Coronavirus Regulations: Assisted Deaths Abroad

Andy Slaughter Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

My hon. Friend makes another important contribution to this debate. There is inevitably a discussion within the medical profession about this important question. That should be taken into account, alongside the views, as the hon. Member for Leicester South (Jonathan Ashworth) said, of faith leaders, the public and those who face terminal disease, as Parliament debates this subject.

[Andy Slaughter (Hammersmith) (Lab)]

Terminally ill people are travelling prematurely and alone to end their lives abroad for a number of reasons, including covid. Another is that they wish to save relatives from the risk of prosecution. Will the Secretary of State liaise with his Home Office colleagues and the police, who themselves find these cases difficult, to ensure that any response is sensitive and proportionate?

[Matt Hancock]

That incredibly important and sensitive matter needs to be considered as part of the overall approach. These questions should all be brought out in a debate on this subject. That is Parliament’s role, given that this is an area of conscience on which the Government do not take a view.

Local Contact Tracing

Andy Slaughter Excerpts

Wednesday 14th October 2020 Commons Chamber

[Rachel Reeves (Leeds West) (Lab)]

I beg to move,

That this House notes the consistently high performance of local contact tracing systems when compared with the centralised system established by the Government; notes the wealth of evidence that the considerable sums of public money spent so far on the national system would deliver better public health outcomes if devolved to local authorities and public health experts; and calls on the Government to extend the additional funding for contact tracing available in Tier 3 areas to all parts of the country and ensure that councils and local public health teams receive the resources and powers they require.

This Government are obsessed with a failed model of outsourcing. It is failing to reach people who come into contact with someone with the virus, it is not getting information to local councils who need to act on it, and it is wasting hundreds of millions of pounds of taxpayers’ money that could be spent on a local response using local expertise. It is not too late for the Government to change course, and I urge them to do so today.

Yesterday, my right hon. Friend the Leader of the Opposition made the case for a short, sharp circuit break of restrictions lasting two to three weeks to firmly apply the brakes on the rising infection numbers that we are seeing. A crucial aim of the circuit break is to drive down infections, but there is another purpose as well: it would buy the Government some crucial time to fix the failures in contact tracing.

The current model of contact tracing is broken and it will get worse, not better, while corporations such as Serco are allowed in the driving seat rather than local public health teams. We might ask: how bad is the Government’s approach to contact tracing?

One director of public health said:

“It needs someone with the courage to say”

it “isn’t working”, and it was described as a

“catastrophe…the very worst system I’ve…seen”.

Well, we do have the courage to say that it is not working and I urge the Government to have that courage, too.

[Andy Slaughter (Hammersmith) (Lab)]

My hon. Friend is right to highlight Serco. Does she agree that another problem with test and trace is the number of consultants being employed, with more than a thousand from one firm alone—Deloitte—that charges several thousand pounds a day for its senior consultants? Should we not be told how much it is costing and what these people are doing?

[Rachel Reeves]

My hon. Friend makes his point well. He has been a staunch advocate of transparency and value for money in the delivery of public services. The Government’s own Minister in the Cabinet Office in the other place has made those points as well, saying that the Government are spending too much money on consultants when that work could be done in-house with better value for taxpayers. I very much agree with my hon. Friend’s comments.

The minutes of the Scientific Advisory Group for Emergencies meeting from three weeks ago on 21 September, as well as suggesting a circuit break to deal with the rising infection numbers, reflected on the performance of the Government’s approach to test, trace and isolate. The minutes said that

“relatively low levels of engagement with the system…coupled with testing delays…is having a marginal impact on transmission”.

All that money spent, yet this key part of the Government’s system to keep us safe is only having a marginal impact on transmission.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move an amendment, to leave out from “when” to end and insert

“working in conjunction with NHS Test and Trace; welcomes the huge expansion of testing to a capacity of over 340,000 tests a day; applauds the efforts of all involved in testing and contact tracing both at a national and local level; recognises that 650,000 people have now been asked to isolate thanks to the work of NHS Test and Trace, and supports the Government’s efforts to expand testing and tracing yet further.”.

I agree with the final sentence of the hon. Member for Leeds West (Rachel Reeves) that this is about protecting people. The entire focus of the Government from day one has been on driving a system that can protect people. It is not a zero-sum game, and it is not an either/or.

