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.