health
Siobhain McDonagh Excerpts(13 years, 5 months ago)
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Siobhain McDonagh (Mitcham and Morden) (Lab)
My local NHS says that it needs to reconfigure services because it has
“to deliver £370 million savings each year...a reduction of around 24% in…costs.”
As a result, it plans, through a programme ironically called “Better Services Better Value”, to close a wide range of services at my constituency’s local hospital, St Helier. Most of the controversy has focused on the closure of our A and E and maternity units, but we also face losing our intensive care unit, neonatal ICU and renal unit, as well as about 50% of St Helier’s 390 in- patient beds.
Since I last raised this subject in the House in July, a number of interesting things have happened. First, the right hon. Member for Sutton and Cheam (Paul Burstow)—whose constituency, like mine, is on the borders of St Helier—lost his job as a Health Minister and launched a withering attack on the plans, describing them as “dangerous and flawed”. As a Minister in the Department for Health, he would know; although I imagine that he wanted to stay and to continue to be collectively responsible for St Heller’s demise.
Then the right hon. Member for Carshalton and Wallington (Tom Brake), whose constituency contains St Helier, decided that he was so upset about the plans that he would take a principled stand by joining the Government as deputy to the man who is responsible for what has happened in the NHS over the past two years. Congratulations are due to him for showing his disapproval so strongly.
Ten days ago, Michelle Baker and Karen Russell, mums from my constituency and part of the Save St Helier campaign, organised a picnic with a purpose outside the hospital. Thousands of local residents joined in, and although it was billed as a fun day, we were deadly serious. The leader of Merton council, Councillor Stephen Alambritis, a former football referee, was cheered as he brandished a red card at the plans, while the medical director of “Better Services Better Value” was booed as he was handed our petition, signed by more than 30,000 people.
In other developments, it is becoming increasingly clear that, behind the scenes, the case for the closure is falling apart. NHS South West London was originally due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed at the last minute. Then, last month, the team proudly issued a press release stating that a decision would be made on 27 September and that
“the aim is for it to go out to public consultation from 1 October”.
Dr Finch said that he was
“excited by the huge potential of the BSBV programme.”
Now even that decision has been put off for at least another month. Perhaps the delay is connected to polls of GPs and patients that showed that a majority were against the closure, but I suspect that that it is mainly due to the publication of the National Clinical Advisory Team’s report on the plans.
NCAT reports represent a key step in any hospital reconfiguration and need to be properly scrutinised, so on 17 July I requested a copy of the report under the Freedom of Information Act. Under FOI rules, I should have received a copy by 14 August, but it was not until a week later that I received one, along with a press release claiming that NCAT had
“given the Better Services Better Value review the green light to move forward”,
and that
“we are very pleased that the NCAT team have agreed that our proposals should be supported”.
However, although the press release gave the impression that everything was running smoothly, that impression was extremely misleading.
The most fundamental criticism of the closure plan is that it is predicated on the assumption that 60%—yes, 60%—of emergency patients can use primary care instead of A and E services. Obviously, it is very much in GPs’ interests for BSBV to succeed. It is led by local GPs, and they clearly have an interest in ensuring that more patients use primary care rather than hospitals, whether or not that is what patients want, because the money follows the patient.
NCAT has looked at the 60% target and, ever so politely, has laughed it off. The report says:
“The assumption that 60% of ED”—
emergency department—
“patients have conditions that can be managed by clinicians from primary care demands detailed… analysis. Elsewhere in the UK a consistent finding is…far lower, usually in the order of 15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”
NCAT goes on to say:
“The ED consultants interviewed suggested that the primary care workload in their departments is in the order of 15-20%”
and that
“The estimate of 60% is often derived from coding data...patients who have no x-rays, no specific treatment, no follow up and are not admitted are regarded as ‘minor’ and therefore it is assumed that they could be seen by primary care clinicians. It is recognised throughout the NHS and particularly in emergency care, that such data lack reliability”.
The report also questions the assumptions behind the proposal that St Helier could be saved by becoming South West London’s elective hospital. It is hard to see why any patient would choose to travel so many miles from Croydon, Wandsworth or Kingston to a hospital that had lost so many services, to receive treatment that they could receive at their local hospitals, or why any ambitious staff member would want to work there.
NCAT says:
“The concept of a planned in-patient care or elective hospital serving the whole area was generally supported”
by clinicians. It continues:
“However there was no evidence that this would free enough in-hospital capacity to absorb the additional acute workload for the remaining three hospitals.”
The report adds:
“There was concern that the links between acute medical services and the community were not dependable.”
