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Dr Huq
I thank my hon. Friend for that excellent intervention, which is very pertinent to where she is going after this debate. As a mother who has been through these services, I know that it is massively disrupting if the goalposts are suddenly moved, causing people to travel for longer to get to their appointments. The closure of Ealing hospital’s maternity unit was called a consolidation. It was meant to be part of the centralisation of services, but it has had really adverse effects.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Obviously, I will respond to the debate at the end. The hon. Lady is making a wide-ranging speech, but when she talks about adverse consequences, particularly in the context of maternity services, I urge her to give examples and to be careful about her language. We do not want to alarm people—particularly those who are accessing healthcare in her area—for the sake of a rhetorical device. Particularly on Ealing’s maternity unit, where there is now 24-hour consultant coverage, I urge her to be cautious in expressing herself.
Bob Blackman
Clearly, the Government must balance the capital and revenue budgets and ensure that they and the national health service are fit for purpose. I believe passionately that it is wrong to expect our medical professionals and brilliant staff across the health service to operate out of substandard buildings. The more that we do to improve them, the better.
As the Minister will know, I have been agitating on this issue for the past six years. I will not stop until we get what we deserve—a rebuilt hospital of which we can all be proud. The reality is that the NHS Trust Development Authority, which seems to dictate finances within the national health service, is holding up this prestigious project. The hospital now has planning permission, and we are ready to go. Immediately on approval by the TDA, demolition of the existing buildings will start, and work will begin on the new hospital in June or July this year. However, the TDA has yet to approve. We now have a further eight-week delay while the TDA looks again at the business case to see whether it is justified. The staff, patients and everyone connected with the hospital are growing frustrated as a result of what has happened over not just the past six years but the 30-odd years before it as well.
We seek assurances from the Minister that the prevaricating TDA will be leaned on to give a decision, which will be to the benefit of the hospital, the patients and the health service in London and nationally, so that we can ensure that this brilliant hospital continues with its great work. I apologise that I will not necessarily be here to hear the Minister confirm the good news that she will do all that she can to make that happen, but I will sit down—
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
On that specific point, as I am conscious that my hon. Friend might not be back, my noble Friend Lord Prior in the other place took a debate on this topic this week and undertook to set up a meeting with the NHS Institute for Innovation and Improvement and interested peers should there be any slippage in the timetable set out today by NHSI for approval of this important project. I know that that invitation will be extended to my hon. Friend as well, to give him a little assurance on that.
Kate Osamor (Edmonton) (Lab/Co-op)
It is a pleasure to serve under your chairmanship for the first time, Mr Turner. I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for her lovely contribution. It was very colourful, as per usual. As well as the subject being serious, I appreciate her opening speech.
I will talk about the crisis in A&E and access to primary care in my constituency. North Middlesex University hospital A&E has recently become the subject of national attention. In December 2015, a patient died in A&E and, at the end of January, the A&E department subsequently received a notification of a risk summit. Waiting times reached crisis point on Friday 19 February, when patients were reported to have been left for up to seven hours on hospital trolleys. Medics came under such extreme pressure that they were forced, at 11 pm, to put a message over the tannoy advising patients to go home unless they were dying. The crisis at the hospital did not go unnoticed. It was widely reported in the media, including in my local paper and many major national newspapers such as The Daily Telegraph, Daily Mail and The Independent.
Earlier, the Minister accused my hon. Friend the Member for Ealing Central and Acton of being alarmist. I would like the Minister really to listen to me and appreciate where I am coming from. My constituents were those people in that hospital and the reality for them is very difficult, so I would like her to reflect on what she said.
The incident was not isolated. Separate reports reveal that, over the previous week, paramedics were forced to wait for hours in A&E because there was a shortage of trolleys. One of my constituents phoned my office from the A&E complaining about the unacceptably long waiting hours. She was so worried about her loved ones that she did not know whether to leave her mother there or to take her home. My staff had to talk her through that and told her to stay because that is where the doctors were, so it was the safest place for her to stay with her mother.
