Andy Slaughter
Main Page: Andy Slaughter (Labour - Hammersmith and Chiswick)Department Debates - View all Andy Slaughter's debates with the Department of Health and Social Care
(10 years, 6 months ago)
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Mr Hunt
The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.
Mr Andy Slaughter (Hammersmith) (Lab)
Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on 10 September, while there are inadequate numbers of beds at the only hospital people have been directed to? It means that there is no acute care, and primary care is in such a state that there is an emergency in-year redistribution of money across north-west London. How is he going to sort that out?
Mr Hunt
What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.
This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.
A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.
Ms Karen Buck (Westminster North) (Lab)
It is often in the specific and the particular that we understand how public policy is most effective, far more than in mission statements, PowerPoint presentations and the sub-sections of the legislation that we pass. That is particularly true of the NHS. We have heard two striking examples of that already in the contributions from my right hon. Friend the Member for Cynon Valley (Ann Clwyd) and the hon. Member for Burnley (Gordon Birtwistle) talking about social care. It is also true of the reconfiguration and change in the health service, which I shall address in the few minutes available to me.
In many respects we understand across the piece what changes need to take place, yet we find that so many of the changes that have taken place at a higher level of public policy, particularly those implemented by the Government through the Health and Social Care Act 2012, have made it harder rather than easier to bring about the change that we need to deliver. In London in particular, an exceptionally complex environment, we saw that set out very clearly by the King’s Fund in its report last year, which made it clear that the Government’s reorganisation of the health service, carried out at considerable expense, had made it harder rather than easier to deliver the fundamental changes that we need by fragmenting its structure and undermining its capacity to introduce strategic leadership.
In north-west London, which we have already heard mentioned today, we are facing one of the most fundamental changes in the delivery of health care since the establishment of the national health service. The “Shaping a healthier future” agenda is rooted in a set of principles with which most of us could agree. We want to reduce the number of accident and emergency attendances and, in particular, to reduce the number of accident and emergency admissions when patients can be better cared for elsewhere, particularly within primary and community services, and we want to reduce the length of stay, particularly for elderly patients who would be better and much happier to be cared for with appropriate social care support in their own homes. Those are undeniable facts that are supported by the general principle that in many cases the higher level of acute care is more efficaciously provided in larger and more specialist units. Those things go together and they are worthy objectives.
It is in the detail of the implementation that we have a major problem. NHS England is apparently seeking to have a total of 780,000 fewer patients admitted to A and E over the course of the next two years. The “Shaping a healthier future” agenda translates into a reduction of 15% in the number of A and E admissions to be achieved in north-west London. As the King’s Fund’s health economist John Appleby has said, that is “not realistic or feasible”. The problem is not that it is not desirable or that we do not want to see it achieved over time, but that we are in the middle of a period of rising demand for A and E and the capacity simply is not there, either elsewhere in the acute hospitals sector or in community and primary care services.
Only a few months ago, Imperial College Healthcare NHS Trust, at the heart of the “Shaping a healthier future” agenda, said:
“We are yet to see any impact of primary care and community Quality, Innovation, Productivity and Prevention…schemes and therefore are planning to maintain the level of emergency care we provided”
over the course of this winter. So, a hospital is saying that it cannot rely on the primary and community services being in place to divert people from A and E, yet almost in the same week the Secretary of State’s letter confirmed that the closure of the accident and emergency units at Hammersmith and Charing Cross, as we understand them, will go ahead as soon as possible. We now have a date in September, and his letter stated that
“the process to date has already taken 4 years causing understandable local concern”.
Mr Slaughter
My hon. Friend has written a devastating critique to the new chief executive at Imperial about the fact that Hammersmith A and E in my constituency as well as other A and Es are being closed before there is appropriate provision to replace them. I would not hold my breath for a reply if I were her. I am still waiting for one to the letter I wrote to the clinical commissioning group on 26 April on the same subject of failure to provide primary care.
Ms Buck
I am grateful to my hon. Friend, who reinforces my exact point.
Since the Secretary of State’s letter and the decision to proceed with the Hammersmith and Charing Cross closures, it has been reported in the Evening Standard that Imperial is having to use winter pressure beds routinely to cope with patients displaced by the planned A and E closures, admitting that there are “risks” of over-crowding, and warning that ill patients will have to spend longer in ambulances. This is a demand for winter pressure beds in the middle of the summer. The expectation is therefore that there is already insufficient capacity years before the construction of a planned new and improved A and E unit at Imperial hospital. The closures are going ahead and Imperial clearly cannot cope. An Imperial official said:
“We have extra acute beds at St Mary’s Hospital, normally used during the busy winter period to ensure we can quickly admit those patients”
in need. That is fine, but what will happen if and when we have a winter crisis or simply during the additional winter pressures? That capacity will not be available to help deal with them.