This pandemic is the most unprecedented public health emergency we have faced in a generation. We knew that our response would require a phenomenal national effort and that we would need to work closely with others. Local authorities and directors of public health have played an enormous part thus far, including in the delivery of test and trace. They have worked exceptionally hard to prepare and support their communities throughout the coronavirus outbreak, protecting the most vulnerable and saving lives.

I take this opportunity to say thank you to all the public health teams and local authority staff for their hard work thus far, and I know I speak for everyone in this place, irrespective of where we sit, and beyond when I say how grateful we are that they have been there.

Local partnerships have been at the heart of both covid and of the NHS Test and Trace response. As this House knows, Test and Trace was stood up at incredible speed and has developed at scale and pace. As would be expected, the Government responded at pace.

The hon. Lady mentioned Serco on more than one occasion but, as she well knows, having reacted to the changing situation at pace, Serco and Sitel went through a full tendering process to became one of the suppliers to the Government, and they can be drawn down at short notice. They gained their place through fair and open competition via an OJEU procurement process. Value for money and capability are part of those assessment criteria.

On 8 May, the Prime Minister announced that we were bringing Test and Trace into a single service, listening to those people who were asking us to respond, and it was formally launched on 28 May. We have brought together a huge range of people and organisations into the system, from the Department of Health and Social Care, the NHS, Public Health England, local authorities, academia, epidemiologists, the private and even the not-for-profit sector. I think my hon. Friend the Member for Milton Keynes North (Ben Everitt) will be speaking. Milton Keynes is just the most glowing example of using people’s skills.

[Andy Slaughter]

The Minister mentioned the private sector. Three weeks ago in named day questions, I asked her Department for details of the private consultants working at the Joint Biosecurity Centre, but she still has not answered, even though some of the information has been published in the press since. What have they got to hide about the employment of consultants and their cost? Will she now answer those questions and publish that information?

[Jo Churchill]

As the hon. Gentleman can imagine, in the current circumstances the Department has a vast amount of correspondence. I will chase his inquiry personally when I return.

As I said at the start, it is not a case of either/or, as the Opposition motion makes out. The pandemic requires us all to work towards that common goal of beating the virus. Contact tracing is an excellent example of partnership in action. We have Public Health England’s epidemiology expertise to ensure that the operationalisation of the tracing model is built on a strong scientific base. Through NHS Test and Trace and its partner organisations, we can do it at scale. The national framework enables us to reach tens of thousands of people a day. It would not have been possible to do that on the existing infrastructure without placing an unbearable burden and strain on the system. To support this, we have local health teams who know their local areas and can provide expert management locally. Probably one of the finest examples of that was the response in Leicester, where local teams responded phenomenally to the challenge presented to them earlier in the summer, with the national oversight identifying that there was a problem and then the local response. We know we need people on the ground locally who can reach the most vulnerable and those who are disengaged from local services.

The local health protection teams form the first tier of the NHS Test and Trace contact tracing service, consisting of public health specialists. NHS Test and Trace and Public Health England work with local government colleagues, including the Association of Directors of Public Health, the Society of Local Authority Chief Executives and Senior Managers, the Local Government Association and UK chief environmental health officers, on part of this programme. It is, therefore, simply untrue that contact tracing does not include those experts front and centre, helping us deliver.

Axial Spondyloarthritis

Andy Slaughter Excerpts

Thursday 17th September 2020 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I congratulate the hon. Gentleman on this timely debate. I have the honour to have the National Axial Spondyloarthritis Society based in my constituency, which is why I have some knowledge of the matter and am involved in the all-party parliamentary group on axial spondyloarthritis. I am sure that he will join me in praising its work and the extraordinary expertise that it brings. The danger is that if people do not have that association or contact, as many medical practitioners do not, it is difficult to diagnose, and therefore, heartbreakingly, young people suffer in pain and do not get a diagnosis when they should. Will he praise the NASS’s work and agree that the NHS needs to communicate about it much more widely?

[Tom Randall]

I pay tribute to the hon. Gentleman’s work. He was an active member of the APPG long before I was in this place. On the issues that he identifies, on which I will go into more detail in a moment, he is absolutely right.

Covid-19

Andy Slaughter Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

That is an incredibly important point. Public Health England is addressing the order of prioritisation, and we are also trying to drive up the number of tests available, as we have discussed many times earlier.

