Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

All these things have to be evidence-based. I am reminded of the evidence that the chief medical officer gave recently on this subject.

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

A freedom of information survey by Labour showed that cancer networks saw their funding cut by 26% between 2010 and 2013 and lost 20% of their work force over the same period, losing vital skills and expertise along the way, despite repeated reassurances from the Government that funding for clinical networks would be protected. Even more shockingly, all this is happening at a time when the Department of Health has handed back £2.2 billion to the Chancellor of the Exchequer. How can the Minister justify handing vital NHS funding back to the Treasury when cancer networks are being cut, specialist staff and skills are being lost and thousands of nurses are being axed?

[Anna Soubry]

I think that that was about four questions in one, but I would certainly dispute all that has been said. Let me make this absolutely clear: we know that there was great success in the cancer networks, which is why we have extended them, so that they now include, for example, dementia and mental health, and far from cutting the overall money going to all the strategic networks, we have increased it by 27%.

Heart Surgery (Leeds)

Andrew Gwynne Excerpts

Monday 15th April 2013 Commons Chamber

[Mr Hunt]

I do pay tribute to the staff at Leeds and to the families of patients. I recognise that this is an issue of huge concern. As my hon. Friend rightly says, they have behaved with great dignity in a difficult situation. I also pay tribute to him for the responsible way in which he has behaved in this difficult situation, as have many Leeds MPs.

My hon. Friend will understand, given that the NHS nationally was provided with data that suggested that mortality could be up to 2.75 times greater at that unit and given that there was a potentially busy holiday weekend ahead, when it did not know how complex the cases would be and when there were locums on the staff rota who may or may not have been up to the standard of the permanent staff, that Professor Sir Bruce Keogh had genuine concerns that led to his decision. But I hope the fact that surgery was restarted on 10 April will assuage my hon. Friend’s worry that the initial decision was linked to the Safe and Sustainable review—it was not; it was a concern about patient safety and because that concern has been addressed, surgery has restarted.

There were, however, issues about the quality of the data, which at least in part was because the hospital was not supplying data properly in the way it needed to. That was one reason why the mortality data were not as accurate and good as they should have been. Although I entirely agree that patient safety must always come first, and not NHS or national politics or whatever it may be, that also means that sometimes difficult decisions have to be taken. What happened at Mid Staffs, where we had a big argument about data that meant nothing happened for too long, and what happened originally at Bristol, where up to 35 children may have lost their lives, is a warning about the dangers of inaction. On this occasion, I think that overall the NHS got it right.

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

First, let me apologise to the House on behalf of my right hon. Friend the Member for Leigh (Andy Burnham) who cannot be here today because he is in Liverpool attending the memorial service for victims of the Hillsborough disaster.

This situation has descended into yet another trademark Government shambles. Just 24 hours after the High Court announced that the decision to close the children’s cardiac unit at Leeds was “legally flawed”, Leeds Teaching Hospitals NHS Trust was effectively instructed to stop surgery. The timing of the decision was strange to say the least, but to quote the head of the central cardiac audit database:

“It rings of politics rather than proper process.”

We now know that the instruction was based on incomplete and unverified data, and that Dr Tony Salmon, president of the British Congenital Cardiac Association, was “very concerned” at the way the data were being used, and that any conclusions drawn from the data were “premature”. The Opposition are therefore pleased that this urgent question has been granted as the House clearly deserves some answers.

First, the Secretary of State needs to outline to the House exactly when he was informed that NHS England had concerns about the centre, and say whether he gave his approval to suspend surgery there. If so, was he satisfied that the data presented were accurate and had clinical support? On the issue of data, why did it take this recent episode at Leeds for the information to be released into the public domain—information that my hon. Friend the Member for Leicester West (Liz Kendall), and others, had asked to be released for some time?

Secondly, does the Secretary of State accept that the suspension of surgery, with all the consequent anxiety that it caused patients and staff, was at best a mistake and at worst an irresponsible and disproportionate action? Thirdly, does he accept that the timing of the decision to suspend surgery so soon after the High Court’s ruling caused a great deal of suspicion in Leeds and gave the distinct impression that it was a political decision and not based on clinical evidence? Finally—this point goes beyond Leeds—the Health Secretary’s record so far has failed to inspire confidence in the process of reconfiguration. Will he therefore conduct an urgent investigation into Leeds and how this happened, and consider what lessons can be learned from this unedifying episode for the children’s cardiac review and future reviews?

