NHS Funding

Andy Sawford Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Sawford (Corby) (Lab/Co-op)]

My right hon. Friend will be aware that my constituents have similar concerns about the future of their local hospital in Kettering, despite assurances that changes are being driven by the best clinical advice and guidance and by clinical outcomes. Contrary to the unrecognisable picture described by those on the Government Benches, we know that the cuts in Kettering hospital’s services, which will affect my constituents in Corby and east Northamptonshire, are a result of a £48 million deficit that is a direct result of the Government’s policies. Does my right hon. Friend share my concern that this is about those cuts in funding rather than the clinical outcomes?

[Dame Joan Ruddock]

I thank my hon. Friend for his intervention. If all hon. Members are honest in providing a record of what is happening on the ground, we will see that the reality is, indeed, cuts and reductions in services.

It is a case of not only how much money we spend on the NHS, but how wisely we can spend it, and there may be agreement throughout the House on that. [Interruption.] I say to the hon. Member for Beverley and Holderness (Mr Stuart) that just four years ago, Lewisham hospital gained a new wing through a successful and affordable private finance initiative contract. Just two years ago, a state of the art new birthing centre was opened, and only in April of this year the £12 million refurbishment of the A and E department was completed.

Now, however, the trust special administrator proposes to close both the full A and E service and the full maternity service at Lewisham hospital. The consequence of closing the A and E department and replacing it with an urgent care centre means the closure of the intensive care unit, the coronary care unit and the acute medical and elderly medical services. Every year, more than 13,000 people benefit from those acute services, 4,500 babies are born in the maternity unit, and more than 120,000 people use the A and E department.

The proposals are, to be frank, catastrophic—they will remove vital services from a growing population of more than 270,000 people. This is an accountant’s solution to a problem that does not even exist in Lewisham itself. Not a single constituent, patient, GP or hospital specialist has come to me in support of the plans.

My colleagues, Lewisham hospital trust and I are not opposed to change aimed at greater efficiencies and higher standards. Indeed, that was the Labour Government’s policy and philosophy for the NHS all along. We know that closures of small hospitals have led to safer services. We know that paramedic services and blue-light ambulances taking people to highly specialised centres save lives every day. We also know that the NHS could be more efficient, but there is no evidence that the needs of Lewisham people for A and E or maternity services can be safely met elsewhere in south-east London. All other existing provision is full to capacity, and travel from most of Lewisham to Woolwich is highly problematic.

The TSA report is full of assertions and aspirations that are completely divorced from the realities of people’s lives in a borough that contains some of the most deprived wards in the UK. If the proposals were to go ahead, the 750,000 residents in the boroughs of Lewisham, Greenwich and Bromley would be dependent on a single A and E department. As the report says, hospitals are part of a bigger NHS family, which is why the Secretary of State must look at London as a whole. It cannot be just or sensible to try to find enormous financial savings to rescue one health trust by destroying another.

The public have had just 30 days to respond to the extraordinary proposals in what is a deeply flawed consultation process, but such is the anger that more than 32,000 people, including more than 100 local GPs, had added their names to a petition started by my hon. Friend the Member for Lewisham East (Heidi Alexander) by the time we presented it to No. 10 last Friday.

Last week the trust board of Lewisham hospital issued its response. It supports in principle the merger of Lewisham with Queen Elizabeth hospital in Woolwich, and I must say that that is worth considering, but the trust says:

“We are concerned that the financial modelling completed by the TSA team at pace will include errors that will work against financial viability of the proposed Lewisham Healthcare NHS Trust and Queen Elizabeth hospital reorganisation.”

That would simply repeat the history of the hospitals in the South London Healthcare NHS Trust that have had continuing financial problems.

The trust board goes on to say:

“The TSA process has made it impossible to have the engagement and involvement that proposals such as these would normally warrant, and our clinicians do not feel they have been listened to in this process.”

The rest of its submission to the TSA is entirely damning. It says:

“We do not believe there is a convincing case for the major change of services proposed in Lewisham. The TSA has overlooked the significant role that LHT provides in the broader provision of services to local people. The TSA recommendations will result in worse, rather than better, care for the people of Lewisham. We believe a health and equalities impact assessment would show this but has not yet been completed—a significant weakness of the TSA Report.”

