Leeds Children’s Heart Surgery Unit

Andrew Gwynne Excerpts

Tuesday 30th October 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate, and on the way in which he and other Members across the House have put their case. The issues surrounding Leeds children’s heart surgery unit are important and certainly merit our debate. I also take the point made by the hon. Member for Leeds North West (Greg Mulholland) that a wider debate on the Floor of the House may be warranted.

I take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services, both in Leeds and across the country. We are all incredibly grateful for the tremendous job that they do, more often than not in complex, difficult circumstances.

Clinicians and professional bodies, including the Royal College of Nursing and the Royal College of Paediatrics and Child Health, have been clear that children’s heart services need to change. Surgeons are too thinly spread, and services have grown in an ad hoc manner in England, which, to be fair, the hon. Member for Pudsey recognised in his opening speech. Changing how we provide any hospital service is difficult, but when changes are necessary to improve patient care, as they may be for children’s heart services, politicians on both sides of the House should be prepared to listen to that argument and, if necessary, support it.

I know, however, that there have been real concerns and a great deal of protest in the communities surrounding the unit at Leeds general infirmary, particularly about the plans to close it. A motion of support from Leeds city council has been supported by people from across the political spectrum in the city. There has also been a large protest in Millennium square in Leeds, where, I am informed, over 3,000 protestors were joined by local MPs, parents and nurses to campaign to prevent the closure.

As we have heard today, there are similar concerns about plans to close the Glenfield hospital in Leicester, and the Royal Brompton in Chelsea, west London. That could mean that in future, children’s heart surgery would remain at the London children’s hospitals, and in Southampton, Birmingham, Bristol, Newcastle and Liverpool. Although the Opposition support the principle of fewer, more specialist centres, we have concerns about the location of the selected sites, which would leave a huge swathe of the east of England, from Newcastle right down to London, potentially without a centre.

As we have heard, the unit based at Leeds general infirmary serves the 5.5 million residents of Yorkshire and the Humber, and performs 360 operations a year, done by three surgeons. We have heard, too, that there are concerns that the closure of the unit will leave millions of people in the region without local access to the children’s heart surgery expertise that currently exists in Yorkshire and the Humber at Leeds. The local Save Our Surgery campaign group, under the Children’s Heart Surgery Fund, believes that families from Yorkshire, north Lincoln and the wider Humber region may have to travel up to 150 miles for treatment at the nearest unit in Newcastle or Liverpool, if the closure goes ahead.

As an aside, I was privileged to visit the hospital in Hull, at the invitation of my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), as part of my duties as a shadow Health Minister. It took me an hour and a half to get from Manchester to Hull to visit the hospital. However, because there was a slight flurry of snow on the way back, the M62 ground to a halt, and it took me over five hours to get back over the Pennines to Manchester. I have never seen so many Lancastrians trying to desert Yorkshire at the same time as me, but it shows that geography matters in such decisions. We cannot ignore the fact that the Pennines are there, and sometimes they are impenetrable.

Clearly, there is concern that families may be faced with having to travel further at what is undeniably a very stressful time for them. That case has been made eloquently by Members on both sides of the House in the debate. It is also worth remembering that it is not only the care of poorly children that needs to be taken into account; the care of the whole family is important.

I ask the Minister, for whom I have a great deal of respect, whether she was satisfied that the NHS joint committee of primary care trusts properly balanced clinical decisions with practical and transport issues for families. Furthermore, does she believe that the review was fair to families in the eastern half of England, which is now left with no centre between Newcastle and London? As we know, the JCPCT came to the decision in July to close the unit. The SOS campaign group launched legal proceedings against the NHS to stop the unit being closed, submitting an application to the High Court for permission for a judicial review. Last week, as we have heard, the Health Secretary asked the Independent Reconfiguration Panel to review the decision to close three centres.

We know that children’s heart surgery matters greatly to many people. However, as we also know, the issues surrounding children’s heart surgery have needed to be resolved for some time. The findings of the Bristol Royal infirmary inquiry into children’s heart surgery 10 years ago highlighted that between 1990 and 1995, a number of children died at the infirmary as a result of poor care. It is clear that children’s heart surgery has become an increasingly complex treatment. The aim must be for children’s heart services to deliver the very highest standard of care. The NHS should use its skills and resources collectively to gain the best outcomes for patients. The Government rightly want changes to children’s heart surgery services, so that they provide not only safe standards of care, but excellent, high quality standards for every child in every part of the country.

[Fabian Hamilton]

Does my hon. Friend agree that it is not only the continuum of children’s heart services and the care of parents and other family members that is important? The treatment should continue beyond 16, if it has to. There needs to be an overview of pre- and post-16 services; they should be taken together, because that is how we ensure that the young person, who becomes an adult, survives and lives the rest of their life.

--- Later in debate ---

[Andrew Gwynne]

I agree absolutely with my hon. Friend. He makes the point that I was about to come on to. We want that for children’s heart services. It cannot be good enough to say that it is possible to move a service; we want to know whether it is desirable to do so, in order to get the very best outcomes. He makes the point that if we are to have a specialist centre for adults, we should remember that it is often the same surgeons who deal with children, and rather than losing that, it is better to have one specialist centre for all.

