Oral Answers to Questions

Andy Slaughter Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer, more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.

[Andy Slaughter (Hammersmith) (Lab)]

Mortality rates for the treatment of congenital heart disease fell from 14% in 1991 to 2% last year. The Royal Brompton, where the service is threatened with closure, does better even than this. What evidence is there that the closure programme will produce any further improvement, and if there is none, why is it being pursued?

[Mr Dunne]

The hon. Gentleman is right to point out that we have some world-leading patient outcomes for congenital heart disease, and I recognise the statistics that he read out. This is being driven entirely by seeking to improve patient outcomes across the country—improving them even on that very good performance—and to ensure greater resilience of service in some areas where there are relatively low volumes and an over-reliance on locums. I accept that that is not the case at the Royal Brompton, but it is in some of the others.

Contaminated Blood and Blood Products

Andy Slaughter Excerpts

Thursday 24th November 2016 Commons Chamber

[Diana Johnson]

It is very worrying to hear that there has not been any progress on what is happening in Northern Ireland, so the Minister needs to explain to the House what work is going on.

[Andy Slaughter (Hammersmith) (Lab)]

I congratulate my hon. Friend on being one of the leaders of this campaign. It is clear that the Scottish scheme is more generous than the one in England. Does she agree that at the very least the Government should ensure parity, and in particular that nobody should be worse off under the new scheme than they were under the old scheme?

[Diana Johnson]

My hon. Friend makes that point very well. Later I will compare and contrast the Scottish scheme, which is more generous.

--- Later in debate ---

[Diana Johnson]

I will come on to the ways in which I think the funding that the Government have put together could be used more effectively to assist more people who have been affected by receiving contaminated blood, including the hon. Lady’s constituent.

I will talk a little about the overall funding of the new scheme. There is much that the Government could do to improve the scheme without any additional cost to the public purse. Even if the Scottish proposals, particularly those for widows and primary beneficiaries, were adopted in England, they would fall within the budget that has been allocated for every year save 2016-17. That is set out in an analysis conducted by the Haemophilia Society, which was presented to the Department of Health at last week’s meeting. I hope officials will consider that carefully.

Any need for additional funding could easily be met from two identifiable sources. I think the £230 million from the sale of our 80% stake in Plasma Resources UK should be made available, as should any reserves left in the accounts of the three discretionary charities when they are closed in 2017. Further, I ask the Minister to promise that any money that is not spent on beneficiaries in each year will be rolled over to support beneficiaries in the next year. At last week’s meeting at the Department of Health, it appeared from what officials told us that any unspent money would have to be given back to the Treasury. That would be a gross act of betrayal towards those affected.

In conclusion, unless the Department of Health accepts that its new scheme still has substantial issues that need to be addressed, the new support scheme will not command the full confidence of the people it needs to satisfy. Indeed, in some crucial respects it will be worse than the system it replaces.

The APPG still believes that people should have the option of a lump sum payment as part of any new scheme, to give them the opportunity to decide for themselves what is best for them—either a regular payment or a one-off lump sum payment.

[Andy Slaughter]

My hon. Friend is making an excellent speech. Why cannot lump sum payments be an alternative to regular payments? Why must the Government be grudging on these matters? This and previous Governments owe these people a huge debt of obligation. This should be a properly funded scheme and we should have a proper investigation to get to the truth of this terrible scandal, which is a stain on our country.

[Diana Johnson]

My hon. Friend puts the point very well. The APPG and the right hon. Member for North East Bedfordshire (Alistair Burt) have spoken to people about what they want from the revised scheme, and they have said they want the option of a lump sum payment, if that would be better for them than regular payments. It is important that we give people the ability to make those decisions for themselves.

As my hon. Friend the Member for Hammersmith (Andy Slaughter) just alluded to, the APPG still believes that we need a Hillsborough-style panel inquiry to allow people to tell their stories and to say what happened to them and how it affected them.

Community Pharmacies

Andy Slaughter Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I beg to move,

That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; calls on the Government to rethink its changes to community pharmacy funding; and further calls on the Government to ensure that community pharmacies are protected from service reduction and closure and that local provision of community pharmacy services is protected.

This is an issue that affects many of our constituents, and it has aroused considerable opposition from so many of them that 2.2 million people have signed a petition. Community pharmacists, I am sure, have lobbied Members of all parties about these cuts and have explained why they should be opposed. Indeed, Members of all parties have raised their concerns and their opposition to these cuts.

I pay particular tribute to my hon. Friend the Member for Barnsley East (Michael Dugher), who has campaigned tirelessly on this issue, and to my right hon. Friend the Member for Rother Valley (Kevin Barron). Government Members have also raised their opposition in Westminster Hall debates, Adjournment debates and parliamentary questions. Their opposition to the cuts is entirely understandable.

When the Government announced, in December last year, that they were going to pursue the cuts, they talked of cutting the budget for community pharmacy services by £170 million, with further cuts to follow. Opposition to the cuts was clear, and indeed was heightened when the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who I see in his place and for whom I have tremendous respect, suggested that the cuts could lead to the closure of up to 3,000 community pharmacies.

[Andy Slaughter (Hammersmith) (Lab)]

We have had a lot of correspondence from local pharmacists and their customers worried about essential parts of the local community such as businesses, but is it not also the case that, with massive cuts in acute services and with primary care under pressure, those pharmacies provide an essential and cost-effective part of the local health service, which we simply cannot do without?

[Jonathan Ashworth]

My hon. Friend has anticipated my argument—I could probably sit down now that he has put it so eloquently, but I shall plough on while I have the indulgence of the House.

I was saying that the right hon. Member for North East Bedfordshire had said that the cuts might lead to some 3,000 community pharmacies closing. Then, of course, the right hon. Gentleman left his post in the Department of Health, which we are all very sad about. Now we have a new Minister, and we are delighted to welcome the hon. Member for Warrington South (David Mowat) to his place—not least because in one of his first interventions when he was allowed out, he visited the Royal Pharmaceutical Society’s annual conference in September and said he was delaying the cuts. He said:

“I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision”.

He continued by saying that

“what we do is going to be right for you, is going to be right for the NHS and right for the public more generally.”

Well, if the Minister had left it there—with that U-turn—he would have won the praise of Labour Members.

Unfortunately, we then had a U-turn on the U-turn from the Minister. When the Minister came before the House last month we found out that, far from having listened, taken account of various consultations and decided to do what was best for the NHS, he intended to impose a 12% cut on current levels to pharmacy budgets for the remainder of this financial year—giving pharmacists just six weeks’ notice—and a 7% cut the year after that.

NHS Funding

Andy Slaughter Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I salute my hon. Friend for the campaign he is leading at the moment, standing up for his constituents. He is right to point to PFI as one of the principal causes, and we now have to find a way to deal with that issue in a way that improves and does not detract from the quality of care offered to the people he represents.

[Andy Slaughter (Hammersmith) (Lab)]

According to Sir Richard Sykes, the chair of Imperial College Healthcare NHS Trust, “the problem is funding”, we are “killing” NHS staff by making them work 18 hours a day, and it is not in a position to close any more accident and emergency facilities in north-west London because there is not the capacity to do so. How is the NHS in north-west London supposed to save £1.3 billion over the next four years, as its sustainability and transformation plan proposes?

