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The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure to serve under your chairmanship, Mr Rosindell, and to have been left sufficient time to address, I hope, some of the concerns expressed by the hon. Member for Hammersmith (Andy Slaughter). I am grateful to him for engaging with my office in advance to indicate his line of questioning. He has made his points with characteristic skill and calm composure, which is much appreciated.
I will set the issue of Charing Cross within the context of the wider north-west London sustainability and transformation partnership to which he referred briefly. That is how the NHS is looking at the future of healthcare provision for populations throughout the country. Charing Cross, within the Imperial trust, sits firmly in the north-west London STP, the footprint for which has funding of some £3.7 billion. Between 2015-16 and 2020-21, that funding is expected to rise by more than £600 million—an increase of some 17%.
The Government’s position, as the hon. Gentleman is aware, is that any potential service change affecting Charing Cross is a matter for the local NHS. It will be determined primarily through the prism of the STP and the leadership of that wider NHS group. In our view it is right that decisions on service configuration are led by local clinicians, who understand better than the national NHS the healthcare needs of their local population, and that those decisions are made in consultation with local people, which was one of his challenges to the process. All proposed service changes will be based on clear evidence that they will deliver better outcomes for patients.
Mr Dunne
I do not agree with that. The analysis at the time was of course of the preliminary drafts of the STP plans, before any assessment by NHS England or the Department of Health. The plans are evolving and becoming partnerships, and they will move at differing speeds in different parts of the country, depending on the quality of the work and the extent to which they meet the four tests for service change, namely that they should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice.
In addition, NHS England introduced a new test from 1 April this year on the future use of beds, which is pertinent to the Charing Cross case. It requires commissioners to assure NHS England that any proposed reduction in the number of acute hospital beds is sustainable over the longer term and that key risks, such as staff levels, have been addressed.
The north-west London STP plan was published in November 2016. It confirmed that the “Shaping a healthier future” programme, to which the hon. Member for Hammersmith rightly referred and which was published in 2012, had set out the right plans to reshape health services across north-west London to respond to rapidly changing health and care needs. “Shaping a healthier future” forms a core part of the STP plan and I understand that the STP leadership intends to take that forward. There was a full public consultation in 2012 on the plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites across north-west London to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that Charing Cross would become a growing hub for integrated care in that services network. Following feedback from the public consultation, the proposals were refined to retain a wider range of services than was initially proposed on the Charing Cross site.
In October 2013, the Secretary of State for Health clearly set out, following the full public consultation, that both Charing Cross and Ealing Hospitals would retain A&E services, even if in a “different shape or size” from current arrangements, and that proposal remains. No final decisions have been made about the exact nature of services that are planned to continue at Charing Cross Hospital. It is certain that, even if changes are made, there will still be a thriving Charing Cross Hospital. There will be engagement with the public in due course on the detailed design and implementation of services on the site, which will include cancer, outpatients, diagnostics and 24/7 local A&E services.
As the hon. Member for Hammersmith quite rightly said, the STP is initially focusing on developing new models of care to reduce demand on acute services. I am grateful to him for welcoming the improvement of services in the community, so that it can be established that those services work before acute reconfiguration takes place through the proposal.
Dr Huq
The Minister is being generous in giving way. He pointed out that no final decisions have been taken, but can he not appreciate that that uncertainty creates a lack of morale among the staff? I had to visit Charing Cross very regularly for my late mother, who we lost during the election campaign, as her specialist Dr Perry was there. Staff morale is sapped: they are demoralised because they do not know what is going on.
Mr Dunne
I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.
It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities—in this case Charing Cross Hospital— have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.
Andy Slaughter
The Minister is being generous in giving way. What I said was that I applaud the aims of improving community services. My CCG faces having to make £17 million of further savings—that creates great difficulty for maintaining services, let alone improving them. The Imperial trust has huge deficits and, as far as I can see, most of the sustainability transformation funds for last year have gone to addressing those deficits. That is the difficulty, which is why I asked for a review of where we are going—because hopes are not being fulfilled.
Mr Dunne
It is fair to say that part of the STP’s objective is to help the NHS in a particular area to work more co-operatively, to encourage better public health for the population as a whole, and thereby work within the available budgets that have been allocated by NHS England. We think that creating a coherent plan for the entire area is the most logical way to try to ensure that that happens.
As I have said, the service change is a matter for the local NHS, which has been clear that there will be no changes at Charing Cross before 2021, as the hon. Gentleman has acknowledged. He did not mention that, in the meantime, NHS England has confirmed its commitment to Charing Cross Hospital and invested £8 million in the hospital in the last year alone. That funding enabled refurbishment of urgent and emergency care wards, theatres, out-patient clinics and lifts, as well as the creation of a patient service centre and the main new facility for north-west London pathology. Further significant investments are also planned, notwithstanding what the hon. Gentleman says about the current financial situation of the Imperial trust.
It remains the case that the STP is planning, in due course, a phased new build across north-west London rather than refurbishing existing buildings, including on the Charing Cross site, but it is not yet at the point of finalising that plan. I can confirm, as the hon. Gentleman asked me, that no hospital run by Imperial College Healthcare NHS Trust, including Charing Cross, has declared any site surplus land. He asked what commitment that means for the future; clearly, until the plans are completely finalised it would be wrong of me to give any further indication of what that might mean in relation to land, because that will depend on the configuration of the buildings, which have yet to be designed. It would be an unrealistic expectation to be definitive about that today.
I am glad that the hon. Member for Ealing Central and Acton (Dr Huq) raised the point about the workforce. It is unsurprising that discussions about proposed service change have created some uncertainty for staff, patients and other stakeholders, including local residents. However, there has been a very clear position on the future development of Charing Cross since the STP plan for north-west London was published a year ago. This position has been shared widely with staff and all stakeholders. As I said earlier, I sincerely hope that my remarks can help to reassure staff working at the hospital that there will be no changes to service levels until 2021 at the very earliest, and that the local NHS commitment to Charing Cross Hospital has been reaffirmed.
In August, the trust leadership undertook a review to more fully understand staff morale at Charing Cross and to develop actions in response. The conclusion was that site-level data do not indicate that Charing Cross is affected by poor morale or that it has more difficulty than other sites in the trust in recruiting and retaining staff. However, there are higher vacancy levels in a few specific staff groups in certain areas, such as elderly care. In response to that review, the trust leadership team has established an action plan, including organising a succession of staff briefings. This week, the trust announced a public meeting for local residents on 27 November to ensure clarity on the future position of Charing Cross and to share information about recent and planned investments on the site. I strongly encourage the hon. Member for Hammersmith to attend that meeting, if he is able to do so, to understand what the trust is saying and to provide reassurance to local residents on the state of the hospital.
The trust has been in correspondence with the leader of Hammersmith and Fulham Council regarding mailings that the council has sent to residents that do not reflect the evolving position at Charing Cross. As well as raising constituents’ concerns, we have a responsibility to allay fears when discussing this subject. We can best do that by being clear about what is and is not in prospect, and by encouraging constituents to take up the offers of engagement made by local decision makers. I understand that the council has expressed some concern about doing that.
The Government remain committed to supporting the local NHS in engaging well with its local population and local clinicians, to ensure that decisions about services in north-west London are made in the best interests of patients, now and in the future. I hope that the hon. Gentleman’s constituents, who are paying attention to this debate, will make the most of the opportunities to participate in future public engagement on the design of services in their area, and that as many as possible will attend the meeting at the hospital on 27 November.
Question put and agreed to.