Accountability and Transparency in the NHS

Andy Slaughter Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

Two NHS stories were leading the news this morning, both of which are relevant to the subject of this debate. The hon. Member for North East Cambridgeshire (Stephen Barclay) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) have talked about the important issue of whistleblowers. I want to talk about the other subject, which is the conflicted interests of clinical commissioning group members.

All hon. Members should be grateful for the British Medical Journal report that was the basis of this morning’s new stories. In case anyone has not seen it, let me read the headline points. It states:

“More than a third of GPs on the boards of the new clinical commissioning groups (CCGs) in England have a conflict of interest resulting from directorships or shares held in private companies”.

It continues:

“conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.

The interests range from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors, such as Harmoni and Circle Health.

In some cases most of the GPs on the CCG governing body have financial interests in the same private healthcare provider.”

Yet the cheerleader for the privatisation, Dr Michael Dixon of NHS Alliance says:

“The priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.”

I say that the British Medical Journal has done a good job, but it has only just scratched the surface. I shall refer to my own experience of trying to get to the bottom of this matter in north-west London.

On 10 November an article by the social affairs editor of The Guardian began:

“Five family doctors have this week become millionaires from the sale of their NHS-funded firm to one of the country’s biggest private healthcare companies in a deal that reveals how physicians can potentially profit from government policy in the new NHS.”

It went through the individual shareholdings of those doctors who had sold out to Care UK and it continued:

“Another winner seems to be NHS reform champion Ian Goodman. The north-west London GP chairs the Hillingdon clinical commissioning group and was also a board director of Harmoni. He could make as much as £2.6 million.”

[John McDonnell (Hayes and Harlington) (Lab)]

This Dr Goodman chairs my local CCG and tried to force Hillingdon hospital to put £13 million of operations out to tender, which would have destabilised the whole hospital. I pay tribute to the Treasurer of Her Majesty’s Household, the right hon. Member for Uxbridge and South Ruislip (Mr Randall) and the Parliamentary Secretary, Cabinet Office, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who joined me in preventing that from happening. It would have meant Hillingdon hospital being financially destabilised in the long term.

[Mr Slaughter]

I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.

A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

We are seeing the creation of a second-grade health service in north-west London.

[Barbara Keeley]

A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

[Mr Slaughter]

I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

[Several hon. Members]

rose—

NHS Commissioning Board

Andy Slaughter Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

My right hon. Friend is right on all counts. As he says, the patient’s interest must trump everything else. One of the things that we will reinforce in the amended regulations is the paramount importance of integrated care. We legislated for that for the first time through the Health and Social Care Act, which the Care and Support Bill will reinforce and which, indeed, is reinforced by the mandate of the NHS. The Government’s whole intent is to drive a fundamental shift to integrated care for the benefit of the patient.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The Minister has been put up by the Secretary of State to explain the Government’s incompetence, which he may be ideally placed to do. Will he tell us what will happen if the four accident and emergency units in west London close and replacement services are taken over by companies, such as Harmoni and Care UK, which are unfit to run them? That can still happen under his redraft. Will he confirm that members of clinical commissioning groups who have financial interests in the private providers that are bidding should not decide what should replace public services when they are inevitably handed over to the private sector?

[Norman Lamb]

The regulations as currently drafted are absolutely clear about the importance of avoiding the conflicts of interests that the hon. Gentleman has described.

Oral Answers to Questions

Andy Slaughter Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.

[Mr Jeremy Hunt]

I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.

Accident and Emergency Departments

Andy Slaughter Excerpts

Thursday 7th February 2013 Commons Chamber

[Angie Bray (Ealing Central and Acton) (Con)]

I sympathise with the problems described by the hon. Member for Mitcham and Morden (Siobhain McDonagh).

It seems a long time since NHS North West London presented its “Shaping a healthier future” proposals and Members from across west London first came together to debate them. On that occasion, I explained why I opposed the plans, and put on record my fear that they would have a serious and negative impact on my constituents. Downgrading the four nearest A and E departments—at Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals—would be completely disproportionate, and would leave the people of Ealing and Acton slap bang in the middle of an emergency care black hole.

Since that debate, a cross-party coalition—including the hon. Member for Ealing, Southall (Mr Sharma), who opened the debate, and the hon. Member for Hammersmith (Mr Slaughter), who is also present—embarked on fighting the plans. We have organised rallies, marches, petitions and leaflets, and pages and pages of coverage have appeared in the local as well as the national press. I am not a natural marcher, but I did attend the big rally on Ealing Common to oppose the plans, along with other local Conservatives.