[Mr Hunt]

The best way it could do that is by ignoring all the leaflets that the hon. Gentleman puts out, totally misleading his own constituents about the plans the NHS has.

[Andy Slaughter]

Give a serious answer to a serious question—you’re a buffoon! [Hon. Members: “Ooh!”]

[Mr Speaker]

Order. I did not hear the offending term, but if it has been reported to me accurately, and the Clerks are invariably accurate in these matters, it seems to me to be a matter of taste, rather than of order.

NHS Sustainability and Transformation Plans

Andy Slaughter Excerpts

Wednesday 14th September 2016 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I hope that I am in a position to assist some of the Members who feel that they are in the dark or confused about what is in their STPs. That is not because my own sub-region, north-west London, is one of the two, I think, that have officially published their schemes—I fear that, like most NHS documents, it is written in a style and language that make it difficult for the ordinary public to understand. Rather, it is because, for north-west London, this process has not mushroomed overnight, as has been the case with STPs generally, but has been developed over four years. In the wonderful Orwellian language that is used, we have had something called “Shaping a Healthier Future” since the middle of 2012, and that has simply morphed into the STP, so I can perhaps give a little insight in the few moments that I have.

What did “Shaping a Healthier Future” mean? It meant the loss of 500 acute beds. It meant that of around nine major emergency hospitals two would, effectively, be downsized to primary care, and four A&Es would lose all their consultant services—and that, as far as I am aware, is still the plan. What has become clear with the transformation into STPs is that this is very much about money. The original language four years ago was that unless we implemented these cuts to acute services, we would “go bankrupt”. When that language did not go down very well—not surprisingly—with the 2 million people affected in west London, the language changed, and it was all about clinical care.

I am pleased that at least the honesty is now back in the system, and the proposals are now very much about money. One sees why when my own hospital trust—a very important, prestigious trust called Imperial, which runs three major hospitals—is over £50 million in deficit this year alone. The CCGs are flatlining on funding. The importance of that is that the only possible justification for these major cuts in acute care is that social care, community care and primary care funding will be increased. How that is possible with budgets that are, at best, standing still, I really do not know.

The other interesting factor is the delays that have occurred over this time. We had this proposal in the middle of 2012 and a slight revision in February 2013—and then silence. I have lost count of the number of times I have been promised that a full business case will be published. I act as the unofficial shop steward for the 11 Labour MPs in the sub-region, and I summoned them all to a meeting and said, “You’re going to get the business plan this month.” It was going to be next Tuesday, and we were all coming in in the recess to look at it, but, guess what, it has been put off until at least after the new year.

Moreover, the plan is now thought to be so unwieldy and so difficult to achieve that it has been split in two. My own hospital—Charing Cross—was due to lose 90% of its acute beds and its consultant emergency services, and we simply do not know when the proposals will now be published, but it has already been taken outside of the STP process. In other words, it is beyond the five-year horizon, and nothing will happen until 2022. Now, in one way, of course, I am delighted that the demolition balls are not going into Charing Cross for that period, but in the meantime the lack of support the hospital is getting worries me greatly.

These STPs are a Trojan horse for cuts. They are about cuts in acute services before there are compensatory services. For that reason, Members should be extremely concerned and worried about them, and I am happy to share my pain and knowledge on the subject if any Members wish to hear about them.

[Several hon. Members rose—]

North Middlesex University Hospital NHS Trust

Andy Slaughter Excerpts

Tuesday 12th July 2016 Westminster Hall

[Joan Ryan]

I do indeed, and I am grateful to my hon. Friend for that intervention. One point that I argue most strongly is that, although the MPs concerned are banding together to defend our hospital and fight for adequate and safe service, it is obvious that this is not just about North Mid—North Mid is just the first point where the crisis has hit. This is an issue around outer London, across London and probably nationally, particularly for district general hospitals.

[Andy Slaughter (Hammersmith) (Lab)]

I am delighted that my right hon. Friend has secured this debate, which resonates across London and probably outside it. We recognise the point about waiting, especially in ambulances outside hospitals. People are waiting for up to four hours and then being admitted just before the four-hour mark, so that it is not registered against the time limit, and then waiting again. That is happening even before the planned closures of accident and emergency departments. As one clinician said to me just today, there is no credible clinical evidence that out-of-hospital services can deliver on the scale necessary, but that is all we are being offered as an alternative.

[Joan Ryan]

I agree with my hon. Friend. Again, that demonstrates that this is not just about North Mid; it is just that North Mid has reached the crisis point before anywhere else.

The CQC has also raised concerns about the lack of equipment within the department, from missing monitors and missing leads for cardiac machines to trolleys in resuscitation rooms that are not fully equipped. I cannot imagine the distress of a patient with chest pains who is connected to a cardiac machine to monitor their progress, only to find that the staff member cannot connect it up to get an instant read-out because the leads are not there. Even a chute meant to carry specimens from the emergency department to the pathology unit was out of operation for six whole weeks. According to the CQC,

“this caused major delays to the speed in which results were returned to the department, thus slowing down the time in which some patients could be treated.”

That is unacceptable.

All those problems have been exacerbated by a lack of effective clinical leadership and a culture of bullying at the hospital, meaning that staff do not feel confident in raising concerns and have even

“stopped reporting incidents of staff shortage as management had not responded to them in the past”.

A quality visit report by Health Education England from March 2016 found that none of the medical trainees interviewed would recommend the emergency department to their family and friends for treatment, principally because they felt that the department was unsafe. The postgraduate trainee junior doctors at the hospital would not themselves recommend the hospital or the emergency department to their family and friends—what an indictment.

The General Medical Council, which oversees the standard of training for doctors, has threatened to ban North Mid from providing postgraduate training because standards have been so poor. The loss of junior doctors would leave the A&E so badly understaffed that it would effectively close. The future of North Mid’s emergency department is at risk.

I note that the chief inspector of hospitals—Professor Sir Mike Richards, whom a number of us are due to meet tomorrow—has said that since the CQC’s inspection in April, “some progress” has been made to improve the situation, although there is

“still much more that needs to be done.”

A new clinical leadership team has been put in place, and there have been moves to appoint more senior doctors. However, in almost every instance, the new appointments are short-term, with the doctors taken on loan from other hard-pressed local hospitals for up to six months. The situation is safe at the moment, given the number of doctors in the A&E, but the measures are only a sticking plaster, as many of the doctors are on a three to six-month loan. What measures are the Government willing to put in place to support North Mid and ensure that it has the consultants and doctors it requires on a permanent, long-term basis?

The CQC also states that North Middlesex University Hospital NHS Trust

“has supplied an action plan setting out the steps it will take to address the concerns identified in the Warning Notice and report.”

Does the Minister agree that the action plan should be published in full and updated regularly with the measures taken to improve patient safety at the hospital?

Tellingly, the CQC says that previous serious incident investigations and subsequent action plans at the hospital have not always been shared with staff in a timely manner, which has

“meant that in certain circumstances, reports were received when actions should already have been taken in order to mitigate against a future occurrence.”

Given the analysis of how things have been kept in the dark, which we have explored, and that statement from the CQC, the Minister will understand why I ask for a fully published action plan and regular reports on progress. This is about implementation and outcomes.

