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 Gentleman is out of date, because the figures cited by the Government are wrong.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.

NHS Annual Report and Care Objectives

Andy Slaughter Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

Yes, I could not agree more. It was precisely because Professor Sir Mike Richards undertook an inquiry and produced a report identifying a lack of access in this country to new cancer medicines in the first year after their introduction that we instituted the cancer drugs fund. It is a matter of considerable regret to many of us that that example was not followed in a similar way in Wales.

[Mr Andy Slaughter (Hammersmith) (Lab)]

What message does the Secretary of State have for the 2 million people in west London, four of whose nine major hospitals are set to lose their A and E departments, including both Hammersmith and Charing Cross, in my constituency? That is the Secretary of State’s policy. He cannot pass the buck to the NHS on this or, indeed, on the threat to the Royal Brompton hospital’s children’s services; he has to answer for it.

[Mr Lansley]

No. Let me reiterate to the hon. Gentleman the point I have just made, because what he describes is not my policy. If there are proposals, they are proposals that have been generated in north-west and west London, and the safe and sustainable review is an independent review. It is not establishing the Government’s policy; it is an independent review in the NHS, looking at how services can be improved.

The review was not in any sense about costs; it was entirely about how we sustain the highest quality of excellent care for patients. The same will be—needs to be—true in relation to services in west London for emergency care. I will not go through this all again, but I reiterate that, if people object and say that such an aim will not be achieved, it is open to a local authority to refer the matter to a mere Secretary of State on the basis that the tests I have set down have not been met.

Health and Social Care Bill

Andy Slaughter Excerpts

Monday 31st January 2011 Commons Chamber

[John Healey]

I am surprised that the Health Secretary was asked a direct question and did not answer. I would simply encourage my right hon. Friend to keep asking the questions that he feels are important for the future.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Mr Nash’s wife also bankrolled my opponent at the last election—for all the good it did him. However, something else was not in the Tory party manifesto, and that was cuts in the health service. I have in my hand a letter from the chief executive of my primary care trust that simply states that

“healthcare in North West London will face a £1bn shortfall in funding by 2014/15, given these upward pressures.”

Is that not something else that the Tory party did not tell the truth about, and something on which it is not following the Labour Government?

[John Healey]

My hon. Friend won his seat at the last election because he helped to expose the truth about the Conservative plans for housing—a truth that it denied but which has now come true. He is absolutely right. The truth about what is happening in the health service now is that patients are starting to see the signs of strain and services being cut, and that is not what they expected when they heard the Prime Minister, before the election and afterwards, promising to protect the NHS.

Contaminated Blood

Andy Slaughter Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

May I say two things to my hon. Friend? My hon. Friend the Under-Secretary has met those groups and will continue to meet them, because we want to ensure not least that those who are now eligible for enhanced payments and so on make proper applications. We have looked very carefully with the clinical expert group at the support that we ought to give. It is not compensation as such; it is an ex gratia form of support. We have made judgments, and if we were to go further, there would be significant additional costs. My hon. Friend the Under-Secretary and I have made it clear to the House in the past that to provide payments on the scale of the Republic of Ireland might involve up to, or perhaps even in excess of, £3.5 billion a year, so I am not in a position to say to my hon. Friend the Member for Colne Valley (Jason McCartney) that I expect to go beyond the support that I have set out today.

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is to be regretted that the review’s terms of reference were so narrow, as it did not consider overall levels of compensation or HIV. If the Secretary of State believes that the Republic of Ireland case is simply too expensive, will he please say so and not rely, as the Department has, on either the idea that the Taintedblood campaigners and others are asking him to look at that and tying us to the Irish system, or the idea that they are asking us effectively to look at those levels of compensation because negligence was involved? That was not the case in Ireland. Is not the result likely to be more litigation? The levels of remuneration are still far too low.

[Mr Lansley]

With respect to the hon. Gentleman, in response to previous questions I made it very clear that the question was not simply about the amount of money. The situation in the Republic of Ireland is unique in respect of its determination of liability because of mistakes made by the Irish Blood Transfusion Service. To that extent, we are making ex gratia payments. The nature of our payments stands comparison to other countries, particularly now, in respect of hepatitis C and my announcements this afternoon.