NCAT admits that, although most experts consider it a bad thing for maternity units to deliver more than 6,000 babies a year, South West London’s three remaining maternity units would have to deliver 6,500 babies each—in addition to the 2,500 babies delivered in midwife units and the 880 delivered at home.
NCAT concludes:
“Successful implementation…depends on a multitude of supporting improvements in primary care, community services and professional practice that are not well defined in the proposals.”
Worse, it admits:
“The reconfigurations are based on an optimistic view of capacity, recruitment, meeting increased demand in primary and community care and the challenges posed by the introduction of new ways of working.”
I could go on and on.
On the basis of such optimism, 200,000 people will have to make longer journeys to hospital in an emergency. An A and E department will close, although the number of A and E visits will rise by 20% in the next five years. Tens of thousands of women will have to worry about how they will give birth at hospitals further from home, and a maternity unit will close, although the number of births will rise by 10%. Thanks to the combination of cuts and GP commissioning, a flawed decision to close St Helier is about to happen. It will not work, and it must be stopped.
Health
Siobhain McDonagh Excerpts(13 years, 7 months ago)
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Siobhain McDonagh (Mitcham and Morden) (Lab)
In south-west London, the NHS has just proposed to close the A and E, maternity unit and various other services at my local hospital, St Helier. It will take 200,000 people longer to get to hospital in an emergency. On its website, outlining why it is doing this, NHS South West London states that providers
“will have to deliver £370 million savings each year…a reduction of around 24% in their costs.”
Yet thanks to birth rates, an ageing population and poor health due to poverty, A and E visits will go up 20% in five years and births will increase by 10%. The area’s four hospitals are overcrowded now, so let us try cramming the same number of patients into just three.
What is worse is that there is no extra funding for the hospitals that remain. In no way do I support the hospital closures in north London, but at least that area gets an extra £138 million for “out of hospital” care to cope with the closures. Down in south-west London, we will get nothing. If St Helier loses its A and E, visits to the remaining three hospitals will rise by a third. Many will have to be admitted, but, with no extra funding, where can they go? Will they go on to the corridors, as in the 1990s?
It is claimed that 50% of A and E patients will go to GPs or community services instead, but even the report by the watchdog, the national clinical advisory team, does not believe that they could cope. That is a key paper and no cuts should take place without the public knowing what the watchdog thinks, so it should be published immediately. NCAT is right to be sceptical about whether GPs can halve the numbers going to A and E. Clinical commissioning obviously makes that very attractive for GPs, but for most people in my constituency it is easier to go to a walk-in centre or A and E than to a GP, so A and E visits have continued to rise year after year. The fact that GPs, who are making all the financial decisions, will get more funding if there are fewer A and E visits, does not mean that people will stop going. Apparently, some GPs now realise that those plans are looking very dodgy. A poll of Sutton’s GPs has shown a majority against the closure and a similar poll is taking place of Merton’s GPs that will, I am sure, show the same.
It is not just St Helier’s A and E that is under threat—so is its maternity unit. However, of the four hospitals, St Helier has the only maternity unit that meets clinical standards. If we lose St Helier, the other three hospitals will need to deliver a third more babies than they do now. It is widely accepted that maternity units delivering more than 6,000 births a year are a bad thing. It is far better, and far safer, to have slightly smaller units with good midwife cover, but not in south-west London, it seems.
We will lose our children’s unit and other services, such as intensive care. The “Better Services Better Value” review states that, to compensate, GPs will force patients from all around south-west London to go to St Helier for minor, planned treatments, but who would want an operation, even a routine one, in a hospital as depleted as St Helier? What is more, making people in St Helier drive across the suburbs for A and E and maternity and making people drive to St Helier for routine operations will add literally millions of miles of journeys to our already congested roads. No, the impact of that is not considered.
The other obvious questions have not been asked. Why would a patient from Kingston want to drive the best part of an hour to St Helier for a treatment they can currently get in Kingston? The other three hospitals do not like the idea either, as they cannot afford to lose the income from those planned treatments.
These plans are all over the place; they are a total shambles. Next Thursday, NHS South West London was due to rubber-stamp St Helier’s closures. It booked a big theatre in Croydon in readiness, but now it has put the decision off. Good, but this is obviously not the end. St Helier has been under threat before, but now it is under threat again from a combination of cuts and GP commissioning. The demands on our four hospitals are growing, not shrinking. I hope the Minister will reassure me, and my constituents, that that disaster will not happen on his watch.
