NHS in London

Andy Slaughter Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

I completely agree with my hon. Friend. We are trying to have a serious debate, but we are pooh-poohed at every turn. When my hon. Friend the Member for Hammersmith (Andy Slaughter) asked a question about the Mansfield report, he was told that he was living in a bygone age. I cannot recall the exact remark, but it was something like, “You’re an old soldier fighting a war that’s concluded.” Dismissing people in that way does not inspire confidence.

[Andy Slaughter (Hammersmith) (Lab)]

I always do what I am told by my hon. Friend—the dismissive comment was that the Mansfield report was commissioned by five Labour councils. I have actually had a slightly more considered response, but it was still dismissive. It was a very serious independent report, and I am sure my hon. Friend will agree that the Minister should take it a bit more seriously.

[Dr Huq]

My hon. Friend puts it very well. People’s concerns are serious and should not simply be dismissed.

I also agree with my hon. Friend the Member for Eltham (Clive Efford) that the community pharmacy network is a vital component of our country’s health and care system. Suddenly, the Government seem to be imposing arbitrary cuts in a high-value, easily accessed, community-based facility, which relies on private investment as well—pharmacists are small businesspeople. Hiten Patel of the Mattock Lane pharmacy opened my eyes when I spent a bit of time shadowing him there. I saw how the burden on the NHS and GPs is reduced by people having such pharmacies at the end of their street. For most people, they are much nearer than a hospital or even a GP service.

Hiten Patel and his staff help people to make lifestyle choices. They provide a range of services and information to promote health, wellbeing and self-care. They are a useful check on prescribing errors and are dedicated and trusted people. We have such pharmacies all over the country, and they form obvious back-up and support at a time of crisis for GP recruitment and retention. We should value those people, not make life more and more difficult for them.

Last Sunday, I collected my elderly mum’s meds from Harbs pharmacy in South Ealing Road. That pharmacist is open out of hours. I recall that one year he was open even on 25 December—I did not go past this year, but he was probably open then as well. That releases the Ealing Park surgery practice next door for more acute and specialist care, but the Government seem to do short-termism. The long-term impact of eroding the network will have a disastrous effect.

Another troubleshooting service that is located at the heart of the community and has hidden value is opticians. They, too, have a valuable role of social contact, with networks and support mechanisms, and they can contribute to signposting and safeguarding the vulnerable. As the right hon. Member for Carshalton and Wallington (Tom Brake) pointed out in connection with community pharmacists, opticians can also catch things early.

I visited the Hynes opticians in Northfield Avenue, where staff are worried about the continuity of their supply chain. Joint strategic needs assessments enable clinical commissioning groups and local authorities to work in tandem, and the Ealing Council assessment mentions effective eye services and sight loss, but the NHS Ealing CCG does not use the JSNA in its commissioning decisions. Will there be some guidance from the Minister about how to integrate CCGs and local authorities better?

I could go into mental health services, which are chronically underfunded and a huge cause for concern. The Prime Minister made a speech about them last month, but I would like to see more action. Labour has a shadow mental health services Minister. The chief executive of Central and North West London Foundation Trust, Claire Murdoch, has claimed in an interview that mental health can be an “easy target” at times of belt tightening, saying that

“during recessions mental health tends to be hit first and hardest and recover most slowly…There is an absolute anxiety that people are depressed and really are suffering as a result of some of the economic reforms. What we don’t know yet is the extent to which some of the welfare reforms are driving people to real, serious illness.”

I have the sense of morale taking a nosedive locally. My constituent Michael Mars, who is now retired but was a senior consultant at Great Ormond Street hospital, said:

“The essential problem is the feeling of impotence experienced by those at the coal face

because of an

“overwhelming management culture where clinical knowledge and experience is secondary to management.”

Such words echo, because we hear them from a lot of other public service professions such as teachers and the police. They all say that they are doing all the paperwork and are not allowed to do what they are supposed to do. Michael Mars talked about survival in the culture of management and worries that we might be in danger of forgetting what clinical consultants are appointed to do.

At the other end of the career scale are junior doctors, on whom there was a debate in this Chamber on Monday. I have had numerous representations from constituents who are junior doctors. The latest NHS staff survey showed that the percentage of junior doctors suffering from work-related stress has gone from 20% in 2010 to 34% in 2015.

