NHS: North-West London

Rupa Huq Excerpts

Wednesday 24th April 2019 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Good news for a change from this Government, who have admitted that the crackpot “Shaping a healthier future” plan to cut the nine major hospitals in north-west London to five is not workable and has been killed off. It was always a David and Goliath battle.

I pay tribute to, on the one side, Ealing Save our NHS, which works shoulder to shoulder with Save our Hospitals Charing Cross and our two Labour councils, as my hon. Friend the Member for Hammersmith (Andy Slaughter) mentioned. They are people like Ollie, Eve, Arthur and Judy Breens, Aysha, Raj and Gill, who held protests and popped up at every carnival. They organised parties, lobbies and petitions, and distributed a quarter of a million leaflets, all of which were paid for out of rattling buckets and their own pockets.

On the other side, we had “Shaping a healthier future”, with its swanky offices in upmarket Marylebone. Tens of millions of pounds of NHS cash from the public purse was spent on private management consultants, who all mysteriously alleged that if they junked departments, A&Es and hundreds of beds, health outcomes would somehow improve. In the end, the figures did not work. Quelle surprise! They never worked.

As early as 2012, John Lister pointed out in his report that the whole thing was a pile of nonsense, as did reports from the two councils, which involved the forensic skills of Sir Michael Mansfield, QC. Even then, seven years into a five-year-long failing plan, local health bosses were still carrying on as if the emperor were fully clothed. There was a heavy-handed threat of legal action against me, because my 2017 general election leaflets pointed out that it did not work. That arrived days after my mother passed away at Ealing Hospital—I know every bit of the hospital, right down to the morgue.

Where next? These disastrous Frankenstein plans have seen the two A&Es nearest to Acton Central—Middlesex and Hammersmith—completely shut their doors. I congratulate the Minister on her appointment, and my question to her is: can we have them back, as well as the stroke unit, paediatrics, maternity services and A&E admissions for children at Ealing? All these things mean that the figures for type 1 A&E urgent visits are going through the roof. No more babies are to be born at Ealing. As a mum, I recently had to schlep out of the borough for a paediatric appointment at the West Middlesex Hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury).

As my hon. Friend the Member for Hammersmith said, we need a serious exercise in lessons learned from this whole sorry episode, rather than clinging on to defend the indefensible and denying that there are serious problems. Ealing Hospital remains perilously underfunded and in crisis. Staff morale has been sapped, as was pointed out, by all the uncertainty. We could go on and on about the Brexit effects—the EU nurses exiting in droves and the social care sector being hollowed out by this Government, who are obsessed with their £30,000 skills target.

The slaying of the beast that was “Shaping a healthier future,” which was always known locally as “Shafting a healthier future,” is not before time and has raised eyebrows, such is the cynicism of politics in our time. As we did at the Drayton Court Hotel in my constituency last week, let us eat, drink and be merry, because tomorrow there might be another election.

Early Parenthood: Supporting Fathers

Rupa Huq Excerpts

Wednesday 30th January 2019 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

I beg to move,

That this House has considered supporting fathers in early parenthood.

As always, Mr Davies, it is a pleasure to serve under your chairmanship. I hope you will forgive me if I make any minor procedural errors; it has been a while since I have been on the Back Benches of the Westminster Hall Chamber, rather than closer to the wise counsel of the Chair.

I begin with two quick disclaimers. First, although my debate is about supporting fathers in early parenthood, I am extremely conscious that there is still much to do to combat inequality during maternity. I am an avid follower of Maternity Action and support many of its campaigns, some of which I know are making good progress. Secondly, this debate is not meant as a dismissal of the wonderful mums out there who are single or in same-sex couples. It is not about mums versus dads, nor am I pontificating only about married parents—not least because that would make me a hypocrite. I simply want to speak up for the many brilliant dads out there who, in an evolving society, are doing an incredible job of bringing up children. I want to highlight some of the real challenges that they too face.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am grateful to the hon. Lady for giving way so early in her speech. She is making a fantastic return to Westminster Hall from the dizzying heights; she is a principled person and we on the Opposition Benches all love her.

The hon. Lady mentions challenges. Is she aware of Dads House, which does all sorts of things to represent single dads? There are 400,000 single-parent families headed up by dads, which is 13.7% of all single-parent families. Dads House has its own food bank and does buddying, breakfast clubs and football—a sport that is close to the hon. Lady’s heart. Would she be interested in meeting members of the group? In fact, everyone in this House has a good opportunity to meet them, because after Prime Minister’s questions on 20 March they are coming to Speaker’s House for a reception with the all-party parliamentary group on single parent families—and all hon. Members are invited. The group does great work.

[Tracey Crouch]

I would love to come. Single parents play an incredibly important role, but for various reasons they are often maligned. Meeting single dads who are doing their very best, in whatever circumstances they find themselves bringing up their children, is an incredibly important part of that conversation. I would be delighted to come to the event on 20 March.