It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and it follows that they will all be working at full capacity, so can the Minister ensure that in the event of a superbug outbreak like the one in the Belfast neonatal unit this year; a fire like the one in the Birmingham hospital in 2010, or the one in Leicester in 2011; or any other unforeseen incident occurring in one of the cardiac units, the other six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?

As I have previously said, I welcome the recent decision by the Health Secretary to have a review of the decision to close the children’s heart surgery unit at Leeds general infirmary. It is important that there be a full review, and that the right decision be made, with full consideration of all the facts. I echo the concerns raised by other hon. Members on that point. Many campaigners are concerned that the review by the Independent Reconfiguration Panel will simply repeat a process that was seen as flawed the first time round. What steps will the Minister take to reassure the campaigners in Leeds that it will be a full and comprehensive review? As I have said before, it is not good enough just to close one service and move it to a different part of the country. We must ensure that any potential decisions take full account of the facts, and that any moving of a service will result in a clear and demonstrable improvement in the outcomes for children’s cardiac services.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I can absolutely confirm that. In fact, I was extremely pleased to see last week that all the standards are being met for both eight-minute category A calls— red 1 and red 2 calls—and 19-minute calls. That is as it should be, but it is no grounds for complacency. Although that is a country-wide picture, there are parts of the country where those standards are not being met in the way that we would like. We will continue to monitor the situation closely.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I will be charitable to the Secretary of State, but he brushed over the figures in his answer to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have got the actual figures through a freedom of information request. They show that under this Government, 100,000 additional patients are being left waiting in ambulances outside accident and emergency departments for more than half an hour when they need urgent treatment—a totally unacceptable situation. What more evidence does the Secretary of State need of the chaos engulfing the national health service under his Government? It shows that the focus has slipped off patient care and that our accident and emergency units are struggling to cope.

[Mr Hunt]

The hon. Gentleman speaks as though the problem of ambulance waits never happened for 13 years under Labour, but he knows that we actually had some appalling problems, with ambulances circling hospitals because hospitals did not want to breach their four-hour A and E wait targets. We are tackling the problem, and as I mentioned, if he looks at the figures published last week he will see that we are meeting the standards for ambulance waits that his party’s Government put in place. However, we are not complacent, and we are monitoring the figures closely. Particularly with the winter coming up, we want to ensure that the ambulance service performs exactly as the British public would want.

Community Hospitals

Andrew Gwynne Excerpts

Thursday 6th September 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I thank the Backbench Business Committee for granting this important debate today and I congratulate the hon. Member for Totnes (Dr Wollaston) on the eloquent case that she made in opening it. I also congratulate and welcome the new Minister to her place. She was a slightly unconventional Parliamentary Private Secretary to the former Minister of State for Health, the right hon. Member for Chelmsford (Mr Burns). I say “unconventional” because, as the hon. Member for Hexham (Guy Opperman) observed, PPSs are usually seen and not heard. I am sure that she will be even more vocal now that she has the freedom to speak from the Government Front Bench, and I look forward to our exchanges in the coming weeks and months.

As many Members have testified today, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups.

It is clear that people generally prefer medical treatments to be taken nearer to their homes and families, whether that involves palliative care, minor injury services or maternity care, and those are exactly the services that community hospitals can help to deliver. Indeed, the Department of Health has estimated that about 25% of hospital patients could be better cared for at home or in the community.

Community hospitals usually also have good relationships with their local communities, and are often supported by local fundraising. We have heard from a number of hon. Members today about the great work being done by friends groups up and down the country. I pay tribute to those groups, and to the staff and volunteers who work to make those groups and the hospitals happen. Staff in community hospitals can also build personal relationships with local patients and carers as they deliver continuous care from outside the hospital environment. That is an important point that should not be overlooked.

It is fair to say that community hospitals continue to play an important part in local health care provision. Their role is valued, and we are right to support it. Labour continues to be committed to community hospitals, when they represent the best solutions for local communities. I take the point made by the hon. Member for Southport (John Pugh) that they might not be the solution everywhere. My own constituency is served by three large district general hospitals and not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop them further. For example, it might be possible for GP or dentistry services to be offered in more community hospitals, which could make some that are only marginally viable at the moment more viable for the future. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. One of the most pressing tasks for the NHS in the coming years will be better to co-ordinate services around the needs of patients, and that might well mean that community hospitals have to change the way in which they provide services and the buildings from which they provide them. She will know, however, of our concerns about the Government’s structural reforms, which will make the co-ordination and delivery of services far more difficult. We believe that the future requires the integration of care, yet the Government’s policies are driving us more towards fragmentation. We know that they are already having a profound effect on the NHS. A recent survey of NHS chairs and chief executives by the NHS Confederation found that 28% described the current financial position as

“the worst they had ever experienced”.

A further 46% said the position was “very serious”.

It is also clear that the financial challenge will continue for many years after 2015, and all this could have an effect on community hospitals, whether it be the reduction of minor injuries provision, the closure of wards or the downgrading of services. As the hon. Member for Bracknell (Dr Lee) suggested in what I thought was a thoughtful contribution, these can sometimes be the right choices for an area. Sometimes, however, they will not be and they will just be financially driven; here, there is a danger that community hospitals will provide an easy cut for bureaucrats.