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[Bob Blackman (Harrow East) (Con)]

It is an honour to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate on London’s NHS. The subject is vital to people not just in London but nationally and internationally because we provide a health service for not just people resident in London but those who work in London and those who come to London for specialist treatment. I apologise that I may not be here for the winding-up speeches; I must attend the debate in the Chamber where I am the lead speaker. My apologies if I have to scuttle off before other contributions.

I want to speak about three issues in my contribution: primary care; the position at Northwick Park hospital; and the Royal National Orthopaedic hospital. In terms of primary care, without doubt, one problem we experience in London is that people have difficulty getting on to a list for a GP and then getting appointments when they are ill. As a result, when a person is ill, they immediately say, “Well, if I can’t get an appointment with my GP, I will go to A&E or the urgent care centre or whatever facilities are around.” That means that people turn up at A&E and at urgent care centres who should be seen by GPs or even by nurses at GP surgeries—they do not necessarily need to be seen by doctors.

We all have anecdotes we can share, but at the health centre to which I go the GP appointments system is now such that people can only register for appointments 48 hours in advance—it is always quite difficult to know whether one will be ill in 48 hours—or walk in and wait; however, how long will it take to be seen after all the appointments? That leads to a challenge. Immediately, people say, “I’m not going to do that, because I can turn up at A&E or the urgent care centre and make sure I am seen.” Therefore, the all-party parliamentary group on primary care and public health, which I co-chair, has pointed to the need for better signposting in the national health service to point patients to the right place and to ensure that primary care in particular can provide care for those who need it.

I will move on to Northwick Park hospital. As I said in my intervention on the hon. Member for Ealing Central and Acton, who led the debate, its A&E performance was truly dreadful. I can speak from personal experience: I waited in A&E for some eight hours before I was seen on an urgent care basis and received medical intervention. It was a disgrace. People were waiting for far too long and never, ever were the targets achieved. However, in November 2014, the Government invested in the new A&E at Northwick Park hospital and since then there has been a complete transformation.

One of the problems we had with Central Middlesex hospital having an A&E was that its brilliant doctors and nurses were sitting around, waiting for patients to arrive; patients would go to the A&E at Northwick Park because it was nearer and more convenient. The consequence of the A&E at Central Middlesex closing and those doctors and nurses transferring to Northwick Park was that performance transformed overnight.

I have the latest figures. When we talk about stats, we should talk about what is going on now in reality, not what happened in the past. At Northwick Park, in January, 89% of patients were seen within four hours and—[Interruption.] I accept that the target has not been reached, but the key issue is that that is far from the dramatic underperformance that the hon. Lady described. The reality is that 90.3% of patients were waiting less than 18 weeks to start treatment at the end of January, and we all accept that January is probably the hardest month for the NHS because of difficulty with the cold weather.

Cancer waiting times are a vital aspect, and Northwick Park hospital meets the targets: 94.1% of patients with suspected cancer were seen by a specialist within two weeks. I would much rather see that figure at 100%, but that is above the target of 93%. Of patients diagnosed with cancer, 99.2% began treatment within 31 days—the target is 96%, so that is an outstanding performance. Finally, 86% of patients began cancer treatment within 62 days of an urgent GP referral; the target is 85%. It is therefore fair to say that Northwick Park hospital—it is not in my constituency but virtually all my constituents use it—has transformed itself under this Conservative Administration. It is important to get the facts on the record, so that people can congratulate the health providers, who are delivering an excellent service. Of course, there are always challenges. We know there is a deficit, but the key is that Northwick Park hospital’s funding from the CCG will see a 6.01% increase this year. That is a good performance; we can see that money is being invested.

Just before the 2010 election, when I was elected for the first time, under the previous Labour Government, there was a review of accident and emergency services in north-west London. We heard not a squeak from Labour MPs about the fact that as part of that review they wanted to close down five of the A&Es in north-west London. [Interruption.] Oh yes. The incoming Health Secretary said, “We are going to stop that review in its tracks, and any review of A&E services will be clinically led, not driven by particular elements or arguments.” The reality is that this is nothing new; this is being driven by the NHS and the NHS bureaucracy. That is what I want to move on to finally.

[Andy Slaughter]

The hon. Gentleman needs to substantiate both elements of what he just said. To go back 10 years to try to defend the current crisis in the NHS in his constituency is a bit unnecessary. The fact is that promises were made by his party about specific hospitals as well as about A&E generally and it has gone back on almost every single one of those. A little less hubris from him would be appropriate.