None of this is meant to suggest that there are not fine people in clinical and managerial practice focusing their attention on ensuring that services are in place to assist with that transition, but the scale of the challenge appears to be beyond what can be achieved realistically within the timetable. In the middle of all this—and no doubt connected to it—there came halfway through the year a letter from the west London clinical commissioning groups announcing that they have
“made an important decision to put funding into a central budget…£139 million…which means CCGs with a surplus will be supporting those with a deficit…We also agreed to explore how to bring together commissioning of primary care services across organisational boundaries”.
That seems to me to be perilously close to the end of clinical commissioning groups as far as we understand them. My understanding was that clinical commissioning groups were designed to be rooted in their local communities, to work in effective local partnerships and to reflect the local service providers, particularly primary care service providers and patients, at a local level. That has all gone with the wind in west London and I am extremely worried about it.
I am all the more worried because the whole transition programme is predicated on the delivery of improved social care, and it is social care with which we are now struggling to cope. In my local authority area, 1,000 fewer residents are getting social care than in 2010, and there will be a further £2.9 million cut this year. It is no surprise that the chief financial officer at Imperial trust, Bill Shields, has said:
“The cynic in me says”
that the proposal to take money away from the national health service to fund social care
“is a way of taking money from the NHS and passing it on to the local authority…this will allow them to make good the cliff edge they have been through in the last few years and rebuild the local government public finances.”
It would also mean
“a significant real-terms reduction in NHS income…going forward”.
Mr Slaughter
My hon. Friend makes a point about this panicked attempt to find more money in the primary care budgets and slosh it around west London at any consultation, and that is exactly the issue on which I am still waiting for an answer. This is chaos in the health service and is a reaction to closure programmes that have been carried out on financial grounds and that have now reduced the health service in west London to a chaotic and dangerous state.
Ms Buck
It is extremely worrying because the whole thing is shrouded in a lack of transparency and a lack of effective communication about what is going on. The local authority is cutting its own social care funding and needs money to fill its black hole, whereas the trust at Imperial says that that is exactly what it is worried about. It says it is concerned about the transfer of money because that might not give it the increased local community services that would allow it to reduce emergency A and E admissions, which is what we want. In fact, those things are so far from being effectively integrated in a common purpose that the different sectors of the health service appear to be at war with each other financially, if not in any other way.
The problem is that the fragmentation and delay caused by the reorganisation in the national health service since 2010 have undermined what should have been a sensible method of progressing and building up community services to reduce the pressure on the acute sector. Meanwhile, today and in the coming weeks my constituents will find that their hospital is at capacity but is expected to deal with the extra demand from the Hammersmith and Charing Cross accident and emergency closures, whereas the constituents of my hon. Friend the Member for Hammersmith (Mr Slaughter) face the loss of their accident and emergency units without any appropriate provision. It is a shambles, I am extremely concerned, and I hope it is not too late to ensure that we can put something in place to prevent a true winter crisis this winter that would be of the Government’s own making.
Mr Andy Slaughter (Hammersmith) (Lab)
I am sorry that this debate began with a speech that was smug and complacent even by the standards of the Secretary of State for Health. I thought we had reached a low point until I heard the hon. Member for Thurrock (Jackie Doyle-Price) using a speech on the NHS to promote the tobacco industry. I am glad that those speeches have been balanced by those we have just heard from my hon. Friends the Members for Walsall South (Valerie Vaz) and for Westminster North (Ms Buck). Indeed, the speech from the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), reaffirms Labour’s commitment to the health service, which is fairly lacking from this Government.
I am going to speak about the crisis in the west London health service, partly because it is such a major crisis and partly because I think it indicates the way the Tories are dealing with the health service generally. It began two years ago, almost exactly, with the announcement of the biggest hospital closure programme in the history of the NHS. Since then we have had sham consultations with 100,000 people petitioning and being ignored, U-turns, confusion, incompetence, refusal to answer questions and political chicanery to make what happened in Ilford, as we heard from my hon. Friend the Member for Ilford South (Mike Gapes), look like a model of probity. Now we have the contamination of the whole NHS locally, including the primary care sector.