We felt that the most constructive use of our time would be to encourage as many people as possible to fill in the consultation document provided by NHS North West London. We offered guidance on how best to navigate the bewildering and unnecessarily lengthy set of questions, and we helped about 600 people to register their views. That was a large contribution in a borough which returned the highest number of responses to the consultation, almost all of which opposed the plans, and it demonstrates the level of worry that exists in Ealing and Acton.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Despite the biased nature of the questionnaire, efforts were made to fill it in, and a few thousand people did so. However, 80,000 people signed petitions which were then studiously ignored. Only the responses to the questionnaire were taken into consideration. Perhaps the hon. Lady would like to comment on that.

[Angie Bray]

I certainly think that a petition of that size cannot be easily ignored. However, as we pointed out when we encouraged people to take part in what was a massive and time-consuming process, I suspect that, technically and legally, the authority is obliged to register only the responses to the consultation.

Beyond what I have described, my role has been to make my objections, and those of my constituents, fully known to and understood by as wide an audience as possible in Government. After doing the rounds of meetings with the previous team at the Department of Health, I held meetings with the new ministerial team and the Health Secretary after last autumn’s reshuffle. I followed that up with a meeting with the Prime Minister, whom I left in no doubt that this issue was of the utmost importance to my constituents.

We all believe that the closure plan must be reviewed. None of us can believe that it is anything other than reckless. We wonder how the A and E departments that are left standing will be able to cope with all the extra pressure that will result from the closure programme. I explained to the Prime Minister in detail why the extra travel time to A and E departments further afield would be unacceptable. He listened carefully, asked a number of detailed questions, and told me that he would certainly discuss the issue this with Health Ministers.

Much of our campaigning has focused on the baffling way in which NHS North West London has chosen to present the proposals as a virtual fait accompli, without adequately explaining quite how they will work in practice. We are told that new “urgent care centres” will cater for everyone’s needs, but we have also learnt that there is a lengthy list of conditions, and that there are a number of possible problems with which they will not actually deal.

--- Later in debate ---

[Mr Andy Slaughter (Hammersmith) (Lab)]

May I first thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for picking up the baton and sponsoring the debate? It was first proposed to the Backbench Business Committee before Christmas by me and colleagues from other parties as a London debate, and it has had the feel of a London debate. However, colleagues from elsewhere in the country should not feel excluded, because a lot of what is being tried out in London will soon be spreading to the rest of the country if they are not careful.

I had to attend the Justice and Security Public Bill Committee, which meant that I was not here at the beginning of the debate, but I am grateful for the opportunity to speak. Balancing whether to oppose the Government’s attacks on civil liberties or the Government’s attack on the health service is difficult, so it is nice to be able to deal with both in one day.

I will not get involved in a hierarchy of misery. Many Members have spoken passionately about their own experiences, but I will say that both the A and E departments at the world-class hospitals—Hammersmith and Charing Cross—in my constituency are marked for closure. Charing Cross hospital, which in many ways has the best site and some of the best facilities in north-west London, is marked for almost complete closure. All 500 beds will go, the A and E will go and the specialist services will go, leaving an urgent care centre and other services high and dry, such as the Maggie’s cancer centre and the mental health services. To its shame, Imperial College Healthcare NHS Trust is supporting those closures because it will provide a very valuable piece of real estate for it to sell and thus improve other campuses.

As my hon. Friend the Member for Harrow West (Mr Thomas) said, it is not the case that community services have been improved before these closures will take place. Indeed, the White City collaborative care centre, which should have been the first polyclinic in the country is, thanks to a Conservative council, six years late and with a fraction of the services it should have. It is still not open and will not adequately replace any of those services.

What is happening in north-west London flies in the face of the facts. Most hospitals in the area do not meet the four-hour target, owing to the demand on their services. Ambulances are less safe and effective than A and E care. For patients, it is clearly better to be in A and E than in an ambulance. Longer journeys and journey times need to be avoided. There is no evidence that when a good A and E closes most cases get dealt with better via centralisation. There are good data suggesting the opposite is true, as local A and Es have the capability to select patients who require more specialised care, easing the pressure on large units, and to stabilise those patients in the critical intermediate period.

In a nutshell, my constituents are being offered a second-class service. There is no clear demarcation. The health service itself cannot tell us which conditions should go to an urgent care centre and which should go to an A and E. The majority of my constituents will have a worse health service, and that particularly applies to poorer constituents who do not have access to private transport.