I believe that the staff in North Middlesex University hospital are under enormous pressure and are doing a fantastic job despite that. The unfolding events are clearly symptomatic of a wider crisis in the NHS locally. A Care Quality Commission report in 2014 failed the department, saying there is an overreliance from people living in the community. That overreliance is understandable given the December 2013 closure of Chase Farm hospital A&E, which is in the west of Enfield, the borough in which Edmonton resides. That has put North Middlesex University hospital under enormous pressure. It is clear that the overreliance on the A&E service results not only from the closure of Chase Farm A&E, but from the pressures on local GP services.
Research published in 2015 by the National Audit Office, entitled, “Investigating the impact of out-of-hours GP services on A&E attendance rates: multilevel regression analysis” found that satisfaction with overall GP services is significantly associated with the level of attendance at A&E both overall and out of hours. A 1% increase in patients satisfied with their GP practice’s opening hours is also associated with the reduction in A&E attendance. The latest report from the NAO, “Stocktake of access to general practice in England”, shows that patient satisfaction continues to decline. A fifth of those surveyed reported that GP opening hours were inconvenient.
Enfield, in general, has a problem with unhealthy living, which has contributed to the problem in my constituency. We have a prevalence—unfortunately, the ninth highest rate in London—of coronary heart disease. Strokes are prevalent; we have the eighth highest rate in London. Enfield also has the seventh highest rate of diabetes in London. As hon. Members can see, my constituents are very sick and poorly. We need GP services that people can attend at a convenient time, and where they can get an appointment that will ensure they get a referral to hospital, so that they do not present themselves at A&E.
With the exception of one ward, Bush Hill Park, Edmonton is, socially and economically, a deprived constituency. Of the seven wards in my constituency, three—Upper Edmonton, Ponders End and Jubilee—are among the five wards in Enfield with the lowest life expectancy. Healthwatch Enfield found, through a survey in the summer, that the vast majority of those not registered with a GP in Enfield are in Lower Edmonton, which is in my constituency. However, when the Government replace public health funding by local business rates, as suggested in the 2015 spending review, it will be challenging for an economically deprived borough such as Enfield adequately to fund public health activities to monitor and sustain the current pace of improvement in the health of Enfield’s population.
I wrote to a Health Minister raising my concerns and requesting a meeting about these matters more than a month ago, and I received a response to one of my questions about half an hour ago. I thank the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) for that—[Interruption.] She has done well. I did ask a few days ago, but I thank her for responding. I was going to say that I received no response but I will not say that because I did. However, I would like to have a meeting, if possible, to talk about the seriousness of the crisis in my constituency and the effect it is having.
Kate Osamor
I thank the Minister very much for that, and I will end there.
[Ms Karen Buck in the Chair]
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It is a pleasure to respond to a debate under your chairmanship, Ms Buck, I think for the first time.
The debate has been extraordinarily rich, with many excellent speeches from my fellow London Members of Parliament. We have a reasonable amount of time left, so I will try to respond to as many points as I can, but certainly on some I would prefer to write a response after the debate. In particular, I would not wish to give my friend, the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, anything but the best information, so I will write to her afterwards about some of the details.
I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate with cross-party support. I echo the words of the shadow Secretary of State: it is a great pleasure to see the hon. Member for Ilford South (Mike Gapes) back in this place. He made typically generous remarks about the NHS staff who cared for him, and we, too, thank them, because he is a popular Member in all parts of the House. We are delighted to see him back.
I am a London MP, so the debate is about my constituents as well. Rightly, hon. Members have taken this important opportunity to champion their local populations and their healthcare needs. However, some consistent threads have run through many of the speeches, in particular on the long-term strategic direction given the nature of London and its population. As well as responding to specific points, I want to give Members a sense of the strategic direction that the NHS wants to take in London, and some of the thinking around that.
The NHS in London serves a population of more than 8 million and spent £18 billion last year. As the shadow Secretary of State and others have said, London’s population is younger than the national average and more mobile, and its transient nature often makes continuity of care harder to achieve. In Battersea, I represent the youngest seat in England, and I see that transient, mobile population all the time, whether they are shift workers or young professionals. There are wide variations between and within boroughs in the health of the population, life expectancy and the quality of healthcare.