Mr Burns
I think I can assure my hon. Friend that the IRP will have available to it all the evidence, in all shapes and forms, to help it to form its final opinion of the complaint referred to it. I hope that that reassures him. I say to my hon. Friend the Member for Loughborough and the hon. Member for Leicester South that the same can apply with regard to the decision about ECMO. I have no doubt that Leicester city council will give consideration to that.
I shall briefly respond to the remaining issues. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) made several extremely interesting suggestions. Some of them might not be in line with current Government thinking, but I shall certainly refer her ideas and views to the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who deals with our alcohol strategy. Similarly, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised an important issue, and again I will refer it to the Under-Secretary of State.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned the potential reconfiguration at St Helier hospital. As she will know, the proposals are still being worked on. There has not yet been a consultation process, but the decisions have been taken locally by the local NHS. I trust that, if and when there is a consultation process, she will get involved.
Mr Burns
I thought she would say that. That is very good. After the consultation, the due processes of reconfiguration can move forward.
My hon. Friend the Member for Hendon (Dr Offord) asked about Avastin. A study is being done into its effects. We are following that closely, and when we find out more we will consider the matter and potentially reach a judgment, but I cannot give him any commitments at the moment.
Finally, I turn to my constituency neighbour, my hon. Friend the Member for Witham (Priti Patel). I am sorry to hear about the problems that she highlighted on behalf of her constituents. I do not want to disappoint her, because she is my neighbour and I have to live with her on a weekly basis, but given the background to the case, I think it is a matter for the GP practice as the employer of the GP whom she mentioned. I encourage her to engage with Mid Essex PCT, even though it has no direct powers or role in this matter, and the clinical commissioning group in the mid-Essex area, because they are best placed to address the concerns about the provision of services for her constituents, which I know she is fearless in defending, protecting and promoting.
NHS Risk Register
Siobhain McDonagh Excerpts(14 years ago)
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Siobhain McDonagh (Mitcham and Morden) (Lab)
I wish to share with the House a cautionary tale and to suggest that the publication of the risk register might be in the best interests of all hon. Members and all parties, because it will allow us to stand back and look at the consequences of the changes.
The London experience—certainly the south London experience—is that the changes will lead to a wholesale closure of general hospitals in urban settings because they confuse the roles of providers and commissioners of services. I am in a fortunate position. After 13 years of argument, one of the last acts of the previous Labour Government was to agree to spend £219 million on the rebuilding of St Helier hospital. Thankfully, the current Government agreed those plans—it was one of only three capital programmes of its size in the country.
St George’s hospital in Tooting, which is known to many, was to merge with St Helier to make St Helier large enough to become a foundation hospital. After those years of argument, the programme was going well until St George’s hospital looked at the GP commissioning plans in my area, which suggested that they would reduce services at St Helier hospital by £40 million over the next five years. St George’s, the only hospital interested in merging with St Helier, backed away immediately, because it knew it could not make the figures stack up.
We now have a £219 million capital programme for a hospital that, as it stands, is completely unviable. I should not be admitting that to the Government because they might think that they do not want to spend that money. I want them to spend it, but I want them to spend it on a viable hospital, because the demand and the need are there.
I can understand why GPs, who are private practitioners, want to provide more services. My argument is in favour of the consumer—the patient. Patients might not want to get up every morning to try and make a GP appointment and not get in that day. They might not want or be able to take a day out of their working lives or sustain the consequences of doing so to get a GP appointment. They might not want to wait a fortnight for a blood test, as I am doing. They might choose to go to their local hospital for that service. I believe it is the right of NHS patients to make those choices, but they are the choices that we will deny to people if the Health and Social Care Bill is passed, because it imposes a 19th century health model on the 21st century. Our experience in London is that walk-in clinics provide for many, but not for everybody, better services than GPs.
We have heard about the relationship between the patient and the GP. In south-west London, people are grateful to see any doctor when they go to the GP service. That relationship does not exist. I appreciate that the experience of people in market towns outside London might be entirely different, but from a London perspective, the changes will have an enormous impact on patients, including the most disadvantaged patients who live in our capital city. As a consequence, enormous numbers of hospitals in suburban areas will face reductions and closure. MPs of all parties must consider whether that is what they want. It is beginning to happen. On a BBC regional programme recently, the medical director of NHS North West London said, quite openly, “Yes, we will see the closure of many hospitals.” Is that what we want? Are we prepared to support that? Is it in the best interests of our constituents? I do not believe so.
Diabetes (Young People)
Siobhain McDonagh Excerpts(15 years, 5 months ago)
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Siobhain McDonagh (Mitcham and Morden) (Lab)
I can assure you, Mrs Riordan, that I will not speak for that long.
