Hospitals: West London

Lord Dubs Excerpts

Wednesday 18th October 2017 Lords Chamber

Asked by

[Lord Dubs]

To ask Her Majesty’s Government what are their plans for the future of hospitals in West London, particularly in relation to their proposals to sell off much of the site of the existing Charing Cross hospital.

[Lord Dubs (Lab)]

My Lords, when the local London elections took place in 2014 everybody was surprised that Hammersmith and Fulham went to Labour—everyone except those of us who were knocking on doors like mad to try to win the council for Labour, which was of course the outcome. It was clear from knocking on those doors that the issue of Charing Cross Hospital was very much in people’s minds. After Labour won the Conservatives, who lost, complained that the health service was not directly a local government issue, to which the answer was that the outgoing Conservative council campaigned to support the closure of Charing Cross Hospital so it was not surprising that it became an issue. The Minister shakes his head but they certainly did; I was there. I understand that the NHS is under serious financial pressure. If it were not, the argument about the future of Charing Cross Hospital and other hospitals in north and west London would not apply.

I want to make three arguments. First, it is wrong in principle to close and demolish Charing Cross Hospital; secondly, the method of doing so was less straightforward than it should have been; and thirdly, public opinion is very much on the side of keeping the hospital. Public opinion was ably led by Andy Slaughter, the local MP and Councillor Stephen Cowan, the leader of Hammersmith and Fulham Council.

In 2013, we had the “Shaping a Healthier Future” policy. The NHS agreed plans to close A&E departments and acute care beds in four hospitals in north-west London. These plans continue to be implemented. The Government’s reconfiguration of those services is ironically entitled the “Shaping a Healthier Future” plan for north-west London. It was signed off by the Secretary of State, Jeremy Hunt. It showed that the plan was to demolish the current Charing Cross Hospital; sell off most of the Charing Cross Hospital site, leaving just 13%; replace the current hospital with a series of clinics on a site no more than 13% of the size of the current hospital; rebrand the clinics as a local hospital; replace the current A&E with an urgent care clinic; rebrand the urgent care clinic as a class 3 A&E; lose more than 300, possibly all, of the acute care beds; halt all complex and emergency surgery; and close the renowned stroke unit, which was possibly the best in London.

Since September 2014, the A&E departments at Hammersmith Hospital and Central Middlesex Hospital have been closed as part of the overall plan for the area. This had an immediate impact on waiting times at other A&E departments across north-west London. The figures are quite dramatic. Before September 2014 hospitals across north-west London were hitting their target of seeing 95% of patients within four hours. After the closures of the A&E departments at Hammersmith Hospital and Central Middlesex Hospital, the figure in December 2014 was 90% and by February 2017 it had reached 87%. As recently as September—last month—the combined figure for Charing Cross Hospital and St Mary’s Hospital had fallen to 69.7%, suggesting that there was a great deal of pressure on A&E services which would only get worse if the plans for Charing Cross were proceeded with. I should add that, among other hospital closures, in July 2015 the maternity unit at Ealing Hospital was closed.

Five London boroughs—Brent, Ealing, Hammersmith and Fulham, Harrow and Hounslow—got together to set up an independent healthcare commission, commonly called the Mansfield commission. The commission spent a year gathering evidence and published its findings and recommendations in December 2015. It said:

“There is still no completed, up to date business plan in place that sets out the case for delivering the Shaping a Healthier Future programme, demonstrating that the programme is affordable and deliverable … There was limited and inadequate public consultation on the original SaHF proposals and the proposals themselves did not provide an accurate view of the final costs and risks to the people affected … The escalating costs of the programme does not represent value for money”,


and were a waste of precious public resources. It said that NHS facilities delivering important public healthcare services had been closed without adequate alternative provision having been put in place, and that,

“the original business case seriously underestimated the increases in population being experienced in West London”,

and failed to address the increasing need for services. The main recommendation by the Mansfield commission was that the “Shaping a Healthier Future” programme itself should be halted.

The implications of the programme for protected groups were disturbing. The commission noted that the hospitals targeted for closure were those located in areas with high concentrations of deprived black and minority ethnic communities while the hospitals favoured for expansion were located in more affluent areas of north-west London. Significantly, the population of Hammersmith and Fulham is expected to increase by almost 12,000 between the 2011 and 2021 censuses. There is also a projected target of 22,000 new homes to be built in the borough by 2035.

We then had the Naylor review, which showed that, due to increasing demand on health services as a result of an ageing and expanding population, the Nuffield Trust estimates that an additional 22 hospitals of 800 beds will be needed over the next 10 years—not in London, but more widely. The review accepted that, even if new models of care are successful, this expansion and ageing of the population will require the same level of hospital capacity as at present. Most of the sustainability and transfer plan is pretty good; it is desirable to keep people out of hospital and to enable them to leave hospital when they are medically fit to leave so they do not block beds, and it is important that there are joined-up social care and health services.

I turn to urgent care centres. The UCC at St Mary’s was rated inadequate by the CQC and placed into special measures. I understand that there is now a bid from the private sector to buy it. What assurances do we have, if the Charing Cross proposals were proceeded with, and I hope to heaven they are not, that its UCC would not be privatised if the main proposal went ahead? We do not want this just to be a back door for achieving more privatisation.

Both Hammersmith and Fulham and Ealing councils have refused to sign up to the proposal regarding Charing Cross and Ealing hospitals. The reason they did not sign up to the whole proposal is the threat to those two hospitals; otherwise they would have signed up. The councils have said that the sustainability and transfer plan has good elements in it, but they will not sign up to it simply because it endorses the plan to close those two hospitals.

There are key questions that need to be answered so that local residents know what is going on. What is the timetable for service closures at Charing Cross Hospital? I understand that the original plan has been dropped and it is now to be in at least 2021. The problem is that a long period of uncertainty over the future of the hospital is very demoralising; it affects staff and the ability of the hospital to get staff, and it is unhealthy for the local community. Of course, the important thing is that the closure should not go ahead at all but, if it does, there should at least be a sensible timetable.

When will part two of the “Shaping a Healthier Future” strategic outline case be published? We need to know that to see what will happen. We need an assurance that those part 2 plans will be subject to widespread consultation.

Finally, and very importantly, I have mentioned the likely population figures. My question is: what population projections and modelling data are being used to estimate future patient demand for acute hospital services across north-west London generally, and in Hammersmith and Fulham specifically? We need answers to those questions.

I appreciate that this is a very party-political issue, but it is party political because local people want the hospital to remain. They do not want it to close. Many of us have used the services of the hospital and we do not want it to go. If it does, there will be no local hospital. There will be a clinic and one or two minor services, with most of the beds going, and all the good features of Charing Cross Hospital will simply disappear. I hope that will not happen.