King George Hospital

Mike Gapes Excerpts

Tuesday 8th November 2011 Westminster Hall

[Mike Gapes (Ilford South) (Lab/Co-op)]

I want to raise the issue of the Care Quality Commission report on the Barking, Havering and Redbridge University Hospitals NHS Trust in north-east London, the related independent reconfiguration panel report and the recent decision by the Secretary of State for Health to endorse the recommendations in the panel’s report and, as a result, significantly to downgrade services at King George hospital in Ilford. It is not the first time that the problems in north-east London health services and hospital provision have been debated in Westminster Hall or the House. Indeed, I introduced debates in 2006, 2009 and 2010, and my right hon. Friend the Member for Barking (Margaret Hodge) introduced a debate in June about maternity services.

Members of Parliament throughout north-east London have been very concerned, and there has been cross-party consensus, in very unusual circumstances, involving eight Members of Parliament: myself, my right hon. Friend the Member for Barking, my hon. Friends the Members for Leyton and Wanstead (John Cryer) and for Dagenham and Rainham (Jon Cruddas), the hon. Members for Ilford North (Mr Scott), for Hornchurch and Upminster (Angela Watkinson), and for Romford (Andrew Rosindell), and the Secretary of State for Work and Pensions. We have had massive support in the community. Decisions have been made by local authority health overview and scrutiny committees and there is wide public concern, with huge petitions and public meetings, about proposals that were initiated in 2006 to downgrade services at King George hospital, the smaller of the two hospitals in the trust.

That trust, in the words of the first paragraph of the Care Quality Commission’s summary,

“had a history of poor performance under the previous regulatory framework. It has long-standing and escalating debts (in 2005/06 this was just under £16m; by 2009/10 it was close to £117m). There have been numerous changes at executive level.”

Queen’s hospital, Romford is the newer of the two hospitals, having opened towards the end of 2006. It cost a huge amount of money and is run under a private finance initiative arrangement, which has led to certain difficulties. There was high-profile publicity, particularly about deaths in maternity services, and the CQC began a series of investigations, as a result of which it decided to carry out a full investigation of the trust as a whole, encompassing both hospitals and all services. That investigation went on throughout this summer, and its report was published at 10 am on 27 October.

At the same time, there have been proposals from the NHS London region bureaucracy, driven by the people within it, who have a vision of reducing the number of hospitals in north-east London from six to five, transferring services to large hospitals and reducing facilities in the Redbridge and Barking and Dagenham areas. We have ended up with a series of proposals that, when they were initially put forward, were deemed by Professor George Alberti to be clinically unsound. Later, they were revamped, tweaked and remodelled, and they became known as the health for north-east London proposals.

Those proposals envisaged principally getting rid of the accident and emergency department at King George hospital, Ilford. There has been an accident and emergency department in the district general hospital there since 1931, when the population was 85,000. Now it is 264,000 in the London borough of Redbridge, and the hospital also serves Barking and Dagenham, with a population approaching 200,000. The proposals also included getting rid of King George hospital’s maternity services, which serve young mothers in an area with a growing, diverse, predominantly ethnic minority population. Many of those young mothers have come recently to the United Kingdom, or at least have recently moved to Ilford. At the same time, it is proposed to increase the number of births taking place at Queen’s hospital in Romford—the one about which there were particular concerns—to make it what some people have called a baby factory. Those words were used in the reports by the CQC and the independent reconfiguration panel.

In March 2010, following concern and a campaign against the proposals, the then Secretary of State for Health referred the matter to the independent reconfiguration panel. The IRP then decided not to carry out an investigation, but to allow the consultation process to continue. That process led to final proposals, which were published towards the end of 2010, and then went through the so-called consultation and decision-making process, based on the primary care trusts. The joint committee of primary care trusts rubber-stamped the proposals despite overwhelming public opposition: aside from the tens of thousands of people who signed petitions against the proposals, within the committee’s own limited, and rigged, consultation procedure the public were opposed by a two-to-one majority—and an eight or nine-to-one majority in areas that were directly affected—to what was put forward.

We were told, however, that there was clinical support. There was no ballot of GPs, or system to ascertain what ordinary GPs thought.

[Margaret Hodge (Barking) (Lab)]

My hon. Friend says that there was no ballot of GPs, but does he accept that I undertook a survey of GPs in Barking and Dagenham, and there was unanimous support for retaining the two A and E departments, at both King George hospital and Queen’s?

[Mike Gapes]

Yes, I should have said that there was no official ballot of GPs, because, of course, the view of the NHS bureaucracy was that the clinical leadership and the practices should make the decision; therefore, there was a strange kind of managed democracy and consultation.

[Mr Lee Scott (Ilford North) (Con)]

Does the hon. Gentleman also agree that it is possible that a number of the GPs who were spoken to were too concerned for their own futures to give their real opinion?

--- Later in debate ---

[Mike Gapes]

I suspect that that may be the case. A number of others were also on the payroll in one way or another—including many who were the lead GPs in the consortia that endorsed the proposals.

It is important to get the chronology right. Following the decision of the joint primary care trust meeting in December to endorse the proposals, all the councillors from all the parties in the London borough of Redbridge made a unanimous referral to the Secretary of State. The joint overview and scrutiny committee for all the boroughs in outer north-east London also made a referral to the Secretary of State. The Secretary of State then decided—the Minister will recall a previous debate in the main Chamber, in which we had an interesting exchange on the matter—to refer the case to a new independent reconfiguration panel investigation.

The IRP spent a lot of time talking to Members of Parliament and councillors, and it worked hard; I have no criticism of the consultation process. In its analysis, although it tended to group us all into one paragraph called, “Save King George Hospital” campaign, which covers many interviews and consultations, the community’s opposition was reflected. The view was expressed, if tucked away, that the local community was overwhelmingly against the proposals.

The IRP published its report internally, but not publicly, and put it on the desk of the Secretary of State on 22 July, and there it sat. Two or three weeks after that, the CQC decided to carry out a full, no-holds-barred look at Barking, Havering and Redbridge trust. Understandably, I guess, the Secretary of State decided to hold back until he had received the CQC report before he published the IRP report and gave his official response; Members of Parliament expected something like that to happen.

Then, interestingly, everything went quiet. We originally thought that we were going to get an announcement in September, but September came and went. Then we thought that we would get an announcement in early October, but that did not happen. Eventually, three hours after the CQC report was made public, the Secretary of State published his response.

There is a little bit of history here. As a local Member of Parliament—I know that other MPs feel the same—I was not appropriately informed about the matters. BBC London news on television at 6.30 pm on Wednesday evening ran a story saying that the Secretary of State was going to announce at 12 o’clock the following day the closure of A and E and maternity services at King George hospital. I raised a point of order in the Chamber that evening with Madam Deputy Speaker, who had no knowledge of the matter—there was no statement or announcement to come.

The following morning, telephone calls to the private and press offices of the Department of Health ascertained that, yes, the news was true: there was going to be an announcement. To be fair, I was phoned back eventually, at 11.15 am, and told that the announcement would be made at 1 pm, and that I would be told in advance of it. That is true: I received an e-mail at, I think, 12.46 pm. Attached was a letter from the Secretary of State with a link to the IRP report, but the report was not available on that link; the link did not work until 1.10 pm. Other people had a similar problem, by which time the announcement was already up and running. Therefore, we knew what the decision was—to endorse the report—but we did not know the content of the report. That is a matter of concern.

Nevertheless, the essence of the proposal is that Barking, Havering and Redbridge trust will be completely reorganised, because the IRP recommended going ahead with the downgrading of services at King George hospital, despite public opposition and deep concerns.

I have a question. The CQC report was published at 10 o’clock. Is the CQC report consistent with the IRP report and the Secretary of State’s decision? The Secretary of State, having read the CQC report, should have thought hard about whether to endorse the IRP report. The CQC report is absolutely damning about services at Queen’s hospital. It contains some criticisms of King George, principally because that hospital is in the same trust as Queen’s, with the same management, which the report is also strongly critical of. However, of the 73 recommendations in the CQC report, concerning maternity, A and E, children’s services, dealing with complaints from MPs, quality of care, cleanliness and all kinds of other issues, the vast majority relate to the new, five-year-old, private finance initiative-built Queen’s hospital in Romford. The report explicitly says on occasion that the recommendations do not apply to King George and that at King George, there is a different case. We have a series of absolutely damning recommendations relating to the larger hospital in the trust.

I do not wish to go through the report in great detail, as it is a long document. If people are looking for horror reading at Christmas, I recommend taking the report away and reading it. Apart from criticising poor management, it says that some staff, particularly in the maternity services at Queen’s, have very poor attitudes to the patients whom they are treating. It also confirms that attempts to cut the deficit at Barking, Havering and Redbridge trust over the years have led to reductions in the quality of care.

The IRP report also flags up concerns, saying that if the trust drove on with the deficit reduction programme and reduced the number of staff and beds, there could be an issue with quality. Damningly, the report makes it clear that although services at King George were reduced over the years, it has not led to efficiency savings. All it has done is reduce the quality of care in a hospital that serves my constituents and those of a number of other MPs. The cost of doing that has not led to improvements in efficiency; on the contrary, it has contributed to the ongoing deficit problems in the dysfunctional trust.