When the Secretary of State comes to view the TSA’s report, whatever form it takes, I urge him also to review all of the evidence that has been presented by local people, local experts, local consultants, GPs and the hospital trust itself. As the local Save Lewisham Hospital campaign says, this is not a difficult decision for the Government—it is potentially a deadly one. I urge him to give the most careful consideration to what is being said. The criticisms are damning and we have absolutely no faith in the proposals that the TSA will put before him.

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[Mr Dorrell]

I have made the point more than once that we should look across the traditional divide between the national health service and the social care system towards a health and care system. The only way of responding to the efficiency challenge that the right hon. Member for Leigh was the first Secretary of State to set out—what the Select Committee has described as the Nicholson challenge—is to rethink the way in which services are delivered across the health and social care divide. The National Audit Office, another independent body, has stated that 30% of non-emergency hospital admissions are avoidable—not unnecessary, but avoidable. We need decent community-based services that meet the demand early in the development of the condition to avoid the unnecessary development of acute cases that have to be treated though hospital admission.

[Andy Sawford]

The right hon. Gentleman has been a vocal advocate for a long-term solution to the issues relating to the integration of health and social care. I have enjoyed engaging with him on those issues in the past. Does he agree that it is incredibly disappointing that we are not making the progress that we should be making in finding consensus on the future of social care funding and, in the short term, on diverting more funding, particularly from NHS underspends, to prevention?

[Mr Dorrell]

I agree completely with the hon. Gentleman’s characterisation of the challenge. I was looking forward to him congratulating the Government on taking a step in the right direction, although it is not a total solution, by investing in prevention some of the resources in the health care. [Interruption.] The hon. Gentleman indicates that it is only a little and that it should be more.

We need to look across the statutory divide that reflects history, but not the demands of today’s generation of patients. The key thing that we must recognise in the debate about health and care is that we have inherited a system, which all of us have supported through most of its history, that is built on the assumption that the typical patient will be restored to good health. In Bevan’s day, that was true of the typical patient in the health and care system, but it is not true of the typical patient in today’s system. The majority of the resources in today’s health and care system go towards delivering care to people who will not be restored to full health. That, not surprisingly, requires a different set of institutions, shaped in a different way from the institutions that we have inherited from history.

The challenge that faces all of us in this House who care about the health and care system is not to protect the different bits of the system as though they were listed buildings, but to change the system so that it uses today’s technologies to meet the needs of today’s patients. That is the core challenge that faces my right hon. Friend the Secretary of State and his colleagues and, if I may say so, the right hon. Member for Leigh and his shadow ministerial colleagues.

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[John Pugh (Southport) (LD)]

While you were not in the Chair, Mr Speaker, you missed a lively and interesting but predictably arid debate. We have reached a kind of stalemate. Those who understand the dark art of political messaging tell me that it is important to say the same things again and again, and psychologists tell me that those who do that are more likely to be believed. Prior to the election, the Tories were unique in having as an important part of their messaging the wish to ring-fence and preserve NHS spending.

That message was then embodied in the coalition agreement and has influenced subsequent spending decisions. We all recognise that there are good reasons for that—the NHS is a demand-led service. It is therefore perfectly sensible, in the Westminster bubble, for the Opposition to make an issue of it. Members have come to the debate with predictable information from the Whips-SpAd axis about the private finance initiative, the misdemeanours of Wales, evidence of unexpected service rationing, reconfiguration trouble, positive and negative variations in waiting lists and ambiguous data on productivity. We have all been given that stuff, and we can use it as we wish.

Meanwhile, the public have clocked that we have a real problem. The demands on and expectations of the NHS will continue to rise, resources are tight and there will potentially be a huge problem. They know that politicians cannot be seen to reduce the NHS offer—they simply would not tolerate that. They do not know quite how all the sums will ultimately stack up, and nor do we. That is the big question.

[Andy Sawford]

Will the hon. Gentleman accept, though, in the interests of being transparent with the public, last week’s letter from Andrew Dilnot, the chair of the UK Statistics Authority?

[Mr Graham Stuart]

Move on.

[Andy Sawford]

The letter stated unequivocally that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

Until both Government parties acknowledge that truth, which independent experts have told us about, they will not have any credibility in health debates.

[John Pugh]

I think I will take the advice of my hon. Friend the Member for Beverley and Holderness (Mr Stuart) and move on.