[Guy Opperman]

The hon. Gentleman will be aware that 3,000 community beds in community hospitals were shut under the previous Government. Is he going to enlighten us about what his policy is, specifically in respect of any particular cuts to community hospitals? Is he in favour of them, against them, or is there no policy?

[Andrew Gwynne]

Community hospitals have a vital role to play. As we have discussed in the debate, however, they may not be the right approach everywhere. We remain committed to community hospitals. The last Labour Government introduced a fund specifically for them. It is fair to say that that fund was not automatically taken up by primary care trusts up and down the country. Some areas had different viewpoints on the role of community hospitals. The Labour party has a commitment to community hospitals where they are the right choice for the local communities.

A further point about the impact of the Health and Social Care Act 2012 is that with responsibility for commissioning health care services moving into the hands of clinical commissioning groups and with primary care trusts no longer being in existence, there is a real danger that the role of community hospitals could be overlooked. Will the Minister reassure us that community hospitals will not be unfairly penalised in the new internal market of the NHS?

We should bear in mind further issues about the possibility of creeping privatisation—an issue that we, at least, are concerned about. The whole health service is currently in a state of flux, but as the reforms in the NHS kick in, it is perfectly feasible for commissioning groups to look outside the NHS to the private sector to provide even more of their services than in the past. This has already happened in Suffolk in March, when Serco won a £140 million contract to manage, among other things, the area’s community hospitals.

It could well be that when trusts are faced with the choice of reducing clinical services, they will look to being more centralised for financial reasons and take services away from the community and, indeed, in some cases from district general hospitals, too. This will almost certainly have an effect on any extensions to these services in community hospitals. Clearly, community hospitals and other community health services need to be able to compete on a fair playing field with other health providers, and I would ask the Minister how she will support that practically.

I would like to ask about some of the additional funding arrangements in the NHS—an issue raised by the hon. Member for Totnes in her opening comments. Previously in the NHS, payment by results was introduced to finance care and treatment according to a national tariff. It was intended to reduce variation in the prices paid by different parts of the country and to encourage providers to do more work, particularly helping to reduce waiting times.

Community services, however, are not covered by payment by results and are instead paid under a block contract negotiated with the local commissioner. I know that some community hospitals are concerned that they will have to make greater budget reductions than providers covered by payment by results. Some community hospitals are concerned that the commissioner will reduce the size of the block contracts, which is easier to do than stopping activity under a tariff.

From April 2013, the NHS Commissioning Board and Monitor will set the national tariff, and we are encouraged that the Government have expressed an interest in expanding payment by results to community services. If payment by results is expanded, it must be done in a way that supports integrated care and does not disadvantage care that is delivered in a community setting. How will the Minister ensure that we do not have a pricing system that disadvantages care that is delivered in community settings and particularly in community hospitals?

Let me deal briefly with the issue of estate ownership, which has been touched on by a number of Members. Many community hospitals do not own the buildings from which they operate, which affects their ability to raise capital to create new services for patients because they cannot secure finance or loans against the value of their buildings. As we have already heard during the debate, earlier this year the last Health Secretary announced that a Government-owned firm, NHS Property Services Ltd, would take over the ownership and management of the existing primary care trust estate and dispose of property that was surplus to NHS requirements. Community hospitals will depend on the setting of affordable long-term rents by NHS Property Services Ltd. I hope the Minister will tell us how the firm will work with community providers, including social enterprises.

There should be no doubt that Opposition Members support the principle of community hospitals. Indeed, we rightly established a fund to support and develop the community hospitals that represented the best choice for local communities. A future Labour Government would also aim to develop community services further within community hospitals. For example, as I have already suggested, it may be possible for more GP, dentistry or other services to be offered by them, and I think that that opportunity should be explored further.

We are concerned about some of the wording of the motion, which calls for community hospitals to have

“greater freedom to explore different ownership models”.

We would need more details of any parameters before agreeing to such an arrangement. It could lead to an opportunity for further creeping privatisation of our national health service, which is something that the Labour party will not support or give carte blanche to. For that reason, Labour will abstain on the motion.

The motion also calls for a national database of community hospitals. Historically their number and location was not monitored, as that was a matter for primary care trusts. However, we believe that in the new NHS, with confusion over where responsibility lies, there may well be a case for a national database. We would be interested to hear more details of what the hon. Member for Totnes has proposed, because we believe that it could give some value to the Department of Health in the future.

We should pay tribute to the important work that community hospitals undertake, the quality of the health care that they give to local people, and the commitment and dedication of all their staff, from medical professionals to porters and cleaners. The Government should be doing all that they can to ensure that patients can make real choices about receiving the health care that they need near to their homes. It remains to be seen how the Government’s changes to our NHS will affect community services and community hospitals. I look forward to hearing from the Minister how she will protect the role of community hospitals, which are valued and must continue to have a role in the more integrated and people-centred health care system that I hope we all support.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Lady for her question. Indeed, officials in my Department are in close contact with officials in all the devolved Administrations to make sure that we share best practice across the nations so that we drive up the quality of care for all.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Only last week, the Secretary of State said about care:

“The…number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not.”—[Official Report, 11 July 2012; Vol. 548, c. 322.]

Figures published by his own Department show the number of delayed days is up by 18% in the last year and 29% since August 2010. Are Ministers completely out of touch with reality, or would the Minister now like to correct the record?