There we have it. The Secretary of State receives a report from the IRP recommending the endorsement of NHS London’s vision to downgrade services at King George hospital in Ilford. He then receives a report saying that there are two hospitals in the trust, covering 750,000 people in the community in the three boroughs, one of which is doing badly and there are criticisms of the other. He therefore endorses the recommendations to cut the services at the hospital that is doing better, on the aspiration, but with no evidence, that it will lead to a miraculous Stakhanovite improvement in the services at the bigger, supposedly better and more expensive hospital in the long term. You really could not make it up.

The Secretary of State could have delayed his decision on the IRP report. He could have said, “I am concerned about the CQC report and the damning indictment of what is going on at Queen’s hospital. I have waited three months with the report sitting on my desk, and I will wait another year to see whether I am satisfied that the improvements at Queen’s hospital are happening and have happened, that the quality of services provided is sufficient and that there has been an improvement in primary care services, which is also called for in the IRP report.” He could have waited, or he could have said, “I have made an announcement. I am minded to support the recommendations unless there is a significant improvement at Queen’s hospital and other services.”

[The Minister of State, Department of Health (Mr Simon Burns)]

I am grateful to the hon. Gentleman for giving way, and I hope this reassures him. As he will know from the decision, nothing to do with the IRP proposals will come into effect until the problems highlighted in the CQC report have been remedied, and the time scale for that in many ways fits in with the hon. Gentleman’s point.

[Mike Gapes]

I am sorry, but that is not good enough. The Minister gives the impression that the Secretary of State has somehow not “fully supported”—to use his own words—the recommendations. The letter that I have from Heather Mullin of the Health for north east London programme states that the Secretary of State fully supports the recommendations of the IRP.

[Mr Burns]

The hon. Gentleman is making a fallacious point. I have never said that at all. It is quite clear from the letter that my right hon. Friend the Secretary of State sent to him and to other hon. Members that he does. The point that I was making in my intervention is that he said that the IRP proposals should not come into effect until the problems have been sorted out at the two hospitals. I am saying that it has already been accepted that those improvements have to be made prior to the IRP proposals coming into effect, which is what I understood that the hon. Gentleman was saying should happen.

[Mike Gapes]

I am saying something different; I am saying that the Secretary of State could have delayed his decision or that he could have said that he was minded to—the words that I used—support the proposals, but would not make a final decision until he was satisfied.

I spoke to people within the Health for north east London programme last week. I asked them what the timetable for the implementation of the proposals was, and they could not tell me. I asked them whether babies will be born at King George hospital, Ilford, in five years’ time, and I was told, “Almost certainly not.” I therefore asked whether babies would be born there in two years’ time, and I was told, “They may be. We have not yet worked out the detail of these proposals. There is still a lot of work to do.”

[Mr Burns]

There is no secret about this. The improvements to care must first be achieved at the hospitals before the IRP proposals are enacted. It is anticipated—one can never be 100% accurate—that the time scale will probably be about two years.

[Mike Gapes]

I give way to my right hon. Friend.

[Margaret Hodge]

Perhaps the Minister will be able to help us in his reply, but my understanding is that the business plan put forward by NHS Outer North East London at the end of the summer suggested that, for the finances to stack up, the proposals will have to be implemented by April 2012. If that has been superseded, that is welcome news, but the local information is that the NHS ONEL business plan suggests the closure of the A and E and maternity services by April 2012.

[Mike Gapes]

There is obviously some uncertainty, because I was not told that when I spoke to NHS ONEL. Perhaps it is having a rethink in light of the report.

[Mr Scott]

If it is helpful, I have also received a letter from Heather Mullin stating exactly what the Minister has said, which is that two years is the minimum time scale for things to be looked at.

[Mr Burns]

rose—

[Mike Gapes]

I am happy to keep giving way.

[Mr Burns]

To respond to the hon. Gentleman and the right hon. Member for Barking (Margaret Hodge), I will repeat what I said before, which is that it is of paramount importance that the recommendations and demands of CQC are met before anything happens with the IRP recommendations, because patient safety is paramount. As far as can be assessed, it will probably be two years to get patient safety to the required levels and to address all the problems highlighted in the CQC report. Whatever the hon. Gentleman or the right hon. Lady may have heard from other people, we estimate that the time scale will probably be about two years, because the CQC’s requirements are paramount.

[Mike Gapes]

I would like to move on to what the CQC actually said, because it has made several criticisms and expressed deep concern. It will prove difficult for the management of the trust and the present configuration of Queen’s hospital to meet the required improvements within a two-year timetable. My right hon. Friend the Member for Barking and I have visited the hospital, and there are, for example, bottlenecks where people are on trolleys around the corner where they cannot be seen, which is pointed out in the report. There are design faults, and it is a bit like Eros at Piccadilly circus with trolleys suddenly coming from both directions. This newly designed hospital has a level of chaos. Whoever was responsible for signing off the design must have decided that it was an airport rather than a hospital, because the design has big issues—

[Mr Burns]

rose—

[Mike Gapes]

Before the Minister intervenes, I am criticising the previous Government, the private finance initiative and the people in the consultancies and the private sector who run the PFI and make a huge amount of money from it, for designing a hospital that does not work well. The reports state that. They criticise the bad signage, the design and the way that wards are structured. Queen’s hospital has, for example, areas where children cannot be seen and areas where people wait for more than an hour before being attended to by a nurse or doctor. There is a whole litany of things that relate partly to design, partly to management, partly to staff shortages and partly to other issues at the hospital.

I do not believe that Queen’s hospital can be turned around in the suggested time scale, and that raises wider questions. The CQC wrote to me after I asked for an update following the publication of its report, and I received it yesterday. The update confirms the reasons why it had to intervene, which included the poor performance of the trust in the past and the fact that long-term problems prevented offering care that consistently meets CQC’s essential standards. To be fair, the CQC refers to both hospitals. It continues by saying that they have taken action to mitigate the risk of immediate harm in the short term, which includes reducing births at both Queen’s hospital and King George hospital and transferring caesareans out of the area. When they will be transferred back is an interesting question, which we can perhaps come to later. The update also states that the CQC met many staff and patients and that their concerns were made known, but the nub of the issue is that if improvements are not forthcoming, the CQC is prepared to restrict access to or close services that appear to be basically unsustainable. It then states that the CQC is not responsible for service reconfiguration.

The CQC, therefore, is not yet convinced that the 74 improvements that it has requested will be met. The final paragraph in the letter to me states that the CQC has set out 16 key recommendations that must be fulfilled by the trust and that it will monitor their implementation, but it admits that the trust needs help from organisations in the local health economy such as NHS London and commissioners and that the necessary significant changes are likely to challenge both clinical flows and trust finances.

There it is. We have problems with capacity and money, and we have a decision from the IRP and the Secretary of State to downgrade King George hospital, but serious concerns remain about Queen’s hospital. Are we confident that within two years those problems will have been addressed sufficiently well, at a time when there are financial problems; that Queen’s hospital will suddenly have been turned around, so that it is such a fantastic place that my constituents and the constituents of my neighbouring MPs—my right hon. Friend the Member for Barking and my hon. Friend the Member for Dagenham and Rainham—will feel happy to go into it to give birth to their children? I already have constituents expressing concerns because of the media reports and other things that are going on.

The CQC report points out that in the past there were more than 2,000 births a year in the King George hospital; at one time, there were 2,500 births a year. However, those numbers were deliberately run down by the trust to around 1,300 births a year. Then, a few months ago, the trust began to push the numbers up again, because Queen’s hospital could not cope. Within two years of now, the capacity for births at King George hospital—a capacity of around 2,000 births a year—will go. We are told that some of that capacity will go to a midwife-led birthing unit on the Barking hospital site, where there are currently about 10 births a week, or about 500 births a year. I am told that that figure is the maximum for that unit, although I do not know whether that is accurate. There is no proposal to have a similar unit on the King George site. That idea was floated in the consultation, but it was ruled out.

We have had a maternity hospital in Ilford since 1926; children have been born in that hospital since 1926. But from 2013 there will be no children born in that hospital, even though we have a young population. People in Ilford will be forced to go to the Queen’s hospital, where there is capacity for 9,000 or 10,000 births a year. It will be one of the largest maternity units in the country and it has been described as a “baby factory” in one of the documents that I have referred to this morning. Alternatively, they can go to Newham hospital or Whipps Cross hospital. Apparently, the facilities for babies to be born at Newham hospital or Whipps Cross hospital will be increased, although the cost of doing that is undefined. That will happen, while the perfectly good maternity service that exists in Ilford at King George hospital is being run down. My constituents will have to travel to Havering or to Whipps Cross. It is not easy to get to Whipps Cross from Ilford lane; the route is complicated and there are sometimes lots of traffic problems. There will be concerns about that.