Surely the Minister will understand that without full transparency, many of my constituents and those of my colleagues who are here today will have little confidence that the required improvements have been made and are being sustained. As I said earlier, the trust’s shocking mismanagement and poor leadership have played a big part in creating the mess at North Mid, but the chief executive, who I understand is stepping down, is not solely responsible for what has happened. The Government cannot be let off the hook when they have done so much to undermine healthcare provision in Enfield.

The tipping point for the crisis at North Mid was the closure of the A& E department at Chase Farm hospital in my constituency. In 2007, the then Leader of the Opposition—the current Prime Minister, for now—posed outside Chase Farm hospital and promised to protect the emergency department on site. By 2013, his Conservative-led Government had ripped the heart out of the hospital, closing both the A&E unit and the maternity services. It went from a 480-bed hospital to one with 48 surgical beds. Those of us who campaigned against the closure at the time said that the decision would put huge pressure on North Middlesex hospital, Barnet hospital, our ambulance services and GP surgeries right across Enfield. We were right.

[Andy Slaughter]

My right hon. Friend describes exactly our experience in west London, where two A&E departments have closed and two more are intended to close, despite assurances having been given that they would not. We have heard nothing at all since February 2013 about what those plans will be. I was told just this week that the next report is not going to be in September, so until another report is done we will not know exactly what services there will be. People are waiting in limbo for years, and meanwhile there is a drain of staff and expertise from hospitals, so their closure becomes a self-fulfilling prophecy.

[Joan Ryan]

And that is exactly what happened at Chase Farm hospital. It was under threat for so long that it had no stability and it was no longer an attractive place for staff because they had no security. I hope I am wrong, but my fear is that in cases such as my hon. Friend outlines, no news is definitely not good news.

One year after the closure of Chase Farm’s A&E department, the CQC reported that services at North Mid were struggling with the additional workload. We know now that the hospital has had to manage an increase in A&E patients of between 20% and 25% as a result. That is unmanageable and unsustainable for an A&E department; many would bend, if not break, if put under such strain. The situation was so bad that by February 2016 only 67% of patients were seen and treated within the national four-hour target at North Mid, compared with an average of 88% across England.

Our local health services and the emergency department at North Mid would have been better placed to cope with the closure of Chase Farm’s A&E department if other promises to improve primary care had been fulfilled. In November 2013, the Prime Minister stood at the Dispatch Box and said:

“Enfield is…getting an increase in primary care funding. That is part of our plan of not cutting but expanding our NHS.”—[Official Report, 20 November 2013; Vol. 570, c. 1226.]

But many people in Enfield find it really hard to get a doctor’s appointment when they need one. Over the last six years, 12 doctors’ surgeries in Enfield have closed and only one new practice has opened. That is why, even though Enfield is now the fourth-biggest borough in London, we have fewer GPs per head than almost anywhere in the capital. That situation is not sustainable.

Will the Minister join me in calling for a proper plan for at least 84 more GPs in Enfield over the next four years, as recommended by the Royal College of General Practitioners? Will he support my calls to improve health funding across the board in Enfield? As he will know, Barnet, Enfield and Haringey Mental Health Trust anticipates a £13 million deficit by 2016-17; Enfield Council needs to deliver a saving of £24 million in adult social care by 2020 because of reductions in funding from central Government; and per capita spending on public health in Enfield is only £43 this year, far lower than the average across London and in England. Given that cutting preventive services piles pressure on hospitals, does he seriously believe that allowing the current situation to continue will take the strain off North Mid—or will it in fact do the exact opposite?

It should come as no surprise that I and many of my constituents have very little faith that the NHS is safe in the Government’s hands. The financial crisis in the NHS is a major reason why North Mid did not have enough equipment, consultants, doctors and nurses to cope with demand. The inability to recruit permanent staff has meant that many hospitals, including North Mid, have been forced to drain their resources on expensive agency workers and locums. One might have thought that, in the light of such circumstances, the Government would be bending over backwards to encourage people to join the medical profession—but no. Instead we are witnessing the sorry situation of a Government fighting with junior doctors over contracts and removing bursaries for nurses. What a slap in the face for the future front-line staff we so desperately need.

The Government also plan to make £22 billion of efficiency savings by 2020. I know that savings must be found, particularly in back-office services, but efficiencies on such a scale simply cannot be achieved without putting patient care at risk. I am also concerned that the Government’s methods to implement those cuts—described using woolly phrases like “the rationalisation of clinical facilities”, “the consolidation of trusts” or “the introduction of transformation and sustainability plans”—will result in takeovers, mergers and the downgrading of services. Even before the crisis at North Mid was revealed, plans were already afoot to launch an NHS pilot programme, involving the Royal Free London NHS Trust, to look at options to link hospitals including North Mid together and to merge clinical and support services. At the same time that it was announced that the chief executive of North Mid was going on leave, we learned that an acting chief executive was being appointed from the trust and that David Sloman, the trust’s chief executive—a very good chief executive, I might add—would be taking on the role of accountable officer on an interim basis. I fear for the future of service provision at North Mid as a consequence.

Local residents remember to their cost that the A&E and maternity units at Chase Farm were shut only a few months before the Royal Free London NHS Trust took over Barnet and Chase Farm hospitals in 2014. Chase Farm has been left as little more than a cottage hospital. North Mid cannot suffer the same fate; that would have terrible consequences for health services across North London. Think how much further people in Enfield would have to travel to get emergency hospital treatment, and how much pressure it would put on A&E departments at hospitals such as University College hospital in Euston, Barnet hospital and the Royal Free hospital in Hampstead.

What assurances will the Minister give my constituents, first that North Middlesex hospital will not be taken over by the Royal Free London NHS Trust by stealth, using this crisis as the back door to a merger; secondly, that constituents will be consulted fully on all future proposals for North Mid; and thirdly and most importantly, that its key services will be protected and improved in the short and long term? The performance of North Middlesex University Hospital NHS Trust must be a wake-up call for the Government. I urge the Minister to use every tool at his disposal to help North Mid make the immediate improvements required in the quality of care provided to patients. The Government must ensure that the hospital and our health services have the funding and support they need so that this situation never happens again. I look forward to the Minister’s response.

Ealing Hospital

Andy Slaughter Excerpts

Tuesday 3rd May 2016 Westminster Hall

[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here this afternoon under your chairmanship, Mr Stringer. Although the debate is difficult, it is a great pleasure to follow my two neighbours from the London Borough of Ealing, and I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate today. As the MP for Ealing hospital, no one has done more than he has to champion the cause of that hospital over the four years that it has been under threat. As we see from the petition that generated this debate—not the first petition of this size—he is admirably and clearly reflecting the view of the vast majority of people not only in Ealing borough but across west London.

Apart from their choice of Member of Parliament, the constituency of my hon. Friend the Member for Ealing Central and Acton (Dr Huq) may be one of the most unlucky in the country. To lose one A&E department may be considered unfortunate; to lose four must be an all-time record. Following the closures of Central Middlesex and Hammersmith and the downgrading of Ealing and Charing Cross to non-type 1 status, her constituents will be in a very difficult position, as will all our constituents.

I am here today for two reasons. I am not an Ealing MP, but I want to support my colleagues and I want to say—I think the Minister will accept this—that the proposals for Ealing hospital are inextricably linked, under the “Shaping a healthier future” programme, to the future of the eight other major hospitals in west and north-west London, four of which, as we have seen, will undergo substantial change and either closure or downgrading of services, or at least movement of services elsewhere.