[Paul Burstow]

Of course what the hon. Gentleman omits to mention in seeking to give an impression is this: the implication is that social services are not coping with delayed discharges and are the principal cause of them, but the figures do not bear that proposition out. [Interruption.] Indeed, the extra investment the Government are making in reablement services means that discharges in this area are being assisted and improving—[Interruption.]

National Health Service

Andrew Gwynne Excerpts

Monday 16th July 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate, albeit one slightly curtailed by statements. We have heard 10 speeches from Back-Bench Members and I would especially like to commend my right hon. Friends the Members for Greenwich and Woolwich (Mr Raynsford) and for Holborn and St Pancras (Frank Dobson) and my hon. Friends the Members for Easington (Grahame M. Morris), for Ealing, Southall (Mr Sharma), for Brent North (Barry Gardiner) and for Stockton North (Alex Cunningham) for their contributions. I also rightly want to pay tribute to the many thousands who work in our national health service, doing a tremendous job in often challenging and difficult circumstances.

As we have heard in the debate today, there are growing problems in the national health service. We know that two thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. As we have heard from right hon. and hon. Members, we are starting to see temporary ward and accident and emergency closures, while a quarter of walk-in centres are closing across England. Despite the “Through the Looking Glass” world of Ministers—one where the Secretary of State for Health closes a debate—we now have growing rationing across the national health service, with treatments—including cataracts, hip and knee replacements—being restricted or stopped altogether by one primary care trust or another.

[John Pugh (Southport) (LD)]

Does the hon. Gentleman not acknowledge that the real weakness of this debate, as specified by the Select Committee Chairman, is that the Labour party has at no point spelled out how it would meet the £20 billion Nicholson challenge? Will he tell us?

[Andrew Gwynne]

We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.

It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:

“NHS Hull will not routinely commission excision of ganglia”.

That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will the hon. Gentleman give way?

[Andrew Gwynne]

I will not, as I do not have time now.

In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:

“Time and again, he says”—

that is my right hon. Friend the Member for Leigh (Andy Burnham)—

‘“Oh, they are rationing.’ They are not”.—[Official Report, 4 July 2012; Vol. 547, c. 923.]

But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the GP magazine, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.

Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.

Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.

It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.

It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.

In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.

[Mr Graham Stuart]

Will the hon. Gentleman give way?

[Andrew Gwynne]

No, I will not.

This was the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office. This is in clear breach of the commitment given by the Conservatives and Liberal Democrats in their coalition agreement.

Of course, a long line of professionals have come, one after the other, to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, and doctor against doctor. That is where we start. The Health and Social Care Act 2012 now allows hospitals completely to change character over time. The Government have essentially set everybody on their own. Hospitals are being told, “You’re on your own. There’s no support from the centre any more; no more bail-outs.”

We know that there are problems with the NHS meeting efficiency targets. Indeed, a survey of NHS chief executives and chairmen found that one in four believe that the current financial pressures are the

“worst they have ever experienced”,

with a further 46% saying they were “very serious”. More than half of foundation trusts missed their savings plan targets, according to Monitor’s review of the last financial year.

Ministers have said that every penny saved will be a penny reinvested to the benefit of patient care, but in reality £1.4 billion of the £1.7 billion not spent by the Department of Health has been returned to the Treasury—more broken promises. It is therefore clear for all to see that there is an increasing gap between what the Government are saying and what is going on in the NHS, and the experience of ordinary patients on the ground.

The Government have increasingly broken their promises on the NHS. They promised no top-down reorganisation and a moratorium on hospital closures and they promised to maintain spending levels in the NHS. They have broken all those promises—they are the three biggest broken promises in the history of the NHS. There is clearly a yawning gap between what the Prime Minister and others say and the reality of patients’ experience.

During the general election, the Prime Minister said:

“I’ll cut the deficit, not the NHS.”

It is now clear that the Government are cutting our NHS. The NHS is important for the people of our country, and they deserve better. I commend the motion to the House.

Hospital Services (West London)

Andrew Gwynne Excerpts

Wednesday 11th July 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

As ever, it is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this important debate. As we have heard, there is widespread concern in his constituency and throughout the capital about the future of hospital services in west London. He has been doing a great job in raising the issues, and has done so again today.

NHS North West London claims that its proposals, as outlined in the “Shaping a healthier future” programme, will improve NHS services for the 2 million residents of the area and save lives. As we have heard, the proposals will lead to the loss of accident and emergency departments at Charing Cross, Ealing, Hammersmith and Central Middlesex hospitals. That means that people will have to travel further for treatment. I ask the Minister: how will that help save lives, and does he agree with NHS North West London’s analysis?

It is not only my hon. Friends who are concerned about the future of A and E departments in west London; the local authorities in Ealing and Hammersmith and in Fulham are also formally opposed to the proposals and committed to fighting the downgrading of their hospitals.

We all know what happens to hospitals after they lose their A and E departments. We have seen in other cases hospitals lose their A and E departments and, sadly, subsequently become glorified health centres without proper resources to provide immediate health care to the local community.