We owe it to the dedicated staff who work in our NHS to ensure that whatever disagreements we may have in Westminster, and whatever our politics, we do not hinder their ability to provide high-quality care to patients. We also owe it to patients and their families not to add to the anxiety and stress of undergoing treatment. On both those counts the Government have failed, and I hope that when the Secretary of State returns to the Dispatch Box, he will have the decency to apologise and start answering these very serious questions.

[Mr Hunt]

I am afraid the hon. Gentleman has let the Labour party down with the total inadequacy of that response. He spoke of an irresponsible and disproportionate decision, but I ask him to reflect on that as someone who would like to be a Health Minister. Would he seriously have wanted anything different to happen? If the NHS nationally is informed of data that show that mortality rates at a particular hospital could be up to three times higher than they should be, would he sanction the continuation of surgery, or would he say, “We need to get to the bottom of the statistics before deciding whether there will be any more operations”? If he is saying that he would have wanted surgery to continue, I put it to him that he and his party have learned nothing from the lessons of Bristol and nothing from the lessons of Mid Staffs. I did not authorise the decision, but wholeheartedly supported it because it was an operational decision made by NHS England. It is right that such decisions are made by clinicians, who understand such things better than we politicians do.

On reconfigurations, the hon. Gentleman’s party closed or downgraded 12 A and Es and nine maternity units in its period in office. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), has said that Labour would not fall into the “easy politics” of opposing every single reconfiguration, but that is exactly what the Opposition are doing. It is not just easy politics; it is what Tony Blair last week called the “comfort zone” of being a “repository for people’s anger” rather than having the courage to argue for difficult reforms.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

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

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

[Mr Hunt]

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

Backbench business

Andrew Gwynne Excerpts

Thursday 14th February 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Walker. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this important debate, particularly as we mark eating disorders awareness week, and on the extremely powerful case that she made in opening the debate. I, too, want to commend the work of the all-party parliamentary group, because it has ensured that this debate has been incredibly well informed. The debate has provided us with an opportunity to highlight the issue not only in Parliament, but, hopefully, in the media and the wider health sector, including among national health service staff, so that we can all examine what more we can do to help those with eating disorders. I also commend the personal contribution of the hon. Member for Braintree (Mr Newmark), who showed extreme courage in sharing his experiences with us today. He has really helped to inform the debate, and I thank him for sharing those personal experiences.

I pay tribute and offer my appreciation and thanks to Beat, a national eating disorders charity, and it would be unfair not to mention also Anorexia and Bulimia Care, and some of the other local charities that hon. Members have mentioned. According to Beat, eating disorders affect 1.6 million people in the United Kingdom, which is one in 39 people or 2.6% of the population. Statistically, that means that around 2,000 people at a top premier league club home game will have an eating disorder; 11 passengers on a jumbo jet; or more than 200,000 people here in Greater London. Therefore I am pleased that, throughout eating disorders awareness week 2013, Beat will highlight that the illnesses are far more common than perhaps most people would think or appreciate. The theme of this year’s campaign is “Everybody knows somebody”. It is a laudable aim of the campaign to encourage people to reach out to others—whether a partner, colleague, best friend, brother or sister—to talk about the illnesses, to express their concerns and to seek help before they reach hospitalisation stage.

Eating disorders primarily affect young women aged 18 to 25, but of course not exclusively. Most people would consider them as a young girls’ disease, and there is a great deal of stigma and misunderstanding still attached to the issue. Conditions such as anorexia, bulimia, binge eating and compulsive overeating have high mortality rates for mental health illnesses. Up to 20% of those affected may die prematurely. I was interested in the contribution of my right hon. Friend the Member for Knowsley (Mr Howarth) regarding diabulimia, which is something I was not aware of, so I thank him for sharing that with us today.

As we have also heard, an increasing number of men—some 20% of those affected—have an eating disorder. An important contribution was made by the hon. Member for South Basildon and East Thurrock (Stephen Metcalfe) in highlighting that issue. However, there can also be issues with older people, particularly the elderly and frail, for whom recognising an eating disorder may be problematic. Beat is right that the problem can affect anyone at any time in their life.