As my hon. Friend the Member for Ealing Central and Acton said, we have debated this subject many times. I do not think that is surprising. I make no apology for that, given the importance of the issue. In the recent debate in March, which was an across-London debate, “Shaping a healthier future” was raised several times. One of the matters on which I and others pressed the Minister was when we would see the next developments. I was grateful when the Minister said that Members would have the next important document—the draft of the implementation business case—as soon as possible.

Since that debate we have also managed to fix a date, 25 May, for the 11 MPs to meet the health service management across north-west London. Unfortunately, I have been told by my clinical commissioning group that the document will not be available for the meeting, although it will be available later in the summer. The sooner we can see that document and have an update on what the proposals are for Ealing and the other hospitals, the better. I say that because this will be familiar not only to Members here, but to the many people in the Public Gallery. The difficulty we have had over the past four years is a lack of information.

We began with the bombshell proposals in the summer of 2012, which effectively proposed the closure of Ealing and Charing Cross hospitals, leaving just a primary care facility on the site. There was a modification when the final proposals were brought forward in February 2013. Those proposals—which most of us regarded as a fig leaf, albeit a very expensive fig leaf—were for the demolition and disposal of a substantial portion of the site, but with the building of new facilities, primarily for primary care and some other treatment, while still using the majority of emergency and acute services on the site. Since then, nothing. Indeed, we have been waiting a couple of years for the business case. In the place of factual information, rumours tend to spread. As was mentioned previously, nothing has changed.

As for Ealing hospital, the very strong rumour is that, given the poor financial condition of the NHS and the scepticism of the Treasury about the programme, it is likely that the service cuts and reconfigurations will go ahead, but also that the existing buildings will be retained. Those buildings were not designed for the purposes for which they will now be used and will not receive the funding to modernise them that was at least the mitigation in the previous proposals. The sooner we know one way or the other on that, the sooner we can have a proper discussion about it. The news that Imperial will have a £50 million deficit this year—I think the situation for north-west London hospitals is even worse—suggests that the financial imperative is continuing to drive this

Although the health service itself may have been quiet—certainly in what it has told Members and the public—my constituents and those of my hon. Friends have not been quiet over the past few years. As I say, the petition that generated this debate is not the first petition of more than 100,000 signatures that has been lodged. I hope that more attention is paid to this one than has been paid to previous ones. I pay tribute to the thousands of people who have not only signed petitions but been active in the campaign, which is going into its fifth year. The uncertainty is not helping anyone.

The public, the organised campaigns and the local authorities have acted responsibly. The local authorities commissioned the Mansfield report, a serious document that was not taken seriously enough by the NHS. The level of demoralisation is extremely high, and is combined with issues relating to the junior doctors’ dispute. Places such as the Imperial College school of medicine are centres of excellence for training junior doctors. I have spoken many times to the staff there and their morale is very low. All staff morale is very low because people do not know where they are going to be working or what job they will have. They do not know whether the facilities they are working in will survive, or whether they are going to be run down in the meantime. Consequently, we have a substantial overreliance on agency staff. That is not a good template for the NHS.

I appreciate the fact that there are financial difficulties throughout the country and that the situation in west and north-west London is not unique. Nevertheless, I do not think that any other areas have had to put up with this reorganisation—or whatever we want to call it—for as long as we have.

[Dr Huq]

When my hon. Friend made the point about the loss of four A&E departments, he reminded me of the saying, “Once is unfortunate, twice is a coincidence, but three times is beginning to look like a habit.” I do not believe that any saying even goes up to four. Does he agree that it is unprecedented to lose four A&E departments?

[Andy Slaughter]

Yes, I do. I anticipate that we are unlikely to get much by way of an answer from the Minister today, although I will be delighted if she does have some news to impart. I hope she will take the debate in the spirit it has been conducted, because there is genuine anxiety. What we are asking for and what will help is transparency. It may be that we do not like what we hear any more than we liked what we heard three or four years ago, but it is getting beyond a joke now.

We talk a lot about hundreds of millions of pounds of money and about people’s love for institutions such as hospitals, but if we are pragmatic about it, at the end of the day the important thing is whether individuals receive a good standard of care. By coincidence, this morning I spent half an hour on the phone to a constituent whose husband’s life was saved two years ago when he had a serious aneurism. They were told by the professor who operated on him that had they taken a few moments longer to reach Charing Cross hospital, which they live very close to, that would have been the end.

The rider to that is that last week the same gentleman was rushed to Charing Cross hospital again with a recurrence of that issue. He spent seven hours there before being transferred to St Mary’s in Paddington, where he again received very good treatment. I hear again and again that the system is beginning to break down and people are not necessarily taken to the right place at the right time or, when they do get there, they are not seen quickly enough. That is not a criticism of the staff, who are working extremely hard against the odds and are highly professional.

We are very lucky to have such world-class hospitals in west London. We do not take that for granted, but I have given just one example of the kind of story I could probably repeat every week. I worry about the future of the health service for my constituents and those of my colleagues if we do not get to grips with the situation quickly. We are drifting in a way that means that the excellent and superb levels of healthcare we have become used to over the years are no longer likely to be maintained.

Junior Doctors Contracts

Andy Slaughter Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is right. Doctors who strike will need to explain that to paramedics, healthcare assistants and nurses working in their own operating theatres. In the end, that issue is why this strike is happening. The BMA said in writing in November that it would negotiate on Saturday pay; it went back on its word in February. As a result, this is the only outstanding issue, and we now have this extreme step—the withdrawal of emergency care. I find that very hard to justify.

[Andy Slaughter (Hammersmith) (Lab)]

At the beginning, the Secretary of State said he was publishing a model contract, which he believed trusts, including foundation trusts, would by convention implement, but he has subsequently said that there is a legal duty that he can impose. He needs to clarify that, and it would be helpful if he could publish the legal advice. That would not be a surprise in the judicial review cases, because his lawyers are presumably doing their skeleton arguments. We have a right to know the answers to these questions.

[Mr Hunt]

With respect, all the hon. Gentleman needs to do is look in Hansard at my response to the urgent question, which made it clear that we have the right to introduce a new contract. On the basis of the conventions that currently apply in the NHS, that contract will apply to all junior doctors. Foundation trusts do indeed have the right to set their own terms and conditions, but they choose not to do so.

Contaminated Blood

Andy Slaughter Excerpts

Tuesday 12th April 2016 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I add my thanks and congratulations to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) on what she has said today and on her outstanding leadership on this issue. She will be encouraged by the commonality of view—it goes further than consensus—across the House, and I hope that the Minister will take note. Back-Bench debates are often not party political, but I cannot remember another debate in which Members’ sympathies have been so clearly at one. I am sure that many Members feel, as I do, quite let down by the consultation. I will not personalise the matter by referring to the Minister. It is a Government responsibility, and this Government are now in power.

We need to bear some basic facts in mind. This is an NHS scandal. The Secretary of State, perhaps more than any other Secretary of State, has been keen to identify where things have gone wrong with hospitals, practitioners and events in the NHS, and to point the finger and say that what happened was not right. This is the clearest case of that, and it is the biggest scandal in the NHS. We are talking about innocent victims. Many of us—even if the Government do not admit it—believe that there has been negligence and there is culpability, but I think we all agree that there is a moral responsibility.