[Andy Slaughter (Hammersmith) (Lab)]

Schools are closing. London Oratory School in Fulham, which had 1,300 pupils, closed today. One effect of that is that other schools in the vicinity then come under pressure to do likewise from the school community. That is no criticism of anyone, but can the Secretary of State review and clarify the policy on schools and what happens if they have to downsize or if the policy changes?

[Matt Hancock]

We are of course reviewing all those points, and there are some measures in the Bill tomorrow to enable them to be addressed directly.

Coronavirus

Andy Slaughter Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

This is really important and quite difficult. Our general approach is that people who become ill should stay where they are and be treated in the country in which they find themselves. This comes back to the previous question, because the first two victims of coronavirus in the UK were not British citizens, but they were treated brilliantly by the hospital in Newcastle. The treatment they received was fantastic, and rightly so. Of course there are cases and examples where we have to support people to come back to the UK. For instance, this afternoon a flight from California landed, bringing people from the cruise ship that had been off California. But the general principle should be that people are supported and treated where they are.

[Andy Slaughter (Hammersmith) (Lab)]

Will the Secretary of State review the criteria for testing? A constituent of mine has returned from the United States with symptoms of the virus but has been refused testing because she has not come into contact with a known case. Will he also say what the policy is on NHS staff wearing masks when on duty, primarily to avoid to the risk of the virus being spread by undiagnosed medical staff?

[Matt Hancock]

I am grateful for the constructive tone in which the hon. Gentleman asked the questions. This is an example of the House working well, because he and I have sometimes had cross words across this Chamber, but he has asked these two questions quite rightly. The advice given on 111 has to be dependent on the circumstances presented to the clinician giving that advice on the other end of the phone. It is really important that I do not fetter their discretion, but if he comes to me with details of the individual case and wants me to double-check that his constituent got the right advice, I am happy to do so.

On the second point, the deputy chief medical officer had a discussion with the Prime Minister today that was videoed and put on Facebook, and in that she was clear on this question about masks. There is not an advantage in wearing a mask if you are healthy—that is the advice from the medics here—but there is an advantage in respect of keeping others safe if someone who is ill wears a mask. There are also examples of when medical staff will need to wear the right type of mask to keep them safe. But the general advice is: don’t wear a mask unless you are advised to by PHE; or if you are ill, it is perfectly reasonable to wear a mask to stop infecting others—that is an act of generosity.

The National Health Service

Andy Slaughter Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

I am genuinely pleased for the hon. Gentleman’s constituents, but there are 4.4 million people on the waiting list. There used to be around 2 million. Every day, another 330 people wait longer than 18 weeks for treatment, and when people wait longer than 18 weeks, not only do they wait longer in pain, distress and anxiety, but they run the serious risk that their health will deteriorate further. That is what is going on in the NHS today under this Government.

The Queen’s Speech was heavily spun as being about—[Interruption.] The Secretary of State will get his chance in a moment. The Queen’s Speech was heavily spun as being about the NHS. [Interruption.] He says I am talking nonsense. These are the official figures. He wants to run away from his own failure, from the fact that so many more people are waiting beyond 18 weeks for treatment and from the A&E crisis that he is doing nothing about. He thinks an app will solve it all. That is not a serious approach to the NHS. [Interruption.] And he is not as good as George Osborne used to be.

The Queen’s Speech was heavily spun as being about the NHS, but in fact it was a missed opportunity to rebuild confidence in the NHS and provide the health services we want. We will scrutinise carefully the Bills in the Queen’s Speech and engage constructively. We are pleased that the Health Service Safety Investigations Bill has not been abandoned and is back. We will engage on it and explore with Ministers how to strengthen the independence and effectiveness of medical examiners.

If the Secretary of State wants to deliver safe care, however, we need safe staffing legislation and a fully funded workforce plan. Pressures on staff are immense. He will know that suicide rates for nurses are higher than the national average and that among doctors the rate is rising. I congratulate Clare Gerada on her leadership on mental health support, but yesterday the Secretary of State suggested on Twitter that all NHS staff would be eligible for this new mental health support, when it is actually just doctors and dentists. I hope he will clarify his remarks at the Dispatch Box and tell us when 24-hour support for all NHS staff will be available.

I also hope the Secretary of State will tell us how he will resolve the staffing crisis. As he knows, we have 100,000 vacancies across the NHS. We are short of over 40,000 nurses. Under this Government, we have seen cuts to community and district nurses, learning disability nurses, mental health nurses, health visitors and school nurses. On current trends, we will be short of 108,000 nurses in 10 years, according to the King’s Fund and the Nuffield Trust.