The media have a central role to play in the issue and, in many ways, have a great responsibility. Some media images of excessive thinness must play a large part in encouraging, particularly, young people to aim for an unrealistic body weight and risk becoming anorexic. What has perhaps been more worrying is the recent trend in social media that could encourage eating disorders. The hon. Member for Romsey and Southampton North and others have raised that issue in their contributions. I am a father of three young children. I have two sons—one has a birthday today; he is a teenager, because he is 13—but I worry particularly about my daughter, who is 11 and very conscious of some of the unrealistic images that she gets bombarded with. It is a concern of mine, as a father, and no doubt of other hon. Members who have children. I can see how the problem could start to escalate. There were concerns earlier this year with online sites such as Instagram, which appeared to allow users to view pictures encouraging eating disorders and self-harming. According to press reports, some of the messages on the website encouraged people not to eat. That is incredibly concerning, because Instagram has more than 80 million users worldwide. The growing influence of a variety of social media and the popularity of phone apps give people, especially young people, access to images that encourage the individual to believe that an eating disorder—we have heard this in the debate—is a lifestyle choice. Surely that is wrong, especially as the number of hospital admissions for eating disorders is growing.

A report last year from the health and social care information centre shows that the number of hospital admissions for eating disorders has risen by 16% to 2,288, a point that was eloquently made by my hon. Friend the Member for North Tyneside (Mrs Glindon).Of those admissions, 203 were men or boys. The statistics also reveal that more than 50 under-10-year-olds were admitted to hospital with an eating problem, and the biggest increase in admissions was among girls aged 10 to 15, which are up 69% since 2011. We must recognise that social media and pro-anorexia sites can affect those who may already be vulnerable to eating disorders and who already feel pressured. I am pleased to see that there have been at least some positive changes in the media. Last year, Vogue announced that it was banning models with visible signs of eating disorders from its glossy pages, and the editor of British Vogue pledged not to use any models under the age of 16, thereby helping to project an image of healthy models.

I also notice that Channel 4, alongside other broadcasters, has actively sought to raise awareness of body image issues, including a wide range of eating disorders, among its audiences through a number of programmes and online projects such as “Gok’s Teens: The Naked Truth”, which looked at British teenagers and offered advice on how to address their issues and anxieties, focusing particularly on teens suffering from body dysmorphia and anorexia. The programme also included an examination of the impact that the media and internet can have on young people’s body image. Clearly, the more programmes that highlight those problems, the better the chances of eliminating stigma and increasing understanding among the wider public. Media and social media have a role to play in addressing all of those issues, and I hope that media organisations work closely with eating disorder charities to introduce more positive stories and messages.

People who are experiencing an eating disorder often feel alone and need to be provided with good advice. We need to bring an end to the stigma surrounding the condition. There is also a need for good advice for those who may be able to spot the symptoms, such as family members or teachers, so that we can ensure that people are aware of the problems. Of course, the media have an important role to play in highlighting that. The symptoms of an eating disorder include finding reasons to skip meals, avoiding family meals or expressing a wish to eat alone, being noticeably self-conscious about body image or becoming very withdrawn. Those are all known warning signs. Clearly, anything that can help to identify the risk signs and help those affected to confide in parents or teachers can only be positive. We know that the sooner people come forward, the sooner treatment can start and the better the outcomes. Of course, we should also consider how to raise awareness in the national health service and to ensure that staff know about such conditions, can identify the signs of an eating disorder and are able to offer the right treatment as early as possible. We should consider how to ensure that all health professionals are fully aware of the symptoms.

This is not the time or the place to make political points. The Minister knows the concerns of Opposition Members about the new NHS structures, but I urge him, in the spirit of co-operation—the hon. Member for Romsey and Southampton North made this point in her opening contribution—to ensure that the commissioners within the new NHS structures take seriously the needs of those who may be at risk from eating disorders and ensure that their needs are seen in the round, because often a holistic approach to their health care needs is required. GPs, as commissioners of services, may not always recognise the symptoms of eating disorders. People must continue to receive the help they need when they need it. My right hon. Friend the Member for Knowsley, and the hon. Lady in an intervention, mentioned the treatment of diabulimia, which starkly highlights the issue. The experience outlined by the hon. Member for Enfield, Southgate (Mr Burrowes) further reinforced those concerns.

I hope that when people are diagnosed with an eating disorder they get the help they need. Clearly, different people will require different treatments, and in some cases they will need access to mental health services. When Opposition Members talk about whole-person care, we mean not only the adult social care needs of the elderly but all society’s health needs. Eating disorders are an important issue that should be included within the concept of whole-person care.