I will not attempt to respond to all the detailed points that have been made about housing, immigration and some of other wider determinants of health, but I fully acknowledge the interaction of all such important factors when it comes to the health of our constituents, and those factors are rightly at the forefront of the ongoing mayoral election campaign. It is inconceivable that the next Mayor of London, whoever is elected, will not have right at the top of their agenda issues such as housing in London, especially for key workers and the people who keep our important public services going. That is entirely right. I acknowledge that some of the issues that have been highlighted are important for the future of London. The population of London is projected to increase to more than 9 million by 2020, with the largest proportional increase expected in the over-65 age group. Members clearly know what that means for the increasing demand for healthcare.
The leaders of the national health and care bodies in England have set out steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service. I accept that there was controversy in the last Parliament, and that the majority of Members present in the Chamber today disagreed with many of the measures enacted. Nevertheless, we have since had a general election and a majority Conservative Government were elected, having stood on the NHS architecture as it is. At the heart of the Conservative manifesto was an acceptance of the NHS in England’s own plan for its future, the five-year forward view. In a fixed-term Parliament, that gives us the opportunity for a stable system, which can look ahead across five years at how it provides sustainable and transformed services.
As in previous years, NHS organisations will be required to produce individual operational plans for the next financial year. Obviously, that work has happened for 2016-17. In addition, every health and care system will be required, for the first time, to work together to produce a sustainability and transformation plan, which is a separate but connected strategic plan covering October 2016 to March 2021. Many Members have highlighted the frustrations felt between the acute sector and CCGs, and some of the other stresses and strains between the different parts of the system. This year will be the first time that the NHS has required all parts of the local health and social care system to sit down together to draw up a five-year plan. That is strategically important in understanding how the system responds.
Those local plans represent an ambitious local blueprint for implementing NHS England’s five-year forward view locally. My hon. Friend the Member for Sutton and Cheam (Paul Scully) and many others talked about the need for long-term planning.
Meg Hillier
I thank the Minister for giving way, because I know she is trying to cover a lot of ground. Long-term planning is sensible, but is she not concerned about a five-year plan when at the same time major transformation is being required of acute hospital trusts through NHS Improvement—again, not a problem in itself, except that it is to be in very short order? Is there not a contradiction between a five-year plan and the short-order demands of the improvement plan for trusts, just to make their books balance?
Jane Ellison
I do not accept how the hon. Lady characterises that. Clearly, there is an interaction between action now and action in the next few years—that is part of how we plan for the future—but, as I said, I will respond to some of the more detailed points in writing. I know that she has examined the matter in some detail in the Public Accounts Committee, with civil servants, Simon Stevens and some of my parliamentary colleagues.
The NHS needs to work beyond the boundaries of individual organisations and sectors. All Members in all parts of the House agree about the need, for example, for health and social care to be further integrated. That process began under the better care fund, but the fact that we need more of it was in all parties’ manifestos. Together with the additional investment that has been made available, the plans are intended to ensure better health for local people, transform the quality of care delivery and, crucially, ensure the sustainable financial position to which a number of Members referred.
That approach represents a step change in strategic planning at the local level, moving away from the year-to-year cycle. However, there is no one-size-fits-all template. London will be covered by a total of five footprint areas, which are geographic areas in which people and organisations will work together to create a clear overall vision and plan for their own area. As Members have eloquently illustrated in their contributions, one sometimes finds different parts of a local system in tension with each other, so it is vital that we sit down and understand how the pathway can become seamless for the individual. We will learn a lot from some of the vanguards in devolution areas such as Greater Manchester.
The NHS’s financial position is undoubtedly challenging. No one would dispute that, least of all me, but it is important to recognise that despite the difficult decisions the Government have had to take, we have chosen to prioritise funding for the NHS. That is why we have committed an additional £10 billion over the lifetime of the Parliament, starting with £2 billion this year. Simon Stevens has been clear that he asked for an amount of money and that is what he got. He also asked for a certain weighting in the spending review settlement, with front-loaded money to drive transformation, and the money has been set up with that structure.
I am a London MP, too, so I do not want the debate to be confrontational. I share many of the concerns that have been raised today. Everyone acknowledges that in London the health system in general is under pressure, for many unique reasons, but I gently point out to the shadow Secretary of State that while she listed many challenges, and many other Members did the same, she did not list that many solutions. At the general election, the Labour party did not pledge to give the NHS the shortfall it had identified in its funding. That is significant, and I need to put it on the record.