Let us look briefly at the process we have gone through, which has been utterly scandalous. As soon as the coalition Government came in they started preparing these closures. They gave millions of pounds to McKinsey to draw up the plans, yet when I asked it about those plans I was lied to about the fact that hospital closures were being prepared and was even told that I had been consulted when I had not. We have heard already about the phoney consultation, the 80,000 signatures that were ignored and the 3,000 or 4,000—

[Mr Speaker]

Order. I am sure the hon. Gentleman was not suggesting for one moment that he was lied to in the House of Commons.

[Mr Slaughter]

Absolutely not. As part of the consultation process that was undertaken, it is on the record in the documentation that I was consulted. I was not consulted on those matters.

[Stephen Lloyd]

Will the hon. Gentleman give way?

[Mr Slaughter]

I am sorry; although I would love to give way, I have been asked not to.

That consultation was ignored. The body taking the decision has no stake in these matters whatever. The joint PCT council, NHS North West London, will not exist. The bodies that do have a stake, namely the clinical commissioning groups that are taking over—the puppet masters, as it were—have too much influence in my view and too much to gain personally. I wish I had time to go through the declarations of interest that members of the CCGs have made. They show that most hold shares in Harmoni, Care UK or other private interests that might benefit from the commissioning powers that the CCGs are about to get. I have not received proper answers from the health service about what those interests are or what they remain.

To conclude, the decision for north-west London will be taken on 19 February, so this debate is very apposite. I have no doubt that the decision will be taken to go ahead with most or all of the proposed closures, but the protests that have taken place—the demonstrations, marches and petitioning—will continue, because this now becomes a political decision for the Secretary of State. In the early-day motion that I tabled last June, I referred to the fact that the health service locally was saying it would run out of money if it did not make these cuts. Services are already being run down by sleight of hand. The buck stops with the Secretary of State and the Government. The ball is in their court. I hope the decision will be taken, first, by the independent panel and, secondly, by the Secretary of State. The Government cannot dodge this issue. This is about cuts, as it was in the 1990s, and the denigration of our local health service. The buck cannot be passed beyond this point. I call on the Minister in her reply to say how she intends to preserve the local health service in north-west London.

NHS Funding

Andy Slaughter Excerpts

Wednesday 12th December 2012 Commons Chamber

[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?

Oral Answers to Questions

Andy Slaughter Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Anna Soubry]

This is an area that is important to the Government’s work. At this stage it is important to make sure that we do not over-regulate but that we work with industry and manufacturers. The four Governments across the United Kingdom will shortly issue a statement about front-of-pack nutrition labelling, and we expect to publish the formal response to this year’s consultation within the next few weeks.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The excellent children’s heart surgery unit at the Royal Brompton hospital will be pleased that a full review has been announced. Why does it have to report within four months, including the Christmas period, and why were previous referrals by both Brompton and Leeds refused? Will the review be full and impartial or not?

[Mr Jeremy Hunt]

It will be a totally impartial and very thorough review. This is an extremely important decision, and that is why I asked the Independent Reconfiguration Panel to take the time that it needs to do the review properly; that is the least that the hon. Gentleman’s constituents would want.

Oral Answers to Questions

Andy Slaughter Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

I would be grateful if my hon. Friend could convey my best wishes to the Countess of Chester hospital, which I visited just before Christmas, and my appreciation of the work of the West Cheshire CCG. I can confirm that discussions between officials in the Welsh Government, my Department and the NHS Commissioning Board are under way to extend and renew the protocol for cross-border commissioning for 2013-14 and beyond.

[Mr Andy Slaughter (Hammersmith) (Lab)]

If the Secretary of State believes that the reconfiguration of hospitals is clinically rather than finance led, will he ensure that NHS North West London publishes full risk assessments of its decision to close four accident and emergency departments and replace them with urgent care centres?

Health

Andy Slaughter Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.

Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.

The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond Street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.

Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:

“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”

Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.

Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.

[Greg Mulholland]

The hon. Gentleman makes a passionate case for the Royal Brompton unit. The chief executive of Little Hearts Matter says that, in the Glasgow case, a unit that does 300 operations can be made perfectly safe by other means, without closing units. Does the hon. Gentleman share my frustration at the fact that in the Royal Brompton, Leeds and other places, those involved are not prepared to do that? It does not make sense.

[Mr Slaughter]

I am grateful for that intervention, because, in case my comments are seen as special pleading from the hospital, I was just coming on to mention some independent recommendations and sources that support the argument that, if there is no opportunity for research, and if experts—in Leeds, as well as the Royal Brompton—are prevented from working to the level of their abilities, many are likely to seek work elsewhere, possibly outside the UK.