There is an increasing incidence of eating disorders among men, and both men and women are influenced by what they see in the media. Indeed, as reported in the Nursing Times, NHS figures show that there has been a 66% increase in hospital admissions for male eating disorders during the past 10 years. That rise has been blamed on the increasing pressure on men to look good, with the media again having a central role. The eating disorder charity Beat has said that men’s reluctance to be open about their health is hampering efforts to address the problem. Again, I commend the hon. Member for Braintree for his contribution to today’s debate. We should bear in mind that resources and treatments for eating disorders are relevant to both male and female patients.

I have a couple of questions for the Minister, the first of which is on monitoring eating disorders. At present, as I understand it, the Government do not collate national statistics on the number of people affected by eating disorders who seek treatment. That would be a useful tool for assessing the overall need and geographical breakdown of eating disorders. What plans does he have in place to begin monitoring eating disorders? Likewise, does he plan to review the guidance on eating disorders issued by the National Institute for Health and Clinical Excellence under the previous Government?

There is overwhelmingly broad agreement on both sides of the House that identifying eating disorders as soon as possible is important and that people should receive appropriate treatment as soon as possible, too. Again, I pay tribute to the work of eating disorder charities and the all-party group on body image, which have done so much to highlight the issue. Although they have done a great deal, there is clearly so much more that society can do to take on this challenge and to ensure that we all work together to prevent more tragedies and blighted lives.

Hospital Services (South London)

Andrew Gwynne Excerpts

Tuesday 22nd January 2013 Westminster Hall

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

It is a pleasure to see you in the Chair, Dr McCrea. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this incredibly important debate. The future of accident and emergency and maternity services across south London is of genuine concern to a great many of her constituents and, indeed, for the wider area, as this is definitely an issue of real significance across the capital. I know from a meeting that I chaired with Labour colleagues before Christmas that it goes to the heart of their communities. I applaud the way in which my hon. Friend the Member for Lewisham East, our right hon. and hon. Friends and others from across the party divide have put together a campaign that highlights their constituents’ concerns in such a high-profile and persuasive manner.

It has long been accepted that difficult decisions might well be needed to secure the sustainability of health services in south-east London, as the challenges facing South London Healthcare NHS Trust are complex and of long standing. As we have heard, the proposals to close the A and E and downgrade the maternity unit at Lewisham hospital are intended to assist a neighbouring hospital trust to find its way out of significant debt problems. It is a highly controversial procedure, to say the least, because Lewisham hospital, as we have heard, is well respected and well managed and recently underwent a £12 million refurbishment.

The proposals also introduce wider considerations that could affect the whole of south London’s health care. At the same time as the trust special administrator has been reviewing services at South London Healthcare NHS Trust, plans for changes to management structures and the merger of services have been progressing, led by King’s Health Partners and three foundation trusts—King’s College hospital, Guy’s and St Thomas’s and the South London and Maudsley—in conjunction with King’s college London.

Any plans for the whole area need to take full account of all the potential knock-on effects on the quality of care that people receive, and they need to consider how the merger plans will affect the health economy right across south-east London and potentially limit other long-term options for changes in south-east London. The figures provided by my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) illustrate the real problems associated with some of the changes being presented today: a 45% increase in emergency admissions and a 54% increase in births at King’s if Lewisham closes. Those huge capacity issues would need to be resolved. The Minister needs to look carefully at those figures.

As we have heard today, there are real concerns among the local Members of Parliament about the future of services at Lewisham hospital, so much so that recently a delegation of local doctors and my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East presented a petition against the closure of Lewisham’s A and E and maternity departments to 10 Downing street. In only five weeks, the petition against the changes has been signed by more than 32,000 people, and the numbers are still growing.

We have also heard that, as part of the campaign, there have been a number of protest marches against the closures. I believe that there will be one this weekend. I am sure that that will attract equally heavy support as the earlier ones, which I believe from my right hon. Friend the Member for Lewisham, Deptford took place in rather grotty weather. Notwithstanding the snow that there may be this weekend, I am sure that the good folk of Lewisham will still be out in force.

[Bob Stewart]

I am intervening quickly to support what my friend—I call him that despite his being on the Opposition Benches—the hon. Member for Lewisham West and Penge (Jim Dowd) has said. This is a matter of fairness. It seems extraordinary that failing hospitals are being supported and allowed to continue essentially as they are, but Lewisham—a wonderful hospital that is within budget and is gaining an increasing reputation— is being kicked, slashed and destroyed. I just do not see that as right. It is a matter of fairness.