When the closure programme began, the medical director of North West London NHS said, candidly, that if it did not close four A and Es and two major hospitals, it would literally run out of money and go bankrupt. Those are the words he used. I suppose we should be grateful to him, because those statements galvanised the population of west London to engage in “save our hospitals” campaigns, and they have been campaigning for two years in rain and snow. Despite huge disinformation paid for by the taxpayer, by a Conservative council and indeed by the NHS, when I now stand in Lyric square in Hammersmith on a Saturday, I can be sure that 99% of my constituents know what is actually happening. I pay tribute to those campaigners from all political parties—including a lot of ex-Tories, as well people from minor parties, Labour supporters and others. They have really made the running on this issue.
Yes, there were changes. Initially, for example, we were going to lose the whole of Charing Cross hospital. Now there will be a local hospital on the site. When that was first mooted, a senior member of the local Conservatives and a Cabinet member said:
“This is an enormous teaching hospital with a 200-year history. You can’t make the Charing Cross hospital into a local hospital. It’s absurd. People won’t put up with that.”
Within weeks, they were spending ratepayers’ and taxpayers’ money putting out leaflets saying that Charing Cross hospital had been saved. That was compounded last October when the Secretary of State for Health stood here and effectively said, “Oh, it won’t just be an urgent care centre. It’ll be a second-tier emergency department.” Let me clarify the three differences between those two: recovery beds, X-rays and GPs. I thought we had GPs on duty in urgent care centres, but apparently not; we can just have nursing cover. It is an urgent care centre by any other name; to call it an A and E is misleading. It will lead to people with serious medical conditions going there and risking their and their family’s lives—as we have already seen at Chase Farm and elsewhere. Charing Cross and Hammersmith will not have blue-light emergencies—except for heart attacks in the case of Hammersmith. We will not have a stroke unit; we will not have the 500 emergency beds; we will not have intensive treatment. This is a second-class, second-tier health service.
The worst transgression happened in only the past few weeks during the local election campaign. I am not making this up, Madam Deputy Speaker. After the postal votes were opened and the Hammersmith Conservatives saw that we were ahead in some of their safe wards, the Prime Minister was brought down at short notice and locked in the basement of the Conservative party offices with a local journalist and came out with this pronouncement:
“Charing Cross will retain its A&E and services”.
I believe that the Prime Minister is an honourable man, and that he was misled into making that statement. The statement is demonstrably false because the NHS has clearly said that most of those services—other than treatment services, primary care services and elective surgery—will not exist at Charing Cross hospital under any analysis.
I thus went to see Imperial. It was the day after the election and I had been up for 30 hours and was not in a terribly good mood. I went to see the new chief executive of Imperial, and I tried to persuade her that Charing Cross should stay open. I said that I would take the new Labour leader of Hammersmith council to see her, as he might be able to persuade her better than I could. I then left and went home. That evening, she e-mailed to say, “Oh, I forgot to tell you when you were here: we are closing the other A and E in your constituency on 10 September. It was just a short meeting and I did not have time to tell you about it.”
At the same time, as my hon. Friend the Member for Westminster North said, the CCG is writing to tell us that it is good news that in year—in the middle of a financial year—it has decided to pull together £140 million from the CCGs around north-west London and to redistribute it into primary care. In other words, they are panicking and having to take desperate measures because the primary care services are so short of money and cannot pick up the slack from the closure of A and E services. We might think, “At least they are doing something”. A substantial proportion—they will not say how much—is going out of my CCG and into other CCGs because, they believe, that is a fair way to distribute money. We are losing not only both A and Es, but our primary care funding and, with the closure of Hammersmith A and E—if we cannot prevent it from going ahead in September—Imperial has admitted in its own board papers that there is insufficient capacity at St Mary’s hospital.
Mr Slaughter
I thank my hon. Friend for that intervention. In exactly the same way, the Government are choosing to close the A and E department at Hammersmith hospital, which is slap bang in the middle of one of the most deprived areas of London, covering White City, Old Oak, Harlesden, north Kensington and east Acton. That means that 22,000 people who rely on those A and E services every year will have to travel to St Mary’s hospital in Paddington. They will not be directed to Central Middlesex hospital, which will be closing on the same day, and they will not be directed to Charing Cross hospital, because the plan is to close that within a year or two. They will be told to go to St Mary’s, where there are not enough beds and not enough capacity in A and E to cope with the current demand. That is contrary to undertakings given in the House that there would be no closures of A and E services until alternative services were provided. There will also not be enough acute services to provide a training base for students at Imperial college.
Two weeks ago we won the election in Hammersmith, against the expectations of, at least, the Conservatives, and we won it on this issue. If the Government will not listen to the 100,000 people who petitioned, perhaps they will listen to the people of west London who, on the issue of the NHS, overwhelmingly voted Labour and against the policies that are being pursued by the Conservatives. They should listen, and they should think again about hospital closures that will cost the health and the lives of my constituents.