Dr Neil Gibson, a consultant in paediatric respiratory medicine at Glasgow’s royal hospital for sick children, wrote to the chair of the review as follows:

“The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record…There is a significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.”

Professor J. Stuart Elborn, president of the European Cystic Fibrosis Society, wrote that

“high quality research is a key determinant of the ability of a centre such as the Royal Brompton to retain and recruit the world leading clinical and academic staff on whom its respiratory services depend. Adverse impact upon the ability of the clinical staff to carry out cutting-edge research will undermine the sustainability of the clinical services, to the detriment of its patients.”

Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign, and the Primary Ciliary Dyskinesia Family Support Group wrote a joint letter to the chair of the committee, saying:

“We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future.”

Patients and staff at Royal Brompton are understandably deeply distressed at the prospect of losing their high-performing children’s heart unit, soon to be followed by their specialist respiratory services. They do not understand how such a decision can be made by bureaucrats who have never visited the hospital and have no specialist knowledge of the care provided there. They have written to their MPs and to the Secretary of State. Indeed, one resourceful mother brought the matter to the attention of the Prime Minister in Downing street last Thursday.

The Secretary of State for Health assures the parents of these seriously poorly children, and the dedicated teams that treat them, that this is a matter not for him, but for the NHS. For the sake of the thousands of children whose care will be damaged by the decision of Sir Neil McKay’s committee, the sake of the research programmes that will be destroyed, and the sake of common sense, I hope that the Minister of State will realise that the time has come for him to meet clinicians from the Royal Brompton and at least hear what they have to say. Perhaps he will be able to persuade them that destroying NHS services and research programmes that are viewed by international peers as among the best in the world is a good idea. I wish him luck in doing so.

National Health Service

Andy Slaughter Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

I am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.

As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.

We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”

We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.

[Mr Andy Slaughter (Hammersmith) (Lab)]

On the subject of brutal closures, did my right hon. Friend have a chance to look at the authoritative report by David Rose in The Mail On Sunday yesterday about the “Beeching-style” closure of major casualty units? Four out of nine of the units to be closed are in west London, leaving my constituents and 2 million people in west London without adequate health cover.

[Andy Burnham]

I have no idea how Ministers expect west London to cope with service reductions on that scale, nor do I know how they square them with the moratorium on hospital closures and changes which they promised at the last election. Perhaps we will hear some justification later today, although I will turn to reconfigurations shortly.

--- Later in debate ---

[Mr Slaughter]

The Minister talks about scaremongering. For seven years my constituents put up with scaremongering from his party that Charing Cross hospital was going to close. The services there expanded. After two years of his Government, the hospital, 500 beds, and the accident and emergency department are closing and being replaced by an urgent care centre, which will treat only minor injuries. What will that do to his statistics?

[Mr Burns]

I am slightly surprised that the hon. Gentleman made that intervention because it rather proves my point about scaremongering. He said that is going to happen. The truth is that the local NHS has determined locally what it believes is the best reconfiguration of services. That is going out to public consultation and so far no decisions have been taken because the consultation process has only just started. It will last for 14 weeks and then the results of that consultation will be considered.

Hospital Services (West London)

Andy Slaughter Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Gray, and a pleasure to see so many colleagues from west London, of various parties, here for an important debate that concerns us all. It is a particular pleasure to see the hon. Member for Ealing Central and Acton (Angie Bray), relieved of the cares and constraints of office and therefore able to speak. I am slightly surprised that she chose to be pushed over House of Lords reform rather than this issue, the third and fourth runways at Heathrow airport or the cuts to Sure Start, pensions and other things that are going into the next manifesto, but we all find our path to salvation. I also welcome the hon. Member for Cities of London and Westminster (Mark Field), who already adorns the Back Benches. I hope that we can see others, including the hon. Member for Chelsea and Fulham (Greg Hands), joining the hon. Member for Ealing Central and Acton soon in order to fight the appalling changes to our health service.

Members of Parliament for the north-west London NHS area represent 2 million Londoners, and I know that all of them, whether they can be here or not, are very concerned by the proposals in the consultation document, “Shaping a healthier future”, published on 2 July. I will primarily deal with that document today. I intend to confine my comments, as the debate’s title suggests, to the effect on the major hospitals in north-west London of the proposed changes. Given the time constraints and the fact that hon. Members with more knowledge of hospitals in their own constituencies are here to speak, I will deal principally with the risks to Charing Cross and Hammersmith hospitals, but I will try to put those in the wider context of what can only be called a crisis in the NHS in north-west London. That is in the light of the further decision last week to put the future of Royal Brompton hospital at risk by the closure of children’s cardiac services there and the failure by Imperial College Healthcare NHS Trust to manage waiting lists and GP referrals.