Charing Cross hospital has a 200-year history of providing a wide range of services and is one of the capital’s largest teaching hospitals. It has one of London’s busiest A and E departments, which had 69,300 cases last year. Under the proposals, it will be downgraded to a local hospital. Ironically, while in opposition, the Conservative party often produced and perpetuated unfounded scaremongering about the future of Charing Cross hospital—my hon. Friend mentioned it in his opening remarks—yet now seems content for it to be downgraded under its watch.

It is understandable that there is such widespread concern about the proposed closures in my hon. Friend’s constituency. The whole of the borough of Hammersmith and Fulham will be left without an accident and emergency department; facilities that both the Prime Minister and the Secretary of State had promised to save as recently as last year will close. Travel times to the nearest alternatives could be far too long. As we have heard from both Government and Opposition Members, journeys to the hospitals run by the Chelsea and Westminster Hospital NHS Foundation Trust can be subject to delays of up to an hour in heavy traffic. That could put the lives of many west London residents at risk. What action does the Minister’s Government propose to take to ensure the safety of my hon. Friend’s constituents and the residents of west London as a whole?

The Secretary of Sate has not, to date, taken a clear position on the proposals, and I understand that he wrote to my hon. Friend on 3 July to say that they are a matter for the local NHS. I appreciate that the consultation closes on 8 October and that, according to the Secretary of State, no final decision will be made until early next year. The plans, however, are not only unpopular with local people; other Conservative politicians, such as Councillor Joe Carlebach of Hammersmith and Fulham council, have not refrained from taking a position and have openly voiced their opposition to the plans.

[Mr Virendra Sharma]

My hon. Friend may recall that, during his visit to my constituency, many constituents voiced their opposition to any threat to Ealing hospital.

[Andrew Gwynne]

Absolutely. I enjoyed my visit to Ealing hospital with Ken Livingstone in the run-up to the London elections, although I am not sure whether my support did Ken’s campaign much good.

[Stephen Pound]

We did win the Greater London assembly seat.

[Andrew Gwynne]

Yes, as my hon. Friend confirms, we did win the GLA seat.

Councillor Carlebach told the BBC in April:

“We have some serious concerns at closing that many A and Es in such a large region.”

The hon. Member for Cities of London and Westminster (Mark Field) has expressed similar concerns.

The scale of the problem is easily grasped when one considers that NHS North West London serves a population of 1.9 million people in eight boroughs: Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster. Does the Minister agree with the remarks made by his colleague on Hammersmith and Fulham council?

The chief executive of NHS North West London, Anne Rainsberry, has been clear on what is driving the decisions. She told the BBC in February:

“The financial challenges in London are pretty much unprecedented.”

The local Joint Committee of Primary Care Trusts has said that there will be a £332 million gap to plug by 2014-15 if no changes are made.

My hon. Friend the Member for Hammersmith, and the Labour party, are not opposed to change. He said a few weeks ago that there was

“nothing wrong with economies of scale if you can join forces and do something cheaper that provides more resources,”

and I associate myself with those remarks. The chief executive of the King’s Fund agrees that

“London’s NHS is in urgent need of change,”

but, he goes on to say,

“the risk is no-one will be in the driving seat”.

My hon. Friend the Member for Westminster North (Ms Buck) also warned about the lack of leadership and the timing of the changes when she said:

“The question is how do we get there from here at a time of chaotic reorganisation in the health service, when planning is falling apart, when north-west London hospitals alone have to save over £120m between now and 2014.”

I am afraid that what we are seeing goes much further than, and is in direct contradiction to, the Prime Minister and Health Secretary’s general election promise to halt the closures of hospitals, A and E units and maternity departments. What happened between the general election and now that caused both those right hon. Gentlemen to change their position? Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London, at a time when the NHS is being put through an unnecessary upheaval?

It is obvious from what the Government have had to say to date that Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished PCTs for the forthcoming closures. We all know what happened between the general election and now: the unpopular and, frankly, unnecessary Health and Social Care Bill—the biggest threat to the NHS in its long history—was introduced. It was a disastrous decision on the part of the Government to spend £3 billion on an unnecessary top-down reorganisation that has led to the loss of financial grip on the NHS.

In the case of west London, we are seeing another broken promise on the part of the Prime Minister, who spent millions during the general election putting up posters throughout the country reassuring the British electorate that, under the Conservatives, there would be a moratorium on hospital and A and E closures.

Does the Minister think that the proposals in the “Shaping a healthier future” document will save money in the long term? If all the closures go ahead, would that not leave Imperial College Healthcare NHS Trust with just St Mary’s hospital as a single site, and pose huge financial and practical problems for the expansion of its services to cope with the extended case load?

The Opposition warned Ministers repeatedly during the Bill’s passage that it would lead to the break-up of the NHS, and the “Shaping a healthier future” proposals seem to be a missed opportunity to improve care by reducing duplication where it occurs and ensuring that hospitals work together for the benefit of patient care.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 12th June 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

At a time when almost 4,000 nursing posts have been axed, the Sandwell and West Birmingham Hospitals NHS Trust is using unpaid jobseekers through the Government’s Work programme to perform duties such as collecting drugs and giving food and drinks to patients. Does not the Minister understand that whatever the good intentions of the scheme, most people will see this as staffing on the cheap, and that there can be no substitute for the necessary number of nurses and health care assistants in our NHS?