I want to address three points: perinatal support, loneliness in new dads, and shared parental leave. The first comes wholly under the Department of Health and Social Care; the second does partially; the third might not, but is important to the debate because it relates to the overall wellbeing of our children.

In December, the Centre for Social Justice published a really interesting report, “Testing Times: Supporting fathers during the perinatal period and early parenthood”. It looked in detail at written evidence submitted to the Select Committee on Health and Social Care inquiry into the first 1,000 days of life by the Fatherhood Institute, which described support for fathers as “toothless” and noted criticisms that within health services,

“well-meaning…father-inclusive policy-making…has been more ‘rhetoric than reality’”.

On the back of those comments, the CSJ did some additional polling. It found that seven in 10 new fathers

“were made to feel like a ‘spare part’”,

six in 10 said that they had

“had no conversations at all with a midwife about their role”,

and nearly half said that they had

“received little or no advice at all…on their role as a dad.”

However, it also found that

“more than 9 in 10 are present ‘at the scans and the birth’”

and that there is

“strong correlation between active father engagement and improved childhood outcomes.”

That is a recurring theme in a really interesting book on equal parenting co-authored by one of our own lobby journalists, James Millar. It includes several quotations from the 2015 UN-backed report, “State of the World’s Fathers”, about how engagement in the first year of a baby’s life is good for the dad as well as the baby. Substantial and high-quality father involvement can encourage a child’s positive social interaction and lead to higher cognitive development scores.

Oral Answers to Questions

Rupa Huq Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Caroline Dinenage]

I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My constituent Holly Alliston has contacted me about the epipens that her two-year-old son, who has a severe nut allergy, relies on. There is a national shortage of them, and the Northfield Pharmacy has been emailed by NHS England to say that the situation is critical. What is the Minister doing about this? We hear about the possibility of troops having to distribute stockpiled medicines when we leave the EU, but this is hitting us now.

[Caroline Dinenage]

The hon. Lady is absolutely right to raise this matter. We are working closely with all the manufacturers of adrenaline auto-injectors to improve the supply situation as quickly as possible.

Surgical Mesh

Rupa Huq Excerpts

Thursday 19th April 2018 Commons Chamber

[Emma Hardy]

Part of the scandal is how many women were treated when they went back to their doctors. The fantastic work of groups such as Sling the Mesh has brought so many women together, and shown them that they are not alone and that many others have suffered.

The number of subsequent gynaecology out-patient appointments per 100 people having the mesh insertion procedure is 79. There are 43 out-patient appointments per 100 for rehabilitation, physiotherapy and occupational therapy. The figures show that the number of women having the procedure has fallen during the last nine years by 48%, which says an awful lot about what doctors think.

These women were injured. These women were ignored. These women are the victims of a scandal.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a very powerful and moving speech. May I include testimony from my constituent, Adele Yemm, from Chiswick? There was a catalogue of errors with her case. She had only mild incontinence, and physiotherapy would have sorted it out. There were issues about consent—she was denied that. She had a full implant fitted. Does my hon. Friend agree that this is the biggest medical scandal since thalidomide?

[Emma Hardy]

I completely agree that this is an absolute scandal.

During the debate in October, I asked the Government to do four things: to commit to a full, retrospective and mandatory audit of all interventions and, if the data proves it necessary, a full public inquiry; to suspend prolapse and incontinence mesh operations while the audit is carried out; to bring forward the NICE guidelines for mesh in relation to stress-related urinary incontinence from 2019 to 2018; and to commit to raising awareness with doctors and patients alike.

In December, NICE issued new guidance, ruling that the evidence for the long-term effectiveness of the treatment for pelvic organ prolapse is

“inadequate in quality and quantity”.

The NHS is not compelled to act on these guidelines, but that would amount to a de facto ban.

In January, the Government caved in to demands for a national audit of surgical mesh, which reported on Tuesday. The audit is not perfect. For example, it looks only at NHS hospital figures and misses off private patients and out-patients; does not include men; does not include ventral rectopexy mesh sufferers; does not cover visits to GPs; and does not indicate how many times someone has to visit their GP before being referred for out-patient treatment. However, it seems broadly to agree with what we have been saying all along: that the Government’s claim that only 1% to 3% of women suffered serious complications is just not accurate.

--- Later in debate ---

[Dr Wollaston]

I do agree.

As I say, informed consent is essential, and that was lacking in very many cases. There are cavalier attitudes and assumptions that medical devices are somehow safer than medicines, but we know that that is simply not the case. We have to rigorously make sure that devices are all part of clinical trials, with long-term follow-up and tracking. Perhaps the Minister could update us on how we are getting on with the barcoding of devices, which clearly makes them over time. One of the tragedies is that many women are completely unaware that they have even had mesh inserted at all. That, again, has to be a lesson that we learn for the future about accurate documentation.