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[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Turner, and to be called early in the debate. I thank the Backbench Business Committee for giving us this long and generous slot on the last day before the recess. Given that it is the last day, there is a good turnout from London Labour Members, and one or two London Conservative Members. Indeed, we had the whole of the Liberal Democrat representation for London, but he has gone now.

I particularly thank my neighbour and hon. Friend the hon. Member for Ealing Central and Acton (Dr Huq) for introducing this debate in a comprehensive manner, which permits me to make my contribution shorter than it otherwise would have been, because I am going to deal with some of the same issues. I preface my remarks by saying that London Members deal with a great many health service issues—on the whole successfully—through their clinical commissioning groups, hospital trusts and the other myriad health service bodies that the Government inflicted on us in the last top-down reorganisation.

We have heard about primary care, mental health and community pharmacies. The reason why we—particularly the 11 Labour MPs for north and west London—keep returning again and again to the issue of acute hospitals and the “Shaping a Healthier Future” programme is not only that it is such a major reorganisation of services but that it has become very politicised. Of course, all these issues are political—money spent on the health service is always political—but we feel that we are either not being given information or being given the wrong information.

I must disagree with the hon. Member for Harrow East (Bob Blackman). My memory goes back a long way. I was part of the campaign against the closure of Charing Cross hospital in the early 1990s. It was successful, obviously, but it was a long and hard-fought campaign, and again, the grounds for closure were entirely spurious. I remember the former Member for Brentford and Isleworth, who was a Health Minister, leading that campaign when she was the head of nursing there.

[Dawn Butler]

I remember leading a campaign in 2006 to save Central Middlesex hospital’s A&E, which was successful. Unfortunately, it then closed when I was not an MP in, I think, 2011.

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[Andy Slaughter]

We all bear these scars. I am grateful for all the efforts that Members have made to protect their local health services.

The next time that Charing Cross hospital came up, it was in the context of the 2005 election campaign, when a Conservative candidate, now the right hon. Member for Chelsea and Fulham (Greg Hands), shamelessly said that it was going to close, with no evidence whatever; there were no plans to close it. The candidate running against me in 2010 did exactly the same in relation to the hospital in my constituency. The difference was that immediately after the 2010 election, plans began to be drawn up—we did not see them until 2012—by McKinsey and others. The reference to consultants was well made by the hon. Member for Harrow East, because the spend on consultants on “Shaping a Healthier Future” alone is running at something like £20 million per annum at the moment.

I did not recognise, in what the hon. Gentleman said, what has actually happened. The brief history is as follows. Those plans were presented. They were kept under wraps and took us all by surprise with the dramatic changes they contained—the downgrading of the four A&Es and what was going to happen to Ealing and Charing Cross hospitals. However, that was a long time ago now, in the summer of 2012. The only revision to those published proposals was at the end of the so-called consultation process in February 2013. Apart from references in board papers and other statements, we have not had a formal upgrade to the process since then. That is more than three years ago, yet the proposals affect about 2 million people across the whole of west and north-west London.

I accept that there can be faults on all sides and that in the run-up to elections, people get quite emotional and political about these issues, but that is partly because they matter so much to our constituents. At the 2015 election, at least we were getting emotional and political about something that was actually proposed, rather than something that was invented. Since the election last year, we have attempted—certainly I have, and I think this goes for a number of my colleagues—to engage in the process with Ministers and officials, partly to find out what is going on and partly to try to influence the outcome. The Minister met a group of MPs last summer and said that there would be a great deal of engagement and transparency. I have not given up on that, but it has not happened so far.

The key document in the “Shaping a Healthier Future” programme—the implementation business plan—is still under wraps. We have been asking for it for the best part of three years, formally, informally or through freedom of information requests. Different reasons have been given at different times—“It’s a work in progress,” or “It’s commercially confidential”; all the usual reasons. It becomes a bit ridiculous after a while. I am not sure it is very helpful to the Government or the NHS, because in the end we have to rely on what information we can scrape together.

Of course, the world has changed a lot in those three years. Let me give some examples. The London head of NHS England, Anne Rainsberry, came to brief Labour London Members earlier this week and gave us some quite interesting information. First, “Shaping a Healthier Future” alone will not deal with the financial problems, which have got substantially worse. My trust, Imperial College Healthcare NHS Trust, last reported that it was running a £25 million deficit, but I know that other trusts, including London North West Healthcare Trust, have higher deficits than that.