Interestingly, Havering has the oldest population of any London borough; that is pointed out in the IRP report. The boroughs with the youngest populations in London are Barking and Dagenham, and Redbridge. So we have this huge increase in young people in north-east London, but their hospital will not be in the communities where they live. I could understand it if we had had a hospital at Queen’s hospital that provided long-term care for people suffering from long-term illnesses, mental health problems and so on, and if we had our maternity hospital in the area where most of the births were taking place. But oh no—the IRP, Health for north east London and the Government do it the other way round. We pointed that out in the consultation and the local MPs and councillors kept making these points, but we have been ignored.

Mr Brady, I am conscious of the time and that other Members wish to speak, so I simply want to get back to the CQC. I have been told that the CQC will review in March 2012 whether or not the Barking, Havering and Redbridge University Hospitals NHS Trust is delivering improvements. The CQC says:

“If we do not see improvements, we are prepared to take further action to restrict and ultimately close services that do not deliver care that meets our essential standards of safety and quality, and that present risks to people using services.”

That review is due to take place in March 2012, which is not very far away. It is not two years away; it is just a few months away.

I hope that the quality of care at Queen’s hospital improves sufficiently; I hope that services at King George hospital are not run down by surreptitious salami-slicing cuts in preparation for the implementation of Health for north east London’s plans, as they have been for several years now; and I hope that quality of patient care and treatment for my constituents is put ahead of the bean-counting desire to reduce the deficit at the Barking, Havering and Redbridge University Hospitals NHS Trust.

However, I am not confident that those things will happen. I am extremely angry at the betrayal of my constituents by the bureaucracy in Health for north east London; by the Minister, who said before the general election last year that there would be no top-down reorganisation; and by others, who said that they would keep district general hospitals open and that those hospitals should not close. The Prime Minister said that in 2007. In 2009, he promised “a bare-knuckle fight”. That was in the context of Chase Farm hospital, but the principles involved are the same. I feel that we have been betrayed and that our services are going to be reduced, and I fear the consequences of that for my constituents.

[Mr Graham Brady (in the Chair)]

It may be helpful for right hon. and hon. Members to know that I anticipate taking Front-Bench contributions from 10.40 am. Colleagues can work out for themselves that we may be able to get everyone in to speak if speeches are reasonably short.

[Mr Lee Scott (Ilford North) (Con)]

I am grateful for the opportunity to speak in this debate.

Before I talk about anything to do with the hospitals that we are discussing today, we should praise the doctors, the nurses and the back-up staff at Barking, Havering and Redbridge University Hospitals NHS Trust. After everything that has happened in these last few weeks, particularly the reports on the trust, morale must be pretty low. I do not believe that those staff are to blame for the problems at the trust. I believe that criticisms of staff can be made and that there are things that need to be learned, but I also believe that the fault for the problems lies much more with the previous senior management at the trust than with the doctors, nurses, back-up staff and front-line staff. Of course, recommendations for improvements have been made, but those staff took their orders from others and we should try to build morale rather than knock it down. That is what I genuinely feel.

I, along with other right hon. and hon. Members in our local area, thought that the Care Quality Commission report was going to be bad, but I did not think for one moment that it would be quite as bad as it turned out to be. It was damning of just about everything. It was probably easier to see what was right than what was wrong, because the good points were fewer than the bad ones.

I will talk about the CQC report in depth, and at this point I want to mention that I am talking on my own behalf and that of my hon. Friend the Member for Hornchurch and Upminster (Angela Watkinson), who is a Government Whip and therefore is unable to speak in this debate. If she disagrees with anything I say, I am sorry but that is too bad. The damning report by the CQC was ostensibly of Queen’s hospital, but it also points the finger at King George hospital. As with the independent reconfiguration panel report, I was disappointed, upset and angry that the decision that was made had been taken.

I will begin with accident and emergency. In my own constituency of Ilford, North, I believe that a large additional burden will be placed on Whipps Cross hospital. My guess is that in an emergency, people from wards such as Woodford Bridge, Fairlop and Fullwell will go to that hospital, rather than cross the A12 right the way through to Queen’s hospital, so there will be a major problem at Whipps Cross.

The CQC report and the letters that I have received say that, that owing to the pressure of our one-paragraph “Save King George Hospital” campaign, the urgent care centre will now be manned by doctors, nurses and some specialists 24/7, 365 days a year. I acknowledge that, and I am grateful for it. However, in his response to the debate, will the Minister say whether we can look at taking the next step and going a bit further to make that urgent care centre an A and E department.

Regarding maternity services, during the consultation I had a meeting at Barking, Havering and Redbridge University Hospitals NHS Trust, and I believe that the hon. Member for Ilford South (Mike Gapes) had a similar meeting, although we were not allowed to have meetings together, for whatever reason. It was hinted—quite strongly—that a birthing unit would remain, in some shape or form, at King George hospital. I do not know what happened to that idea, but I would like it to be considered, because it came through loud and clear at the meeting that I attended.

[Mike Gapes]

I recall the conversation that I had very well. I was told that the local trust wanted to have the birthing unit, but that they had to get the approval of NHS London and that, as usual with regard to services in Ilford, NHS London’s bureaucracy was less inclined to go along with it.

[Mr Scott]

I thank the hon. Gentleman for that intervention.

I want to praise the hospital’s new management. Averil Dongworth is doing a good job with her staff. She inherited a difficult situation, with a £117 million deficit and low morale, and she should be praised for doing her utmost to turn things around. The CQC report stated that things had improved over the past months.

The hon. Gentleman said that there are 265,000 people in the London borough of Redbridge alone and, given the amount of new build that has outline or detailed planning permission, the population is going to grow considerably. I understand that the situation is similar in Barking and Dagenham, and it is estimated that the area could grow by about 50,000 people in the next five years or so. When I met with the independent reconfiguration panel and the CQC, I mentioned that issue in relation to my own constituency, and I am sure that colleagues have also done so.

On the ballot of GPs that did not take place, GPs were consulted and the report says that they gave their blessing to what was happening. However, that seems to contradict what I heard from a number of GPs who contacted me in private, as they made it clear that although they did not feel confident enough to make their views public they had grave concerns. I know that that is anecdotal, but I want to put it on the record. It certainly happened with me; I know not whether it happened with other Members, but I would be surprised if it had not.

I think that it is fair to say that the private finance initiative at Queen’s hospital has been a failure. It was badly negotiated—the hon. Gentleman acknowledged that that was done by the previous Government and not the current one—it was a bad deal; it was badly set out and there are grave concerns. I understand that the planning applications for the new units that would need to be built at Queen’s have not even gone in, and are unlikely to do so before the new year. The time scale for the build ties in with the two years the Minister mentioned earlier, so that would obviously be a constraint.

In a letter to the hon. Gentleman, we heard that the CQC would undertake a re-evaluation in March 2012. I urge it to make a full report before any changes are made—in two years’ time or whenever—to say, “Yes, we are satisfied that our 73 points of concern have been rectified.”

[Mr Scott]

I thank the Minister. I am sure that the CQC will take note of what the Minister, other colleagues and I say in this debate. I have presented petitions signed by a total of 39,000 people, and other Members have presented petitions directly to Downing street; via our local Ilford Recorder, to which I pay tribute for its continued campaign; and in other ways. I am sure that it is an underestimate to say that there must have been a total of 50,000-plus signatures.

[Mike Gapes]

I presented 25,000 signatures, which became 28,000, to NHS London on the initial proposals, and another 32,000 in the latest round. Adding all those together with the ones that went in from other groups, I would guess that it was more like 100,000.

[Mr Scott]

My arithmetic shows why I will probably never be in the Treasury. None the less, a huge number of people have signed petitions.

I ask the Minister to take on board the fact that there is cross-party support for keeping the services that our constituents need at King George’s, and to consider upgrading the urgent care centre by renaming it an A and E and adding a little to it—I do not ask for a lot in life—and a birthing unit at King George’s.

--- Later in debate ---

[Jon Cruddas (Dagenham and Rainham) (Lab)]

I echo every point made by my right hon. Friend the Member for Barking (Margaret Hodge) in her powerful speech, which I think will resonate with the local community. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this debate and on the extensive speech that he made, as did the hon. Member for Ilford North (Mr Scott). There is total agreement across the aisle on issues of local concern about the provision of health care in north-east London and the sub-region. I will not repeat the points made, but I will emphasise a couple of them, especially about the pressure on Queen’s hospital if the King George closes. Those points are echoed in the report, and I will touch on them.

I welcome the Care Quality Commission’s investigation of Queen’s hospital. I recognise that it must have been a stressful and worrying time for many people involved, but it is definitely a process that we needed to go through. The report has 16 key recommendations for the future, and I, like my colleagues, will support the chief executive and her staff in trying to meet them. I have major concerns, however, about how the two reports will affect each other, specifically in relation to Queen’s hospital. Many of my constituents are extremely worried about the proposals to close the A and E and maternity services at King George hospital, especially when the only alternative for them is to go to Queen’s hospital.