I hope that the Minister will comment on whether there are plans to introduce compensation for victims. As I said, many of the women I have met have had profound, life-changing injuries, and many are entitled to compensation.

[Dr Huq]

The hon. Lady mentions the physical injuries and physical pain, but does she agree that these women have also had great emotional pain and psychological suffering? Many are suicidal. The Minister would be well advised to introduce, within a future action plan, counselling services of some kind for these sufferers.

[Dr Wollaston]

I thank the hon. Lady for making that point. Yes, absolutely: the scars have been profound not only in physical terms but in the impact on how people feel about themselves. There is a great impact not only on them but on their families and their relationships.

On access to services, while we all welcome a tertiary service being set up for victims of urogynaecological mesh, there is concern about current waiting times for those who wish to have a referral to a tertiary centre, and about access to investigations, which need to be timely. When women come forward to report deeply personal and distressing experiences, it is important that they can be seen as rapidly as possible. I hope that the Minister will comment on that.

Charing Cross Hospital

Rupa Huq Excerpts

Wednesday 1st November 2017 Westminster Hall

[Andy Slaughter]

I am grateful for the clarity that my hon. Friend brings on that point. What is proposed is the loss of all consultant-led emergency services—type 1 A&E services. The site will therefore lose blue-light ambulances, emergency surgery and emergency consultant services. That is a very substantial change to the health facilities available.

The change came under the heading, “Shaping a healthier future”, which I am afraid my constituents regarded as a rather Orwellian title. That programme has now been subsumed within the sustainability and transformation partnership proposals, which are now nationwide, but essentially the meat of the proposal has not changed over that time. I do not deny—I look for points of agreement if I can—that some of the objectives are perfectly laudable, such as specialisation and the bringing together of expertise on a particular site, as has happened with stroke services, major trauma, renal services and so on, even within the three hospitals in the Imperial trust. That is to be commended. No one objects to improvement to primary, social and community care, which may in time lead to less pressure on acute services. If the consequence is not just better health outcomes but a saving for the public finances, we do not object. The problem, and the reason why there has been a breakdown of trust, is that the changes are being advanced before we know the consequences.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Does my hon. Friend agree that the plans may be transformational, but they are certainly not sustainable, given that London is heading to a population of 10 million before long? It is projected that there will be 12,000 more people in his borough, Hammersmith and Fulham, between the last census and the next one in 2021. We were both at a meeting on Monday night, and he pointed out that the borough has a target of 20,000 new homes by 2035. Where are all those people meant to get treatment, given that we have lost A&E at Charing Cross and Hammersmith, and maternity and paediatrics at Ealing? Demographically, that is illiterate.

[Andy Slaughter]

My hon. Friend puts it very forensically. The difficulty is that however much the aspiration may be to relieve acute services, most independent analysis—whether from the King’s Fund or the Mansfield review, which specifically looked at west London—shows that that is not likely to happen in the foreseeable future. The precious little additional investment in primary and social care is barely keeping up with the pressure on those services. That is where the lack of confidence comes from. However pious and laudable the aspirations, what is hoped for is simply not happening in fact.

I welcome the announcement that nothing will happen in the current sustainability and transformation partnership period, which runs to 2020. That is an admission by the Government that the pressure on services is so great that one could not possibly think about the proposed downgradings at the moment, but that is simply to put off a wrong decision. It means that nothing can happen physically to the Charing Cross site, other than maintenance, until 2021. I have been told privately that it probably means a number of years beyond that, because the eastern part of north-west London, which includes the three Imperial hospitals, has now been put in the slow lane behind what is happening in the western half, so it is unlikely that any changes will happen before 2025. That is 13 years after the first proposals were put forward; that is a very long time in politics, but it is a very long time in the NHS as well.

I am looking for something of more substance from the Government. We have had virtually nothing in writing, or in terms of consultation or engagement with the public, since those announcements back in 2013. Substantial expertise in the community has sprung up in the vacuum that has been created by the health service simply not engaging—expertise through the hospitals movement, trade unions and local people generally. An independent survey conducted by a polling organisation recently showed that 90% of people in the west London area opposed the proposals—that has been borne out in every other survey that I have seen—and 82% think that they have not been involved properly in the decisions. I urge the Minister to listen to that, to turn over a page and to engage with the community on these matters.

Going back to the point made by my hon. Friend the Member for Ealing Central and Acton, last month the four-hour waiting time target was achieved only in 70% of cases for the two hospitals in Imperial. Figures are not disaggregated, so I cannot give them exactly for Charing Cross—only for St Mary’s and Charing Cross combined. That has been a regular pattern over the previous months and years, in particular since the closure of the A&E departments at the Central Middlesex and Hammersmith Hospitals.

