The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by the hon. Member for Ilford South (Mike Gapes). I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate the hon. Member for Ilford North (Wes Streeting) on joining us. He obviously has experience of these matters as well, given his role in the local council.
I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.
The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.
The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.
The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.
We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.
Wes Streeting
Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?
Mr Dunne
I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.
I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.
There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.
Mike Gapes
Does the Minister think that the whole process could be completed by 2019?
Mr Dunne
I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.
In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.
In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.
Wes Streeting
Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?