Some figures have not been cited this morning, but they are worth rehearsing. According to page 26 of the independent reconfiguration panel report, planned activity for 2011 for Queen’s hospital is 885,511 people, while for King George hospital it is 284,459. The combined total of 1,169,970 people simply cannot be treated by Queen’s hospital alone. A 24% increase in patient numbers will result in havoc in a hospital that is struggling to cope with its current intake of patients. The estimated increases from 2010 to 2017 of 12.5% in the Barking and Dagenham primary care trust and of 5.7% in Havering PCT demonstrate that the acute sector in the sub-region has a serious structural problem, and closing the services at King George hospital will do nothing to help.

The question of the structural debt has been raised throughout the debate. The trust is clearly suffering from its escalating debts. From 2005-06 to 2009-10, the trust debts rose from £16 million to £117 million. Those levels will only increase and make any future improvements very difficult to sustain. That takes us back to the changes in the staffing of people who were keen to remove some of the structural debts to resolve some of the health problems that we have seen over the past few years, but who have since departed because they did not receive the support that they desperately needed to secure that.

I want to touch on the four general issues in the CQC report. First, capacity at Queen’s hospital is already too high for hospital staff to cope. The report states:

“An independent review of maternity services at the trust was undertaken at the beginning of 2011, which concluded that ‘Capacity at Queen’s is of major concern to the review team’. The recommendations from this review included the need to develop measures to ease the capacity at Queen’s, including ‘an impact assessment of the changes at KGH. It should also include an updated Escalation Plan, with clear indicators relating to capping numbers at Queen’s and temporary closure if required in the interests of patient safety’.”

Nevertheless, the Health Secretary is looking to increasing capacity further. Does the Department not understand what multiple panels are recommending to it?

Secondly, on demographic changes, which have also been mentioned, the IRP’s decision to transfer maternity services to Queen’s hospital seems peculiar, given that the CQC report states that

“King George Hospital is geographically located for the populations of Barking and Dagenham and Redbridge,”

an area with an expanding, multicultural and relatively young population and a high level of teenage pregnancies. Under the IRP’s recommendations, however, provision of maternity services would be predominantly from Queen’s hospital. Moreover, as has been mentioned, a third of the population of Havering is over the age of 65, which means a different health profile and different needs in the sub-region that cannot be catered for solely by Queen’s hospital. With people living longer and the population growing at an ever-increasing rate, the number of patients presenting at Queen’s hospital will increase year on year, and it is very unlikely that it will be able to manage these levels in five, 10 or even 15 years’ time.

Thirdly, on travel, it does not help the fears of local residents that, historically, transport links between the hospitals have been incredibly poor. My right hon. Friend the Member for Barking has mentioned the Thames View estate. It can easily take someone living on the other side of Ilford up to an hour and a half to get to Queen’s hospital, as opposed to 20 minutes or less to get to King George hospital.

[Mike Gapes]

I travel to Queen’s hospital by public transport. If people get the train from Ilford to Romford and come out of the station, they will see that two buses on one side of the road go in one direction to Queen’s hospital, and that two buses on the other side go in the other direction. I have been pressing for years for proper signage at Romford station, and, while various chief executives of the trust have said that they will do it, they still have not done so. The links for people who have to rely on public transport to get to Queen’s hospital are appalling.

[Jon Cruddas]

I agree. The point has been made in Havering, Barking and Dagenham, and Waltham Forest, as well as Redbridge.

The fourth point relates to evidence of no gains from the previous transfer of services in the sub-region. There has already been a long, ongoing transfer of services form King George hospital to Queen’s hospital, but the efficiency gains that were predicted have not occurred, as my hon. Friend has said. What are the guarantees that any future transfer of resources will lead to such efficiency gains? What is the correct move for both hospitals and the wider trust to see a rise in standards and for the faith of local residents to be restored in their local NHS trust? If that is to be achieved, King George hospital’s A and E and maternity services simply cannot close. It would go against all logic suggested by the CQC report and cause no end of damage to the confidence of residents in their local hospitals. I urge the Government to step in and implement the CQC report and hold back the IRP report, until we can re-evaluate after the CQC has been able to see whether its initial recommendations have been met.

My right hon. Friend the Member for Barking has talked about one case that was recently brought to her attention. All local MPs have a series of cases that are equally dramatic and heart-rending. A few hours after the two reports were published on 27 October, I received this e-mail:

“Just wanted to give an example of what could happen if the above A&E is closed.”

The correspondent is referring to King George hospital. They continue:

“Two weeks ago I had to take my eldest daughter to Queens as she thought she was having an early miscarriage. All the spaces in the Early Pregnancy Unit were full, (apparently they even called in the consultants), we had to wait in the A&E department for approximately 7 hours before she was seen by a doctor, she could not have a scan as there were 15 women in the unit which meant it was full, so she was sent away and told that there was no point in returning at 9am as they had a full unit to clear before they could see her. We tried to arrange a private scan but were unable to do so (not that we are awash with money but she was distraught). Homerton agreed to see her and scan her and we are returning there tomorrow, unfortunately we are almost certain that she has lost a much wanted baby.

How is Queens going to cope if King Georges is closed as they are not coping now?”

Overall, such reports confirm what all the local MPs have known for years about the standards of care throughout the sub-region. The pressures are growing. Extra capacity is needed and should not be cut.

Maternity Services

Mike Gapes Excerpts

Wednesday 22nd June 2011 Commons Chamber

[Mike Gapes (Ilford South) (Lab/Co-op)]

I congratulate my right hon. Friend and neighbour the Member for Barking (Margaret Hodge) on securing the debate. It is also a pleasure to follow my friend and neighbour the hon. Member for Ilford North (Mr Scott); we have campaigned together for five years to keep the services at King George hospital in my constituency.

Let me quote an e-mail that I received today:

“My wife had a baby in King George hospital and had a wonderful experience. My brother’s wife had a baby at Queens Hospital and found it traumatic and suffered complications up to 6 weeks after the birth.”

That is one of a series of e-mails and phone calls that I have been receiving for the past two years. Although some improvements have been seen at Queen’s, in the reception area and other aspects, the fundamental problems remains. My right hon. Friend the Member for Barking referred to a culture, and I believe that the issue is one of culture and of management, as well as of quality of care. It is an absolute disaster to contemplate closing the maternity unit at King George hospital, taking 2,000-plus births out of the equation each year, and as a result adding to the existing unbearable pressures on Queen’s hospital. It does not make sense. We have had a maternity hospital in Ilford since 1926, when the population was 85,000. The London borough of Redbridge now has a population of 280,000. We need to keep the maternity service—people have a right to be born in Ilford. I am pleased that we have such a united campaign, and I hope that the independent reconfiguration panel, the Secretary of State and the Minister are listening to the loud and clear message that we must keep the maternity service in Ilford.

Health Services (North-east London)

Mike Gapes Excerpts

Thursday 21st October 2010 Commons Chamber

[Mike Gapes (Ilford South) (Lab/Co-op)]

It is a great pleasure to begin the Adjournment debate so early in the day. I rushed back to get here in time, and I am delighted that my constituency neighbour, the hon. Member for Ilford North (Mr Scott) is here, because the future of the NHS in outer north-east London is vital to both of us as constituency MPs, and to residents not only of the London borough of Redbridge, but residents of Barking and Dagenham, who all use the facilities at King George hospital, Ilford, which is in my constituency.

Those who follow Hansard closely may have a feeling that this is a case of déjà vu yet again. I introduced a debate in Westminster Hall in December 2006 on the future of King George hospital and a debate in the Chamber in November 2009 on the same subject, and I am here again today. Why is that? We had a consultation process—the misnamed Fit for the Future proposals—launched in 2006, with supposed options that would have led to the scrapping of the accident and emergency department and all elective work at King George hospital. Then we had an independent review by Professor George Alberti that said that the proposals would be clinically unsound. The people behind the proposals, including Heather O’Meara, the then chief executive of the Redbridge primary care trust, were forced to go back to the drawing board, and we thought that we had seen those proposals off. But in 2008-09, they came back. In autumn 2009, we discovered that the new proposals would lead to the loss not—this time—of all the elective work, but of the accident and emergency department, all children’s surgery and all births at King George hospital.

The consultation on the original proposals was launched at a board meeting of the outer London primary care trusts held at Upton Park football ground—as a West Ham United season ticket holder, I feel very uncomfortable about this—in November 2009. Many glossy documents were published, and the whole exercise cost £800,000. One of those documents was called “Health for North-East London: Delivering high quality hospital health service for the people of north-east London”. It said that it was a consultation document launched in November 2009 until—or so we were originally told—15 March 2010. That was subsequently extended to 22 March.

The document gave people all kinds of boxes to tick and options for the future. However, in the summary, on page 39 it had a list of improvements or reductions in services, with only two red crosses, which meant a reduction in services. One was

“A & E, acute inpatient care for adults and children, complex planned surgery.”

There will be a reduction in services because it is proposed to get rid of the services at King George hospital in the London borough of Redbridge. The other was maternity and birthing services. It was proposed that women could have their antenatal care in Ilford and their postnatal care in Ilford, but they could not actually give birth there.

I had some doubts about the whole consultation exercise, including the questions being asked and the selection of the subjects, and I refer hon. Members to the debate that I introduced in November 2009 for the details.