I hope that we all still believe in the welfare state that was set up after the second world war, and that we all think that the state should act as a safety net. The matter goes further than that, however; it is about state error. It is about the state making mistakes that it is bound to correct. The state has made a variety of mistakes—Equitable Life, flooding and many others—after which it has been able to dig into its pockets and find money because it believes that there is a compelling case for doing so. Perhaps a closer analogy is mesothelioma. Mesothelioma victims have not had the complete compensation that they need, but at least the responsibility to make provision for those people has been recognised, even if one cannot point the finger and say that it is anybody’s fault in particular.

I want to say that this has been a very long struggle. I have been engaged in it only since my constituency boundaries changed in 2010 and I found that I had some sufferers, victims of incidents of contaminated blood, in my constituency. Since then, I have been pretty active as a Member by taking part in meetings, debates, reviews and the all-party group. There have been some important interventions. I credit the Minister for Community and Social Care for the work he has tried to do, and the Prime Minister for the apology he made in relation to that. There have also been concessions, such as that the existing schemes are inadequate and badly run, and that there are too many of them.

We have asked for a full and final settlement, for the overall impact on victims to be assessed and for each victim and their family to be dealt with as individuals, so I do not think that we expected to be in the position we are today. It is a position in which the Haemophilia Society can write quite baldly that

“the majority of people currently receiving financial support will be worse off under the new scheme.”

How did we get into this situation?

If I and other Members feel let down, what do our constituents feel? What do people such as my constituent Andrew March feel? His whole life has been fundamentally altered by this. His health, his life expectancy, his earnings ability and his career, as well as aspirational things such as the ability to own his own home and to live a normal life—I thought the Government believed in them—are all out of his reach now. This is a fundamental change, but it has been going on not for years but for decades.

I would say to the Minister that the issue of reduced income must be looked at in full, whether that reduction is because of discretionary payments or other reasons, as must the overall impact on the individual and their family, and the implications, more widely than simply health, on their whole lifestyle. We should not confuse treatment, including the good and innovative schemes that are now available—anybody should receive such treatment from the NHS, to which we all pay in, as of right—with paying proper compensation and ensuring that people are properly rewarded.

Let me end by making two quick points. First, it has been said that Scotland has set an example. It is not a perfect example, but I strongly believe that we should at least be able to match what happens in Scotland. Secondly, my constituents have told me that they do not feel comfortable filling in responses to the consultation. They do not believe the consultation is presented clearly and honestly, and the questions are phrased so prescriptively that they are unable to communicate what they think. The Government can do what they want—it would have been better if they had withdrawn the consultation, but that has not happened—but they do have the power to respond by saying, “We have made a mistake. We haven’t taken into account everything that should be done. We have to act with compassion and with honesty, and we have to give proper compensation.”

Finally, I must say that I disagree, as I rarely do, with the hon. and gallant Member for Beckenham (Bob Stewart). This is about justice, and justice can be delivered by recognising the needs of the community who have been infected in this way. I think that the Government have a duty to act.

NHS in London

Andy Slaughter Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

I completely agree with my hon. Friend. We are trying to have a serious debate, but we are pooh-poohed at every turn. When my hon. Friend the Member for Hammersmith (Andy Slaughter) asked a question about the Mansfield report, he was told that he was living in a bygone age. I cannot recall the exact remark, but it was something like, “You’re an old soldier fighting a war that’s concluded.” Dismissing people in that way does not inspire confidence.

[Andy Slaughter (Hammersmith) (Lab)]

I always do what I am told by my hon. Friend—the dismissive comment was that the Mansfield report was commissioned by five Labour councils. I have actually had a slightly more considered response, but it was still dismissive. It was a very serious independent report, and I am sure my hon. Friend will agree that the Minister should take it a bit more seriously.

[Dr Huq]

My hon. Friend puts it very well. People’s concerns are serious and should not simply be dismissed.

I also agree with my hon. Friend the Member for Eltham (Clive Efford) that the community pharmacy network is a vital component of our country’s health and care system. Suddenly, the Government seem to be imposing arbitrary cuts in a high-value, easily accessed, community-based facility, which relies on private investment as well—pharmacists are small businesspeople. Hiten Patel of the Mattock Lane pharmacy opened my eyes when I spent a bit of time shadowing him there. I saw how the burden on the NHS and GPs is reduced by people having such pharmacies at the end of their street. For most people, they are much nearer than a hospital or even a GP service.

Hiten Patel and his staff help people to make lifestyle choices. They provide a range of services and information to promote health, wellbeing and self-care. They are a useful check on prescribing errors and are dedicated and trusted people. We have such pharmacies all over the country, and they form obvious back-up and support at a time of crisis for GP recruitment and retention. We should value those people, not make life more and more difficult for them.

Last Sunday, I collected my elderly mum’s meds from Harbs pharmacy in South Ealing Road. That pharmacist is open out of hours. I recall that one year he was open even on 25 December—I did not go past this year, but he was probably open then as well. That releases the Ealing Park surgery practice next door for more acute and specialist care, but the Government seem to do short-termism. The long-term impact of eroding the network will have a disastrous effect.

Another troubleshooting service that is located at the heart of the community and has hidden value is opticians. They, too, have a valuable role of social contact, with networks and support mechanisms, and they can contribute to signposting and safeguarding the vulnerable. As the right hon. Member for Carshalton and Wallington (Tom Brake) pointed out in connection with community pharmacists, opticians can also catch things early.

I visited the Hynes opticians in Northfield Avenue, where staff are worried about the continuity of their supply chain. Joint strategic needs assessments enable clinical commissioning groups and local authorities to work in tandem, and the Ealing Council assessment mentions effective eye services and sight loss, but the NHS Ealing CCG does not use the JSNA in its commissioning decisions. Will there be some guidance from the Minister about how to integrate CCGs and local authorities better?

I could go into mental health services, which are chronically underfunded and a huge cause for concern. The Prime Minister made a speech about them last month, but I would like to see more action. Labour has a shadow mental health services Minister. The chief executive of Central and North West London Foundation Trust, Claire Murdoch, has claimed in an interview that mental health can be an “easy target” at times of belt tightening, saying that

“during recessions mental health tends to be hit first and hardest and recover most slowly…There is an absolute anxiety that people are depressed and really are suffering as a result of some of the economic reforms. What we don’t know yet is the extent to which some of the welfare reforms are driving people to real, serious illness.”

I have the sense of morale taking a nosedive locally. My constituent Michael Mars, who is now retired but was a senior consultant at Great Ormond Street hospital, said:

“The essential problem is the feeling of impotence experienced by those at the coal face

because of an

“overwhelming management culture where clinical knowledge and experience is secondary to management.”

Such words echo, because we hear them from a lot of other public service professions such as teachers and the police. They all say that they are doing all the paperwork and are not allowed to do what they are supposed to do. Michael Mars talked about survival in the culture of management and worries that we might be in danger of forgetting what clinical consultants are appointed to do.

At the other end of the career scale are junior doctors, on whom there was a debate in this Chamber on Monday. I have had numerous representations from constituents who are junior doctors. The latest NHS staff survey showed that the percentage of junior doctors suffering from work-related stress has gone from 20% in 2010 to 34% in 2015.