[Andrew Gwynne]

The hon. Gentleman is absolutely right. It is also telling that a very substantial number of GPs, including the chair of the new clinical commissioning group and the head of every single clinical area in the hospital, have written to the Prime Minister to express their concerns about the proposals. That clearly shows that the proposals do not have the support of local clinicians. I urge the Minister to read the very passionate article in Saturday’s Guardian online by Lucy Mangan as well. That helps to address some of those points.

As we have heard, more than 120,000 people visit the A and E at Lewisham hospital each year and more than 4,000 babies are born in the maternity department. With the prospect of the A and E being closed and the maternity unit being downgraded, a number of worries have quite rightly been expressed, not least because, as we have heard from my hon. Friend the Member for Lewisham East in the debate, Lewisham’s population is estimated to rise significantly in the next few years as a result of the huge increase in the birth rate.

As I have said previously, there is no doubt whatever about the unanimity among the professionals and the population about the importance of maintaining services at Lewisham hospital—something that Ministers have always stressed they would fully take on board. As we have heard in the debate today, the right hon. and hon. Members who represent the areas affected believe that the plans are based on inaccurate data and flawed assumptions and that the whole issue has been misunderstood and largely mishandled.

We have the final report from the trust special administrator, urging this closure at Lewisham, and the Secretary of State is to make the final decision by 1 February. However, it is difficult to understand how the Government can consider that that report constitutes a full strategic review of the sustainability of services across south-east London. Labour Members believe that the trust special administrator has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital. In addition, the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.

It is quite concerning when the rules on making changes to hospitals seem to have been changed to allow back-door reconfigurations in the way that I have described, without the proper scrutiny and consultation that would ordinarily take place. Indeed, the trust special administrator used powers passed by the Labour Government in a way that was never intended. I take the point made by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). Nevertheless, what has happened sets a worrying precedent whereby the normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services could be pushed through. This is a worrying situation, as it takes the NHS over a very dangerous line and is potentially the first back-door reconfiguration in that manner. If it is allowed to go ahead in that way, it could mean that any hospital services could be changed for purely financial reasons, which has never been the case in the past. We need to ask where the clinical case for change is in these proposals.

The 2009 Act clearly says that administrators must make recommendations relating to the trust that is failing. That has not happened in this case. Reconfigurations need to be based on solid clinical evidence that they will save lives. Where there is a clear clinical case, I think that that is right, and we should look carefully at changes before deciding whether we should oppose them. However, the TSA’s actions are leaving a very confusing and worrying situation surrounding hospital reconfigurations.

My hon. Friend the Member for Lewisham West and Penge got it right. We are starting to see a situation in which primary care trusts are moving quickly to try to secure service changes before the clinical commissioning groups take over, and it is becoming all too clear that it is financial pressures that are starting to lead to closures and health service changes. That is clearly wrong.

On the four tests for reconfigurations, does the Minister really think that they have been fully met and does she believe that this change has the support of local commissioners?

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.

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

One of the biggest drivers of patient experience on hospital wards is the dedication and care of the nursing staff, but, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, the Care Quality Commission has identified 17 NHS hospitals that are operating with unsafe staffing levels, putting vulnerable patients and especially older people at risk. Frankly, it is the Secretary of State’s job to ensure that every NHS hospital operates with safe staffing levels, so does he now think it was a mistake to strip out almost 7,000 nursing posts from our NHS?

[Mr Hunt]

It is my job, and that is why the Government have protected the NHS budget. The hon. Gentleman’s Front-Bench team, on the other hand, want to cut it in real terms. He has to think carefully before he starts talking about all these so-called cuts, given that his shadow Health spokesman wants to cut the NHS budget in real terms. [Interruption.] That is what he said last December. I agree with the Care Quality Commission that it is totally unacceptable for hospitals to have unsafe staffing levels. The commission also said, however, that budgets and financial issues were not an excuse, because those budget pressures existed throughout the NHS and many hospitals were able to deliver excellent care despite them.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Hunt]

We are making good progress on the Nicholson challenge. This year we expect to save £5.8 billion under that important programme to improve efficiency in the NHS so that we can treat more people.

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

The Secretary of State cannot have it both ways. Is he aware that in the past year alone Monitor spent more than £9 million on NHS transition costs, with a staggering £5.6 million of that being squandered on management consultants? Is this not a further sign of a Government with their priorities all wrong, wasting precious public money on management consultants to push through a reorganisation that nobody wanted, while they are handing out P45s to our nurses?

[Mr Hunt]

If the hon. Gentleman is shocked at consultancy spend in the NHS today, he will be even more shocked to know that it was nearly double when his party was in power.

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.