Jane Ellison
No, I will press on, particularly as the hon. Member for Ealing Central and Acton, who introduced the debate, took half an hour for her opening speech. I will give way if I have time towards the end. It is a matter of record that we committed—[Interruption.] All right, I give way to the shadow Secretary of State, if she would like to remind us of what the Labour party pledged at the election.
Heidi Alexander
I am grateful that, when making a political point, the Minister is happy to give way to the shadow Front Bencher.
We have been clear that we would always have given the NHS every penny that it needs. However, the calculations for the five-year forward view were predicated on social care being properly funded and there being no further cuts to the public health budget. I think Simon Stevens would say that those two things are essential if we are to deliver a sustainable NHS. Will the Minister therefore tell me how much money her Government took out of adult social care in the previous Parliament?
Jane Ellison
We have been clear that we have given a large amount: £3.5 billion has been made available to local authorities for social care. Ditto on public health—we will spend £16 billion over the next five years. If I have time, I will come to the good point that was made earlier about the move to business rates retention. It is matter of record that the Government committed at the election to what the NHS had asked for in the five-year forward view, and we will continue to make that commitment.
The London health system—CCGs and provider trusts—has planned for a deficit in 2015-16 of about £350 million, and overall the system is expected to be in that position. Some recovery is expected during 2016-17, and I am sure we will debate that again. In addition, a £1.8 billion sustainability and transformation fund is available, designed to address provider deficits in 2016-17. However, I think all Members would accept that additional Government spending is not the only answer to the challenges faced by the NHS. We have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits, but much of the change Members have talked about is driven by desire to get better healthcare rather than to make savings. If we can make savings as well, that is all to the good, because we can reinvest them in great healthcare.
In London, from early April, the new NHS Improvement body will be providing additional expert support and capacity to trusts experiencing particular financial challenges. That support will include identifying and implementing financial improvement and helping them to identify savings to put them in a stronger position to maintain those savings.
Let me talk about the pressures on urgent and emergency care. It is acknowledged that the urgent and emergency care system faces increasing pressure. More and more people are visiting A&E departments and minor injury units, which is stretching their ability to cope. Members listed some reasons for that in their speeches. A lot of visits are unavoidable, but some people are visiting because of inconsistent management of long-term health conditions, difficulty in getting a GP appointment or insufficient information on where to go.
Winter sees an even bigger rise in visitor numbers and pressure on staff. Although the debate inevitably dwelled on Members’ concerns about their local healthcare systems and problems in them, I am sure we all want to place on record our huge thanks and praise, as many have, to the staff of London’s NHS, who work extremely hard under a lot of pressure and delivering some really good results against that backdrop. I will come on to that.
London’s A&E units have been significantly challenged this winter, and that has been reflected in performance. However, despite those pressures, the capital’s urgent and emergency care system has proved its resilience, with fewer serious incidents declared than in previous years. This winter, London accounted for just three out of 625 serious incidents declared across England. It is important to praise the staff in saying that.
In January, London’s performance was significantly higher than all other regions, with 90% of patients seen within the four-hour A&E standard. London is also the highest-performing region in England this year to date, with 93.1% of patients seen within the four-hour standard. My thanks and congratulations on that improved performance go to the hard-working staff of London’s services.
Reconfiguration schemes have loomed large in the debate. The health needs of people in London are changing and demands on health services are increasing. The hon. Member for Ilford South in his excellent speech illustrated through his personal stories some of the reasons for the changes in the shape of our health service in terms of how we are investing in specialist services and centres of excellence. The work done to centralise stroke expertise was brought up earlier in the debate. I remind Members, although many will remember, that those changes were bitterly opposed by many people. I am not sure whether that includes anyone in the Chamber, but it certainly includes campaign groups. However, all our London clinicians now say with certainty that those changes, with centralised expertise and specialist care, have saved many lives. That is always worth reflecting on.