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[Bob Blackman (Harrow East) (Con)]

It is an honour to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate on London’s NHS. The subject is vital to people not just in London but nationally and internationally because we provide a health service for not just people resident in London but those who work in London and those who come to London for specialist treatment. I apologise that I may not be here for the winding-up speeches; I must attend the debate in the Chamber where I am the lead speaker. My apologies if I have to scuttle off before other contributions.

I want to speak about three issues in my contribution: primary care; the position at Northwick Park hospital; and the Royal National Orthopaedic hospital. In terms of primary care, without doubt, one problem we experience in London is that people have difficulty getting on to a list for a GP and then getting appointments when they are ill. As a result, when a person is ill, they immediately say, “Well, if I can’t get an appointment with my GP, I will go to A&E or the urgent care centre or whatever facilities are around.” That means that people turn up at A&E and at urgent care centres who should be seen by GPs or even by nurses at GP surgeries—they do not necessarily need to be seen by doctors.

We all have anecdotes we can share, but at the health centre to which I go the GP appointments system is now such that people can only register for appointments 48 hours in advance—it is always quite difficult to know whether one will be ill in 48 hours—or walk in and wait; however, how long will it take to be seen after all the appointments? That leads to a challenge. Immediately, people say, “I’m not going to do that, because I can turn up at A&E or the urgent care centre and make sure I am seen.” Therefore, the all-party parliamentary group on primary care and public health, which I co-chair, has pointed to the need for better signposting in the national health service to point patients to the right place and to ensure that primary care in particular can provide care for those who need it.

I will move on to Northwick Park hospital. As I said in my intervention on the hon. Member for Ealing Central and Acton, who led the debate, its A&E performance was truly dreadful. I can speak from personal experience: I waited in A&E for some eight hours before I was seen on an urgent care basis and received medical intervention. It was a disgrace. People were waiting for far too long and never, ever were the targets achieved. However, in November 2014, the Government invested in the new A&E at Northwick Park hospital and since then there has been a complete transformation.

One of the problems we had with Central Middlesex hospital having an A&E was that its brilliant doctors and nurses were sitting around, waiting for patients to arrive; patients would go to the A&E at Northwick Park because it was nearer and more convenient. The consequence of the A&E at Central Middlesex closing and those doctors and nurses transferring to Northwick Park was that performance transformed overnight.

I have the latest figures. When we talk about stats, we should talk about what is going on now in reality, not what happened in the past. At Northwick Park, in January, 89% of patients were seen within four hours and—[Interruption.] I accept that the target has not been reached, but the key issue is that that is far from the dramatic underperformance that the hon. Lady described. The reality is that 90.3% of patients were waiting less than 18 weeks to start treatment at the end of January, and we all accept that January is probably the hardest month for the NHS because of difficulty with the cold weather.

Cancer waiting times are a vital aspect, and Northwick Park hospital meets the targets: 94.1% of patients with suspected cancer were seen by a specialist within two weeks. I would much rather see that figure at 100%, but that is above the target of 93%. Of patients diagnosed with cancer, 99.2% began treatment within 31 days—the target is 96%, so that is an outstanding performance. Finally, 86% of patients began cancer treatment within 62 days of an urgent GP referral; the target is 85%. It is therefore fair to say that Northwick Park hospital—it is not in my constituency but virtually all my constituents use it—has transformed itself under this Conservative Administration. It is important to get the facts on the record, so that people can congratulate the health providers, who are delivering an excellent service. Of course, there are always challenges. We know there is a deficit, but the key is that Northwick Park hospital’s funding from the CCG will see a 6.01% increase this year. That is a good performance; we can see that money is being invested.

Just before the 2010 election, when I was elected for the first time, under the previous Labour Government, there was a review of accident and emergency services in north-west London. We heard not a squeak from Labour MPs about the fact that as part of that review they wanted to close down five of the A&Es in north-west London. [Interruption.] Oh yes. The incoming Health Secretary said, “We are going to stop that review in its tracks, and any review of A&E services will be clinically led, not driven by particular elements or arguments.” The reality is that this is nothing new; this is being driven by the NHS and the NHS bureaucracy. That is what I want to move on to finally.

[Andy Slaughter]

The hon. Gentleman needs to substantiate both elements of what he just said. To go back 10 years to try to defend the current crisis in the NHS in his constituency is a bit unnecessary. The fact is that promises were made by his party about specific hospitals as well as about A&E generally and it has gone back on almost every single one of those. A little less hubris from him would be appropriate.

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[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Turner, and to be called early in the debate. I thank the Backbench Business Committee for giving us this long and generous slot on the last day before the recess. Given that it is the last day, there is a good turnout from London Labour Members, and one or two London Conservative Members. Indeed, we had the whole of the Liberal Democrat representation for London, but he has gone now.

I particularly thank my neighbour and hon. Friend the hon. Member for Ealing Central and Acton (Dr Huq) for introducing this debate in a comprehensive manner, which permits me to make my contribution shorter than it otherwise would have been, because I am going to deal with some of the same issues. I preface my remarks by saying that London Members deal with a great many health service issues—on the whole successfully—through their clinical commissioning groups, hospital trusts and the other myriad health service bodies that the Government inflicted on us in the last top-down reorganisation.

We have heard about primary care, mental health and community pharmacies. The reason why we—particularly the 11 Labour MPs for north and west London—keep returning again and again to the issue of acute hospitals and the “Shaping a Healthier Future” programme is not only that it is such a major reorganisation of services but that it has become very politicised. Of course, all these issues are political—money spent on the health service is always political—but we feel that we are either not being given information or being given the wrong information.

I must disagree with the hon. Member for Harrow East (Bob Blackman). My memory goes back a long way. I was part of the campaign against the closure of Charing Cross hospital in the early 1990s. It was successful, obviously, but it was a long and hard-fought campaign, and again, the grounds for closure were entirely spurious. I remember the former Member for Brentford and Isleworth, who was a Health Minister, leading that campaign when she was the head of nursing there.

[Dawn Butler]

I remember leading a campaign in 2006 to save Central Middlesex hospital’s A&E, which was successful. Unfortunately, it then closed when I was not an MP in, I think, 2011.

--- Later in debate ---

[Andy Slaughter]

We all bear these scars. I am grateful for all the efforts that Members have made to protect their local health services.

The next time that Charing Cross hospital came up, it was in the context of the 2005 election campaign, when a Conservative candidate, now the right hon. Member for Chelsea and Fulham (Greg Hands), shamelessly said that it was going to close, with no evidence whatever; there were no plans to close it. The candidate running against me in 2010 did exactly the same in relation to the hospital in my constituency. The difference was that immediately after the 2010 election, plans began to be drawn up—we did not see them until 2012—by McKinsey and others. The reference to consultants was well made by the hon. Member for Harrow East, because the spend on consultants on “Shaping a Healthier Future” alone is running at something like £20 million per annum at the moment.

I did not recognise, in what the hon. Gentleman said, what has actually happened. The brief history is as follows. Those plans were presented. They were kept under wraps and took us all by surprise with the dramatic changes they contained—the downgrading of the four A&Es and what was going to happen to Ealing and Charing Cross hospitals. However, that was a long time ago now, in the summer of 2012. The only revision to those published proposals was at the end of the so-called consultation process in February 2013. Apart from references in board papers and other statements, we have not had a formal upgrade to the process since then. That is more than three years ago, yet the proposals affect about 2 million people across the whole of west and north-west London.