[Andy Slaughter (Hammersmith) (Lab)]

My hon. Friend is making an excellent speech. He is right to talk about rationing. My CCG has started rationing referrals to consultants to clear one of the biggest deficits in the country. Will he also talk about the massive backlog of capital? As he knows, I have two world-class hospitals in my constituency, Hammersmith and Charing Cross. It will cost half a billion pounds to bring them up to standard, but there was not a penny of that in the money the Secretary of State allocated. They are lucky they get a few million pounds of seed money to plan for work for which there is not the money to pay.

[Jonathan Ashworth]

My hon. Friend is absolutely right. Imperial College Healthcare NHS Trust has one of the worst maintenance backlogs of all trusts. I congratulate him and Labour-controlled Hammersmith and Fulham Borough Council on leading the campaign to save Charing Cross Hospital; it is because of the pressure he exerted that it was saved.

Health Infrastructure Plan

Andy Slaughter Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I notice that my hon. Friend did not invite me to visit Dorset, although I visit him fairly regularly anyway so may well take advantage of such an occasion. The seed funding in the HIP 2 for Dorset is for the trust to develop its proposals for 12 community hospitals. That is an improvement. He is absolutely right to highlight the importance of community hospitals in a large rural county with transport challenges, given its rurality, and often an older population in some villages. As I said to my right hon. Friend the Member for Harlow (Robert Halfon), if it is helpful, I will be happy to write to my hon. Friend to set out the process by which his local trust will work with the seed funding.

[Andy Slaughter (Hammersmith) (Lab)]

I spoke to Imperial College Healthcare NHS Trust earlier and asked what there might be from this announcement for our local hospitals; I was referred to the Conservative party press release, which is the only information that the trust has so far received. If I divide up the seed money between the three major hospitals that will get some money, I see that we could get as much as £9 million for planning for currently unfunded work that could happen in six to 10 years. That can be compared with £76 million wasted on consultants; £170 million, which is the current-year deficit for north-west London; and £1.3 billion, which is the Imperial maintenance backlog. We need that money now. When are we going to see it?

[Edward Argar]

The hon. Gentleman made several points. I am pleased that he has been enjoying improving reading of Conservative party press releases. On his serious point about the Imperial trust, the seed funding will be for the trust to develop its plans as a trust and to put forward its proposals. I am happy, as I am in respect of other colleagues, to write to the hon. Gentleman to set out the process, how the money will be spent and how swiftly it can be allocated. There is always a need for the development of a business case when large sums of public money are involved, and I am sure he would expect one for any major investment in his trust. The seed funding will enable the trust to get going quickly and put together its case.

Interim NHS People Plan

Andy Slaughter Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.

[Andy Slaughter (Hammersmith) (Lab)]

I raised the cost of the Babylon GP at Hand app and the cuts in the number of conventional GPs at Prime Minister’s questions but, with respect to the Minister for the Cabinet Office, he missed the point, astonishingly. Even if NHS England funds £21 million of the shortfall for this year, that is still money from the public purse and it does not address the past cost to Hammersmith and Fulham of at least £12 million or any future costs. Will the Government suspend the Babylon contract while there is a proper investigation into this privatisation of the NHS?

[Stephen Hammond]

It is not a privatisation of the NHS; it is a scheme allowing greater access to GP services. The hon. Gentleman will know that it is delivering healthcare to a number of his constituents as well.

Oral Answers to Questions

Andy Slaughter Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

Yes, I am always happy to meet my hon. Friend to talk about interesting new policy innovations like that. It sounds right up my street. In fact, I met the Mayor of the West Midlands combined authority to discuss this subject only last week. There is a huge amount of enthusiasm and energy in this policy area, which will enable us to improve patients’ lives across Birmingham and, indeed, the whole country.

[Andy Slaughter (Hammersmith) (Lab)]

As the Secretary of State knows, because he is a member, the Babylon Health GP at Hand digital service is based in Hammersmith and Fulham. By the end of this year, it will have run up a deficit of about £35 million for my clinical commissioning group. Given that the clinical commissioning group is cutting GP hours and closing an urgent care centre overnight because it is so short of funds, when are we going to be reimbursed for that £35 million?