Contaminated Blood and Blood Products

Andy Slaughter Excerpts

Thursday 14th October 2010 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

I wish to say a few words about my constituent, Andrew March, who is a victim of contaminated blood. He is not only a remarkable man and campaigner; he is the reason we are talking about this today, because he was the claimant in the judicial review that led to the written ministerial statement. That statement was correctly attacked by my hon. Friend the Member for Coventry North West (Mr Robinson) today.

I am new to Mr March, in the sense that he has been a constituent of mine since May, as he lives in the Hammersmith and Fulham part of the constituency that I inherited. However, I have caught up quickly with what he has been doing over many years and decades. The easiest way for me to summarise his predicament and what he has done is to read from a letter that he sent to me on 23 July. He said:

“I was one of the young children at the time of the AIDS outbreak, and I had to cope with being told that I had HIV at the age of 9. It was extremely difficult to deal with back then—and the devastation was compounded by the stigma. Before that, I had already been ill from Hepatitis B, again, from blood products because of my haemophilia condition. By 1992, whilst I was studying at the Royal College of Music on a 4-year degree, I was informed that I had also been exposed to hepatitis C, and only 5 years later, I was given another blow when I was informed that I had been exposed to two batches of Factor VIII blood products taken from a donor who later went on to develop vCJD. I had been treated with over 110 bottles of this vCJD-implicated material being injected directly into my bloodstream.”

[Lorraine Fullbrook]

Does the hon. Gentleman agree that this very debate helps to raise awareness of those people suffering from hepatitis C contracted from contaminated blood products and helps to remove the stigma attached to hepatitis C? I am thinking of people such as a constituent of mine, who wishes not to be named but is suffering from hepatitis C1a, which is the severest form of hepatitis.

[Mr Slaughter]

I think that this debate does do that, and I am grateful for this opportunity to increase my own knowledge. However, I think that we need to move on to some very specific recommendations because, as the mover of the motion eloquently said, this is a time for action more than contemplation. That is exactly what Mr March did when he brought the judicial review in April, and the matter has been just been clarified, as my hon. Friend the Member for Foyle (Mark Durkan) described, in relation to the mistake that the previous Government made on the situation in Ireland. That was the error made by that Government. That was the finding of the judicial review, and it is what the Government are responding to today.

I shall not read from the judicial review, other than to quote its final paragraphs, because they again relate to Mr March. The learned judge, Mr Justice Holman, said that counsel for the claimant

“paid a warm but measured tribute to…Andrew March, ‘for his tenacity and balance in the asking of questions and soliciting of information, and not taking no for an answer when the reasons are not good ones.’ My impression is that that tribute is justified and well judged, and that the many other people interested in this cause owe gratitude to Mr March for his tenacity or persistence.”

I say again that Mr March has done that for many years, suffering as he did not only from his original medical condition but from the effects of the contamination.

Taintedblood, an organisation that has done a lot of excellent work in briefing us all and preparing us for this debate, states:

“The Under-Secretary of State for Health”—

the hon. Member for Guildford (Anne Milton)—

“recently held a series of meetings with campaigners, the Haemophilia Society, the Macfarlane and Eileen Trusts, the Skipton Fund and others. In those meetings she demonstrated a new willingness by Government to face up to and deal with what has happened to the Haemophilia Community.”

Those organisations must be very disappointed today by the amendment that the Government attempted to move and by the written ministerial statement.

I welcome what is said in the terms of reference about hepatitis C, as has been mentioned. I want to clarify whether the Minister is offering full parity for hepatitis C sufferers with what AIDS sufferers experience, including the £12,800 per annum payments, and that that will be susceptible to the review.

[Mr Marcus Jones (Nuneaton) (Con)]

The constituent whom the hon. Gentleman mentioned is the son of one of my constituents in Nuneaton. I want to mention the families of those affected by this disaster, because they have also had to bear a real burden in supporting people such as Mr March over the years. Does the hon. Gentleman welcome the terms of reference that the Minister announced in her statement about supporting the families who have had to bear that burden?

