The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)
My Lords, I congratulate the noble Lord, Lord Dubs, on securing this debate and thank him and all noble Lords for their contributions. As ever, I will try to address as many of the points made this evening as possible.
In responding to this debate as a Minister in the Department of Health, I should declare an interest as a resident of west London for the past 11 years. I have counted up the number of hospitals in the STP area that my family have used—often too often. That figure incorporates pretty much all of them one way or another for various services. Therefore, I know from personal experience as a resident, patient, husband and father what we are talking about, and the very strong emotions that can be evoked by the discussions we are having about the future of Charing Cross and other hospitals. I also confirm to the noble Lord, Lord Dubs, that this has been an issue on the doorstep during local and national elections. However, some of the accusations I have heard about what will happen have been wrong, very misguided and, frankly, scaremongering. I see posters up all the time, as I am sure does the noble Lord, saying that hospitals are going to close. Indeed, he talked about hospital closures when, as he well knows if he has looked at the plans, we are not talking about closing hospitals and the sustainability and transformation plans are not talking about closing hospitals.
Noble Lords will know that west London—I think pretty much everyone who has spoken is a resident of west London—is a large area with many clinical commissioning groups, local authorities and providers split across two transformation plans in north-west London and south-west London. The north-west London plan covers about 2 million people. As that is the one that the noble Lord and other noble Lords have highlighted, that is where I shall focus my attention. The area covers a broad range of population and some of the country’s leading hospitals, including world-famous trusts such as Imperial, the Royal Brompton and the Royal Marsden, and cherished district general hospitals such as Ealing and Charing Cross. I note that this year the funding for the North West London Sustainability and Transformation Plan area is £3.7 billion, and that between 2015-16 and 2020-21, funding is expected to rise on current plans by £602.5 million—a cash increase of 17%. I think that answers the question asked by the noble Lord, Lord Warner, about funding. We also know that it is an area with a growing population with changing needs, driven by a relatively high turnover of people, with large-scale, inward migration from the UK and other countries. The changing needs of this population must of course shape the local NHS’s plans for the future.
Many times in this House we have discussed how the healthcare needs of patients in our country are changing. On average, we are becoming older and frailer, but also more mobile and more networked together by technology. Added to this, the science and practice of health is changing. We understand that some services are better centralised into highly specialised facilities—the noble Lord, Lord Warner, talked about stroke care and my noble friend Lord Suri talked about neurology, which are two good examples—while other treatment, such as rehabilitation, is better delivered in the community.
Therefore, because of demographic and professional developments, service change is inevitable. But it is of course always an issue that raises concerns, so it is vital that any proposed changes are looked at with great care. The noble Lord, Lord Warner, talked about it as being like the Somme mud; in slightly more uplifting terms, my noble friend Lord Lawson once said that the NHS is the closest the English get to a religion—and I think hospitals are our churches. That describes how people feel about them. It is therefore incredibly important that I stress that any potential service changes affecting west London hospitals must be driven by local health organisations and, while I am sure local people will follow this debate with interest, the opportunity to shape their future health services is driven by engaging with their own clinical commissioning groups and the STP.
The Government are clear that any health service changes proposed are subject to an agreed set of procedures. Proposed changes stand and fall on their ability to show clear evidence that they will deliver better outcomes for patients, and they must meet the four tests for service change. First, they should have support from GP commissioners; secondly, they should be based on clinical evidence; thirdly, they should demonstrate public and patient engagement; and fourthly, they should consider patient choice.
In addition, in April this year NHS England introduced a new test on the future use of beds, which requires commissioners to assure NHS England that any proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed. This is precisely the point that the noble Lord, Lord Hunt, made about preserving beds, and he will also know that the number of acute beds has been falling over many years under many different Governments. Indeed, the number has stabilised in the last couple of years, which speaks to the point he raised from the King’s Fund research.
Where local discussions fail to provide resolution, proposed changes may be challenged on a number of grounds—for example, if there has not been proper local consultation or where the local oversight and scrutiny committee concludes that the changes are not in the best interests of the health service. The Independent Reconfiguration Panel exists to arbitrate and provide independent and authoritative advice to the Secretary of State in such instances. That is therefore the policy background against which any plan must be judged.