The population is growing hugely—as are the health demands, because the area’s population is not only ageing, but mobile and diverse, and those are not on the whole people who do not need acute care. For many years Charing Cross has had good practice: people who arrive at that hospital and have something that can be dealt with by a nurse, a GP or an urgent care centre—in some way other than through consultant care—are simply filtered off, because all those services are available on site. This is not a case of unsuitable use; this is a case of growing demand, and lack of resources to deal with that demand.

I will sit down in a moment, because I want to give the Minister a proper opportunity to respond. I urge him not to read out the brief again because, with respect, I have heard it a number of times over the past five years. I genuinely wish to engage in reassessing what has happened. I welcomed the debate in the other place on 18 October, which was called by my friend Lord Dubs, a Hammersmith resident. More eloquently than I could, he too led a debate specifically on Charing Cross, in which a number of peers took part. The Minister there responded:

“there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved”.—[Official Report, House of Lords, 18 October 2017; Vol. 785, c. 659.]

Those are very welcome words to have put on the record. I am sure that the Minister here will not resile from that today, but will there therefore be an assessment of whether the changes are likely to happen in the foreseeable future? If they are not going to happen for another four, eight or 12 years, or however long, I put it to him that the Government cannot persist in saying simply, “We will do this when the time is right.” That creates uncertainty, demoralisation among staff, and a motivation for management not to maintain or keep up services because they are in effect throwing good money into a building that they believe will not be there in the foreseeable future.

That is my first request to the Minister: that we have a proper assessment of whether those “Shaping a healthier future” proposals are still fit for purpose, as the Government believed in 2012—although I did not. My second request involves the land on the hospital site, because none of it has been designated as surplus land for redevelopment. I push the Minister to say what exactly is meant by that. In 2012 and 2013 we were told in terms that the land not used for health service purposes would be disposed of privately to subsidise the cost of building on the land that would remain within the health service. Will that not now happen, or is it simply that no formal proposals have yet been brought forward?

As I said, this has been a hospital site for well over a century, and the hospital has existed for two centuries. It would be a great pity if that were to change on my watch and the Minister’s, particularly when the hospital is needed most by people in my constituency and others who have used it throughout their life and their family’s lives.

--- Later in debate ---

[Dr Huq]

Is the Minister familiar with the King’s Fund analysis of the STP plans from February this year, which concluded that, despite all the warm words about the new models of care, they are driven more by financial imperatives than by clinicians?

[Mr Dunne]

I do not agree with that. The analysis at the time was of course of the preliminary drafts of the STP plans, before any assessment by NHS England or the Department of Health. The plans are evolving and becoming partnerships, and they will move at differing speeds in different parts of the country, depending on the quality of the work and the extent to which they meet the four tests for service change, namely that they should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice.

In addition, NHS England introduced a new test from 1 April this year on the future use of beds, which is pertinent to the Charing Cross case. It requires commissioners to assure NHS England that any proposed reduction in the number of acute hospital beds is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

The north-west London STP plan was published in November 2016. It confirmed that the “Shaping a healthier future” programme, to which the hon. Member for Hammersmith rightly referred and which was published in 2012, had set out the right plans to reshape health services across north-west London to respond to rapidly changing health and care needs. “Shaping a healthier future” forms a core part of the STP plan and I understand that the STP leadership intends to take that forward. There was a full public consultation in 2012 on the plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites across north-west London to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that Charing Cross would become a growing hub for integrated care in that services network. Following feedback from the public consultation, the proposals were refined to retain a wider range of services than was initially proposed on the Charing Cross site.

In October 2013, the Secretary of State for Health clearly set out, following the full public consultation, that both Charing Cross and Ealing Hospitals would retain A&E services, even if in a “different shape or size” from current arrangements, and that proposal remains. No final decisions have been made about the exact nature of services that are planned to continue at Charing Cross Hospital. It is certain that, even if changes are made, there will still be a thriving Charing Cross Hospital. There will be engagement with the public in due course on the detailed design and implementation of services on the site, which will include cancer, outpatients, diagnostics and 24/7 local A&E services.

As the hon. Member for Hammersmith quite rightly said, the STP is initially focusing on developing new models of care to reduce demand on acute services. I am grateful to him for welcoming the improvement of services in the community, so that it can be established that those services work before acute reconfiguration takes place through the proposal.

[Dr Huq]

The Minister is being generous in giving way. He pointed out that no final decisions have been taken, but can he not appreciate that that uncertainty creates a lack of morale among the staff? I had to visit Charing Cross very regularly for my late mother, who we lost during the election campaign, as her specialist Dr Perry was there. Staff morale is sapped: they are demoralised because they do not know what is going on.

[Mr Dunne]

I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.

It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities—in this case Charing Cross Hospital— have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.