[Mr Slaughter]

No, I definitely do not. I ask the Minister to clarify—if not now, when she makes her speech—whether the terms of reference will allow hepatitis C sufferers to be treated at least as HIV/AIDS sufferers are under the current scheme. I hope that she will do that. However, all that could have been done today. The limited amount that is offered in the review could quite easily have been announced today. If there had to be a review, I should have liked it to have been along the terms of Lord Morris’s Bill, which considered all the remaining provisions of the Archer inquiry and said specifically—this is the contentious part:

“When making the regulations the Secretary of State shall have regard to any comparable compensation schemes offered in other countries.”

The noble Lord’s Bill was a good Bill, but I would say—this is the only criticism that I would make of my hon. Friend the Member for Coventry North West—that I think today’s motion goes a little too far. It calls specifically for parity with the scheme in Ireland. I do not think that it gives the Government sufficient room. I would ask the Government—this is the commitment that I would look for today—to widen the terms of the review and to reconsider all the matters that Lord Archer raised, including compensation. Even if the conclusion is that parity is unlikely with Ireland, where the situation is different even given the judicial review—that was suggested in the opening speeches—in the current financial climate we need to look at the levels of compensation that are paid.

I also think that the motion, while criticising previous Governments, could at least have acknowledged that the previous Government responded to the Archer review by making regular annual payments at a higher level, although I understand that my constituent and many others regard that as inadequate. I regard it as inadequate. We are looking, I think, for something between the two. The unfortunate thing about the Government response today is that it cuts off that option. The amendment and the ministerial statement do not allow the option of considering more generous compensation in the light of Lord Archer’s proposals. That is why I would have voted against the amendment and that is why I think it is wrong for the Government to have given false hope to sufferers and to have dashed that hope with their announcement today.

--- Later in debate ---

[Anne Milton]

I thank my hon. Friend for his question. We are talking about a long time ago; that is the trouble. I know that campaigners have been concerned about cover-ups, and that not all the documents have been released. I assure him that officials have told me that all documents have been released, but somewhere in the back of a cupboard, somebody at some point might discover more. It is a mistake to think that there is any conspiracy, however. I do believe, in all honesty, that previous Governments and the current Government have done, and continue to do, all that they can to ensure that all information is in the public domain.

As the consensus on the virus developed and technological advances occurred, the Government and the NHS moved quite quickly to address the risks. Heat treatment was introduced in 1985, and that effectively killed the hepatitis and HIV viruses. Validated tests for screening blood donations were also introduced. Since then, Governments have introduced a number of important safeguards to protect the blood supply, not least, as we heard today, from newer risks such as new variant CJD. We carefully assess, and shall continue to assess, all new evidence as it comes to light, and we now have EU directives that set standards of quality and safety.

I fully understand again the financial difficulties that many of those affected by contaminated blood products face. I have met some of them, and they have told me in some detail of their extraordinary experiences of living with the aftermath of infection. Not only were many of them infected, but they went on to infect their partners. They are, understandably, very concerned about their own and their family’s financial security, and they look to the Government to provide a degree of certainty in the years ahead.

Going—what may feel like—cap in hand to the state is demeaning, I know, but it is worth laying out the financial settlements that are currently available. Those infected with HIV receive a flat-rate payment of £12,800 per year, and they may also be eligible for additional discretionary payments. In the year ending April 2010, the average total payment to an individual infected with HIV was £17,400, although of course some received less and some received more. Those infected with hepatitis C are eligible to receive an initial one-off lump sum payment of £20,000 when they develop chronic infection. Despite contracting the virus, some people will make a full recovery, but many do not and go on to develop serious liver disease. For that group, there is a second one-off payment of £25,000. All those payments are tax-free and not used when calculating an individual’s eligibility for state benefits. Therefore, if they were unable to work for health reasons they would receive those benefits, but I take the point made by the hon. Member for Kingston upon Hull North (Diana R. Johnson).