The Minister will have seen the letter that I sent last week to the Secretary of State, asking for independent intervention to rescue the health service in west London before matters get more out of hand. I will expand on that and hope that the Minister can respond positively.

The other point that I will make in opening the debate is that the consultation should not be a Dutch auction. I do not think that any hon. Member will have come here to say, “Don’t close my hospital; close his or hers.” Every hon. Member and, indeed, every member of the public I have spoken to in the past few weeks wants to challenge not the detail or options that we are offered, such as they are, but the premise that such a major downgrading of the health service is sustainable, safe or sensible. If any hon. Member here felt a moment’s relief when they saw the schedule of closures—in particular, of accident and emergency departments—and realised that their local hospital was not on it, that relief was short-lived. The question immediately arose: how will the five remaining A and Es cope with the consequence of closing four busy departments and the consequent downgrading of other hospital services?

I am pleased to see here hon. Members representing, I think, all the north-west London hospitals, not only those under threat. Neither I nor my constituents are resistant to change in the NHS or unaware of the cost pressures that it faces. Indeed, it is the Government, not us, who need to be candid about both their failure to fund the NHS and the underlying financial motivation for these proposals.

The medical director for north-west London has been admirably frank. In approving the consultation two weeks ago, he stated that the local NHS would

“literally run out of money”

if the closures did not go ahead.

[Mary Macleod (Brentford and Isleworth) (Con)]

I congratulate the hon. Gentleman on securing the debate. Does he agree that whatever the shortfall in funding in London that he talks about, more funding has gone into the NHS from the current Government than ever before?

[Mr Slaughter]

Apart from the bit of fun that I had at the beginning of the debate, I am going to stay off party politics. I think the hon. Lady knows that the NHS was rescued under a Labour Government, and knows about the increase in funding then. She will also know from articles in the press this week and last that in fact, the promise made by the Prime Minister before the election to increase funding for the health service is not being kept. [Interruption.] I therefore think that that was a bad point to make. [Interruption.]

[Mr James Gray (in the Chair)]

Order.

[Mr Slaughter]

There has already been significant change in hospital services in north-west London. That has been for clinical and financial reasons. It has involved within Imperial the centralising of services, including renal, paediatric, oncology and vascular specialisms. More of that was anticipated. Other proposals for savings have been leaking out of Imperial for the past six months. Further moves away from hospital to community or GP services were expected—but nothing on the current scale.

This review is driven by the need to cut costs and is unrestrained because the chaotic reorganisation in the NHS, for which the Minister must answer, means that there is no accountability on the part of those who are making decisions. The Joint Committee of Primary Care Trusts, itself a body artificially created to make these cuts, is neither their author, nor will it survive to see their execution.

I would like to say a little about the history of hospital services in my part of west London, the scale of the changes proposed and the flawed process under which they are being made. I would then like to summarise the emerging public and professional views on the proposals, before finally asking the Minister for his response. Given that many in the NHS see the north-west London proposals as a prototype for what will happen elsewhere, it is not satisfactory for him to disown interest. He must either justify or be prepared to criticise the loss of front-line hospital services.

Each of the hospitals now under threat has a long and distinguished history. I am afraid I am old enough to remember when Charing Cross was Fulham hospital and when Chelsea and Westminster was St Stephen’s. Hospitals have stood on the Hammersmith campus since 1905 and at Charing Cross since 1884. Originally, these were workhouse infirmaries, fever hospitals or military hospitals. They have evolved into the world-class treatment centres that they are today. I do not want to take up a great deal of time with the history, but while preparing for the debate, I did come across this interesting paragraph on the opening of Hammersmith hospital:

“Immediately on opening, there was an outcry about the cost of the…building…£261,000…and its lavishness. The vestibule was paved with mosaic and was surrounded with a dado of the most expensive encaustic tiles. The dining hall was ‘of baronial splendour’. The press dubbed it the ‘Paupers’ Paradise’ and the ‘Palace on the Scrubs’.”

I did not know the Daily Express was going in 1905, but clearly it was. I am not sure that that was a completely accurate representation of the hospital, because its annual report for 1957 illustrated a granite block—part of the last consignment to the workhouse for breaking up by the inmates of the casual ward. I do not want to give the Minister any ideas about reintroducing rock breaking for out-patients, but that does show that we have come a long way over that time.