I think we all agree that the only acceptable answer to the problem is to spend public money wisely. Currently, the NHS is holding up—sort of—by making economies and savings, largely off the back of a wage freeze, which is not sustainable. However, I am starting to be alarmed by the disagreement about what else we can do and what strategies we should follow. I will run briefly through the suggested options.

It has been suggested that we should keep people out of hospital, but we already have fewer hospital beds than almost anywhere else in Europe, and according to the NHS Confederation there is no clear evidence that treating people outside hospital would necessarily be cheaper.

Some people recommend personalisation and personal budgets, but it can be argued that that would not lead to better use of scarce resources, despite the fact that it would be more popular than some current service configurations. Telehealth has also been suggested, and I am a great enthusiast for it—it is my personal favourite suggestion, and I am chair of the all-party telehealth group. However, although there are cost-effective pilots, the Nuffield Trust has expressed some criticism of telehealth, saying that it may not save us anything like the money that we believe it will. The industry itself is concerned that if the roll-out is not efficient and effective enough, telehealth simply will not take off.

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[Andy Sawford (Corby) (Lab/Co-op)]

I am grateful for the opportunity to speak in a debate that is incredibly important to my constituents. I thank my right hon. Friend the Member for Leigh (Andy Burnham) for opening the debate. He is aware of my grave concerns about the future of hospital services that serve people in Corby and east Northamptonshire.

It has long been the ambition of people in Corby—a large, important town that is growing—to have their own hospital. I hope that in future we can realise that ambition. For a long time, however—and for the foreseeable future—we will be served by Kettering general hospital for most of our hospital needs. At Kettering general hospital there are 650 beds and more than 3,000 staff. The hospital is more than 115 years old, and received massive investment, including under the Labour Government. I make that point not so much politically point but as a local person who remembers driving down Hospital hill in Kettering and seeing the fundraising barometer outside the hospital and wondering why we relied on car-boot sales to fund vital hospital services.

My right hon. Friend the Member for Leigh, a former Health Secretary, and his predecessors began to put that right, and there was huge investment. Kettering general hospital now has 17 operating theatres and an obstetrics unit that delivers more than 3,500 babies a year. It has something that serves only a few of my constituents but is incredibly important to all of us—a neonatal intensive care unit, or special care baby unit. My own family has had cause to be grateful to that unit and its brilliant staff.

Kettering general hospital offers a 24-hour accident and emergency service, with level 2 trauma services, which sees more than 2,000 trauma patients a year. There are concerns, however, and I have agreed with the hospital and local people to champion certain issues in the House as the local Member of Parliament, including per capita funding of Kettering general hospital, which we believe is inadequate and lower than average compared with other areas. With a growing population and growing health needs, that must be addressed.

Recently, a report on the hospital by Monitor raised serious concerns, particularly about accident and emergency. I have met the hospital chief executive and the chair of the trust to discuss those concerns, and to assure them that I will seek to do whatever I can, including making sure that a case for adequate funding for the hospital is made, so that those concerns are addressed.

The big issue that causes us all concern locally is a major review of health services—the kind of review that other Members have experienced in their areas. In Kettering, the Healthier Together review of five hospitals has already cost more than £2 million; that was the figure in the summer, and I have no doubt that it is rising rapidly. The review has also taken a great deal of time and effort. In early September, together with local nurses and others, I met the people leading that review, as a public member of the trust, and I was incredibly worried about what I heard, both as a user of the services, and as a representative of local people.

The Healthier Together team gave us a pledge card telling us about their plans and giving us some assurances. The context was also set. We were told that the review was driven by a desire for the best clinical outcomes, by expertise, and by research on how local people could be provided with the best health care. We were told that there were considerations to do with more services being provided in the community, and a shift to prevention, which are things I recognise it is important for our local hospital and its partners—the clinical commissioning group and the other hospitals—to consider.

It was slide 2 that really got to the heart of the problem. It told us that the five hospitals face a combined funding gap of £48 million, and that my local hospital, Kettering general hospital, faces a future funding gap of £6 million a year. I have no doubt that the comments that Andrew Dilnot recently made about the real-terms reduction in funding are very much connected to that, but I do not want to make that wider political point again; it has already been made eloquently by my right hon. Friend the shadow Secretary of State. I simply say that all local people recognise that resources are getting tighter and tighter at the hospital.