People are living longer, the population as a whole is getting older and there are more patients with chronic conditions. We often say that people are living longer, but we forget to say that they are living with chronic conditions for longer, and that presents a longer-term challenge than might be seen at first sight. Heart disease, diabetes and dementia will all increase as they are conditions associated with an ageing population.
We did not dwell on the prevention agenda, but I was delighted that the hon. Member for Edmonton (Kate Osamor) spoke about it. The shadow Secretary of State also touched on it when she mentioned dementia and the problems we all know of older people in hospitals. I urge her to look at the dementia implementation plan we published on 6 March, which is a detailed response to the Prime Minister’s 2020 challenge. Dementia has sat in my portfolio since the election, and that plan is a detailed look at how we deliver against that challenge and in particular at the joined-up care that is key to ensuring that people with dementia have safer and better care in our system and are kept out of the acute sector whenever that is possible.
In a number of areas across the capital, the local NHS has concluded that the way it has organised its hospitals and primary care in the past will not best meet the needs of the future. We are clear that the reconfiguration of front-line health services is a matter for the local NHS, tailored to meet the local population’s needs.
I was glad to hear that Members recently met with Anne Rainsberry. The Members who came to the cross-party “Shaping a Healthier Future” meeting last summer will know it is vital that officials at all levels and NHS managers engage with elected Members. I was therefore disappointed to hear what the hon. Member for Eltham (Clive Efford) said. I will ask my officials to look into that. A number of Members asked reasonable questions about why they could not have certain bits of information. I have some specific answers and it may be that we can take a moment after the debate and I will point them in the right direction.
Andy Slaughter
I am grateful for what the Minister has said. If she could give an indication to health officials that we must have an open review of where we are with “Shaping a Healthier Future”, look at the implementation of the business plan and consider the Mansfield commission report, which really just asks questions along those lines, it would be very useful indeed.
Jane Ellison
We have had the time, during a three-hour debate, to make inquiries, so I will perhaps give the hon. Gentleman an update afterwards.
There have been a lot of references to the interaction with Members. Members of any party may feel they are knocking their heads against a brick wall, but sometimes, to be fair, information cannot be shared for good reasons. There may be commercial confidentiality, or things may be at a particular stage where information cannot be shared. However, I am quite clear that all plans for the local populations that Members represent must be shared with the best level of detail possible, at the most opportune moment. I am always happy to hear from London Members if they feel that that is not happening.
Reconfiguration is about modernising the delivery of care and facilities. I recognise that proposals for those changes sometimes arouse concern. There has been a particular focus on “Shaping a Healthier Future” in this debate, but under that programme, many more community services are now in place across all eight boroughs, so more patients can be seen closer to home. Eleven new primary care hubs are now open. Improved access to GP services has meant an additional 32,000 appointments in Ealing since August 2015, while weekend appointments are now offered to more than 1 million patients across north-west London. Rapid access services in each borough are helping to keep patients with long-term conditions out of hospital where possible, which has already prevented 2,700 hospital admissions in Brent alone.
Jane Ellison
I will not, if the hon. Lady will forgive me, because I think she is going to have a moment to speak at the end, if I can allow it. She gave a half-hour opening speech, which is a little longer than I have to respond, so I will press on.
The Mansfield commission report, which I have read, has been referenced. The costs stated in that independent health commission report are not from the NHS and are not recognised by the NHS. In terms of the response, the unanimous conclusion of the north-west London clinical board was that the commission’s report offered no substantive clinical evidence or credible alternative to consider that would lead to better outcomes for patients than the plan the NHS has put in place. That plan enjoys an extraordinary level of clinical support, and it is important to say that that unanimous clinical support has been sustained. The financial impact of significant delay and challenge cannot be dismissed, and I know Members are aware of that.
Members have rightly focused on primary care. We all know the important role that primary care in London will play in helping us to meet the significant challenges we face. There are still a large number of single-handed GP practices in London. A significant number of GPs are approaching retirement age, and in some London boroughs, patient list turnover is as high as 37% in a year. The Government have made a number of important commitments on improving primary care. In June 2015, the Secretary of State set out details of a new deal for general practice. In London, the transformation of primary care is being planned and implemented with the support of local resources and a pan-London transformation team. More than £40 million has been invested in primary care transformation in the capital this year.