The North West London Sustainability and Transformation Plan was published in November 2016, and a core component is a programme called Shaping a Healthier Future, plans of which were first published in 2012. The public consultation in 2012 set out plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that the Charing Cross Hospital would become a growing hub for integrated care within this network of services.
Following feedback from the public consultation, the proposals were refined to retain the integrated care approach and, in addition, for the Charing Cross site to house a wider range of services than initially proposed. Following examinations by both the IRP and the Secretary of State, the plans changed further. Since then, as noble Lords may be aware, NHS England invested a further £8 million in the Charing Cross Hospital site last year. This funding enabled refurbishment of urgent and emergency care wards, theatres, outpatient clinics and lifts, as well as the creation of a patient service centre and the main new facility for North West London Pathology.
There is widespread recognition that in north-west London and other areas of the country we need to ensure there are strong primary and community services to keep people well, effective urgent care services to deal with more intensive need, and world-class services to treat the most severe and urgent emergencies. That is why I welcome the sustainability and transformation plan commitment that there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved—and, as the noble Lords, Lord Warner and Lord Hunt, pointed out, it cannot happen before 2021. Furthermore, despite the accusations of local campaigners, there are no plans to close Charing Cross Hospital, and none of the land on the hospital site has been designated as surplus land for redevelopment.
I turn to some of the points raised in the debate. There is of course with any difficult decision such as this the question of whether there is support from the clinical community. Members of the clinical community were clear from the beginning in 2013 that they,
“remain absolutely confident that delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS”.
The noble Lord, Lord Dubs, pointed out that two councils had not signed up to any plan that involved a hospital being closed. I will say two things in response. First, there is no suggestion that any hospital will be closed. Secondly, I suggest that one reason those councils are not engaging is that they won elections on the basis of suggesting that hospitals would be closed and it is not in their political interest to endorse a plan which makes clear that that is not going to happen.
My noble friend Lord Suri was absolutely right about the need for a bipartisan approach and to avoid mud-slinging at local political level. He made a particular suggestion about the potential use of Wormwood Scrubs. It is not one that I personally endorse, but the point is that any suggestion for reconfiguration must emanate from local health organisations and then go through the service-change tests that I outlined.
The noble Lord, Lord Warner, made a very valid point about co-ordination across London. This is something that we are looking at in particular at the moment. I hope that we will be able to say more about it in due course. Clearly, the interaction between services across the five STP areas is incredibly important; people are clearly moving across boundaries for the healthcare that they need and it is important that there is a degree of local co-ordination.
Of course, there is always with our health service a need for more funding. I know that many noble Lords feel that the Government are not giving the funding they should. With the STPs, I have to disagree; the Budget provided £325 million as a first capital instalment towards transformation and we are absolutely supporting the process—which of course was begun and is being led by NHS England—to transform our health service into an integrated process. One way in which that can be delivered, as my right honourable friend the Secretary of State set out in a speech to the Royal College of General Practitioners, is to have more GPs in training so that there can be more community-based care.
The noble Lord, Lord Hunt, called the STPs a “fantasy”. I know that his right honourable friend the shadow Secretary of State for Health said in his party conference speech that he did not support the STPs but did want integrated care. That is a very easy thing to say, but the challenge is how it will be delivered if STPs are not going to get the backing of the Opposition.
In conclusion, I hope that I have been able to reassure noble Lords and local residents on two fronts. First, there are strict rules that govern the reorganisation of NHS services and that put patient outcomes first. Secondly, Charing Cross hospital has a critical role to play in the sustainability and transformation plan for north-west London and will continue to operate A&E and acute services while the demand for them exists.
The Government remain committed to supporting the local NHS to make complex and sometimes challenging decisions about the future configuration of the services on which we all depend. As those discussions take place locally, it is incumbent on all of us to deal with the facts about what is and is not in prospect, and to avoid playing political games with people’s healthcare.
I will close by congratulating all noble Lords on their incisive and, as ever, forthright contributions to the debate, informed by their role both as legislators and local residents—and once again thank the noble Lord, Lord Dubs, for securing it.