The position has got markedly worse. I know the Government say there is a clinical basis for “Shaping a Healthier Future”, but it is interesting that there has been a concession that there is a financial basis to it; it is about saving money. Opposition Members would say that it is mainly about saving money, but the Government might say that that is an ancillary purpose. We are now being told that even if “Shaping a Healthier Future” were implemented, it would not save enough money given the deteriorating situation.

The shadow Secretary of State, my hon. Friend the Member for Lewisham East (Heidi Alexander), mentioned the shift from capital to revenue, partly as a bail-out. That may be a crisis move to offset the immediate financial crisis, but it has implications, particularly for a grandiloquent project such as “Shaping a Healthier Future”, which is about a major redesign of hospital sites—particularly the Charing Cross and St Mary’s sites, which are taking the bulk of the money.

We know—the NHS is now being slightly more candid about this—that the Treasury is getting cold feet about the programme, and the date is being pushed back and back. That is good in a way, because originally we were told that Charing Cross was going to be demolished in 2016-17, and now we are talking about 2020 at the earliest. I am delighted by that, because the longer it is pushed back, the less likely it is to happen, but it reflects serious concerns in the Treasury, and possibly in the Department of Health, about where the programme is going.

[Dawn Butler]

My hon. Friend is being generous with his time. Is he concerned, as I am, by the letter from Clare Parker, the senior responsible officer for “Shaping a Healthier Future”? Brent has been trying to get hold of the latest version of the implementation business case. She notes the request, but states:

“Unfortunately this document is in draft form and not currently suitable to be shared.”

Does he wonder, as Brent and I do, when we will be able to have sight of that document?

[Andy Slaughter]

That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.

[Ruth Cadbury]

Skiing injuries.

[Andy Slaughter]

Well, perhaps. The situation does not give us a lot of confidence in the plans that are being made.

I hope that I have given a flavour of what is happening. I cannot do much more than that, because I do not have the information available. This is the No. 1 issue for my constituents, yet when I look back to see how often I have raised it—I have made one speech on it since the election and asked a few questions to Ministers—I am sorry to see that on the whole, I get pretty dismissive answers. I do not think that is how this Minister would wish to behave.

I ask that sooner or later—sooner, preferably—we get the business plan so that we can see what changes are being proposed and what the timetable is. I also ask for a realistic reassessment of the need for acute hospital services, because I do not believe that “Shaping a Healthier Future”—2010 or 2012—will be the appropriate mechanism for doing that. If the Government are prepared to do that, I am sure that all Members, irrespective of party or of the proposals for their local hospital, will be prepared to sit down and negotiate.

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[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck, and a pleasure to follow so many contributions from hon. Members from across London. I congratulate my hon. Friend the Member for Ealing Central and Acton (Dr Huq) on securing the debate. I thank the Backbench Business Committee for granting us this opportunity to talk about the NHS across London.

The context is challenging across London, with a swiftly growing population, huge health pressures arising from demographic change and from London lifestyles, and a national health service that across the city is struggling to cope with those myriad pressures. We have seen that across the capital since the 2010 general election. A&E waiting times in hospitals throughout London, referral-to-treatment times and cancer waits have worsened throughout the period. As we have heard, Members from every corner of our capital city are reporting local pressures that reinforce that picture of national health service provision across London.

We feel that pressure acutely in Redbridge. Both the NHS trusts that cover our borough are in special measures: Barts Health NHS Trust, which covers the west of my constituency; and Barking, Havering and Redbridge University Hospitals NHS Trust, which serves patients throughout my constituency. Primary care is an issue, with patients increasingly struggling to get a GP appointment and finding new barriers put in their way, such as telephone consultations before a GP practice will even grant an appointment. There are also service reconfigurations.

We have already heard about service closures across the rest of London, and in Redbridge we remember the Conservative party’s commitment before the 2010 general election that there would be no enforced closures of accident and emergency or maternity units. Well, we lost the maternity unit at King George hospital, and the decision to close the accident and emergency department was taken in 2011 by Andrew Lansley when he was Secretary of State for Health. That decision still stands, although it has not yet been implemented because the NHS is in such a state of crisis locally. Our local A&E waiting times for the last six months show that we have failed at any point to hit the target of 95% of patients being seen within four hours. The worst rate in the last six months was 76.8%, in December, and the best was 92.6%, in February. People living in my constituency will not find that satisfactory. In the last couple of weeks, the chief executive of the Barking, Havering and Redbridge trust has had to apologise to the 1,015 patients who have waited more than a year for routine treatment such as knee operations, which is simply unacceptable.