We went through the consultation exercise—I still believe, as I said at the time, that it was as free and fair as a rigged Afghan election—and people sent back their responses. I worked closely with my right hon. Friend the Member for Barking (Margaret Hodge) and my friend, the hon. Member for Ilford North, on a cross-party basis, and we went to see the then Health Minister, Mike O’Brien. He was an excellent Minister and is a sad loss to this House. He agreed to come and visit King George hospital with us at the end of the consultation. He said that he understood the deep concern and recognised that tens of thousands of people had signed petitions against these proposals because they had serious concerns about the implications for the future. He agreed to refer the matter to the independent reconfiguration panel of the NHS. Over the next few weeks, the panel looked into the matter, but decided that it was not appropriate for it to intervene. The panel said that the consultation conclusions should be reported and that the process should continue.

Fair enough, but in July the results of the consultation were revealed to us at a meeting, again at the West Ham United football ground. There were a number of different documents, one of which was a great big analysis by Ipsos MORI of all the boxes that had been ticked, all the replies that had been received and all the different statements that had been sent in by clinicians, individuals, local authorities, LINks—local involvement networks—and various other organisations. In summary, despite the rigged nature of the consultation and the fact that those responsible did not take into account the petitions that I and others had organised—they simply said that petitions had been received, but did not add the figures into the equation—the proposals for maternity and accident and emergency were rejected by the public, by a two-to-one majority among all the respondents in all the boroughs concerned. Indeed, if we add the petitions, the figure is 90% against the proposals.

I went along to the meeting, I sat there, and I had my say, eventually. We were told that no decisions would be taken at that meeting, that people would go away over the summer and work up proposals, and that there would be further consultation with “stakeholders”—obviously we are not talking about vegetarians, but I do not quite know about the term “stakeholders”.

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a new Labour term.

[Mike Gapes]

It may be a new Labour term, but it is still being used by the current Government, so if the Minister can do something to stop that, I would be grateful.

There was a report back to “stakeholders” in September. I shall come to that in a moment, but let me first give a flavour of the responses that were received as a result of the whole exercise. For instance, the responses from the local authorities have been listed. The London borough of Redbridge sent in a clear response, which was a resolution adopted unanimously by the council that said:

“having taken account of the need to provide a wide range of health services in Redbridge which are able to meet the needs of our growing and diverse population, we express our strong opposition to the Health for North East London ONEL proposals to downgrade services at King George Hospital which would include (a) closure of the Accident and Emergency department (b) the ending of critical care support and acute surgical and medical treatment; (c) the ending of Children’s surgery and (d) the ending of maternity delivery in the Borough”.

That was the unanimous Redbridge position, supported by all parties and councillors among the 63 members of Redbridge council.

Barking and Dagenham council took a similar position, writing in its covering letter that it was “concerned about the proposals”. In particular, it was concerned that Queen’s hospital in Romford, which is the larger of the two hospitals in the Barking, Havering and Redbridge trust, would not be able to cope with the increased pressures, including the increased pressures on A and E, and maternity services. Interestingly, Waltham Forest council, which, in a previous incarnation in 2006, had come out in favour of the Fit for the Future proposals, said in 2010 that it would not comment on the A and E position. However, the council was critical that concerns about mental health had been neglected, saying that alternative services were needed. Waltham Forest council also said that Health for North East London needed to

“spell out what will be involved in reducing the number of A & Es from six to five especially in terms of impact on the remaining A & E departments”,

adding that the proposals were not clear. Newham council said that it was not convinced by the proposals either:

“We also note the significant changes to service provision at King George’s hospital. It will be necessary to closely monitor any resulting impact on our local Newham Hospital… Our expectation is that any increase in activity will be matched by appropriate resource levels.”

That was a conditional position. Tower Hamlets did not want to comment on the proposal either. Among the borough councils—these are representative bodies, the people who represent the community—there was either a clear opposition or at least indifference or ambivalence.

What about other organisations? I have already mentioned the Newham trust. It said something very important in its documents:

“experience with the Gateway Surgical centre supports the model of locating elective care in a separate building but on the same site as acute provision, allowing easier access for staff.”

The whole thrust of the proposals is to separate the two out, whereby the elective and the acute are in different places, yet this has been questioned even by one of the hospitals that could benefit by receiving the transferred patients.

The position adopted by other organisations is also significant. The Ipsos MORI documents make it clear that very strong views were expressed. The essence of my debate is captured by an important sentence, which states:

“The views opposing the reduction… from six to five hospitals providing accident and emergency, critical care and maternity services…came from organisations representing the public (elected local authorities and patient representative groups such as LINks)”.

It continues:

“It should also be noted that some opposition was also expressed from representative groups associated with NHS staff, notably some Local Medical Committees.”

Who, then, is in favour of these proposals? Not a lot of people, it seems. Within the local community in Redbridge, it is very hard to find anybody in favour of the proposals. Perhaps some people in other boroughs might be found, but it is certainly true that in Redbridge it is very hard to find anybody of any authority or any representative political role who is prepared to speak out.

[Mr Lee Scott (Ilford North) (Con)]

Does my constituency neighbour agree that of the people who seem to be in favour of this proposal, none have actually lived in the area? Indeed, if I am not mistaken, some of the doctors involved in it were from Newham.

[Mike Gapes]

The clinical director behind these proposals is Dr Mike Gill, who is based at the Newham General hospital, and the general practitioners involved come from Waltham Forest. I think we can safely draw the conclusion that they have other interests in these matters.

On the proposals to end maternity services, I remind the House that we have had a maternity hospital in Ilford since 1926 and there are presently about 3,000 births a year at King George hospital. The Ipsos MORI summary of the conclusions states:

“On maternity services specifically, there were detailed submissions that made specific comments”,

some of which are cited. It notes that the Royal College of Obstetricians and Gynaecologists—a not insignificant organisation—had

“changed its view of maternity service provision”

and cites the royal college as saying:

“The trend towards a rising birth rate in this area over the next decade cannot be ignored, which will have a direct bearing on the capacity of a large unit at Queen’s Hospital.”

It made the following recommendation:

“Both units (King George V Hospital and Queen’s Hospital Romford) should be developed and sustained as fully-fledged maternity units.”

Those, it said, should be accompanied by “midwife-led units”. That was directly contrary to the position taken by Heather O’Meara and the outer north-east London organisation.

The document quoted the Royal College of Midwives as saying that the proposal for King George V Hospital and Queen’s raised concerns about

“the ability to deliver the configuration of services in such a way as to not result in a high volume of births at Queen’s Hospital.”

It also said that there were

“challenges in relation to…capital investment and workforce planning…in achieving the recommendations.”

The team of midwives from Barking, Havering and Redbridge University Hospitals NHS Trust, who work at the two hospitals, said:

“Geographically, there will be no obstetric unit in Redbridge to serve the women of this area. Residents of Barking will need to travel further for obstetric led care… Although women will have greater choice for low risk birth there will only be one option for hospital birth in three boroughs.”

I could produce more quotations. There are so many in the document. But what has been the outcome? A meeting was organised on 30 September, of which neither the hon. Member for Ilford North nor I was given notice. I only received the information about it because one of my local councillors managed to get hold of the slide presentation. It was advertised as a “stakeholder discussion event”, and was held not at West Ham football ground but at the Holiday Inn, Newbury Park, in the constituency of my constituency neighbour, the hon. Member for Ilford North.

The “stakeholder discussion event” document is very interesting. Anyone reading it might assume that the recommendation was done and dusted. It contain presentations by Heather O’Meara, who is now the chief executive of all the outer north-east London primary care trusts; by Helen Brown, who works for NHS London; and by leading figures in the process. They spoke of “proposals”.

There has been a consultation, which has revealed serious concern among professional organisations in the area, and strong opposition from the local authorities. It might be assumed by anyone believing that consultation and public involvement really matter that something would have changed. On Friday morning, my neighbour and I had a meeting with Heather O’Meara, who described the outcome of the consultation as “some caveats”. She also said that the stakeholder discussion event had been based on clinical working groups where the ideas had been tested, and that there had been consultation with GPs and a huge number of public events. I had not noticed those huge events. Perhaps they happened in big places.

[Mr Scott]

Is it not fascinating that neither of the two local Members of Parliament most closely affected by the proposals was informed about the events and consultation that were allegedly happening, or was invited to take part? Is that not slightly strange? It might give us a complex: we might imagine that they did not want us there.

[Mike Gapes]

Why on earth could that be? I do not know.

On Friday morning, we discovered that the stakeholder discussion document and other proposals would be put before a meeting on 15 December of the joint committee of primary care trusts for outer north-east London. We asked questions. We asked what the process is before then. We asked whether there will be a role for the health overview and scrutiny committees of the local councils—we were told that there would not be. We asked what would happen to the role of the London region NHS and we were told that the meeting on 15 December will make the decision. So we asked who is to be consulted about these proposals before that meeting. That is when the statements that have been made and the positions of the Minister were quoted to us; what we were told is in line with the guidance from the Government since the election.

