Accident and Emergency Departments

Lord Barwell Excerpts

Thursday 7th February 2013 Commons Chamber

[Gavin Barwell (Croydon Central) (Con)]

I have quite a bit of sympathy with some of the points that the hon. Gentleman is making because some of my constituents work at Lewisham hospital and have contacted me about this issue. However, he has to make his argument in a balanced way. Is it not the case that under the previous Government, when there was a problem in one PCT neighbouring PCTs were required to subsidise it, and that that, to a degree, unfair as it seems to people, is the consequence of having a national health service rather than separate individual units?

[Jim Dowd]

No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

--- Later in debate ---

[Gavin Barwell (Croydon Central) (Con)]

For the second time this week I have reason to thank you, Mr Speaker. Six minutes seems like an eternity compared with four. A number of colleagues kindly commented positively about my speech on Tuesday, but this one is going to be much less popular, particularly with the hon. Member for Mitcham and Morden (Siobhain McDonagh), and I apologise to her at the outset for that. I am going to strike a slightly different tone from that of many of the people who have spoken in the debate.

The hon. Lady mentioned the “Better Services, Better Value” review, which has been commissioned for health services across south-west London. In the final clinical report’s introduction, the clinicians involved in the review found that

“health services in south west London are not sustainable in their current configuration. In the opinion of the clinicians leading the review, no change is not an option.”

A number of points made in the review are specifically relevant to A and E departments and I wish to draw the House’s attention to them.

The review looked at the number of full-time equivalent emergency medicine consultants in each of the four A and E departments in the area and compared that with the recommended minimum number to achieve cover for 16 hours a day, seven days a week. Croydon Health Services NHS Trust should have 16 whole-time equivalent consultants, but it has 4.9. The figures for St Helier show that it should have 12 but actually has 4.5. Kingston Hospital NHS Trust should have 16 but it has 10. St George’s should have at least 16 but it has 21. So that provides clear evidence that the departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended minimum level of consultant cover.

The review says specifically:

“In London, data shows that the probability of dying as a result of many emergency conditions is significantly higher if the admission is at the weekend, compared to a weekday.”

That is because of that low level of consultant cover. It continues:

“Each year, there are around 25,000 deaths following emergency admission to London’s hospitals. If the weekend mortality rate in London was the same as the weekday rate there would be a minimum of 500 fewer deaths a year.”

[Heidi Alexander (Lewisham East) (Lab)]

How does the hon. Gentleman know that those different mortality rates that he cites are down to less consultant cover at weekends and are not, for example, the result of a sicker population entering A and E at weekends?

[Gavin Barwell]

The honest answer to the hon. Lady’s question is that I do not know. I am simply relying on the report, which is suggesting that that analysis points to 500 as the number of deaths that are purely due to the timing of the week. We could argue about the figure, but I hope that she would agree on the point of principle that having fewer consultants on at the weekend must impose some level of risk.

The report also says:

“The Royal College of Surgeons state that a critical population mass is required in order to provide an efficient and effective emergency service. This is supported by literature that suggests that surgeons who perform a high volume of procedures tend to have better outcomes. The preferred catchment population size for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency surgical cases would be 450,000-500,000.”

We have a problem. We have a large number of hospitals in London with accident and emergency departments and they do not have the recommended level of full-time equivalent consultant cover to provide the best medical outcomes. Every single Member of this House will defend their local hospital, as that is where their constituents go for treatment. If I was in the same position as the hon. Member for Mitcham and Morden, I would be doing exactly the same.

[Mr Charles Walker (Broxbourne) (Con)]

rose—

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Mr Charles Walker]

The problem in north London—and in Broxbourne on the edge of north London—is that Chase Farm is serving a growing population. I do not want to keep Chase Farm A and E open because of any emotional attachment to it, but because we have a population that is due to grow by another 40,000 over the next few years.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

[Dame Joan Ruddock]

rose—

[Gavin Barwell]

I am afraid I cannot take any more interventions.

The hon. Member for Lewisham West and Penge was wrong to state that that has only started to happen under this Government. In my part of London in the past things have gone wrong in neighbouring boroughs and Croydon PCT has had to help them out. In the past two years Croydon PCT has got into trouble and neighbouring boroughs have helped us out. That does not mean that what is happening is right. I am not making a judgment on it. I am just saying that it is not fair to suggest that the present situation is a wholly new departure.

Hon. Members have made powerful arguments for their local hospitals, but there is a balance to be struck between convenience of locality and ensuring sufficient acute cover. I completely understand the point made by the hon. Member for Mitcham and Morden (Siobhain McDonagh) in relation to St Helier, but as a Croydon MP I have to say that there must a solution that gets us to the recommended minimum level of consultant cover in our hospital, and I will continue to fight for that.