[Matt Hancock]

I do not recognise the number that the hon. Gentleman talks about, but we are changing the way in which the GP contract works to ensure that this new technology can be most effectively harnessed to deliver patient need in a way that also works for the NHS. I am slightly surprised that he has not yet got up to say thank you for our announcement on primary care services in his part of London, which we are going to be expanding while stopping the closure of A&E. A little bit of gratitude for that would also go down well.

NHS: North-West London

Andy Slaughter Excerpts

Wednesday 24th April 2019 Westminster Hall

[Andy Slaughter (Hammersmith) (Lab)]

I beg to move,

That this House has considered the NHS in north west London.

It is a pleasure to serve under your chairmanship, Sir Christopher, and to see so many of my Labour colleagues from north-west London here to support this debate. It will be a relatively short debate on a rather lengthy subject, so I will try to keep my remarks concise, or at least as well ordered and structured as I can. To that end, I will touch on two subjects, and perhaps mention one or two other issues. The first subject is the collapse or withdrawal of the “Shaping a healthier future” programme, which was principally around the reorganisation of acute care; the second is the commercial Babylon GP at Hand service, which is distorting the primary care market, and not just in Hammersmith and Fulham, or indeed in north-west London.

I will begin by reflecting on how we got to where we are. In 2012, “Shaping a healthier future” was heralded as the biggest hospital reorganisation programme in the history of the NHS, but was quickly called the biggest closure programme in its history. It was a scheme for closing four of the nine type 1 A&Es across north-west London, and completely restructuring, demolishing and—in common parlance—closing two of its major hospitals, Ealing and Charing Cross, which is in my constituency. When the scheme was announced, it was unambiguous that it was about saving money. It was part of a programme to save about £1 billion, and we were told that if it did not happen, the NHS in that area would go bankrupt. Those were literally the words that were used. Much water has flowed under the bridge over the past seven years, until almost exactly a month ago, when the scheme was withdrawn wholesale in a rather hole-in-the-corner way.

This is something of a bittersweet debate. I do not know anybody in north-west London who is not delighted that the scheme for hospital closures has been withdrawn, yet because of the way those seven years have been wasted and how the scheme has been dealt with over that time, we are left with as many questions as have been answered. I do not have time to go through the whole history of those seven years. Suffice it to say that Charing Cross Hospital is the second-largest hospital of the nine in its sub-region; it has 360 beds, almost all acute. It was to be demolished. It was to lose more than 300 of those beds—more than 90%. It was to lose all of its major emergency services and its A&E, and effectively be replaced by what was called a local hospital, with primary care and treatment facilities. In other words, it would have been a very radical shake-up.

Throughout the process, there was a frustrating lack of honesty; there was no admission of what the scheme was, certainly not at a political level. If someone drilled down into the business plan or clinical strategy, it was clear what was being advocated. We were told that in some way, the increase in community services and primary care that was also part of the “Shaping a healthier future” scheme would make up for the loss of those hundreds of acute beds and those A&E facilities. It is now commonly accepted that this was always an entirely misconceived plan, as the King’s Fund—to give just one example—has said. Given the rise in demand, the best that could be hoped for was that if the increases in primary and other care services took place, we would be able to cope with the current amount of acute capacity.

The idea that we could dramatically reduce capacity was entirely misconceived. That is not conjecture; it was proven in 2014, when stage 1 of “Shaping a healthier future” went ahead, with the closure of the A&Es at Hammersmith Hospital and Central Middlesex Hospital. We were told that as those were not two of the main A&E departments, those closures would easily be coped with. However, demand at St Mary’s, Northwick Park and Charing Cross went up to such an extent that they had some of the worst waiting time figures of anywhere in the country. Since then, those figures have come down only slowly and gradually.

I hope that the Government and the health service will learn lessons from this scheme—that is probably the best gloss I can put on this. It has taken a huge amount of time and effort, and a huge amount of money wasted by the health service, to get to where we are today, which is effectively back to where we were seven years ago. In 2012, it looked as though the situation was hopeless, and I have to praise Ealing Council, which was then Labour-controlled. At that stage, Hammersmith and Fulham Council was under Conservative control, and from 2013 onwards it fully backed the closure strategy. Ealing Council stood absolutely solid and firm; it mounted a judicial review, and opposed those proposals from day one.

