Hospitals: West London

Lord Hunt of Kings Heath Excerpts

Wednesday 18th October 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to my noble friend for bringing to the House’s attention the concerns of residents about the future of Charing Cross Hospital. Although my noble friend has focused on issues in west London, the kind of debate that we are having is reflected up and down the country, as each area develops its sustainability and transformation programmes. My noble friend Lord Warner has outlined some of the issues with STPs. I particularly share his view about the loss of a London-wide SHA in terms of trying to lead change in the metropolis.

If the Minister thinks that STPs are going to get this Government out of trouble on the NHS, he should think again. Essentially, the wording may be different but, actually, when you look at them, they are previous plans dusted down and regurgitated in new language. At heart they are based on the belief that think tanks have had for 30 years that, if you invest in prevention, community and primary care, demand for hospital care will reduce. The evidence for that is very thin indeed. The fact is that there have been any number of attempts to implement those kinds of programmes, but of course the investment has never been of the order required out of the hospital setting, because the programmes almost invariably rely on acute bed closures to fund future investment. That is particularly difficult in current circumstances. Clearly, that is the case in west London.

The STP document really goes back to the 2012 consultation. My noble friend described that; the proposal was to reduce the number of major hospitals in north-west London from nine to five in a programme called “Shaping a Healthier Future”. That was subject to a searching independent review chaired by Michael Mansfield QC. My noble friend explained to the House some of the conclusions of Mr Mansfield’s review.

Despite that, the STP has decided to plough on with the proposals before us tonight. It is clear, reading between the lines, that the STP’s overriding motive is financial. It says that a clinically and financially sustainable system cannot be delivered in west London without reconfiguring acute services. Although it says—and the noble Lord, Lord Warner, is right—that no planned changes are to be made to Charing Cross’s A&E services before 2021, the fact is, because of the decision over the land closure on the Charing Cross site, there is a risk that, once the public and staff become uncertain about the future of the hospital, people will leave, retention and recruitment will become more difficult, patient confidence will be lessened, and the hospital will become blighted. This is the real risk for Charing Cross.

What is happening in west London cannot be divorced from general concerns about capacity in the NHS. We have debated twice in the last week the King’s Fund report, which identified that we have fewer acute beds in this country than any advanced healthcare system. We could of course use them better—we know that we could improve the way that discharge procedures work—but the fact is that it would be very risky indeed to go ahead with further reductions in acute capacity when the number of patients, particularly frail, older people who need the kind of care that hospitals provide, is going to grow. The King’s Fund therefore concluded that further significant reductions in bed numbers are unrealistic, which ties in with the Naylor review that I think my noble friend referred to.

We have not had much opportunity to debate STPs, but I point the Minister to the recent IPPR report, which found a deficiency of leadership within STPs and that funding was the overwhelming pressure on them, to the expense of any other action that they take and, of course, that there are no statutory powers with which to deliver the reform agenda as a result of the fragmentation created by the 2012 Act. The King’s Fund analysis of STPs in February 2017 concluded that, despite all the warm words about new models of care, they are driven by financial imperatives. I remind the Minister that a survey of 172 NHS trust chairs and chief executives, carried out last autumn, found that achieving financial balance was seen as the most important issue in STP land.

It is clear that the north-west London STP is financially driven. The noble Lord, Lord Warner, referred to the London STPs as a whole and the “do nothing” deficit of over £4 billion by 2021. The figure in the north-west London STP puts its funding gap at £1.113 billion. The STP then goes on to make the highly questionable claim that, through a combination of normal savings delivery and the benefits to be realised through the STP proposals, this huge deficit can be turned into a £15 million surplus. I hope that Ministers realise that this is a fantasy. It is a requirement, because the system bullies STPs if they do not come up with financial balance. But I do not know anybody who thinks that this STP could deliver anything like a £15 million surplus by 2021—it is a complete and utter fantasy.

The STP goes on to talk about the need to transform general practice and for,

“a substantial upscaling of the intermediate care services … offering integrated health and social care teams outside of an acute hospital setting”.

Well, every STP says that. The question I put to the Minister is: how on earth is this going to happen? Clearly, it expects general practice to take on greater responsibilities, yet only a few days ago the Secretary of State acknowledged the overload on GPs. Many practices are now closing their lists to new patients, many GPs are choosing to go part-time and others are retiring. I wonder how on earth this STP envisages that by 2021 the GPs in west London will miraculously suddenly develop a new drive and energy to provide the kind of additional services that are required.

What about intermediate or step-down care? Unbelievably, we hear that while these STPs talk about the importance of intermediate or step-down care, they have proposals to close community hospitals. Again, I ask the Minister: where on earth is the confidence that the STP will deliver what it says to bring down the deficit, reduce acute capacity—clearly, that is what it will do—and provide the kind of enhanced service that it talks about?

Ministers tend to hear what they want to hear, as we all do. However, the word on the street, when one talks to any senior person locally who is not in the earshot of one or other of the regulators, is that STPs are a mere flight of fantasy designed to get Ministers off the back of the NHS and give it a little more time until somebody comes up with something new that Ministers will latch on to as the next solution for the NHS. STPs will not work. We all know they are not going to work.

The risk is that Charing Cross Hospital becomes absolutely blighted. I agree with my noble friend Lord Warner, who says that in the light of previous experience, whatever the STP says about Charing Cross, if anyone thinks that all this is going to be done by 2021, they need to think again. The risk is that poor old Charing Cross will be stuck in this awful blighted position, good people will leave and it will become increasingly difficult to manage this hospital. That is why residents are right to be concerned and why we look to the Minister for reassurance tonight.