The Minister wrote to me on 12 October about a complaint I had received from a constituent. He stated:

“In May, the Secretary of State for Health announced a review of all service change proposals. He has outlined new, strengthened criteria that he expects decisions on NHS service changes to meet…proposals must have support from GP commissioners; arrangements for public and patient engagement, including local authorities, must be further strengthened; there must be greater clarity about the clinical evidence base underpinning proposals; and proposals must take into account the need to develop and support patient choice.”

Let us leave aside the last two of those. We have been given a clear view from our local authorities about the original proposals and we have been given a clear view of the public attitude to those proposals. What we have now been given is a slight tweaking of the consultation document. Three or four minor modifications have been made to the proposals and, as a result, those involved now intend to go ahead with the essence of the original proposals.

To confirm what I am saying, I wish to quote from a document produced by Helen Brown as part of the stakeholder consultation. On page 48 of the stakeholder presentation, under the title “Activity and capacity”, is a table describing the

“Proposed shift of activity to hospital sites”.

The figure for the row headed “Non-elective”, which relates to people admitted to the accident and emergency department for King George hospital, is minus 25,937 or minus 100%. That hospital’s figure for “A&E” is minus 59,565, or 100%, and its figure for births is minus 2,910, or minus 100%. Its elective activity is increasing, with some 18,000 being transferred from the Queen’s hospital, so that is a partial shift. Originally this was to be limited, but now some facilities are being moved in. However, the essence of the proposals—to get rid of the A and E department, the children’s surgery and births at the King George hospital site—remains.

So what does this mean? It means that the consultation that has been engaged in at great cost—the public stakeholder engagement—is a sham, a charade and a waste of money. The people behind the proposals, who tried and failed in 2006, and who tried in 2009 only to have this dragged out for longer, are now absolutely determined. This is a juggernaut being driven by unelected people in the NHS bureaucracy. They are disregarding the views of the local community and disregarding the Members of Parliament and the local councillors, and they are not going to be stopped because as far as they are concerned they are right.

My neighbour, the hon. Member for Ilford North, will doubtless wish to comment on the fact that on Friday morning we got into the essence of the issue, when we heard the argument that clinicians know best. In which case, what is the point of pretending that a public consultation is being carried out? What happens if the consultation comes up with a conclusion that these people do not like? I recall the old quote of Bertolt Brecht, “The electorate has made the wrong decision, so change the electorate.” Joseph Stalin’s 1936 constitution was adopted and the result was announced the day before the referendum was held in the Soviet Union. Are we moving that way with certain people in the professions believing that they know best, disregarding the wishes of the community?

King George hospital is not perfect. We have a lot of problems, but we also have a lot of problems with the other hospital in the trust, Queen’s hospital. The two together have a big ongoing deficit that they have had for five years and, despite promises to get rid of it, they have not done so. There is a real difficulty and I believe that an element of this is financially driven. As I pointed out in 2009, getting rid of the A and E at Newham general hospital would save £28 million a year, whereas getting rid of the A and E at King George hospital—according to the figures provided by those behind the proposals, not mine—would save only £19 million. Nevertheless, the decision has been made to go ahead with getting rid of the A and E at King George.

We are facing a very important time. We need a decision that is in the interests of the people, not in the interests of the people who run the bureaucracy of the national health service. There are strong arguments, but I want to finish with a quotation of the Prime Minister. In answer to a question yesterday from my hon. Friend the Member for Ealing, Southall (Mr Sharma), the Prime Minister said:

“The whole point of the reform of the NHS is to put power in the hands of patients and doctors, so decisions about hospitals will be made on the basis of what local people want”.—[Official Report, 20 October 2010; Vol. 516, c. 947.]

Interestingly, last Friday morning we asked, “How will the doctors be consulted?” We were told, “We will take soundings,” so we asked, “How do you take soundings? Is there a ballot? Do the GPs vote on whether they agree to the proposals?” We were told, “No, we will take soundings of health practices.” So we asked, “What is a health practice?” My GP is part of a health centre and there are eight or nine GPs. We were told that each practice would have one vote. So a single-handed GP could be equivalent to eight or 10 GPs in a group practice or health centre. That is a very strange way to find something out. It is perhaps like the Hong Kong Legislative Council or the estates in pre-revolutionary France, but if we are talking—as the Prime Minister said—about decisions made on the basis of what local people want, we need to be clearer about who is making those decisions.

I fear that at the meeting on 15 December these proposals will be pushed through regardless, and the running down of the accident and emergency—which is already beginning, with salami-slicing—and of the maternity services will start, so that in future no one will be born in Ilford except in the back of a car or taxi rushing them to the Queen’s hospital in Romford. People who need to go to the local hospital will not have that hospital facility, because they will have to go several miles away.

These matters are so important to my community and my constituents that I hope that I will not have to come back to this House for a fourth time with a debate on the future of my hospital—but if necessary I will do so. I hope that when the Minister responds he will reassure me that this process will not be allowed to be driven in the interests of people who are disregarding the wishes of the local community and their elected representatives.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this debate. I know from previous debates he has secured on this subject how strongly he feels about it—and rightly so—as a constituency Member of Parliament. I also congratulate my hon. Friend the Member for Ilford North (Mr Scott) on his contribution. He has worked for a long time with the hon. Member for Ilford South in representing the interests of their constituents. I know that the quality of service provided by the local NHS is very important to both hon. Members and their constituents, and I assure them that I share their commitment to achieving the best possible health care for the people of north-east London. I also praise the hard work and dedication shown by NHS staff in north-east London. Their jobs are not always easy, but they always strive to provide the best possible care for patients.

Today, the NHS has some of the best people and facilities in the world, but when it comes to what is really important—outcomes for patients—we lag behind many other countries. The Government’s ambition is clear: for health outcomes in this country to be among the best in the world. Just over three months ago, we published the White Paper “Liberating the NHS”, showing how we will achieve the real gains. We will liberate clinicians from top-down targets and endless micro-management by politicians and civil servants. It is an ambitious plan for reform focused on three key aims: the first is to put patients first. Patients should feel that no decision is made about them without them. Secondly, we want to focus on outcomes, not inputs or processes, and to build a culture of evidence and evaluation, to ensure that health care uses innovation and evidence to provide quality care and is accountable for improving outcomes. Thirdly, to deliver the best care, we must empower NHS staff, whose responsibility it is to give that care. Decision making must take place close to patients, so that clinical decision making can be better combined with the use of resources. GPs already influence the commissioning of decisions by the way in which they manage and refer patients, and by deciding which medicines to prescribe and which treatments. They decide what is best for their patients based on the options available and on their clinical judgment of what would be best for them.

We are asking GPs to take the next natural step by giving the responsibility for designing, commissioning and paying for local services to groups of GP practices. This will ensure that decisions are clinically led, involving all other health care professionals, hospital consultants, nurses and social care workers in order to design services that put patients first and are focused on improving clinical outcomes.

GP commissioning also opens up the potential for working closely with local authorities to commission services jointly—even for the pooling of budgets to tackle local priorities jointly. For example, by working closely with local authority and social care providers, far more can be done to help older people or those with a disability to live independently, reducing their reliance on the NHS by avoiding things such as hospital admissions.

My right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith) recently opened the Macmillan information and support centre at Whipps Cross hospital in north-east London. The centre is available free to anyone affected by cancer and offers confidential advice and support. Such partnerships between the NHS and the third sector take exactly the kind of innovative and exciting approach to health care that we are actively encouraging.

Before addressing the specific concerns of the hon. Gentleman and my hon. Friend, I should set out the wider context of local health care reform. Thanks to the NHS, most of us will enjoy better health and longer lives than our parents and our grandparents. That is a tremendous achievement, as I am sure both hon. Members recognise, but, as the NHS effects great change on the health of this country, so the changing nature of the population must transform the NHS.

An ageing population is just one of the many challenges to which the NHS must adapt over time. Every day, new medicines and treatments are developed to meet our changing lifestyles and expectations. We know that change can sometimes be unsettling, but we also understand that the NHS needs to evolve—to move with the times. All we ask is for the NHS to make collective, informed and local decisions that improve outcomes for patients.

On 15 December a joint committee of primary care trusts will make some important decisions about the future of King George hospital and about health services in north-east London more generally. I am confident that those decisions will be made by those best qualified to make them, based on a solid foundation of clinical evidence and local engagement.

[Mike Gapes]

rose—

[Mr Burns]

I thought that the hon. Gentleman might want to intervene at this point.

[Mike Gapes]

How are the views of elected local authorities, of elected Members of Parliament and of the community, as expressed even in that dubious consultation exercise, to be taken fully into consideration against an NHS management bureaucracy who seem determined to carry on regardless? Is 15 December the date of the final decision? Is there no other way in which we the public can have our say?

[Mr Burns]

I am grateful to the hon. Gentleman for that intervention, because I fully understand how strongly he feels about the issue—what he recognises, from his constituents’ point of view, as a potential problem—and how important it is to get the matter right. I shall not duck the question, but will the hon. Gentleman bear with me a little so that I can put it in context? I shall then respond to his intervention and answer his specific question about whether 15 December is the end of the road, or whether any other avenues might be open to him and to my hon. Friend the Member for Ilford North.