The independent public inquiry on NHS-supplied contaminated blood and blood products, chaired by Lord Archer of Sandwell, investigated the circumstances surrounding the supply of blood products. It made several recommendations, the majority of which are in place in one way or another. However, a small number of recommendations have not been implemented. These primarily relate to aspects of the ex gratia payments, free prescriptions in England, and access to insurance.

I have instigated a review of those recommendations to see what more can be done. I know that hon. Members would love me to finish that review before Christmas. I will do what I can in the time available; I know that time is of the essence. The review will be conducted by Department of Health officials, but with the support of relevant clinical experts and external groups. The terms of reference should be in the Library. At this stage, let me put on record that I will place in the Library how the costs of implementing the Irish scheme in the UK were arrived at. I know that that has caused some concern, but I will come back to it, because time is very short.

I do not have time to go into detail on what happened in Ireland, but it is important to place on the record that in an article in The Irish Times—I will ensure that this is also in the Library—Brian Cowen, then Minister for Health and Children in the Republic of Ireland, and currently Taoiseach, confirmed that the Irish Government knew in 1995 that the Blood Transfusion Service Board had been negligent and had attempted to conceal that fact.

[Mr Slaughter]

Will the Minister deal with the two points that I raised in my remarks? First, do the terms of reference permit the inquiry body to consider the issue of hepatitis C in it widest sense—that is, to give it full parity, including in relation to the ex gratia payments of £12,800 a year for HIV? Secondly, given that she says that there are only a small number of recommendations to be addressed, why does not the new inquiry consider all those remaining issues, including the level of ex gratia payments?

[Anne Milton]

I thank the hon. Gentleman. I will admit to a certain amount of ignorance. I do not know what I can do, but I will do everything I can within what I am allowed to do. It is important to say that I am very keen to get on with this. The danger with an inquiry that extends its remit is that it drags on and on, and this issue has dragged on for more than 25 years.

No fault has ever been found here in the UK—a fact that has been tested in the courts. In 1988, a group of haemophilia patients and their families sued the Government of the day. They settled their case outside court, midway through the proceedings, as their solicitors had advised that they had very limited chance of success.

Whatever happened all those years ago does not change the facts of today. In the United Kingdom, decisions over tax and spend are made here in this Parliament. The decisions of the Irish Parliament, like those of any other national Parliament, have no authority here in the UK. The debate on contaminated blood products has continued for many years, and I would like to close my remarks by again offering my sympathy and expressing my deep regret at the events, and by saying how sorry I am that this ever happened.

Supporting Carers

Andy Slaughter Excerpts

Thursday 1st July 2010 Westminster Hall

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Benton, although the matters that I have to deal with are somewhat distressing. I wish to address the proposed closure of the Hammersmith and Fulham carers centre, which is the main carers centre in my constituency. Hammersmith and Fulham council is closing the centre at the end of July in the most irregular and arbitrary way, and that will leave no service for carers in the borough for the foreseeable future.

I should perhaps begin by declaring an interest. The centre was set up in 1998, when I was the leader of the council, and I have been a strong supporter of it over the past 12 years. The centre occupies substantial premises in Hammersmith road, which is about five minutes’ walk from Hammersmith Broadway, so it is located in the centre of the borough and highly accessible for the carers who use it. It has a lot of space, so it can run activities, and it has—or had—six staff. It has provided a service to many thousands of people, and I shall read some of their testimonials in a moment, but let us just say for present purposes that it has run a good service. It should now be delivering a service to adults and young people using its budget of £300,000, which is split roughly 70:30 between those two groups. In addition to providing services in the main building, it also provides outreach services across the borough.

In 2008, the then relatively new Conservative council decided to conduct a tendering exercise. It is a moot point as to whether that was necessary, and the council failed to identify whether the body involved should be voluntary or whether staff would be employed by the council, but it went ahead. The problem was not the exercise itself, but the fact that it was so incompetently managed that three separate tendering exercises were carried out over the ensuing two years with no successful resolution. Despite the council going to great lengths and spending a lot of money on the process, the most recent exercise had only one bidder, which was the existing carers centre. The centre passed its appraisal, at least as far as the adult part—the majority part—of the quality assessment was concerned, so it anticipated being awarded the contract. However, at that point—again, entirely arbitrarily—the council decided that it would terminate the contract with immediate effect. Indeed, it should have been terminated yesterday, on 30 June, but a winding-up extension has now been granted until the end of July.