When there was a change of political control in 2014, that council was joined by Hammersmith and Fulham Council, which, together with surrounding Labour councils, set up the Mansfield commission under Michael Mansfield. That independent commission looked at the “Shaping a healthier future” proposals, and when it reported, it said that those proposals would be a health disaster for the area. By that stage, the sustainability and transformation plans had been introduced. In a way, it is regrettable—although it was the right thing to do—that both Hammersmith and Ealing councils refused to participate, because they knew how damaging “Shaping a healthier future” and the hospital closures would be for the area.

Over all that time, I do not think a week went by in which I did not deal with this issue, both here and in the constituency. There was a sustained campaign of what I can only call disinformation. A lot of money—£72 million is a conservative estimate—was spent on consultants, preparing for the “Shaping a healthier future” programme. All of that money was wasted. Despite the fact that we relied entirely on internal health service documents to prove what was being planned, I was constantly told by everyone from the then Prime Minister down that we were scaremongering, and that the proposals were sensible and helpful.

It is curious that when the Health Secretary announced the withdrawal of “Shaping a healthier future” a month ago, the Government withdrew support from the scheme, as if somebody else had thought it up. Until that point, we had been told every day and every week for seven years that it was a sensible scheme, which would only improve resources and services within the health service. It is to be regretted that the Government did not sit down with politicians, campaigners, local residents and the local health service to talk through where we were and where we were going. Instead, in a rather hole-in-the-corner way, they used the contrived trick of using a planted question from a Conservative Back Bencher to announce withdrawing from the scheme. That does not bode well for the future.

Although we are extremely pleased that the programme has been cancelled, and that both Ealing Hospital and Charing Cross Hospital will stay open, where do we go now? First, Charing Cross Hospital has the largest maintenance backlog—£300 million—of any hospital in the country. That was clearly not under consideration, because it was intended that the structure would be demolished. In actual fact, the capital moneys are simply not there to have done that in any event.

The other hospitals in the area, including West Middlesex, Chelsea and Westminster and St Mary’s, were promised that they would benefit from the closures, and that there would be substantial investment. My question to the Minister is: what is the plan going forward? For political expediency, the Government have bailed out of “Shaping a healthier future”, and we are grateful for that, but where do we go now? Certainly the clinicians and the managers in west London cannot answer those questions. This thing has been entirely derived and supported by the Conservative party and this Government. It is for them to answer that question, rather than simply leaving our local health service to stew in that way.

Before I move on, I want to say that some of the staunchest campaigners have turned up to listen to this debate. I last saw them at the victory party at Hammersmith town hall a couple of weeks ago. Without their contribution, we would not be here. They countered well funded, well resourced and entirely disingenuous statements about what would happen to the health service. Every week, rain or shine, they were out talking to and converting the local population. One could say that the local population might not need much conversion to preserve a much-loved, major local hospital that has just celebrated its 200th anniversary, but the reality is that that needed to be done, because millions were being spent on spinning the yarn that the changes would be good for local health services. The campaign was not based simply on sentiment or popular feeling. It was well researched, and well supported with independent clinical evidence. The campaign was based on the day-to-day, week-to-week, absolute dedication of people who worked for nothing, and had nothing in common other than their love of the national health service and their feeling that Government at all levels had got it wrong.

With that, I will move to another topic, GP at Hand, which the Minister probably does know something about. We have become increasingly alarmed at its trajectory. For those who do not know, GP at Hand is a digital app provided by a private company called Babylon Health. The service has raised an enormous amount of concern at different levels; I will narrow that to four points.

The first and most obvious concern is how GP at Hand works. It attaches itself to a particular bricks-and-mortar GP practice—in this case, a particular surgery in Fulham. It was an orthodox GP surgery with a list of around 4,000 patients before that association began. As of today, it is approaching 50,000 patients, and is one of the largest GP practices in the country. That distortion has a cost implication for the clinical commissioning group, initially in Hammersmith and Fulham. It is estimated that over the two years from 2018 to 2020, that distortion alone will cost the CCG about £26 million. There is no provision for that at the moment, and that has to be addressed. I would like to hear from the Minister that there is a scheme for addressing that, and that there will be full reimbursement of those costs.

For those who are not aware of how the system works, it is very straightforward. When patients sign up to a GP practice, the money effectively goes with them. What is not anticipated is that there will suddenly be a tenfold increase in a patient list over one or two years. Why is that money not simply redirected? It has been, to some extent, to the CCGs in west and north-west London, but the money is not provided to the much wider catchment area—GP at Hand now serves not only Greater London and a wider travel area, but has expanded to Birmingham—because those other CCGs are saying, “Hang on.” A digital app of this kind attracts a certain type of patient: younger, fitter patients—effectively those without complex medical conditions or co-morbidities. They do not take up a lot of the GP’s time, as their issues are relatively simple and straightforward to deal with. Often they do not contact the GP at all for long periods.