The Minister may say that I am being nostalgic in looking at the history of Hammersmith’s hospitals or that it is evidence that change in the health service is nothing new, but that misses the point. These hospitals have grown up on their current sites and changed in response to local need. These are some of the most densely populated parts of the UK. There is intensive residential development in the area: tens of thousands of new homes are planned for the next decade. This is a population with complex health needs and high turnover. This is an area with major transport infrastructure—air, road and rail—and with risks ranging from major trauma accidents to tropical and infectious diseases.

The accident and emergency departments under threat are always busy. They are trusted by my constituents. They have evolved to work side by side with GP practices, walk-in clinics and urgent care centres. However, they work, because the level of clinical expertise available can be adapted to cases ranging from the relatively minor to the very serious. I understand the debate about having fewer major trauma centres—the trade-off between travelling further and losing critical treatment time against the quality of care on arrival. I do not think that that argument is settled, not least because of the unpredictable and congested road system in west London, but also because of the conflicting opinions as to how crucial minutes can be in reaching specialist care in different trauma cases. What is unarguable is that the vast majority of patients currently attending A and E will potentially receive a worse service. They will not be sure whether their condition merits a longer trip to a hospital that still has A and E services, or whether seeing a GP at an urgent care centre will suffice. There will certainly be confusion and delay, and overall standards in quality of care will fall.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I apologise for missing the first couple of minutes of my hon. Friend’s remarks. Does he accept that, notwithstanding the proposed closure programme, there is already growing concern about the length of waiting times in A and E? Many of my constituents will be worried that their wait at Northwick Park hospital A and E unit will increase as a result of this closure programme.

[Mr Slaughter]

My hon. Friend missed the point that I made at the beginning: this affects all MPs and all communities in north-west London, not only those expecting the closure of services. The closures go against the thrust of the changes in the health service over the past five to 10 years, which have seen the huge pressure on A and Es relieved by the addition of urgent care centres, not the replacement of A and Es by them.

[The Minister of State, Department of Health (Mr Simon Burns)]

rose—

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

rose—

[Mr Slaughter]

I give way to my hon. Friend and will give way to the Minister in a moment.

[Ms Buck]

I am grateful to my hon. Friend. He was with me when we met representatives of north-west London recently and were advised that the number of A and E attendances is rising by about 10% a year. Does he agree that, even for those of us who agree that in an ideal world, we would reduce unnecessary A and E admissions through the provision of quality care in the community, it is wrong to propose the closure of A and E units before we have a demonstrable improvement in the community facilities that would allow for that reduction in unnecessary A and E admissions?

[Mr Slaughter]

Indeed, and I will come on to that when I talk about the process and history of the closure of services.

[Mr Burns]

I rise in response to the comments of the hon. Member for Harrow West (Mr Thomas) on A and E waiting times. Would he like to tell us what the percentage standard is for A and Es and what was achieved in his trust?

[Mr Slaughter]

I am here to question the Minister, and I hope that in response he will not adopt the complacent tone that he has just shown.

[Mr Burns]

rose—

[Mr Thomas]

rose—

[Mr Slaughter]

I will not give way to the Minister again yet. I want to make some progress. We shall see what happens in a few moments, but after I give way to my hon. Friend, I really must move on.

[Mr Thomas]

I am grateful to my hon. Friend for giving way. I do not know whether the Minister’s intervention was prompted by the recent answers he gave to my parliamentary questions. He will be aware of the approximately 180,000 people who waited more than four hours from arrival in A and E to departure. Will my hon. Friend ask the Minister for an assurance in his final remarks that the figure is not likely to rise for the 2011-12 period?

[Mr Slaughter]

I am happy to trade statistics with the Minister, but the debate is not about incremental performance, but the fundamental change to services.

[Mr Burns]

I just want to inform the hon. Member for Harrow West (Mr Thomas), because he clearly does not know, that the percentage standard for A and E waits is 95% and in his trust in the past quarter it is 97.5%, which is 2.5 percentage points above the standard.

[Mr Slaughter]

I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

[Stephen Pound (Ealing North) (Lab)]

Will my hon. Friend give way briefly on a point of information?

[Mr Slaughter]

Yes.

[Stephen Pound]

At that particular meeting of GPs, the voting figures, which I am sure hon. Members will want to know about, were 47 against and three for.

[Mr Slaughter]

I am grateful to my hon. Friend for that information. I had thought that the vote was 47 against, with three abstentions, but I always stand to be corrected by him.

The bodies that have supposedly devised these proposals are indeed the commissioning groups. As far as I can see, the only people supporting these proposals on a clinical level among the GP community are those who are heavily involved and who perhaps have a vested interest in relation to those commissioning groups, which of course will not take control until April next year.