Some people thought that these events might be connected with the fact that the council, as part of its fire sale of most of the borough’s capital assets, wanted to sell off the building for an estimated £1.7 million. It had initially tried to move the centre into small, unsuitable premises in a less accessible location, which had to be accessed through another charity’s premises, but it then decided to get rid of the centre altogether.

Events then take a more remarkable turn. The chair of the management committee, Kamaljit Kaur, who has an extensive background in the voluntary sector, has been trying to run the centre in an exemplary way over the past few years since taking over that role. She met the council’s director of adult services on 23 June and failed to persuade him—because his mind had already been made up by politicians—to reconsider or even to extend the centre’s tenure while alternative provision was made. We now know that there will be no alternative provision until at least April. After the failure of that meeting, she wrote a letter to carers and other interested parties, including me, in very mild terms given the circumstances. Part of her letter read as follows:

“The Council went through a tendering process for Carers Support Services and made three attempts to attract potential bidders for this contract. However, we were the only bidders for their adult and young carer’s contracts. Our bid was evaluated by the Council's TAP: our bid was successful in the adult carer’s contract and was recommended for funding by the TAP, but eventually turned down at senior officer level.

The Council have been informed that the prime reason for the lack of interest in this contract for potential bidders was the requirement to employ existing centre staff and the financial liabilities that go with this requirement. We now believe that the Council's sole intention behind closing down the Carers Centre is part of its strategy to remove existing staff, thereby removing the requirement for new bidders to take on this financial responsibility. We also believe that this will attract national organisations to bid for this contract.”

That is quite likely, because that is a method that the council has used before—getting rid of local organisations and bringing in national ones that they believe can handle matters cheaply if not as well.

The response to that letter, which also explained how people could protest about what was happening, was an extraordinary six-page letter from the director of adult services making serious personal allegations against the chair, including an allegation of an improper family relationship with someone who had a pecuniary interest in the contract. Late last night, the councillor responsible—Councillor Carlebach—and the director of community services had to issue an apology:

“Since issuing our letter of 28th June on this matter, we have received a single representation that we have misunderstood and mis-stated the position”.

They state that they are

“writing to clarify that it has now been made clear”

to them that the individual in question

“is not the brother of Kamaljit Kaur.”

The letter continues in an exculpatory way to try to excuse them for what happened. The chair informed me earlier that she now feels under an obligation to resign and is taking legal advice with a view to an action for defamation. I do not want to pursue that matter, but I simply set out those facts to show that the local authority is out of control and behaving in a highly improper way—as it is in many other respects.

Leaving aside the process, what is the effect on carers? Hon. Members might have seen in the debate pack an article from The Guardian of 16 June, part of which I shall quote:

“For 12 years, Margaret Turley has known where to go in a crisis. Eighteen months ago, when the 26-year-old learning-disabled son she cares for developed epilepsy and began going blind, Turley headed for the Princess Royal Trust Hammersmith and Fulham Carers Centre.

‘You’re among people who know what carers do,’ she says of the Hammersmith Road centre in west London. ‘I can come in here just because I’ve had a horrendous day.’ The centre provides advice and peer support, and runs a Department of Health-funded programme, Caring with Confidence, offering free training for carers who want to develop their caring skills.”

Later the article says:

“Pat Williams, who cares for her disabled son and runs the Caring with Confidence sessions, says: ‘It’s a fait accompli—get us out of the building, don’t give us the contract, and run the organisation down.’ ”

Hon. Members will not be surprised to learn that I have received an extraordinary number of letters about this matter. I will not take up too much time, but I want to read excerpts from some of them, as I think that hon. Members should realise what a serious matter this is for thousands of carers in my constituency. I shall not give names, but one letter states:

“I have been a member of Hammersmith and Fulham Carers Centre for the last 10 years and have relied on the Centre for support through all my times of crisis during those years…I am shocked and devastated at the closure of the Carers Centre…Not only will the Centre close, but there will be no co-ordinated service for carers…How can the Council close down our service and offer nothing in its place? What on earth are the Council playing at?”