I accept that there can be faults on all sides and that in the run-up to elections, people get quite emotional and political about these issues, but that is partly because they matter so much to our constituents. At the 2015 election, at least we were getting emotional and political about something that was actually proposed, rather than something that was invented. Since the election last year, we have attempted—certainly I have, and I think this goes for a number of my colleagues—to engage in the process with Ministers and officials, partly to find out what is going on and partly to try to influence the outcome. The Minister met a group of MPs last summer and said that there would be a great deal of engagement and transparency. I have not given up on that, but it has not happened so far.

The key document in the “Shaping a Healthier Future” programme—the implementation business plan—is still under wraps. We have been asking for it for the best part of three years, formally, informally or through freedom of information requests. Different reasons have been given at different times—“It’s a work in progress,” or “It’s commercially confidential”; all the usual reasons. It becomes a bit ridiculous after a while. I am not sure it is very helpful to the Government or the NHS, because in the end we have to rely on what information we can scrape together.

Of course, the world has changed a lot in those three years. Let me give some examples. The London head of NHS England, Anne Rainsberry, came to brief Labour London Members earlier this week and gave us some quite interesting information. First, “Shaping a Healthier Future” alone will not deal with the financial problems, which have got substantially worse. My trust, Imperial College Healthcare NHS Trust, last reported that it was running a £25 million deficit, but I know that other trusts, including London North West Healthcare Trust, have higher deficits than that.

The position has got markedly worse. I know the Government say there is a clinical basis for “Shaping a Healthier Future”, but it is interesting that there has been a concession that there is a financial basis to it; it is about saving money. Opposition Members would say that it is mainly about saving money, but the Government might say that that is an ancillary purpose. We are now being told that even if “Shaping a Healthier Future” were implemented, it would not save enough money given the deteriorating situation.

The shadow Secretary of State, my hon. Friend the Member for Lewisham East (Heidi Alexander), mentioned the shift from capital to revenue, partly as a bail-out. That may be a crisis move to offset the immediate financial crisis, but it has implications, particularly for a grandiloquent project such as “Shaping a Healthier Future”, which is about a major redesign of hospital sites—particularly the Charing Cross and St Mary’s sites, which are taking the bulk of the money.

We know—the NHS is now being slightly more candid about this—that the Treasury is getting cold feet about the programme, and the date is being pushed back and back. That is good in a way, because originally we were told that Charing Cross was going to be demolished in 2016-17, and now we are talking about 2020 at the earliest. I am delighted by that, because the longer it is pushed back, the less likely it is to happen, but it reflects serious concerns in the Treasury, and possibly in the Department of Health, about where the programme is going.

[Dawn Butler]

My hon. Friend is being generous with his time. Is he concerned, as I am, by the letter from Clare Parker, the senior responsible officer for “Shaping a Healthier Future”? Brent has been trying to get hold of the latest version of the implementation business case. She notes the request, but states:

“Unfortunately this document is in draft form and not currently suitable to be shared.”

Does he wonder, as Brent and I do, when we will be able to have sight of that document?

[Andy Slaughter]

That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.

[Ruth Cadbury]

Skiing injuries.

[Andy Slaughter]

Well, perhaps. The situation does not give us a lot of confidence in the plans that are being made.

I hope that I have given a flavour of what is happening. I cannot do much more than that, because I do not have the information available. This is the No. 1 issue for my constituents, yet when I look back to see how often I have raised it—I have made one speech on it since the election and asked a few questions to Ministers—I am sorry to see that on the whole, I get pretty dismissive answers. I do not think that is how this Minister would wish to behave.

I ask that sooner or later—sooner, preferably—we get the business plan so that we can see what changes are being proposed and what the timetable is. I also ask for a realistic reassessment of the need for acute hospital services, because I do not believe that “Shaping a Healthier Future”—2010 or 2012—will be the appropriate mechanism for doing that. If the Government are prepared to do that, I am sure that all Members, irrespective of party or of the proposals for their local hospital, will be prepared to sit down and negotiate.

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[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck, and a pleasure to follow so many contributions from hon. Members from across London. I congratulate my hon. Friend the Member for Ealing Central and Acton (Dr Huq) on securing the debate. I thank the Backbench Business Committee for granting us this opportunity to talk about the NHS across London.

The context is challenging across London, with a swiftly growing population, huge health pressures arising from demographic change and from London lifestyles, and a national health service that across the city is struggling to cope with those myriad pressures. We have seen that across the capital since the 2010 general election. A&E waiting times in hospitals throughout London, referral-to-treatment times and cancer waits have worsened throughout the period. As we have heard, Members from every corner of our capital city are reporting local pressures that reinforce that picture of national health service provision across London.

We feel that pressure acutely in Redbridge. Both the NHS trusts that cover our borough are in special measures: Barts Health NHS Trust, which covers the west of my constituency; and Barking, Havering and Redbridge University Hospitals NHS Trust, which serves patients throughout my constituency. Primary care is an issue, with patients increasingly struggling to get a GP appointment and finding new barriers put in their way, such as telephone consultations before a GP practice will even grant an appointment. There are also service reconfigurations.

We have already heard about service closures across the rest of London, and in Redbridge we remember the Conservative party’s commitment before the 2010 general election that there would be no enforced closures of accident and emergency or maternity units. Well, we lost the maternity unit at King George hospital, and the decision to close the accident and emergency department was taken in 2011 by Andrew Lansley when he was Secretary of State for Health. That decision still stands, although it has not yet been implemented because the NHS is in such a state of crisis locally. Our local A&E waiting times for the last six months show that we have failed at any point to hit the target of 95% of patients being seen within four hours. The worst rate in the last six months was 76.8%, in December, and the best was 92.6%, in February. People living in my constituency will not find that satisfactory. In the last couple of weeks, the chief executive of the Barking, Havering and Redbridge trust has had to apologise to the 1,015 patients who have waited more than a year for routine treatment such as knee operations, which is simply unacceptable.

There are some positives. I have mentioned the chief executive of the Barking, Havering and Redbridge trust. I have confidence in the trust’s leadership. Since they came on board, they have approached the task energetically. They inherited an absolute mess that developed over a number of years, and there are some improvements, but as recent events have shown, there is still a long way to go.

I welcome the work that the clinical commissioning group and GPs are leading on primary care transformation to try to improve primary care services locally, but we are yet to see the fruits of their labour. I also welcome the extent to which the local authority, which is now Labour-led, has been leading the way on integration to help partners across the local health economy. I am pleased to see that my borough is taking part in piloting the accountable care organisation initiative, which I hope will bring real benefits to patients through greater integration between healthcare providers and our local authority. In that context, the cuts to local government spending and, in particular, to public health budgets are a real concern.

I should probably declare that I am still a serving councillor in the London Borough of Redbridge, albeit an unpaid one, so I am excellent value for money for my constituents.

[Andy Slaughter]

They should be the judge of that.

[Wes Streeting]

They may well be the judge, but I am standing down as a councillor in 2018. I was elected to Parliament while serving as a councillor, which is a good indication.

Seriously, the London Borough of Redbridge has the fourth lowest public health grant in London. Given the diversity of our population, and the pressures that that brings, it is a cause for concern. In that context, I was even more disappointed to find that the Government have cut our public health grant in-year. As a former cabinet member for health and wellbeing in Redbridge, and as the former chair of our health and wellbeing board, I know that we were already struggling to meet our statutory duties on public health, not least the new responsibilities we have been given, such as for health visiting, for which the allocation received from the Government was not sufficient. We managed to squeeze some extra funding out of the Government, but we are still struggling.