I want to highlight the impact that diabetes, like all chronic conditions, has on not only the individual, but their family, friends and community. That is particularly relevant, given the age at which people are being diagnosed with type 1 diabetes and the huge increase in the number of children who are diagnosed with it. About 25,000 children in the UK have type 1 diabetes. Some 98.6% of children and young people with diabetes have type 1. The incidence of type 1 diabetes increases by about 4% each year. The biggest increase is in children under the age of five, among whom there has been a fivefold increase in the past 20 years.
When children are diagnosed with diabetes, it has a profound effect on their families. The parent group, Children with Diabetes, did a survey of parents, in which 85% said that their household income had gone down; 83% said that they had problems with their marriage and family life; 84% said that their child’s treatment was affected by where they lived; 71% said that they were concerned about long-term complications; 60% said that their children were most worried about being seen as different, as the hon. Member for Torbay (Mr Sanders) said; and 50% reported that their children had been bullied at school as a result of suffering from type 1 diabetes.
My right hon. Friend the Member for Knowsley (Mr Howarth) asked me to contribute to the debate because of its importance to him as an individual. That made me think about constituents I have seen and the problems that they have had. My hairdresser, who is a very important person in my life, told me that his niece, Sophia, was diagnosed with type 1 diabetes at the age of five. There was no history of diabetes in the family. The family spent ages completely terrified, wondering what the problem with their young daughter was, only to find that she had type 1 diabetes. Her mother, Nicole, tells me that she came home on the day of diagnosis with a load of equipment, not knowing what to do or understanding the consequences. She knew that she had to give up her employment, because she could not control the diabetes and did not know the consequences for her daughter. Her husband had to accept the fact that, unlike other married couples, they could not leave their daughter with other people, because those others were frightened about knowing how to care for her. Nicole was concerned about just not knowing how the family would approach routine family life, celebrations, festivals and even Christmas.
Nicole told me today that the single thing that was of benefit to her was the recently set up parent group at St. George’s hospital in Tooting. The scales fell from her eyes as the clinical paediatric nurse, Richard Todd, told her how she could cope with Christmas—all the food and treats of the period—and how she could have access as a carer to discount cards, which no one had told her about in the past, although her daughter has had type 1 diabetes for seven years. She could also just meet other families and mums, and discuss the consequences, for them and their family, of their children’s diabetes. If there is anything I would ask the Minister to do, it is to consider the fact that St. George’s will not carry on the parent support service, because it does not feel able to keep Mr Todd’s services. I am sure that there are many demands on the hospital, but that parent group—just from one parent’s perspective—had an enormous impact.
The other time when a problem begins to arise in a family’s life is when children transfer from primary to secondary school. While having a pacemaker, or another condition, might affect a child’s school preference place, despite having type 1 diabetes Sophia did not obtain a school place in the Minister’s constituency, although her mum and dad wanted her to go to school there so that they could be close at hand if anything happened and so that all the burden would not fall on the school. At the school, in turn, there was a fear about having Sophia there. Of course, with the transfer to secondary school the issue of puberty comes into play, with its impact on the treatment of type 1 diabetes, and the need to understand whether mood changes result from the illness or the normal changes that any teenager goes through.
Having a child with type 1 diabetes can also have a financial impact. I know from other families who have been to see me that that can involve simple things such as school uniforms. One mum who came to see me bought the uniform for her daughter who was going to secondary school, only for her to be diagnosed with the condition over the summer holidays; in that period she lost two or three dress sizes. Apart from the sheer fear that that must have created, the financial impact for a single mum on benefit is huge. There are implications for all the things that we would want to happen: getting mums back into work; flexible working; the need to work close to home; and the need for the wider family to understand things. I am sure that that is only a small and perhaps secondary consideration, but in the treatment of this chronic disorder, diagnosed in children so young, it has a huge impact for the wider family. The soft services of parent groups, which might be seen as less important in times of financial restraint, are crucial in enabling parents to understand the difficulties and problems, and in preventing some of the problems that other families have probably been through.
Mid Staffordshire NHS Foundation Trust
Siobhain McDonagh Excerpts(15 years, 9 months ago)
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Mr Lansley
My right hon. Friend is absolutely right. That is why we have to move from all those questions to some serious answers—so that we can have the reform that the NHS so badly needs. I know and he knows that this is about not just a different set of structures, but a change of culture and a focus in the NHS on patients and results for patients to the exclusion of other bureaucratic impositions. There is such immense bureaucracy—PCTs, SHAs and regulators—that everything should have worked perfectly, but it did not. Why? Because in all of that, the underlying pressures in the service were not focused on results for patients. We have to drive towards that conclusion.