Those patients effectively subsidise older and sicker patients. There is a perfectly understandable resistance from local GPs and CCGs to allowing those patients to escape, leaving them only with the most demanding and least cost-effective patients. If the issue is not addressed, the problem that results for my CCG is an annually increasing bill, going from £10 million to £16 million and who knows what beyond that, with no provision for that in any way.

The second concern, which has been expressed by clinicians and those who have simply tested out the app, is whether the app—like other apps, it is based on algorithms and diagnostic tools—is accurate and good enough. Has it been sufficiently tested? It is growing logarithmically across the country. It is not a question of it perhaps being tested in a small area and got absolutely right before it moves on. It could be in your constituency tomorrow, Sir Christopher, and it could be across the entire country in a year or two.

The third issue is that GP at Hand is driven entirely by a single commercial provider. It is a way of doing digitisation, but it is the way of the wild west to simply allow one particular firm to start from one location and expand across the country at a rate that it determines, controlled only by its advertising budget and its ability to attract customers. In my submission, there is no thought behind how that is done. The NHS is jumping to the tune that is being played by GP at Hand. One might suggest that it should be the other way around.

The fourth and perhaps most contentious issue is the fact that this particular private provider has had the support of the Secretary of State for Health from the beginning. He is a subscriber and has written about it in glowing terms. Whenever the matter is raised in the House and he is responding, at Health questions or wherever else, he has only praise to give it, but he is parti pris to this. Not only is that of concern in itself, but it means that when one is talking to local, regional and even national organisations within the NHS—this is now a national issue—they are looking over their shoulder, because their boss or their boss’s boss is saying, “This is the future and this is what is going to happen.”

With the support of a number of colleagues, I have written today to the Chair of the Health and Social Care Committee, asking the Committee to undertake an investigation into GP at Hand. I know that she shares a lot of my concerns, so I am hopeful that that investigation will follow. I ask the Minister to give what assurances she can on those four points that I have raised.

Sir Christopher, I can see you are looking at the clock, and my colleagues are looking at me with daggers drawn, so I will speak for one more minute and then sit down. That means that I cannot go into detail about the other local health service issues, which will have to wait for another day. Suffice it to say—I will give a lightning portrait—that in Hammersmith and Fulham, we have a number of failing GP practices that are either suspended or require improvement. We have planned substantial cuts to our CCGs of £30 million. We have cuts planned to palliative care, community care and the hospital sector, including a proposal to close the hydrotherapy pool at Charing Cross Hospital. Everybody who has been involved in that has told me that it provides an invaluable service.

The overall picture is one of declining and reducing services. Only yesterday, a letter informed us that the “Beyond places of safety” scheme, which is very good, has been suspended because the funding is not there. There is no pretence any more that we are restructuring services, or reducing such things as management costs—that has all been done. What is being cut now are basic and essential services from the community, primary and indeed acute sectors.

I will conclude, as colleagues want to contribute to the debate. I hope that the Minister appreciates the seriousness, complexity and universality of the cuts that are happening across the health service. I hope that she will be more magnanimous than some of her colleagues in admitting the mistake that was made over “Shaping a healthier future”. We can turn the page and move on. We all want to work together for improved health, but first, some of these issues have to be addressed.

[Several hon. Members rose—]

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Hammersmith (Andy Slaughter) for securing this important debate, and all hon. Members for speaking so passionately. I welcome the campaigners, who have been following our deliberations this afternoon. Everybody has spoken passionately about NHS services in north-west London, and the hon. Gentleman spoke about his area of Hammersmith and Fulham. I am under considerable time pressure, and if I do not answer all the questions that hon. Members raised, which ranged over primary and acute care, I am happy to write to them later.

I would like to start by thanking everybody who works in the NHS—in primary, secondary and community care—for everything they do, particularly in north-west London, which is a busy area with a lot of demand on services. It is exposed to unique pressures, but there are also unique opportunities. It has some of the country’s busiest services and is used by an increasing, complex and dynamic population. Our capital city challenges our NHS, but it is also home to transformation and innovation that has delivered important benefits for patients.