[Norman Lamb]

Does the hon. Gentleman share my view that in many local health economies, private finance initiatives are causing a massive strain on resources?

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The hon. Gentleman mentioned the Healthier Together programme; it is clear that many of the hospitals in that programme have very high PFI debts. We will get the figures for him, to clarify that, in the closing remarks.

[Andy Sawford]

A few weeks ago, the hon. Gentleman—I am sure that he had no intention of misleading the House—talked about the funding issues at Kettering general hospital being driven by PFI deals in Anglian hospitals, which are not really part of the group that I am talking about.

[Dr Poulter]

rose—

[Andy Sawford]

I will not give way; I want to make important points for my constituents. It is important that these things are put on record, so I shall not be giving way to the hon. Gentleman again. He has not done a great service to people in my constituency in the way that he has addressed these issues.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I had the pleasure of visiting my hon. Friend’s constituency earlier this year, and I am sorry to hear about Kettering. Both the accident and emergency departments and one 500-bed hospital in my constituency are due to close. Neither of those A and E departments is PFI, and none of the four A and Es closing in west London is PFI, so is that point not a complete red herring?

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[Andy Sawford]

I have had some experience of my hon. Friend in the past, and as ever, he talks a great deal of sense. Certainly, in Kettering, we are looking at something driven by funding cuts.

I want to address the issues, because I seek real answers from the Front Benchers, and real assurances about the future of my local hospital. Healthier Together has assured us that no hospitals in the group of five of which Kettering is part will close. I have never heard any claims that those hospitals will close. The local media have been very clear that they are not aware of any assertions that Kettering hospital will close. There has, at times, been the presentation of an Aunt Sally by some of my political opponents, who have sought to say, “The hospital won’t close, so there’s nothing to worry about.”

Let us be clear what is being talked about. The Healthier Together review had six different models, and it has refined that to two options. The status quo is very clearly not an option, and it is not consulting on it. One of the two options would see five hospitals going into three for some of the services, though all the hospitals would remain open and provide some services. The services that are at real risk in two of the five hospitals include in-patient paediatrics. Last year I took my son, who had pneumonia, late at night to the Dolphin ward at Kettering general hospital. It concerns me deeply that paediatrics might not be there. I would have had to go elsewhere, and so will local people in the future if the paediatric ward goes.

Under the proposals, obstetrics would go at two of the five hospitals and be replaced by a midwife-led unit. People in Corby have experience of a midwife-led unit. At one time there was a births in the community facility in Corby, as there still is in some other smaller midwife-led hospitals around the country. Where those exist, if local people want them to continue, they should have that opportunity, but we have a full maternity service in my area and people are very concerned that that could be lost under the proposals.

I have talked to midwives who tell me that during labour it would not be possible to give an epidural, for example, if the labour became more painful for the mother. Among my family and friends, I have heard about people who hoped their children would be born at Melton hospital, which is a midwife-led unit, describing the worst hour of their life as following a blue light on an ambulance taking their wife and hoped-for child across to Leicester royal infirmary or another available hospital so that the care that was needed could be given. We want our proper obstetrics-led unit to remain and we do not want it downgraded to a midwife-led unit.

At two of the five hospitals, trauma services would be lost. I have already described how Kettering general hospital provides level 2 trauma and treats more than 2,000 trauma patients a year.

As to where we go from here, it is important for Healthier Together and the Government to be honest about the proposals. It is important for geography to be recognised as a critical factor. Healthier Together will talk about the clinical evidence and the clinical drivers, but it must recognise that local people are very concerned that Luton and Dunstable hospital is 50 miles away, and that the nearest hospital in the group is 45 minutes away from Corby at Northampton along a very busy road. The journey takes 45 minutes at the best of times; the road is seriously in need of upgrading and improving. People are really concerned about the geography, and that has to be balanced with specialisms which people understand. There are already specialisms in our local health care system at other hospitals.

I am pleased that despite the empty assurances from Government Front Benchers, the hon. Member for Kettering (Mr Hollobone) had the courage to raise these issues on 9 November—notwithstanding the by-election inconvenience for Government Front Benchers. I now look to work with him as we seek real assurances from the Healthier Together team and from the hospital that they will not proceed with the proposals if they mean that we will lose all those vital services for my constituents.