The letter continues:

“I can get no sense from anybody at the Hammersmith and Fulham Council…In the meantime, where will we H and F Carers meet for our support groups? Who will we talk to when we need help? Will a building be made available to us? Without a place to come to, when we are in distress, how will we manage?”

Another carer wrote:

“Dear Andy, I am one of the borough’s many fulltime carers and have learned this week that after some 12 months of what the council has termed ‘review’, they have pulled all funding from the carers centre…My 2 sons use the services of the Young Carers Group, and get the kind of support and respite that we will not, again, find anywhere else. I feel passionately that carers are such a soft target, as our responsibilities make it so hard to mount the kind of defence of these services that they deserve.”

Another of my constituents writes:

“I care for my mother who is over 90 years, and also my daughter who is disabled. I do use the carers centre and found that the people who run it are very helpful.”

A further letter reads:

“I have been caring for my wife with severe dementia for 20 years, and the aspect that worries me most is the fact that the centre holds the emergency contact to look after my wife, if anything happened to me; an accident or such like.”

This is the letter that touched me most:

“I am an eleven year old boy. I have a brother with cerebral palsy. My dad died when I was seven from a heart attack. I love my brother so much but I had to face very difficult things. Children have made fun of me because of my brother’s condition. People that don’t understand my brother’s condition treat me differently to other people. I didn’t go on holidays. People made fun of me when I was near my brother. I missed a lot of school. I felt stressed and unsure. I was unsure if I was doing the right or wrong thing. I didn’t have anyone to talk to.

When I first went to the young carers project I made friends quite quickly. I told them my experiences and they told me theirs. The young carers project took me on trips and I was able to express my emotions and feelings. They helped me to understand bullies and that there was nothing wrong with me. They helped me realise that I did do things correctly. They also took me camping, which was lots of fun and taught me different dances for example street dancing and martial arts style dancing. It is a chill out zone for all young carers and adult carers. It gives us freedom from our caring role.

If you close the young carers project, you'll be closing a family of people who came together because of difficulties. Which is unfair for all young carers and adult carers. I just can’t believe you’re closing down the young carers project for all the good work they have done.”

There is, of course, substantial resistance to the decision. There are daily pickets outside the town hall. I have written to the leader of the council to ask him, at the very least, to extend the contract until alternative provision is in place, and to allow the carers centre to bid again for the contract. The matter was debated at full council last night on a motion from the Labour opposition, but of course that was voted down by the Conservative majority on the council. Given the exceptional circumstances that I have set out, I ask the Minister to take a personal interest and to look at the matter. I believe that the situation has arisen not simply because the council is a Conservative one; the local authority is acting without its jurisdiction, in a highly improper way.

What I have described is not an isolated incident. Some hon. Members might know about the council newspaper in Hammersmith and Fulham. Last weekend, the Secretary of State for Communities and Local Government, referring in part to the Hammersmith and Fulham council newspaper, said:

“Councils should spend less time and money on weekly town hall Pravdas…our free press should not face state competition from propaganda on the rates dressed up as local reporting.”

To read the paper in question one would think that everything was well at the carers centre. According to its front page, the leader of the council says:

“We will sell assets we no longer need because, when times are tough, we have to put services before buildings.”

Last night, the council announced a fire sale of most of the public buildings in the borough, ranging from the Irish centre in Hammersmith Broadway, which has an international reputation, to Fulham town hall and many voluntary sector buildings, including one that was referred to in the article in The Guardian, Palingswick House, which is home to more than 20 voluntary groups but is to be sold later this year.

Lest there be any doubt, the incident that I am recounting is not a mistake or isolated incident; it is a calculated attack on the poorest and most vulnerable people in the borough of Hammersmith and Fulham, in the guise of putting through a policy that was never agreed. It is being put through not just callously, but without the remit of the local authority. I ask the Minister to take a particular interest in what is happening in Hammersmith and Fulham not just because of the staff and the build-up of expertise in the past 12 years, which will be lost for ever at the end of next month if a stop is not put to what is happening, but on behalf of the thousands of people—we believe that there are more than 11,500 adult carers and many young carers in the borough—who rely on an excellent service, but will be without it from next month.