There are some positives. I have mentioned the chief executive of the Barking, Havering and Redbridge trust. I have confidence in the trust’s leadership. Since they came on board, they have approached the task energetically. They inherited an absolute mess that developed over a number of years, and there are some improvements, but as recent events have shown, there is still a long way to go.

I welcome the work that the clinical commissioning group and GPs are leading on primary care transformation to try to improve primary care services locally, but we are yet to see the fruits of their labour. I also welcome the extent to which the local authority, which is now Labour-led, has been leading the way on integration to help partners across the local health economy. I am pleased to see that my borough is taking part in piloting the accountable care organisation initiative, which I hope will bring real benefits to patients through greater integration between healthcare providers and our local authority. In that context, the cuts to local government spending and, in particular, to public health budgets are a real concern.

I should probably declare that I am still a serving councillor in the London Borough of Redbridge, albeit an unpaid one, so I am excellent value for money for my constituents.

[Andy Slaughter]

They should be the judge of that.

[Wes Streeting]

They may well be the judge, but I am standing down as a councillor in 2018. I was elected to Parliament while serving as a councillor, which is a good indication.

Seriously, the London Borough of Redbridge has the fourth lowest public health grant in London. Given the diversity of our population, and the pressures that that brings, it is a cause for concern. In that context, I was even more disappointed to find that the Government have cut our public health grant in-year. As a former cabinet member for health and wellbeing in Redbridge, and as the former chair of our health and wellbeing board, I know that we were already struggling to meet our statutory duties on public health, not least the new responsibilities we have been given, such as for health visiting, for which the allocation received from the Government was not sufficient. We managed to squeeze some extra funding out of the Government, but we are still struggling.

The reduction is disappointing, particularly in the context of London, where people’s healthcare needs and lifestyles are placing pressures on the NHS. Public health investment is an upfront investment in people’s lifestyles that will reduce NHS costs in the longer term, as well as improving people’s health and wellbeing. I cannot understand why, in that context, preventive budgets such as public health budgets are bearing the brunt of cuts. I hope Redbridge’s public health allocation in particular is something that the Department of Health will revisit.

I have talked about the financial challenge for local authorities, and I will now address the financial challenge facing the NHS and our local health economy. I was concerned, as everyone else was, to read David Laws’s revelation at the weekend that, far from the £8 billion that keeps being mentioned as the hole in the NHS budget, Simon Stevens actually identified a £30 billion hole, of which he said £15 billion could be found through efficiencies and improvements. My maths makes that a £15 billion hole in the NHS budget, and it is a source of concern that the £8 billion promised by the Conservatives at the last election is still not there. We have seen the Chancellor having to shuffle money around. Earlier, my hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, talked about the reallocation from capital to revenue in terms of the health budget.

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[Jane Ellison]

We have been clear that we have given a large amount: £3.5 billion has been made available to local authorities for social care. Ditto on public health—we will spend £16 billion over the next five years. If I have time, I will come to the good point that was made earlier about the move to business rates retention. It is matter of record that the Government committed at the election to what the NHS had asked for in the five-year forward view, and we will continue to make that commitment.

The London health system—CCGs and provider trusts—has planned for a deficit in 2015-16 of about £350 million, and overall the system is expected to be in that position. Some recovery is expected during 2016-17, and I am sure we will debate that again. In addition, a £1.8 billion sustainability and transformation fund is available, designed to address provider deficits in 2016-17. However, I think all Members would accept that additional Government spending is not the only answer to the challenges faced by the NHS. We have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits, but much of the change Members have talked about is driven by desire to get better healthcare rather than to make savings. If we can make savings as well, that is all to the good, because we can reinvest them in great healthcare.

In London, from early April, the new NHS Improvement body will be providing additional expert support and capacity to trusts experiencing particular financial challenges. That support will include identifying and implementing financial improvement and helping them to identify savings to put them in a stronger position to maintain those savings.

Let me talk about the pressures on urgent and emergency care. It is acknowledged that the urgent and emergency care system faces increasing pressure. More and more people are visiting A&E departments and minor injury units, which is stretching their ability to cope. Members listed some reasons for that in their speeches. A lot of visits are unavoidable, but some people are visiting because of inconsistent management of long-term health conditions, difficulty in getting a GP appointment or insufficient information on where to go.