The GP access fund has accelerated delivery in some areas of London. For example, 700,000 patients in Barking, Havering and Redbridge now have the opportunity to see a GP in the evenings, and 305,000 patients in south-east London have seven-days-a-week access to GPs via new primary care hubs. Some important measures are being invested in and taken forward, but we acknowledge that we need to do more in those areas.
Members have raised a number of concerns about trusts in special measures. I reiterate that those trusts are receiving support to ensure they have in place the strong leadership they need to implement their improvement plans. It was good to hear an expression of support from the hon. Member for Ilford North (Wes Streeting) for local leadership in that regard.
We have touched very little on mental health services in London, which I know is not because Members do not think it is important; we all want to drive towards the parity of esteem that is rightly this Government’s aspiration. In March 2015, the London mental health transformation board was established to support the development and delivery of projects to improve the mental health of Londoners. I do not have time to go into local examples of how that is beginning to make a difference, but they are important and making progress.
I have talked about the integration of health and social care. There are 25 integrated care pioneer sites developing and testing new and different ways of joining up those two important services. In Waltham Forest and east London, services are focused on keeping patients at home, providing care close to home and, if patients are admitted to hospital, getting them home as quickly as possible. In Islington, the local health and social care network is providing a named professional to take responsibility for the co-ordination of the patient’s care plan, with a view to providing the seamless, co-ordinated and proactive care that we want to see particularly for our most vulnerable patients.
In the time left to me, I will try to address one or two particular points raised. I have said that I will look to respond in more detail to points made by the hon. Member for Hackney South and Shoreditch on the McKinsey report and the issues around NHS land. One Member mentioned in an intervention the recruitment of nurses and the position of the MAC.
The hon. Member for Edmonton (Kate Osamor) made important points about the particular needs of our poorest populations. Like many hon. Members, my seat in Battersea has everything, from very wealthy to very poor people and everything in between—that’s London. She talked about the need to invest in prevention. This week, we saw the national diabetes prevention programme launched, which is the first at-scale intervention of its kind in the world. We are also working on important areas, such as a new tobacco plan.
A number of Members touched on the issue of public health budgets when we move to business rates retention. Of course we need to get the balance right, to ensure we continue to bear down on health inequalities. I would be happy to have further discussions, but I reassure Members that we are very conscious of that in the Department of Health and will be doing work to address it. Important points were also made by the hon. Member for Edmonton about North Middlesex hospital. She rightly mentioned that key safety issues are being addressed there by some of the local leaders.
I am glad that my hon. Friend the Member for Harrow East (Bob Blackman), who has had to go to the main Chamber, talked about the transformed performance at Northwick Park hospital. It is right to shine a light where we see such improved performance, and I know that the staff very much appreciate it. It was good to hear from my hon. Friend the Member for Sutton and Cheam that his mother had great service. He also illustrated the sometimes unintended consequences of local healthcare campaigns, which he has seen at close hand.
I want to give an assurance that the Department’s capital settlement meets the needs of the NHS and allows the Department to continue with priority public capital projects and support delivery on the five-year forward view over the coming years. St Helier was mentioned on a number of occasions. In anticipation of all the plans there, further work is going on around their affordability, and that ongoing work is important.
The hon. Member for Brent North (Barry Gardiner) made quite a detailed point that I will, of course, look into. We have the recess to look back at Hansard and pick up some of the many detailed points made in this debate. Many notes were being written behind me, and we will look to come back to Members.
There will be things that I have not quite been able to capture, but I give fellow London Members my reassurance that I am always happy to talk to them. I would rather they talk to me at an early stage if they are concerned about something. We share many of the same challenges, but we also share the same ambition: to have the very best healthcare for our local residents. This Government are determined to invest in the NHS to be able to deliver on that. With that, I leave the hon. Lady a minute to close the debate.
Dr Huq
She is not a robotic one of those; I think people recognise that she is not a robot. She made the point a few times that we should not use this issue as a political football and we should want the best for everyone. Some of the people I quoted in my speech are not Labour party members. Michael Mars is the chair of Ealing synagogue. He came for a visit this week and pointed out that managerial culture is stifling what the—
Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).