[Mr Burns]

First, the shadow Minister is incorrect in the number of nurses who he says have left the NHS. The figure is nowhere near 4,000, as he mentioned—[Interruption.] It is 2,693. Secondly, he denigrates a scheme where people have the opportunity, through the jobcentres, to gain familiarity with the workings of the NHS so that they can take a view as to whether they want to invest their future talents in a career in the NHS. I should have thought that that was to be welcomed, rather than snidely denigrated.

Points of Order

Andrew Gwynne Excerpts

Tuesday 12th June 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

On a point of order, Mr Speaker. During Health questions, I gave a figure for nursing redundancies. It would appear that the Minister of State gave an incorrect figure in his reply, inadvertently including midwifery and health visitor posts as well as nursing posts. If that is the case, may I please ask the Minister to correct the record?

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

rose—

EU Working Time Directive (NHS)

Andrew Gwynne Excerpts

Thursday 26th April 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

Thank you, Mr Howarth, for calling me to speak. It is a pleasure to serve under you.

I congratulate the hon. Member for Bristol North West (Charlotte Leslie), who opened the debate, and the Backbench Business Committee on granting the debate. In fact, I want to pay a particular compliment to her for the comprehensive way in which she opened the debate and put forward her case.

Clearly, the working hours of all health workers, and not just junior doctors, are incredibly important to our NHS and to the quality of care that patients receive. I am glad that we have had a chance to examine those issues in some detail today in this Backbench Business Committee debate.

It is concerning that there have been reports in the press, and indeed from Members in Westminster Hall today and on other occasions, that there are cases where locum health workers have charged extortionate amounts for short-term cover in the NHS, with the potential knock-on effect on the quality of care that patients receive. As a number of hon. Members, including the hon. Member for North Antrim (Ian Paisley), have said, that is a matter that is of particular concern, especially for small rural hospitals; that was a point that he made eloquently. It is an issue that I will explore in some detail later.

As we all know, the European working time directive is European Union legislation and it was enshrined in UK law as the Working Time Regulations 1998. Except for doctors in training and workers in certain excluded sectors, the directive has applied in full to most workers, including all employed doctors, since 1 October 1998. The directive imposed a general limit of 48 hours on the working week. However, it allowed member states to let individuals opt out of that limit if both an employer and an employee agreed. At the time of its introduction, the UK was the only country to take advantage of that measure and allow an individual opt-out. There are now 16 member states using total or sectoral opt-outs, as the hon. Member for South Northamptonshire (Andrea Leadsom) correctly stated.

Particular concerns arose in relation to the health and social care sector, and importantly in relation to the position of doctors, as well as junior doctors, who, since August 2004, were gradually brought within the provisions of the directive. From August 2004 to August 2009, junior doctors’ working hours gradually moved towards compliance with the 48-hour working week. Although junior doctors in some specialties could work a 52-hour week until 31 July 2011, most junior doctors have been subject to the average 48-hour working week since 1 August 2009 and all junior doctors have been subject to that limit since 31 July 2011.

Of course, there have been particular concerns in relation to the health sector, and importantly regarding the position of doctors and junior doctors, which have led to this debate today. Although the directive applies to other sectors as well, it has always had a particular effect on the NHS, given how night-time and weekend cover has been organised in most hospitals, as we heard from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

I note what several Members have said, particularly in relation to training. My hon. Friend the Member for Vauxhall (Kate Hoey) commented on Guy’s and St Thomas’ hospital, which is nationally and internationally renowned. The previous Labour Government commissioned the independent chair, Professor Sir John Temple, on behalf of NHS Medical Education England, to examine the impact of compliance with the directive on the quality of training. The hon. Member for Totnes (Dr Wollaston), who speaks on such matters with a great deal of experience, specifically referred to that. Although Sir John Temple’s 2010 report concluded that quality medical training can be delivered within a 48-hour working week, it also highlighted some challenges to be addressed, including round-the-clock team working. Those concerns have been echoed during today’s debate.

Other issues relating to the working times of doctors and junior doctors also need to be addressed. As Sir John Temple’s report found, there were concerns about post-graduate medical training, the objective of which is to produce fully qualified specialists who are able to provide high-quality, safe patient care. Experience of delivering services is an integral part of a junior doctor’s training. “Time for Training” highlighted some of the difficulties created for trainees and the service, especially in providing out-of-hours and weekend emergency patient care. Again, a number of Members have spoken about that today.

Some small, practical changes by employers, such as improving handovers and team-working at night, more involvement of doctors in designing their own working patterns, less reliance on junior doctors and more involvement of consultants during out-of-hours periods, have led to positive results without the need for excessive working hours. Clearly, issues remain, and I do not say that we have it right. Such matters should always be kept under review.

As I have said, the directive raises issues for health services across Europe, and Members have raised a number of concerns today about the directive’s impact on the NHS in the United Kingdom. We should consider ways to resolve those issues and be ready to work constructively with the European Commission and other member states to seek suitable solutions fit for our country’s needs.

As we know, the Commission is re-examining the directive. That is an acknowledgement that, although the legislation will remain, member states have had a number of issues with its implementation.