Winter sees an even bigger rise in visitor numbers and pressure on staff. Although the debate inevitably dwelled on Members’ concerns about their local healthcare systems and problems in them, I am sure we all want to place on record our huge thanks and praise, as many have, to the staff of London’s NHS, who work extremely hard under a lot of pressure and delivering some really good results against that backdrop. I will come on to that.

London’s A&E units have been significantly challenged this winter, and that has been reflected in performance. However, despite those pressures, the capital’s urgent and emergency care system has proved its resilience, with fewer serious incidents declared than in previous years. This winter, London accounted for just three out of 625 serious incidents declared across England. It is important to praise the staff in saying that.

In January, London’s performance was significantly higher than all other regions, with 90% of patients seen within the four-hour A&E standard. London is also the highest-performing region in England this year to date, with 93.1% of patients seen within the four-hour standard. My thanks and congratulations on that improved performance go to the hard-working staff of London’s services.

Reconfiguration schemes have loomed large in the debate. The health needs of people in London are changing and demands on health services are increasing. The hon. Member for Ilford South in his excellent speech illustrated through his personal stories some of the reasons for the changes in the shape of our health service in terms of how we are investing in specialist services and centres of excellence. The work done to centralise stroke expertise was brought up earlier in the debate. I remind Members, although many will remember, that those changes were bitterly opposed by many people. I am not sure whether that includes anyone in the Chamber, but it certainly includes campaign groups. However, all our London clinicians now say with certainty that those changes, with centralised expertise and specialist care, have saved many lives. That is always worth reflecting on.

People are living longer, the population as a whole is getting older and there are more patients with chronic conditions. We often say that people are living longer, but we forget to say that they are living with chronic conditions for longer, and that presents a longer-term challenge than might be seen at first sight. Heart disease, diabetes and dementia will all increase as they are conditions associated with an ageing population.

We did not dwell on the prevention agenda, but I was delighted that the hon. Member for Edmonton (Kate Osamor) spoke about it. The shadow Secretary of State also touched on it when she mentioned dementia and the problems we all know of older people in hospitals. I urge her to look at the dementia implementation plan we published on 6 March, which is a detailed response to the Prime Minister’s 2020 challenge. Dementia has sat in my portfolio since the election, and that plan is a detailed look at how we deliver against that challenge and in particular at the joined-up care that is key to ensuring that people with dementia have safer and better care in our system and are kept out of the acute sector whenever that is possible.

In a number of areas across the capital, the local NHS has concluded that the way it has organised its hospitals and primary care in the past will not best meet the needs of the future. We are clear that the reconfiguration of front-line health services is a matter for the local NHS, tailored to meet the local population’s needs.

I was glad to hear that Members recently met with Anne Rainsberry. The Members who came to the cross-party “Shaping a Healthier Future” meeting last summer will know it is vital that officials at all levels and NHS managers engage with elected Members. I was therefore disappointed to hear what the hon. Member for Eltham (Clive Efford) said. I will ask my officials to look into that. A number of Members asked reasonable questions about why they could not have certain bits of information. I have some specific answers and it may be that we can take a moment after the debate and I will point them in the right direction.

[Andy Slaughter]

I am grateful for what the Minister has said. If she could give an indication to health officials that we must have an open review of where we are with “Shaping a Healthier Future”, look at the implementation of the business plan and consider the Mansfield commission report, which really just asks questions along those lines, it would be very useful indeed.

[Jane Ellison]

We have had the time, during a three-hour debate, to make inquiries, so I will perhaps give the hon. Gentleman an update afterwards.

There have been a lot of references to the interaction with Members. Members of any party may feel they are knocking their heads against a brick wall, but sometimes, to be fair, information cannot be shared for good reasons. There may be commercial confidentiality, or things may be at a particular stage where information cannot be shared. However, I am quite clear that all plans for the local populations that Members represent must be shared with the best level of detail possible, at the most opportune moment. I am always happy to hear from London Members if they feel that that is not happening.

Reconfiguration is about modernising the delivery of care and facilities. I recognise that proposals for those changes sometimes arouse concern. There has been a particular focus on “Shaping a Healthier Future” in this debate, but under that programme, many more community services are now in place across all eight boroughs, so more patients can be seen closer to home. Eleven new primary care hubs are now open. Improved access to GP services has meant an additional 32,000 appointments in Ealing since August 2015, while weekend appointments are now offered to more than 1 million patients across north-west London. Rapid access services in each borough are helping to keep patients with long-term conditions out of hospital where possible, which has already prevented 2,700 hospital admissions in Brent alone.