[Mr Joe Benton (in the Chair)]

Before I call the next speaker, I ask all hon. Members to ensure that they have switched off their mobile phones.

--- Later in debate ---

[Mr Burstow]

The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.

[Mr Slaughter]

For the avoidance of doubt, I just want to say that it is not so much the financial situation in my area that I am concerned about, because my local authority says that it will, in due course, provide a service for carers. I am more concerned about the impropriety and mismanagement that has led to a long-standing service being simply dissolved overnight although there is no provision in place for the best part of a year to come. I would have thought that that was something in which a Minister and the Government would be interested. It is not to do with involvement in individual cuts; it is to do with the fact that a local authority is unable to manage its own affairs.

[Mr Burstow]

The hon. Gentleman has been a Member for some time, so he will know that there are regulatory systems in place that would deal with local authorities that were performing in the way that he describes. I am not aware that the authority’s activity has been reported in such a way. However, I stand by the offer that I have made, and I will be happy to receive further representations about the impact of tendering arrangements.

I want to pick up on the references that were made to the operating framework because the hon. Member for Worsley and Eccles South was right to point out that, in the operating framework that the Government issued just last week, we identified a requirement in the local priorities for the publication of dementia strategies. We think that that is an important signal. It was a signal to local PCTs that we wanted them to be more public facing and accountable to their local communities, and that they should account for why they have chosen not to spend money on dementia strategies. The signal was not specifically about dementia, but that we expected more of that sort of transparency in general. People should not need freedom of information requests to get information from PCTs about how public money is being spent, and I hope that that message will be understood by our local organisations that deliver such services.

The hon. Lady also talked about ring-fencing more broadly. The Government are determined to ensure that there is as much flexibility as possible for local authorities to make choices about how they prioritise their resources to deliver what is necessary to meet the needs of their local communities. We have made it clear that because we see the social care transformation grant as such a priority for investment in changes to services, so that they are genuinely personalised in the future, the budget for the final year in which it is available to local authorities will continue to be ring-fenced. We wanted to send the signal that we considered that grant to be important, and we want to ensure that local authorities deliver that grant during the course of this year.

The hon. Lady made a number of very useful points about good practice and the way in which GPs, schools and others play a part in delivering early identification of carers, whether those carers are young, old or otherwise. That should certainly inform the thinking of any Government when it comes to delivering a good carers strategy.

The hallmark of this important debate has been the great consensus about what needs to be done and the value that Members from all parties place on carers. I shall now try to address some of the other points that have been made.

The hon. Member for Stretford and Urmston (Kate Green) talked about financial issues and benefit changes, and such concerns were echoed by others. The carers cross-government programme board, which is charged with providing cohesion around the carers strategy, will look at those issues and hold cross-government discussions about them to ensure that the way in which we go about simplifying the benefit system actually delivers the right results at the end of the day.

The hon. Lady also expressed concern about the impact of public service cuts, which was also referred to by several hon. Members. Again, it is important to remember that some of the measures that are already in place were not initiated by this Government. Nevertheless, we have to be mindful about the impact of any budget decisions that we make through the spending review process. That will certainly be at the forefront of Ministers’ thinking in the coming weeks and months as we consider all the options that will have to be considered as part of the review.

The hon. Lady also talked about the difficulties faced by carers coming back into the workplace—the cliff edge, as she described it. The coalition Government’s programme sets out very clearly a desire to improve this country’s tax system significantly so that we raise the amount at which someone starts to pay income tax to £10,000. We believe that as we move towards implementing that change, we will begin to smooth out some of that cliff edge and start to have a significant impact on easing people’s return to work.

The hon. Member for Kingswood (Chris Skidmore) made a very good speech in which he set out a number of the challenges that we face. In particular, he rightly discussed the current complexity in the benefit system and the way in which it can be an obstacle to take-up of benefits.