“Shaping a healthier future” looked at the pressures on the NHS in and around the hon. Gentleman’s constituency. It achieved significant benefits for patients in north-west London. It delivered 24/7 urgent care centres in every local borough and improvements in maternity and emergency paediatric care, and introduced a range of initiatives to help people obtain the specialist care they need closer to home. The NHS in north-west London is now in agreement to move on from the “Shaping a healthier future” programme. The hon. Gentleman asked specifically what the future will hold. In January, the Government announced that there will be an extra £20 billion a year for the NHS by 2024. As part of that, every area in the country will need to develop its own local plan for the next five years for how to spend the extra money. The north-west London sustainability and transformation partnership, working with clinicians and the public, will develop a new long-term, five-year plan for how best to spend that money, working together as a single health system.

I want quickly to address the points that the hon. Gentleman made about the lack of honesty in the north-west London process. Reconfiguration processes are, by their very nature, contentious, and raise many passions locally and nationally. His passion was evident from his contribution. The consultation process in north-west London involved extensive public consultation and clinical engagement throughout. It is important to recognise the high level of clinical engagement. It was never a political exercise or a fait accompli. Its underpinning principle was what was best for patients with the available resources. We need to support NHS staff and managers as they face the challenges before us. We must help them to manage service change responsibly. General practice primary care is the front door to and the cornerstone of the NHS, which is why the long-term plan addressed it when it was published in January.

I want to speak about Babylon GP at Hand. The hon. Gentleman raised a number of issues, and I will do my best to answer them. He spoke about the cost to the CCG. I wrote to one of his council colleagues this morning about the issues he raised. I understand that the CCG has reported that it overspent by £10 million in 2018-19, specifically in relation to GP at Hand. NHS England will of course have to look at the year’s final accounts and any overspend in more detail to understand better the precise financial impact of changes in the borough. For 2019-20, the CCG’s target allocation has increased, all else being equal, in line with the growth in its overall registered population up to the 12-month average for November 2017 to October 2018. NHS England does not believe that the CCG has had to scale back services because of any extra financial burden from GP at Hand, but we will continue to work with the CCG and other partners to explore options for maintaining the robustness of the commissioning system, both now, while GP at Hand is focused in London, and in the future.

I just want to address the hon. Gentleman’s point about safety.

[Andy Slaughter]

I suspect the Minister was referring to my colleague, Councillor Ben Coleman, the cabinet member for health and adult social care, who wrote to the Secretary of State on 15 April specifically asking for the money spent—£10 million—to be refunded, and for a commitment to reimburse the CCG fully for the cost of GP at Hand. I did not hear the Minister say that, so will she give that assurance?

[Seema Kennedy]

I cannot give that reassurance, and I would only reiterate what I have just said to the hon. Gentleman.

On the safety of the app, all NHS providers are held to account through a robust network of systems, including, and not limited to, the inspections of the Care Quality Commission. Any apps providing video consultations must be evaluated and regulated to ensure that the patients who access those services can be confident that they receive safe, effective and high-quality care. Hammersmith and Fulham CCG, along with NHS England, has commissioned an independent evaluation of GP at Hand, which will report shortly.

I question what the shadow Minister said. Digital technology is part of the solution, but the Department is looking at other ways of transforming primary care. We are looking at how we look at partnership models and at how we pivot to primary in future. All patients will have a right to digital-first primary care, including web and video consultations, from April ’21. All patients will be able to have digital access to their full records from 2020. They can, from this month, order repeat prescriptions electronically as the default.

By the end of the next decade, digital innovations are likely to have transformed the NHS. They will allow clinicians to work more efficiently and flexibly so they have more time to spend caring for patients. Every pound spent will go further. That will allow for greater responsiveness and personalisation for patients. We need to design services for patients and things that are available for people when they want them and at times that are convenient for them. I am pleased that the Government have committed to saying that all patients will have access to digital-first primary care from April 2021.

I acknowledge the hon. Gentleman’s concerns about the effect of GP at Hand on primary care as a whole in his constituency. The challenge for the Government and NHS England is to ensure that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers, ensuring that the new technology is safely integrated into existing pathways without unduly destabilising the services it works alongside. Two important principles within the NHS are that a patient can choose which practice they register with, and that funding follows the patient. The emergence of digital-first providers, which register patients who may live some distance from the practice, raises the question of whether these funding arrangements are fair. This year, NHS England is analysing and reviewing the out-of-area registration.