Health Services (North-West London)

Andy Slaughter Excerpts

Tuesday 15th October 2013 Westminster Hall

[Ms Karen Buck (Westminster North) (Lab)]

I am grateful for the opportunity to raise some issues in this short debate, and I welcome the Minister to her role. It is good to have a London colleague here to respond to the debate, which deals with my serious concerns about the management of the delivery of health services in north-west London.

I asked for the debate with considerable sadness. I have been involved with health care delivery in north-west London for decades, on the community health council, when it existed, and as a member of the health authority for the same area; and for many years I enjoyed positive relationships with hospital management and primary care trusts, so it is of concern to me that I shall be describing a diversion away from such good relationships and communications, and the serious implications of that.

The debate is not about individuals, although I have concerns arising from the communication of some individuals’ views about health care delivery in recent months. The problem is structural, and it is not fixable just by improvements in the exchange of e-mails. It goes to the heart of trust and clarity in the way health care is provided. I am not alone in my concerns—I know other elected officials feel the same; but this is not just about politicians having our noses put out of joint when communications are not handled effectively. It is about some fundamental questions that have arisen, to do with how care is and will be provided to my constituents, and residents of the London borough of Westminster, where St Mary’s hospital is situated.

Because the challenges are so great in north-west London, as they are, indeed, in many parts of the health service, it is even more incumbent on those who deliver and manage health care to ensure that communications are clear, that there is a shared strategic approach to planning, and that there are common assumptions. As the Minister knows, the backdrop to the issue is important changes in the provision of hospital care and the “Shaping a healthier future” strategy for north-west London. That, of course, proposes the closure of several accident and emergency units in north-west London.

Fortunately, from my point of view—because it something about which we all care very much—A and E will not be closed at St Mary’s hospital in Westminster. It is good to see my hon. Friends the Members for Hammersmith (Mr Slaughter) and for Ealing North (Stephen Pound) here for the debate; I know that my colleagues have concerns about how emergency services will be provided in their areas when A and E units close.

[Mr Andy Slaughter (Hammersmith) (Lab)]

My hon. Friend shares my pain. Four out of nine accident and emergency units are designated for closure, and two of those are in my constituency; but the point that she is making is that every MP in north-west London shares the pain, because there is simply no capacity in the system to cope with such a decline in emergency services. The sooner the Government and the NHS realise that, the better.

[Ms Buck]

I agree with my hon. Friend. Of course, the proposed closures and the “Shaping a healthier future” strategy are themselves set against a financial context that puts extreme pressure on delivery. North-west London hospital services must accommodate a £125 million reduction in service between 2011 and 2015. At the same time—and this is pertinent to the core of my comments—local authorities have imposed dramatic cuts in their social care budgets. That is particularly germane to the issue, because the work of local authority care services relates to prevention and hospital discharge arrangements, and needs to be integrated with those areas, so that the highly pressured hospital service can work effectively.

Of course, another factor is the impact of the top-down NHS reorganisation that we were told would never happen, and the £3 billion that it cost, which has taken valuable resources and a great deal of energy away from the planned delivery of services. The slow death of the primary care trusts and the slow emergence of clinical commissioning groups during a time of massive changes has been part of the problem.

Colleagues such as my hon. Friend have legitimate concerns about the effect of the proposed A and E closures on their communities. St Mary’s hospital was not scheduled to lose its A and E unit, and we were pleased about that. I and others were briefed about ambitious plans for the development of a new, improved emergency care service, to be built at St Mary’s hospital. During the discussions and briefings there was no suggestion that there would be any specific consequential changes in the pattern of hospital services at St Mary’s. Therefore, when, at the invitation of my hon. Friend, I attended the independent review panel called to consider the A and E closures in other parts of west London, I was somewhat taken aback to be asked by the chairman how I felt about the closure of up to 200 beds at St Mary’s, and the movement away of most or all elective surgery, as part of the consequential changes resulting from “Shaping a healthier future”.

I immediately contacted the chief executive of the Imperial college health care trust, to ask whether that was accurate, what the implications were, and why I and others had not been told. That was not because I am automatically totally opposed to consequential changes in service delivery. We must be grown up about such things, and it is right that hospitals evolve and change. Things should not be, and never have been, set in stone. Good clinical reasons and financial necessity may drive change. However—and this is my theme today—to make that change work there must be clarity and partnership, and everyone must understand what is being proposed and how decisions are to be taken.