The hon. Member for Hartlepool (Mr Wright) made a very good speech. He set out a range of issues relating to young carers in particular, but he also raised other points. He made a very important point about the Hartlepool carers centre, which he mentioned a lot in his speech, and it clearly provides an important service in his area. He also cited the £150 million a year that it saves taxpayers by reducing pressures on NHS resources. We need to ensure that such examples of social enterprises playing a part in easing pressure on public services and helping carers are considered. Such mutual operations can really make a difference.

The hon. Gentleman, like several hon. Members, talked about the role of GPs. He also made some comments about benefits. I refer him to what I have said about how we intend to move forward on benefits.

The hon. Gentleman also asked specifically about young carers. The key point I would make is that the Department of Health is piloting personal health budgets. In my written ministerial statement on Monday, I announced how we intend to evaluate those schemes. The schemes should give us yet another way of smoothing and removing some of the cliff edge that we have heard about by providing access to resources for care and health in a way that allows people to exercise real control over them and therefore much more control over their lives. That is particularly important for managing and smoothing the transition from childhood into adulthood, and we all want to ensure that that transition is made smoother.

The hon. Member for Chatham and Aylesford (Tracey Crouch) spoke about the key issue of the identification of carers. She said that only 5% of carers in her area had been identified by the local carers centre. A large number of people are hidden at the moment and do not necessarily identify themselves as carers. The identification of carers is a key challenge as part of the process of refreshing the carers strategy.

We have heard about the importance of flexible support for carers. Again, that is why personalisation will remain an absolutely central part of how the Government take forward the development of services. Such services should be tailored to fit around people’s lives, rather than requiring people constantly to navigate around them, often for the convenience of the service provider rather than the convenience of the person or family themselves. We want to accelerate towards achieving that vital aim, and we also need increased use of more user-led organisations that are much closer to the circumstances of the family, meaning that they can play an important part in advocacy, brokerage and helping families to navigate around the system.

I think that I have already addressed the main point made by the hon. Member for Hammersmith, who clearly put on record a number of powerful testimonies from his constituents about the value that they place on the centre to which he referred. However, as I have said, I will not attempt to micro-manage the decisions of local government colleagues of any particular party persuasion, as it is for them to account to their electorate for the way in which they spend public money.

The hon. Member for Totnes (Dr Wollaston) discussed young carers and talked about the devastating impact that alcohol can have on people’s lives. She offered advice about some of the ways in which the Government might tackle that issue, such as a pricing policy, and cited advice that the NICE has given. I can tell her that we will be publishing a White Paper on public health later this year setting out the Government’s approach on such challenging issues. I hope that my right hon. Friend the Secretary of State for Health will say more about that White Paper in the not-too-distant future.

The hon. Lady also talked about safeguarding, and we have announced a review of the vetting and barring system. I am one of the Health Ministers with responsibility for safeguarding, so I will receive the recommendations from that review. We need to ensure that the system is proportionate to the risk and that it delivers the appropriate safeguards, but it must not be so bureaucratic and difficult that it actually becomes a barrier to people participating as volunteers, so that is one of the tests that we will apply to the system.

The hon. Member for Liverpool, Wavertree (Luciana Berger) talked about the USDAW campaign, as well as the importance that she attaches to the role of carers in her constituency, some of whom she has already visited. She also discussed the plight of working carers, their interaction with the benefits system and the need for an examination of tapering as a way in which people could retain an element of carer’s allowance. All I can say at this stage is that the Government are committed to reviewing the system with a view to simplifying it.

The hon. Lady also asked how we could ensure that there is greater awareness of the right to seek flexible working. Again, that is not just a challenge for the Department of Health. We will need a cross-government approach on the issue involving my colleagues in the Department for Business, Innovation and Skills and the Department for Work and Pensions. Together, we have a part to play in ensuring that people are genuinely aware of that right.

The hon. Member for Blackpool North and Cleveleys (Paul Maynard) spoke very effectively. I was in the House when he made his maiden speech and it was one of the most impressive that I have heard. I know that his speech was excellent compared with mine 13 years ago.