It is absolutely true that, unlike some other hospital trusts, Imperial College Healthcare NHS Trust is at best acceding to this process and at worst actively supporting it. It is very clear why it is adopting that approach and why it would see the closure of two of its own A and E departments. The Imperial trust is in deep and dire financial trouble. It has a deficit of more than £100 million and the ability to close down significant services and, perhaps more importantly, to free up one of the most lucrative pieces of real estate in London—in other words, most of the Charing Cross hospital site—presumably for commercial disposal will, it believes, allow it to see its way out of its financial difficulties. Therefore, I am afraid that its opinion is coloured by that judgment.

Let me move on to discuss public opinion briefly. At 48 hours’ notice, I called a public meeting by e-mail and 250 people turned up. I also put a petition online and within a day 750 people had signed it. We have set up a consultative committee under the banner, “Save Hammersmith and Fulham hospitals”, which involves 40 concerned local residents. They have no particular political affiliation; they simply care about their local health services.

All that is but the germ of what I am sure will be the largest campaign of public opposition across west London that we have seen. There will be no safe parliamentary seats in west London if the Government pursue this course of action; there will be no limit on the opposition to the proposals, and there will be marches, petitions and protests until they are withdrawn.

I am hopeful that there will be a debate—at least a partial one—next Tuesday on the Floor of the House about children’s cardiac services, and therefore I will not spend as much time today discussing that issue as I had planned to. All I will say now is that the same body that has been involved in the proposals about my area—the Joint Committee of Primary Care Trusts—has taken the extraordinary step of recommending the closure of the children’s cardiac unit at the Royal Brompton hospital, despite knowing that there were no risks attendant on keeping it open. On the contrary, it is a world-class unit with world-class doctors and surgeons. Moreover, the JCPCT also took that step in the knowledge that a range of other world-class services at the Royal Brompton hospital—the respiratory service, the cystic fibrosis service and the neuromuscular services—are also at risk. The Royal Brompton hospital is not in my constituency, but it is used by my constituents and indeed I substantially used it myself when I was severely asthmatic in younger life. It is unthinkable that it should be put at risk by this decision to recommend the closure of services and I am glad to see that there is opposition to the review by the JCPCT from around the country.

Let me also mention the concerns that we in Hammersmith have about the Imperial trust and its use of data. I will quote from an article in last week’s Fulham and Hammersmith Chronicle, a local newspaper:

“An investigation has been launched to determine whether data recording blunders by Imperial College NHS Healthcare Trust could have cost lives. The panicked trust…realised there had been major errors in the way it handled recording files for patients referred for cancer tests earlier this year. People suspected of having cancer are required to be tested within two weeks of being referred by their GP. But Imperial found its records of this treatment path was flawed, with many incomplete, giving no indication of whether the patient was tested or not, and others duplicated.”

Furthermore, as was widely reported in the press last week, there were 25 deaths in that period in the local area that are still under investigation.

The issue of the Imperial trust’s record keeping and referrals was first raised by me in February. I know that there has been some limited improvement in clearing the backlog of cases, but it is simply not acceptable that a trust serving such a large proportion of west London’s population can continue to keep data in this condition.

That brings me to my final point, which is what I am seeking from the Minister. The Secretary of State for Health wrote to me last week and said that the consultation process

“is a matter for the local NHS.”

However, he acknowledged that

“there is an independent scrutiny and review process…which is overseen by local Health Overview and Scrutiny Committees (OSCs). OSCs have the power to refer proposals…which I am then able to pass…to the Independent Reconfiguration Panel for advice.”

I have no doubt that will happen at some stage, because there is such overwhelming opposition to these proposals from local authorities as well as from MPs and their constituents across west London. However, given the farce of this purported consultation and the way that this matter has been handled so far by NHS North West London, it would be better for the Government to act now and call off this consultation, review the proposals and engage genuinely with MPs, clinicians and local authorities in reaching a sensible set of conclusions and proposals. We are not luddites; we do not oppose change in the health service for the sake of it. But our NHS and our local hospitals are very special places. People who have used those hospitals—sometimes over generations—have a unique relationship with them. I am sure that is true. I know that the Minister is familiar with the area and has past associations with it, so he will know what I am talking about. I know that he will also be aware of my constituents’ special and particular problems in terms of complex health needs.

I ask the Government in what I hope is an open-handed spirit to look now at what is happening, not only in the Imperial trust but in NHS North West London, because this situation cannot be allowed to continue.

--- Later in debate ---

[Angie Bray]

I agree. It is always important to bear in mind the impact on families who want to visit, because that is all part of the healing process. That is an important consideration.