[George Eustice (Camborne and Redruth) (Con)]

The hon. Gentleman will be aware that in 2008 the previous Labour Government attempted to make some changes to the working time directive. The European Commission started that process, but the European Parliament voted at that point to abolish altogether the opt-out on the 48-hour maximum working week. The previous Government quickly slammed the lid and ran away from any idea of reforming the working time directive. Does he think that that was a mistake and that the previous Government should have persevered with their original intention?

[Andrew Gwynne]

The previous Government were right to attempt to have the matter re-examined. Whether the previous Government’s acceptance of the ruling needs to be reconsidered is something we are discussing today. We have a new Government, of course, and they have a responsibility to take up such matters with European Union institutions, as I would expect a future Labour Government to have the same responsibility to pursue concerns raised by this Parliament. Of course, it is incumbent on the Government of the day to try to resolve such matters with EU institutions. I accept that, were there a Labour Government instead of the current coalition, it would be right for our Government—irrespective of which party is in control—to take up such matters with EU institutions.

[George Eustice]

Does that mean it is the Labour party’s policy in opposition to seek to reform the working time directive?

[Andrew Gwynne]

The Labour party’s position is to support much of what the working time directive has brought about. Some real issues have been raised by Members of all parties in today’s debate. I recognise a lot of the issues and concerns, and it is incumbent on the Government of the day to resolve such matters to best suit the needs of the member state—in our case, the needs of the NHS throughout the United Kingdom. We support the working time directive, however, and its positive achievements, which have not been touched on to a great extent in today’s debate. There have been some positives.

We therefore have reservations about changes to the European working time directive. High-quality, safe patient care and the maintenance of further enhancement of the quality of training and education for junior doctors are important. I note the issues raised today, and specific areas must be looked at. We heard concerns about the maintenance of training standards, but patient safety must be paramount, and we should co-operate with all interested parties to develop sensible, workable and achievable solutions to the problems. If we allow a relaxation of the European working time directive for junior doctors, the danger is that we run the risk of a gradual return to their working dangerously long hours. I urge the Government to tread carefully because as the hon. Member for Bristol North West said, to be fair, some aspects of the working time directive had laudable aims. As was echoed in a number of contributions today, we do not want to see a return to the dangerous working hours worked by some doctors in the past.

[Charlotte Leslie]

Does the hon. Gentleman acknowledge that even if we relax the working time directive, with its detriments to the NHS, doctors would still be bound by the new deal and the 56-hour week? I see no return to the bad old days while the new deal is in place, although I think it, too, needs looking at again.

[Andrew Gwynne]

I shall come on to the new deal shortly, but no one would want to go back to the past with tired doctors working excessive hours. Many Members recall the very real horror stories that surfaced from time to time, in particular through the 1980s and early 1990s, when it was not uncommon for junior doctors to be working a 100-hour week, as we have heard in the debate. The hon. Member for Totnes called on her personal experience and the hon. Member for Stafford (Jeremy Lefroy) called on his domestic experiences from the past to make some reasonable points about the stress and strain that the old ways of working placed on doctors. I was reassured by their comments that they did not want to see a return to those days.

An article in the BMJ, the British medical journal magazine, looking at the effects of the working time directive, suggested that it was hard to draw firm conclusions. It also found that reducing working hours to fewer than 80 a week had not adversely affected outcomes for patients or in postgraduate training in the USA, where similar restrictions were introduced. As we heard from my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), the systematic review found the same, and that cannot be discounted because it does not necessarily fit some arguments. I do, however, take full account of today’s anecdotal evidence from Members, although it might well be wise to look at the wider, long-term implications of relaxing some of the directive’s conditions.

If we go back a number of years, to the 1990s, the new deal tried to establish that full shift working should not exceed 56 hours. Through the 1990s, compliance with the new deal was poor, so a new contract was introduced in 2000. The implementation of the Working Time Regulations for employed doctors in the training grades has helped to protect doctors from working dangerously long hours, improving patient safety.

I accept, as we have heard from several hon. Members, that press reports of locum doctors costing hospitals and the NHS some quite extortionate amounts are concerning. Some reasonable points were made by the hon. Member for Central Suffolk and North Ipswich, who speaks with experience on these matters, about the clocking off and clocking on culture, which is certainly a concern. Clearly, questions must be raised about spending so much public money in these financially restricted times, and we need to know what will be the knock-on effect for the quality of patient care, especially if patients are continually seeing different doctors every time.

The Minister, in answer to the hon. Member for Kingswood (Chris Skidmore), mentioned the 11% drop in the use of locums since May 2010 and the increase in the number of doctors, which is welcome. I will just make the point that those extra doctors were trained and came through the system under the previous Labour Government. It would be churlish of the current Government not to recognise that as they take some political capital. May 2010 was not month zero; those doctors were coming through the system previous to that.

This debate has been a positive step. As we have heard, a number of issues surround health workers, especially junior doctors, and I agree that they should be further examined as we seek ways to resolve the problems. However, we should approach with some caution the idea of relaxing some of the directive’s conditions in relation to junior doctors as in the longer term it might cause more problems than it solves.

