We need to look at the whole of the south-west London health economy in the light of those new expectations, particularly that for seven-day-a-week, consultant-led services. That is a challenge right across the NHS, not least for those of us in south-west London. Hospitals are expected to comply fully with the recommendations set out in the Keogh review and, of course, to be financially sustainable.
Should the outcome of discussions mean major changes at any trust in south-west London, proposals will, of course, be subject to public consultation. Most importantly, the local NHS has stated that it will involve local people in the work to develop these new solutions to the longer-term challenges faced by the NHS in the area.
As well as involving local people, it is absolutely essential to involve local Members of Parliament. I take the point made by the right hon. Gentleman in his intervention. Whenever I meet representatives of NHS London, as I do from time to time—another meeting is in the diary—I always stress the importance of liaising very closely with Members of Parliament so that they can best represent their constituents and make sure that they are fully in the picture about developments. For the record, I was not particularly impressed by the notice I got of BSBV not going forward, given that I have to respond in this House about it, and I have made that view clear to some of the people in my local area.
Epsom and St Helier trust has made it clear that the broad range of in-patient, out-patient and day services remains available at its two hospital sites. Local CCGs will work together—the new umbrella name is South West London Collaborative Commissioning—to develop a five-year commissioning strategy. The trust will work with its commissioners in the coming months to contribute to those plans. I understand that the trust expects to see the strategy in June, which will give it a clear idea of the future direction of local health services and its role in delivering them. As local Members of Parliament, we all expect to see the strategy at the same time.
Once a decision has been made on which services will be located at St Helier, the trust will need to revisit its original business case for the redevelopment of the site. I realise that that is frustrating, after everything that local people have campaigned on, but that is in its nature: it was only ever an outline business case. Any new or updated business case for redeveloping St Helier would initially need to be considered by the NHS Trust Development Authority, which is responsible for approving capital funding and ensuring that the repayments are affordable for the trust. As much is likely to have changed in the four years since the business case was last considered, it will probably be reviewed again by the Department of Health and the Treasury.
It is obviously essential that any options must be sustainable in the long term, both financially and, as I mentioned in relation to the Keogh review, clinically. When local consultations have taken place and have determined a sustainable service configuration for the locality and the hospital, we anticipate that requests for capital funding will be submitted to the Department of Health for consideration.
In conclusion, I urge the hon. Lady and other Members of the House to continue to represent their constituents, engage with the process and participate in future consultations. What we all want to emerge from the process is a sustainable, safe and excellent local health economy for south-west London that works to the most modern standards of care and is sustainable for the long term.
Question put and agreed to.