If the hon. Gentleman will allow me, I will describe how we reached this point. Back in February 2009, as he mentioned, the NHS in north-east London began to think about how it could better use its resources to provide safe, modern health care. The NHS in north-east London as a whole faces considerable challenges. Health outcomes and key health indicators are poor: people in the area have lower than average life expectancy and higher rates of infant death. The NHS recognised that it needed to improve services to meet those challenges head-on. For example, it found that long-term conditions could be managed better: instead of being admitted unnecessarily to hospital, patients could be treated in the community, closer to their homes.

One of the solutions suggested was to turn two of the existing hospital sites—the Royal London and Queen’s—into major acute hospitals and for them to become centres of excellence. Doctors can achieve that level of quality only if they see high numbers of complex cases, and patients can receive the best care only when surrounded by expert clinicians. To reach that critical mass of doctors and patients, specialist services would be consolidated into the two major acute hospitals, not spread thinly across each hospital in the region. The Royal London and Queen’s would be supported by three local hospitals, all with accident and emergency departments. The final site—King George hospital, which has been the main focus of this debate—would also play a vital role, taking a lead in providing primary, community and urgent care.

King George hospital would receive enhanced children’s services. An urgent care centre at the hospital would operate around the clock, the task being to manage as many patients as possible outside A and E services. Access and continuity of care for minor injuries and illnesses would be significantly improved. I know that there has been concern about rumours that the local NHS is planning to close King George hospital. I can categorically reassure the hon. Gentleman and my hon. Friend that that rumour is not true. Among the substantial number of services proposed to stay or to be moved to King George hospital was a recommendation that the hospital become a centre of excellence for planned surgery.

Barking, Havering and Redbridge University Hospitals NHS Trust has proposed the transfer of all breast surgery from Queen’s to King George. That will mean that some women who currently have treatment at King George but then have to be transferred to Queen’s for surgery will have the whole procedure carried out under one roof, which I am sure the hon. Gentleman and my hon. Friend will agree is an infinitely preferable and superior sequence of treatment to the present one. Those women will not have to go through the trauma and inconvenience of having to be moved to another hospital site for their surgery. In addition, local clinicians have identified a further 20,000 procedures a year that they believe would benefit from being provided solely at King George hospital.

Of the proposals made in north-east London, I know the hon. Member for Ilford South is most concerned about the potential loss of maternity and A and E services from King George hospital. I hope to be able to reassure him that, whatever the outcome of the meeting in December, nationally this Government remain committed to maternity and A and E services. When somebody walks through the doors of an A and E department, an urgent care centre or a walk-in centre, what sorts of service should they expect? To which facility should they go in the first place for the most appropriate care for the condition from which they are suffering? Part of the anger that we often see when the local NHS suggests replacing A and E with other, more appropriate services is due to a certain degree of confusion about what those services provide. The Government are committed to clarifying that, and work is already under way to standardise which services can be expected in various facilities. As well as improving A and E services, we want to improve urgent care radically. We are committed to providing universal access to high-quality urgent care 24 hours a day, 365 days a year. Whatever the need, place or time, patients should be able to find the care they need. That is what part of our reforms in A and E will achieve.

The Government are also determined to drive forward improvements in maternity and newborn services so that women and their partners have access to local services and so that children have the best start in life. The safety of mother and baby is paramount. It is fundamental to safe, high-quality maternity care that a full range of services must be available to all women, whatever their medical and social circumstances. Services must be as near to home as possible, depending on the complexity of needs, with facilities and expertise available to provide optimum care.

[Mike Gapes]

I know that the Government are committed to improving the quality of care, as the previous Government were, but I have a large number of young families in my constituency and they will be forced to go several miles for the births of their children at Queen’s hospital rather than going to a hospital in the community where they live, as people in Ilford have done for 80-odd years. Is there a national policy that births can be allowed only at sites with a coterminous accident and emergency department, or could the proposals be reconsidered? One of the arguments in the relevant documents is that maternity services have to be moved because the A and E is being moved. Is that national policy?

[Mr Burns]

It is not national policy that if there is an A and E department there automatically has to be a maternity facility by its side. If one strips out the whole area of safety and quality of care, which is vital, one realises that the guiding rule is that maternity services are provided where they are relevant to the local community’s needs. It is about having the best siting relevant to the community’s needs. Clearly, however, there cannot, for a variety of reasons, be a maternity ward in every hospital in the country. Where they are sited will be determined by need and by the wishes of local communities. Once the reforms are in place, it will also be up to commissioners to decide where to site maternity units.

[Mike Gapes]

The Minister has heard me quote the Royal College of Obstetricians and Gynaecologists, which takes the strong view that there should be maternity facilities and births at both the Queen’s and King George hospitals. I feel very strongly about this. There is clearly a difference of opinion between the people in NHS London, who are driving the change, and the people who deal with obstetrics and gynaecology—the experts—about what is necessary. Leaving aside the democratic arguments, the views of the people in the specialist royal college have not been taken into account.

[Mr Burns]

As with any proposals for reconfiguration anywhere, a range of views will be fed in, including those of the relevant royal colleges, GPs, clinicians, members of the public and other interested parties, and will be considered as part of the consultation process before a decision is made. I am going to come to the whole issue of consultations, on which the hon. Gentleman rightly has strong views, because I want to clarify the situation and, as I said earlier, I want to give him some answers about the options that might be open to him after 15 December.

In pursuit of true local backing for the proposals in the hon. Gentleman’s area, the local NHS has already started a debate about them. To date, it has talked through the issues with GPs, councillors, medical committees, national bodies and local patient representatives. I was going to say that perhaps he will recognise this from his own experience, as I am assured that the NHS has made every effort to keep him informed and to listen to his concerns. However, having listened to what he and my hon. Friend the Member for Ilford North said, it would seem that that is partly the case and there may have been certain slip-ups: for example, posting a letter the day after a meeting was held. I cannot confirm or deny that because I am not party to the information, but my hon. Friend has put it on the record, and if it did indeed happen that is somewhat unfortunate.

The hon. Member for Ilford South submitted a petition on behalf of his constituents, and the local NHS has confirmed that that will be taken into account. However, it asks different questions from those in the official consultation, which slightly skews the point that he made about it. I understand that one of the questions was: “Do you support the closing of King George hospital?” I suspect that in the case of the vast majority of people signing it, the answer would be no, they do not support it. The trouble is that there is not, never has been and will not be a proposal to close the hospital. I hope that he therefore understands that the question is not relevant to the consultation on the reconfiguration of services.

[Mike Gapes]

I do not know what advice the Minister has had from his officials. I do not want to get into a long textual discussion, but he should get the full wording of the petition that I submitted. I have to admit that there were several petitions from different organisations and individuals, but mine referred specifically to A and E, maternity and children’s services. It may have been headed “Save King George hospital”, “I support Mike Gapes’s campaign”, or whatever, but the wording specifically referred to those issues.

[Mr Burns]

I agree that we do not need to get into to-ing and fro-ing about what exactly was written. My point was that some of the questions—I am not saying all of them—on some of the petitions were not directly relevant to what was being consulted on. Having said that, it has been recognised that they will be considered as part of the consultation process.

[Mr Burns]

I have no doubt that they will, as part of the ongoing consultation and evaluation of responses to the consultation process.

Before 15 December, the London strategic health authority will assess north-east London’s readiness against the four tests that my right hon. Friend the Secretary of State introduced in May this year to ensure more local engagement in the proposed reconfigurations of services throughout the country. In certain previous consultations, there was a long-held view that although lip service was paid to local people and medical practitioners—clinicians and GPs—the views of the local community did not matter because, in effect, a decision had been taken at the launch and things would end up in exactly the same state at the end of the process.

To give greater credence and importance to local views, my right hon. Friend the Secretary of State announced his changes to the criteria that had to be conformed with for reconfigurations to take place, to empower people to take part in the discussions and to ensure that their views would be fully considered before decisions were taken. To achieve that, he has said that reconfigurations and consultation processes that are already in progress will have to be checked against the revised and strengthened criteria to ensure that they have been carried out under the new format. I can assure the hon. Member for Ilford South that that will happen prior to the meeting on 15 December.

[Mike Gapes]

Will the Minister clarify who will do that? Will it be the person in the London NHS who is behind the proposals, or will it be somebody independent of the proposals?

[Mr Burns]

It will be done by the national health service in London. People could be tempted to shout “Foul” if they do not agree with the decision, but that does not mean to say that it necessarily is a foul. In the case of a straightforward matter such as checking whether the consultation process has taken place under the new guidelines, we have to accept the professionalism of the people carrying out the job, and trust that they will do it properly. If it emerged that the guidelines had not been abided by in any way—I hasten to add that I make this point illustratively, and I am not saying that it will—the hon. Gentleman would be extremely happy. If it were found that they had been abided by, he would need to have an open mind, and not automatically say that things had not been done properly.

While the discussion in north-east London continues, the clinical working groups have already made changes to their previous recommendations. If the hon. Gentleman will allow me, I will give him some examples. From talking to parents it was obvious that many were anxious about the prospect of travelling long distances to get treatment for their children. Clinicians needed to find a way to reduce the chance of that happening, and now it is proposed that only children needing specialist or high-dependency care will be transported to specialist centres. That means that more children will be treated locally than was originally anticipated, but they will still have access to specialist care when they need it.