The reduction is disappointing, particularly in the context of London, where people’s healthcare needs and lifestyles are placing pressures on the NHS. Public health investment is an upfront investment in people’s lifestyles that will reduce NHS costs in the longer term, as well as improving people’s health and wellbeing. I cannot understand why, in that context, preventive budgets such as public health budgets are bearing the brunt of cuts. I hope Redbridge’s public health allocation in particular is something that the Department of Health will revisit.

I have talked about the financial challenge for local authorities, and I will now address the financial challenge facing the NHS and our local health economy. I was concerned, as everyone else was, to read David Laws’s revelation at the weekend that, far from the £8 billion that keeps being mentioned as the hole in the NHS budget, Simon Stevens actually identified a £30 billion hole, of which he said £15 billion could be found through efficiencies and improvements. My maths makes that a £15 billion hole in the NHS budget, and it is a source of concern that the £8 billion promised by the Conservatives at the last election is still not there. We have seen the Chancellor having to shuffle money around. Earlier, my hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, talked about the reallocation from capital to revenue in terms of the health budget.

--- Later in debate ---

[Jane Ellison]

We have been clear that we have given a large amount: £3.5 billion has been made available to local authorities for social care. Ditto on public health—we will spend £16 billion over the next five years. If I have time, I will come to the good point that was made earlier about the move to business rates retention. It is matter of record that the Government committed at the election to what the NHS had asked for in the five-year forward view, and we will continue to make that commitment.

The London health system—CCGs and provider trusts—has planned for a deficit in 2015-16 of about £350 million, and overall the system is expected to be in that position. Some recovery is expected during 2016-17, and I am sure we will debate that again. In addition, a £1.8 billion sustainability and transformation fund is available, designed to address provider deficits in 2016-17. However, I think all Members would accept that additional Government spending is not the only answer to the challenges faced by the NHS. We have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits, but much of the change Members have talked about is driven by desire to get better healthcare rather than to make savings. If we can make savings as well, that is all to the good, because we can reinvest them in great healthcare.

In London, from early April, the new NHS Improvement body will be providing additional expert support and capacity to trusts experiencing particular financial challenges. That support will include identifying and implementing financial improvement and helping them to identify savings to put them in a stronger position to maintain those savings.

Let me talk about the pressures on urgent and emergency care. It is acknowledged that the urgent and emergency care system faces increasing pressure. More and more people are visiting A&E departments and minor injury units, which is stretching their ability to cope. Members listed some reasons for that in their speeches. A lot of visits are unavoidable, but some people are visiting because of inconsistent management of long-term health conditions, difficulty in getting a GP appointment or insufficient information on where to go.

Winter sees an even bigger rise in visitor numbers and pressure on staff. Although the debate inevitably dwelled on Members’ concerns about their local healthcare systems and problems in them, I am sure we all want to place on record our huge thanks and praise, as many have, to the staff of London’s NHS, who work extremely hard under a lot of pressure and delivering some really good results against that backdrop. I will come on to that.

London’s A&E units have been significantly challenged this winter, and that has been reflected in performance. However, despite those pressures, the capital’s urgent and emergency care system has proved its resilience, with fewer serious incidents declared than in previous years. This winter, London accounted for just three out of 625 serious incidents declared across England. It is important to praise the staff in saying that.

In January, London’s performance was significantly higher than all other regions, with 90% of patients seen within the four-hour A&E standard. London is also the highest-performing region in England this year to date, with 93.1% of patients seen within the four-hour standard. My thanks and congratulations on that improved performance go to the hard-working staff of London’s services.

Reconfiguration schemes have loomed large in the debate. The health needs of people in London are changing and demands on health services are increasing. The hon. Member for Ilford South in his excellent speech illustrated through his personal stories some of the reasons for the changes in the shape of our health service in terms of how we are investing in specialist services and centres of excellence. The work done to centralise stroke expertise was brought up earlier in the debate. I remind Members, although many will remember, that those changes were bitterly opposed by many people. I am not sure whether that includes anyone in the Chamber, but it certainly includes campaign groups. However, all our London clinicians now say with certainty that those changes, with centralised expertise and specialist care, have saved many lives. That is always worth reflecting on.

People are living longer, the population as a whole is getting older and there are more patients with chronic conditions. We often say that people are living longer, but we forget to say that they are living with chronic conditions for longer, and that presents a longer-term challenge than might be seen at first sight. Heart disease, diabetes and dementia will all increase as they are conditions associated with an ageing population.

We did not dwell on the prevention agenda, but I was delighted that the hon. Member for Edmonton (Kate Osamor) spoke about it. The shadow Secretary of State also touched on it when she mentioned dementia and the problems we all know of older people in hospitals. I urge her to look at the dementia implementation plan we published on 6 March, which is a detailed response to the Prime Minister’s 2020 challenge. Dementia has sat in my portfolio since the election, and that plan is a detailed look at how we deliver against that challenge and in particular at the joined-up care that is key to ensuring that people with dementia have safer and better care in our system and are kept out of the acute sector whenever that is possible.

In a number of areas across the capital, the local NHS has concluded that the way it has organised its hospitals and primary care in the past will not best meet the needs of the future. We are clear that the reconfiguration of front-line health services is a matter for the local NHS, tailored to meet the local population’s needs.

I was glad to hear that Members recently met with Anne Rainsberry. The Members who came to the cross-party “Shaping a Healthier Future” meeting last summer will know it is vital that officials at all levels and NHS managers engage with elected Members. I was therefore disappointed to hear what the hon. Member for Eltham (Clive Efford) said. I will ask my officials to look into that. A number of Members asked reasonable questions about why they could not have certain bits of information. I have some specific answers and it may be that we can take a moment after the debate and I will point them in the right direction.

[Andy Slaughter]

I am grateful for what the Minister has said. If she could give an indication to health officials that we must have an open review of where we are with “Shaping a Healthier Future”, look at the implementation of the business plan and consider the Mansfield commission report, which really just asks questions along those lines, it would be very useful indeed.

[Jane Ellison]

We have had the time, during a three-hour debate, to make inquiries, so I will perhaps give the hon. Gentleman an update afterwards.

There have been a lot of references to the interaction with Members. Members of any party may feel they are knocking their heads against a brick wall, but sometimes, to be fair, information cannot be shared for good reasons. There may be commercial confidentiality, or things may be at a particular stage where information cannot be shared. However, I am quite clear that all plans for the local populations that Members represent must be shared with the best level of detail possible, at the most opportune moment. I am always happy to hear from London Members if they feel that that is not happening.

Reconfiguration is about modernising the delivery of care and facilities. I recognise that proposals for those changes sometimes arouse concern. There has been a particular focus on “Shaping a Healthier Future” in this debate, but under that programme, many more community services are now in place across all eight boroughs, so more patients can be seen closer to home. Eleven new primary care hubs are now open. Improved access to GP services has meant an additional 32,000 appointments in Ealing since August 2015, while weekend appointments are now offered to more than 1 million patients across north-west London. Rapid access services in each borough are helping to keep patients with long-term conditions out of hospital where possible, which has already prevented 2,700 hospital admissions in Brent alone.