First, the Imperial trust referred me back to the “Shaping a healthier future” proposals, and to a slide pack that was shown to me and the hon. Member for Cities of London and Westminster (Mark Field) in the spring. That set out very broad headings for how services at the three hospitals in the Imperial group—Hammersmith, Charing Cross and St Mary’s—would develop. There was nothing in it that would have led me to conclude that St Mary’s would lose the bulk—or all—of its elective surgery.

I checked with Westminster council, to see whether I was missing the blindingly obvious. I am grateful to the excellent health strategy officer at the council, who has been a model of clarity in explaining how things worked. He told me, with, I believe, the full agreement of local authority members, that the authority—a statutory partner, which there is a requirement to consult about major changes in hospital services—

“did not receive any indication that there would be significant consequential changes to elective surgery at St Mary’s Hospital as a result of Shaping a Healthier Future. Furthermore, Westminster City Council has not been informed of any proposals to re-locate much or all elective surgery currently performed at St Mary’s Hospital to Charing Cross and any developments in this area would be submitted to both the Cabinet Member and Chairman of Health Scrutiny to investigate.”

He said the authority would consider the assumption by the chief executive of the Imperial hospital group

“that these proposals were in the Decision Making Business Case to be incorrect”,

and continued:

“At Imperial College Healthcare NHS Trust’s Board meetings on 24th July and 25th September, we were informed that Imperial were considering their options.”

Indeed, the chief executive of Imperial verbally, when I met him, and in writing indicated that no decisions had been taken and that the timetable for such decisions was for conclusion in the New Year. On 23 August, he wrote:

“I can assure you we are very much in the modelling and evaluation stages of any changes so are yet to consider whether we should propose moving any clinical services between our sites”—

note the use of “any”. That letter was widely circulated, so clarification could have come from other members of the local health service family, but no such clarification was received—to coin a phrase.

Meanwhile, a quick look at Hammersmith council’s website showed me that it was promising its community a reinvigorated Charing Cross hospital, but on a basis that did not appear to have been explained by Imperial to anyone in Westminster. Hammersmith announced in September:

“News that elective surgery is now on the list of possible future services would further boost the amount of expertise at the site, meaning patients in the local community benefit from the care it gives, and giving it greater status as a teaching hospital.”

[Mr Slaughter]

My hon. Friend is making a good case for the second of our concerns, which is not the closures themselves, but the chaotic, shambolic and amateur way in which they are being carried out. In the past six months, I have been told that Charing Cross hospital will close and be a clinic, a local hospital, a specialist social care hospital—whatever that is—or an elective surgery hospital. The person who told me most of those things, the chief executive of Imperial, has just left, suddenly, after only two years in the job. That is typical of the utter chaos in the hollowed-out NHS in north-west London and, no doubt, elsewhere.

[Ms Buck]

I totally endorse my hon. Friend’s words.

To return to my point about how Hammersmith council is presenting its achievements in winning services for Charing Cross that no one in Westminster or at St Mary’s hospital knows about, Hammersmith continued:

“Charing Cross will also become a specialist centre for community services which means that the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel. It will mean local people will be better supported to live independently at home”.

It was good of Imperial to share that vision with Hammersmith and around Charing Cross, but it is a great shame that it chose not to share a single word with Westminster city council.

Reinforcing my hon. Friend’s point about chaos, however, I am not sure that even that is the true picture, because when I showed the press releases on Charing Cross from Hammersmith council to the chief executive of Imperial in September, I was told that it was spin on Hammersmith’s part and that what was proposed was only a 23-hour ambulatory care model, with no new beds at all. It is hard to square that with Hammersmith council’s vision and harder still to know what is true.

I do not begrudge Hammersmith residents their hospital—quite the reverse—but I am concerned about any sense of deals being done to secure their future, at the expense of local residents in Westminster and, critically, without so much as an opportunity for Westminster council even to consider the matter or to think about support services or the community care dimension, which Hammersmith so rightly talks about as important in a local hospital context and which can be applied to Westminster. If Hammersmith council can proudly claim that its new hospital means that

“the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel”,

surely that cannot mean that older and chronically ill Westminster residents, who also need regular visits to hospital, should have further to travel—with no debate and no chance to put in place social care support or travel arrangements.