Women told the NHS that they wanted more midwife-led care. As a direct result, a study has been commissioned, working with local mothers and mothers-to-be, to find out what choice really means to them. Clinicians are working up plans for midwifery-led units across the region as we speak.

Some residents expressed concern about having no A and E at King George hospital. Doctors are still convinced that clinically, any small increases in travel time will be more than compensated for by having better, safer, faster care, but they have recommended changes to the original proposals for urgent care at the hospital. Now, as well as the 24/7 urgent care centre originally proposed, a 24/7 short stay assessment unit is being recommended. It would be staffed by a team of skilled clinicians with expertise in assessment and treatment as well as in emergency medicine. The service would offer facilities for longer periods of observation, assessment and treatment, including access to a range of tests not currently available in primary care and specialist advice from hospital clinicians. Staff would work closely with community health and social care services, including mental health services, so that as many patients as possible could be cared for in the community without recourse to a hospital admission.

The NHS in north-east London is also working closely with Transport for London to ensure a good bus service between Queen’s hospital and King George hospital. I am sure that the hon. Gentleman agrees that that is vital to help many of his constituents who may need to use such a service.

I believe that discussions with the local community have already made a positive impact. The local NHS is now truly listening to GPs and consequently changing its plans. That reflects the improvements that my right hon. Friend the Secretary of State introduced to engage local communities with reconfigurations.

[Mike Gapes]

Will the Minister address my point about consulting GPs? How will their views be taken into consideration?

[Mr Burns]

I am grateful to the hon. Gentleman for reminding me of that. My understanding is that the “health for north east London” programme team is prioritising engagement with GP practices whose patients would be most affected by the reconfiguration proposals, and GPs who are currently likely to be leaders in the commissioning consortiums that will flow from the NHS reforms.

[Mike Gapes]

rose—

[Mr Burns]

I will give way for the last time.

[Mike Gapes]

We are considering an important point. The letter from the Minister, the May proposals and the Prime Minister’s remarks yesterday place great emphasis on GPs’ views and wishes. Yet what we were told on Friday has made me very worried. Which GPs are we talking about—the lead person in a commissioning consortium, single-handed practitioners joining together and outvoting a group of GPs in a health centre, or what? There is no provision for a ballot. What is the process? People can get whatever result they want if they skew the process. My fear is that the process will be discredited unless it is seen to have democratic legitimacy. I suspect that we will have a big problem, because the views of certain GPs will be taken into account and those of others will not.

[Mr Burns]

I will confirm what I said before the hon. Gentleman’s intervention. The consultation will prioritise engagement with GP practices whose patients would be most affected by the reconfiguration. If the hon. Gentleman is saying that there should be a ballot of GPs, I do not agree. There should be engagement, discussion and GPs contributing to any reconfiguration proposals by meeting people who undertake the consultation process to make known their views and their preferences—the pros and cons that they envisage—but I do not think that a ballot is either feasible or necessary. To take his idea to its logical conclusion, why restrict a ballot to GPs? Why not have a ballot of social workers or community nurses? That sort of engagement is unnecessary when there are other perfectly satisfactory forms of engaging.

If the hon. Gentleman supported what was happening, he would be happy with the procedures.

[Mike Gapes]

No.

[Mr Burns]

I think that he would. Let me point out gently and tactfully that my right hon. Friend the Secretary of State expressly introduced criteria for the engagement of GPs, clinicians and other interested parties because of their concern that they did not have enough ownership of consultation processes. I have to say that until 6 May, for 13 years, we were not the Government—and that it was we who looked at the position afresh and recognised the concerns throughout the country about reconfigurations. By introducing his criteria, my right hon. Friend the Secretary of State responded to the concerns of local communities that their views were not being properly considered. This Government, in a very short time—within two and a half weeks, I think—took decisive action to give greater power and ownership to those groups to contribute to consultation processes.

On local scrutiny, which featured significantly in the hon. Gentleman’s speech, I fully recognise that there are considerable public concerns about the proposals for north-east London. In the light of those, the Redbridge overview and scrutiny committee referred the case to the previous Health Secretary, the right hon. Member for Leigh (Andy Burnham), in January 2010. He asked the independent reconfiguration panel for advice. In its response, the panel concluded that a full review was unnecessary. In July 2010 my right hon. Friend the current Health Secretary accepted the panel’s recommendation that due process by way of public consultation and formal engagement should be allowed to continue—a process that has not yet come to an end, as the hon. Gentleman knows.

However, as I said, we are determined that local voices will be properly heard, and we expect any concerns to be taken extremely seriously. I shall lay out again for the hon. Gentleman the critical tests that have been applied in the consultation process in the past two or three months, and that will be applied until the consultation’s conclusion. First, the proposals should have the support of GP commissioners; secondly, arrangements for public-patient engagement, including local authorities, should be further strengthened; thirdly, there should be greater clarity about clinical evidence underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.

Given the complexity and scale of the challenge in London, the Secretary of State, as the hon. Gentleman knows, called a halt to existing clinical strategies and asked the NHS to look at its plans afresh. That means that north-east London now has an opportunity—it has had one for some time—to have a frank and open discussion with GPs, clinicians, councils and patients on how their health services can change for the better. I believe that if that process is managed well, any changes made will lead to better health care for people across north-east London, including the hon. Gentleman’s constituents.

As was said in the debate, the question of whether those four criteria are fully met will be considered prior to the meeting on 15 December. Providing it is seen that those criteria have been met, the meeting will go ahead, and a decision will be taken. What happens if the decision is not popular with a number of people? I suspect, from what the hon. Gentleman said, that it will not be. Unless I misheard him, he said that the overview and scrutiny committee would have no opportunity to look at the proposal, reach a decision on it and write to the Health Secretary if necessary. I am not quite sure why he said that.

[Mike Gapes]

My understanding of what we were told at the meeting on Friday is that the decision on 15 December will be the final decision, subject only to the Secretary of State, and that there was no intermediate process. If that is inaccurate, I would be delighted, but that was my impression from what we were told on Friday. The hon. Member for Ilford North (Mr Scott) will confirm that.

[Mr Burns]

I am interested to hear what the hon. Gentleman was told on Friday, and I hope that I will be able to delight him. My understanding is that after the meeting on 15 December, the OSC can look at the decision that has been made. If it is not convinced that it is the right decision, it can contact the Secretary of State. That is a step forward from what the hon. Gentleman was told at his meeting on Friday. We cannot anticipate the decision to be taken on 15 December, because that would be irresponsible, but I have confirmed that he will have some further opportunity—if warranted by the OSC’s decision, because we cannot prejudge that either—to have the decision revisited.

As I have said, we must not prejudge the outcome of the meeting of the joint PCTs on 15 December, when local NHS leaders will gather to make a decision that will dictate the future of health services in north-east London. I believe—even if I do not altogether carry the hon. Gentleman with me—that that decision will, rightly, be made locally. I understand that these issues arouse strong feelings: they involve difficult decisions about how resources should be used to achieve the best care for patients, which must always be the priority for, and guiding force behind, any reconfiguration or provision of health care.

Similarly, the NHS must continue to develop its plans for the future, and it must do so by giving local people and GPs a far greater say. Obviously, we will have to wait to hear the judgment on how the consultation has been carried out in relation to the four criteria laid down by the Secretary of State, but we need to create an NHS run by empowered professionals free of the shackles of central Government. The NHS has received massive investment, but it is drowning in bureaucracy. We will cut the red tape and sweep it away, letting NHS professionals organise themselves locally. It is a measure of the importance that we afford the NHS and the future health of this nation that its budget will be protected, as was confirmed in the announcement of the comprehensive spending review by my right hon. Friend the Chancellor yesterday.

The hon. Gentleman must await the decision on 15 December. I am convinced that what will be done throughout the health service, especially in the case of difficult reconfigurations, will have as its guiding priority the desire to get the highest-quality health care for all our constituents.

Question put and agreed to.

Oral Answers to Questions

Mike Gapes Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Lansley]

In 2005 the previous Government charged NICE with producing public health guidance as part of its work. As I establish a more integrated and effective public health service, I shall consider how the advice of NICE fits into that strategic framework.

[Mike Gapes (Ilford South) (Lab/Co-op)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improving health outcomes in England; to lead a public health service that improves the nation’s health and reduces health inequalities; and to lead the reform of adult social care that supports and protects vulnerable people.

[Mike Gapes]

When the new Secretary of State intervened to stop the reorganisation of health services in London, he said that there would be no forced closures. Can he give me an unambiguous and categorical assurance that he will not allow the closure of the accident and emergency department, the children’s surgery or the maternity services at King George hospital in Ilford? Yes or no?

[Mr Lansley]

The hon. Gentleman’s question seems rather churlish, given that he wanted to stop the top-down configuration that NHS London imposed so that people in his area—GPs, the local authority, local people and patients—could have an opportunity themselves to decide how services might best be designed for local people. That is the pledge that I have made. Those criteria will enable that process to be led locally, rather than imposed and forced on people.