The consultation is not made easy when the options to choose from are buried in such a heavy document. I have concerns about how that will affect the consultation process. The consultation document is itself a barrier to participation, as it is so huge and bulky as to be virtually impenetrable.

It would be helpful if NHS North West London were to encourage the GPs that it says support its proposals to actually speak out in support of them. The public are much more inclined to listen to their doctors than their politicians—we all know that, unfortunately—and I have urged those behind “Shaping a healthier future” on numerous occasions to do exactly that. So far, however, there has been a deafening silence. If the case for change is so strong, why are we not hearing more local GPs coming out publicly in support of the recommended options?

It is, of course, important to acknowledge that the NHS is set to undergo a series of improvements. The health reforms will fully kick in in April next year, crucially putting GPs in charge of decision making. It therefore seems extraordinary that, after the lengthy process of getting legislation through Parliament, we are now seeing a last-minute, top-down reorganisation of local health care pushed through by NHS North West London, instead of waiting for the GPs to take charge.

The “Shaping a healthier future” programme is a bureaucratically-led initiative by NHS North West London. As such, I urge my neighbouring MPs to accept that this is not about Government cuts. In fact, the Government are putting extra funding into the NHS in real terms year on year, and the Conservatives were the only party to pledge to do so in their 2010 election manifesto.

[Mr Slaughter]

I entirely respect the position that the hon. Lady is speaking from today, and I accept that the NHS locally is behaving very badly. However, does she not agree that the Government must take some responsibility and that, as local MPs, we all ought to be talking to the Government as well?

[Angie Bray]

I spend quite a lot of time talking to Ministers, who have been very generous with their time on this and other issues. Finance is at the root of the problem, but I suspect that the Government have decided to make the NHS a major spending priority; rather more so than some other Departments. We have to accept that there was a problem with funding relating to NHS London for a long time before the Government took power—a point that I was going to come on to in a moment.

As I said, we were the only party to make a pledge on extra funding in its 2010 election manifesto. Furthermore, any efficiency savings do not go back to the Treasury, but are instead ring-fenced for reinvestment in the health service. The latest figures from the Department of Health show that by 2014-15, there will have been funding growth of £12.5 billion across London. The problem is that NHS North West London has been struggling in the face of a huge £5 billion or £6 billion deficit in the past five years or so.

Clearly, we cannot stand against every proposal for change. All institutions occasionally need refreshing and reforming. The key to “Shaping a healthier future” is to work with local communities to establish clinical need that works for those who use the hospitals. This clunky consultation does not do the trick. Nevertheless, I urge people to persevere and wade through the massive document. My message to the Minister is that for my constituents to have all four of their nearest A and Es downgraded is absolutely disproportionate. I hope that, should the consultation go the way that I suspect is intended, the decision will be then called in and a fairer way forward will be found.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Hammersmith (Mr Slaughter) on securing this debate, the importance of which is indicated by the significant number of Government and Opposition Members who have either taken part or listened. I also congratulate my hon. Friends the Members for Ealing Central and Acton (Angie Bray) and for Cities of London and Westminster (Mark Field) and the hon. Members for Ealing, Southall (Mr Sharma), for Hayes and Harlington (John McDonnell) and for Ealing North (Stephen Pound) on their contributions.

Before I get to the nub of the debate, it is important to pay tribute to all those who work in the NHS in north-west London, including in the constituency of the hon. Member for Hammersmith, for the selfless dedication and determination that they put in day in, day out—whether doctors, nurses, consultants, porters or ancillary workers—to ensure that the people of north-west London get the quality of care that they deserve.

I am aware of the controversy and high emotions that surround any service reconfiguration, or proposed reconfiguration, and I respect the way that hon. Members, including my hon. Friends, rightly draw the attention of the House to their concerns about aspects of the proposed reconfiguration. I should like to give a general message to all hon. Members: I urge them to engage fully in the consultations, to the best of their abilities, and make their case and argument, which can be part of the information gathering and ideas that will be considered when the consultation process ends in early October.

The reconfiguration of services is a matter for the local NHS. I hope that the hon. Member for Hammersmith agrees that that should not be dictated or micro-managed by Ministers in Whitehall. Reconfigurations are affecting local services and should be determined by the local NHS in full consultation with stakeholders within the local NHS in north-west London and the local community.

[Mr Slaughter]

Given that the medical director of the NHS, who the Minister says has to make the decision, has said that the NHS is doing this because it would be out of money otherwise and given that he has said that it would not take any notice of the consultation, does not the Minister see a role for the Government?

[Mr Burns]

First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays. We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.