Things get worse. Four weeks after my meeting with the chief executive of Imperial, all my follow-up questions about what that means, whether decisions have been made or what services will be located where still remain unanswered. That is no doubt partly a consequence of the unexpected departure of the chief executive, who has been replaced in what is clearly a holding operation, in a manner that does not indicate a smooth and planned transition.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

This is the first time I have served under your chairmanship, Mrs Riordan—in fact, under anyone’s chairmanship, because it is my first Westminster Hall debate. It is good to start off with such a straightforward and easy subject.

I congratulate the hon. Member for Westminster North (Ms Buck) on securing the debate. I am a London MP and I know that this matter is important to her and her constituents, to the constituents of her hon. Friends the Members for Ealing North (Stephen Pound) and for Hammersmith (Mr Slaughter) as well as to those of other MPs who are not here today.

Before I turn to the issues raised, I put on record my thanks to the staff of the NHS for their commitment and dedication in providing a first-class service, particularly as they enter a period of change. We know that that is sometimes not easy, but they are maintaining a first-class commitment to patients throughout.

The debate around aspects of the north-west London reconfiguration has been going on for some time, but it is fair to say that the hon. Lady discussed a slightly new feature of it. Today is the first time I have heard in detail directly from her about these important issues. I will give her a response, but I will look at the detail of what she said, reflect on it and come back to her more fully after the debate. It is not possible to do that instantly, because until now I had not heard directly from her about some of the problems on communication and so on in the past year that she said illustrate some wider issues.

My understanding is that the joint committee of primary care trusts agreed in February this year that further work was needed to bring about improvements to services at both Charing Cross and Central Middlesex hospitals. I am aware that Imperial College Healthcare is developing its clinical and site strategy based on the principles set out in “Shaping a healthier future”. The trust has put forward a case for some elective surgery to be carried out at the Charing Cross site and has developed a vision for each of its three main sites becoming centres of excellence for the service they provide.

It is right that hon. Members and local authorities should expect openness and transparency when discussing local health issues and changes, and the hon. Lady has vividly put across that she does not feel that that has happened. It is regrettable that she feels she has encountered, in her dealings with Imperial, a lack of clarity around its clinical and site strategy and, in particular, around planned care and elective surgery.

The hon. Lady rightly stressed the need for partnership working through periods of difficult change such as these. Her comments on the overall exercise and the expressed clinical priorities were balanced, and I take seriously what she said about wishing to work in partnership and her point that we can clearly do a lot better. I have been assured by NHS England that a real effort will be made by the new leadership team at the trust and the local clinical commissioning group to engage more fully with her, other local MPs, local councillors and the local NHS as the site strategy is developed.

I am aware that the hon. Lady met the chief officer and the GP chair of the central London CCG to discuss her concerns about the changes to planned care and surgery in north-west London. As a result, she will know that under “Shaping a healthier future”, St Mary’s will continue to provide out-patient services, diagnostics, therapies and appropriate follow-up. I understand that work is under way to agree the best locations across north-west London for planned care surgery services.

[Mr Slaughter]

I hear what the Minister is saying—it is reasonable and I know that she is sincere—but we constantly meet these people and they are, frankly, hopeless. The issue is now becoming political. So far, we have had political unity across the board and we now know that the issue is on the Secretary of State’s desk. I implore the Minister to talk to him about these proposals—in the interests of her party, if none other.

So far, apart from Hammersmith and Fulham council, which is supporting the closures, everyone across west London is united on this: it does not matter what party they are or what position they hold. This issue is moving from the local to the national. Will the Minister please look—it is in her interest as well as ours—at what is going wrong in north-west London before we take steps in closing hospitals that we will not be able to correct?

[Jane Ellison]

I am not sure that describing NHS colleagues as “hopeless” is a particularly helpful contribution to future partnership working, but the hon. Gentleman has chosen his words in his own style, as he always does. He is right to say that the matter is on the Secretary of State’s desk. I will report back to the Secretary of State after this debate, specifically on the new concerns expressed by the hon. Lady on the dialogue and the relationship she has had. Beyond that, I cannot comment further on the reconfiguration, because of its status.