In closing, I refer to the opening comments of the hon. Member for Bristol North West in which she said that we all value the expertise and professionalism of NHS staff and that the aims of the working time directive were very reasonable. Long hours were dangerous for both doctor and patient and we do not want to return to those days. She is right. Although we recognise that there are issues to consider in relation to staffing implications and the cost to the NHS, we do not want to see the positives that have been secured disappear. I look forward to hearing from the Minister an indication of the current Government’s thinking on how to strike that important balance for those working in our medical and clinical professions in the NHS. I feel a bit like Daniel in the lion’s den. I urge the Minister to tread cautiously, and I mean that with all sincerity. Yes, there are some issues, but he really should resist the knee-jerk reaction of his party’s anti-EU wing, which is probably its mainstream. He needs to look holistically at the issues, the concerns and the benefits.

Mental Health Care (Hampshire)

Andrew Gwynne Excerpts

Wednesday 18th April 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship as always, Dr McCrea, and to contribute to this important debate. I commend the hon. Member for New Forest East (Dr Lewis) for ensuring that this issue is raised in Parliament and for the comprehensive, forceful and eloquent case that he and his colleague, the hon. Member for Romsey and Southampton North (Caroline Nokes), made for protecting services in Hampshire. After contributions from his colleague from the not-quite-neighbouring county of Staffordshire, the hon. Member for Burton (Andrew Griffiths), and from Northern Ireland—the hon. Member for Strangford (Jim Shannon)—we are indeed a United Kingdom in making the case for adult acute mental health care beds.

Given the huge changes that are going on in the NHS, it is important that we do not forget those who are genuinely most in need. Mental health services and mental health provision have often been referred to as the Cinderella service. It is crucial that the provisions for those with mental health needs do not slip down the gaps in health care provision.

The hon. Member for New Forest East forcefully raised local concerns about the plans of the Southern Health NHS Foundation Trust, and he is right to do so. This debate is important, because statistically one in four of us will experience a mental health problem in our lifetime—an example of how we live our lives in the 21st century. Mental ill health will soon be the biggest burden on society, both economically and sociologically, costing some £105 billion a year. The World Health Organisation predicts that, by 2030, more people will be affected by depression than any other health problem.

The previous Labour Government made important progress on mental health, with the national service framework early on and the improving access to psychological therapies programme towards the end. But we must also look to the wider challenges of modern life. People are living longer, less stable, more stressful and isolated lives. It is clear that there is still a tendency not to talk openly about mental health. The stiff-upper-lip culture is ingrained in our society, at home, in our work places and, yes, even in Government and Parliament.

The challenges of 21st century living demand a rethink in our approach to mental health. We need to consider a number of issues. For people to get the support that they need from the NHS to live full and economically active lives, and if it is to be sustainable in the 21st century, mental health must move from the edges to the centre of the NHS. Also, we can no longer look at people’s physical health, social care and mental health as three separate systems. They must be part of one vision for a modern health care system. Changes in our public services will be successful only if matched by a wider change in attitudes towards mental health.

We need to pay attention to and look at the stigma surrounding mental health, because not only must people face the direct effects of depression but their problems can be compounded by the reactions of others. People do not feel able to admit to having a problem that could change their employment and prospects or lose them their friends. With most illnesses, people get a sympathetic shoulder to cry on, but with mental illness, they may get the cold shoulder. Even if people admit a problem, family and friends might not know how to advise them adequately. The public debate that has been so powerfully led by Stephen Fry, Frank Bruno and others is therefore tremendously important. It is essential that the excellent “Time to Change” campaign, led by Mind and Rethink and funded by the Department of Health, ultimately prevails.

The specific issue of today’s debate was put so eloquently by the hon. Member for New Forest East. I do not wish to stray into the politics of Hampshire’s health overview and scrutiny committee, nor into the internal politics of the local Conservative party—fun though that might be—but he made some important points. It would be helpful if the Minister clarified whether he has seen any meaningful assessment of how many mental health beds there should be in Hampshire. Of course, trusts all over the country have to make efficiency savings, but cutting front-line services and making efficiency savings are two very different things. So although I understand the need for referral from the health overview and scrutiny committee to the Minister, has he been able to analyse whether there is an adequate supply of beds for mental health patients throughout the county of Hampshire, particularly if required in an emergency admission? Is there adequate capacity? If so, has there been an assessment of future operations with the reduced beds available?

I ask those questions not least because the hon. Member for New Forest East made it clear that the statistics that he had obtained contradict the statistics that have been put forward by his local NHS trust and that are being used by the health overview and scrutiny committee. To move forward, we need certainty, clarity and confidence in those statistics, so that decisions made locally are based on sound statistics. We will see more instances of trusts forced to make difficult decisions. Indeed, we have heard what is happening in other parts of the country today. Such decisions will undoubtedly have real consequences for the care received by patients, not least because of the combined effect of the Nicholson challenge, set in train by the previous Government, and the huge top-down reorganisation pushed through by this Government under the Health and Social Care Act 2012.

Finally, mental health is an equality issue, and social progress in the 21st century depends on us waking up to that fact. Children from the poorest 20% of households are at a threefold greater risk of mental health problems than children from the most affluent 20% of households. We will only have a fairer and more equal society in this century if we work to change attitudes to mental health and to look at a whole-person approach to health care, so that the problems that we might all face at some point in our lives do not stop us from reaching our potential. Again, I commend the hon. Gentleman for putting his case for mental health in Hampshire so forcefully. I, too, look forward to the Minister’s response.