Charing Cross Hospital

Andy Slaughter Excerpts

Wednesday 1st November 2017 Westminster Hall

[Andy Slaughter (Hammersmith) (Lab)]

I beg to move,

That this House has considered the future of Charing Cross Hospital.

It is a pleasure to see you slide effortlessly into the Chair at the beginning of this debate, Mr Rosindell. I am grateful for this opportunity to raise what is perhaps the central issue for my constituents: the future of the major hospital in my constituency, although it also contains the world-class Hammersmith Hospital. This issue matters not only to me but to many people across west London, and I am very grateful that my hon. Friends the Members for Brentford and Isleworth (Ruth Cadbury), and for Ealing Central and Acton (Dr Huq), are here.

Next year is the 200th anniversary of Charing Cross Hospital and the rather more recent 45th anniversary of the building on the current site, although there has been a hospital—Fulham Hospital and its predecessors—on the site since 1884. It has a long and prestigious history. It is one of London’s major teaching hospitals and is part of the Imperial College Healthcare NHS Trust. It does not rest on its laurels, and has an unprecedented, and growing, level of demand.

I will spend just two minutes on what one might call the history, simply to set the scene. I deliberately titled this debate “the future of Charing Cross Hospital”, and I have been in contact with the Minister’s office to indicate how I would like to move forward on an issue that is a long-standing sore for the local community, if not entirely this afternoon—that might be asking slightly too much—then certainly over the next weeks and months.

This is not just about history, but about a devastating series of decisions. They are not new decisions. The first plans to downgrade the hospital substantially were made back in the 1990s. I remember being involved in campaigns led by the former Member of Parliament for Brentford and Isleworth, Ann Keen. When she later became a Health Minister, I knew that the hospital was in safe hands. I hope it will be in safe hands with this Minister.

The current events were, to begin with, a great surprise—it may surprise the Minister that I say that—because the plans for the changes at Charing Cross were made largely in secret over two years between 2010 and 2012. When they were announced in 2012, the plan was for a full-scale clearing of all Imperial College Healthcare NHS Trust buildings from the site, and for a new clinic to be built on 3% of it. It was modified in 2013, partly because of the pressure and partly to give some cover to the Conservative-controlled local authority and others, so that they could get behind the changes. The new proposal was for what was described as a new hospital but is in fact—I say this advisedly—a collection of primary care and treatment services with an urgent care centre. It is going to be called a local accident and emergency unit and a local hospital, but let us not get hung up on the terminology. It is very clear what actual services will be provided on the site if the proposals go ahead. They will be on 13% of the floor area of the existing hospital. That is what has caused these problems and difficulties.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I congratulate my hon. Friend and constituency neighbour on securing this debate, and on his leadership in the campaign on the future of Charing Cross. The great fear among my residents—particularly in the eastern half of my constituency—and among people from a far wider area is about the loss of the full-scale accident and emergency service at Charing Cross, which would potentially mean downgrading many in-patient and out-patient services linked to it.

[Andy Slaughter]

I am grateful for the clarity that my hon. Friend brings on that point. What is proposed is the loss of all consultant-led emergency services—type 1 A&E services. The site will therefore lose blue-light ambulances, emergency surgery and emergency consultant services. That is a very substantial change to the health facilities available.

The change came under the heading, “Shaping a healthier future”, which I am afraid my constituents regarded as a rather Orwellian title. That programme has now been subsumed within the sustainability and transformation partnership proposals, which are now nationwide, but essentially the meat of the proposal has not changed over that time. I do not deny—I look for points of agreement if I can—that some of the objectives are perfectly laudable, such as specialisation and the bringing together of expertise on a particular site, as has happened with stroke services, major trauma, renal services and so on, even within the three hospitals in the Imperial trust. That is to be commended. No one objects to improvement to primary, social and community care, which may in time lead to less pressure on acute services. If the consequence is not just better health outcomes but a saving for the public finances, we do not object. The problem, and the reason why there has been a breakdown of trust, is that the changes are being advanced before we know the consequences.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Does my hon. Friend agree that the plans may be transformational, but they are certainly not sustainable, given that London is heading to a population of 10 million before long? It is projected that there will be 12,000 more people in his borough, Hammersmith and Fulham, between the last census and the next one in 2021. We were both at a meeting on Monday night, and he pointed out that the borough has a target of 20,000 new homes by 2035. Where are all those people meant to get treatment, given that we have lost A&E at Charing Cross and Hammersmith, and maternity and paediatrics at Ealing? Demographically, that is illiterate.

[Andy Slaughter]

My hon. Friend puts it very forensically. The difficulty is that however much the aspiration may be to relieve acute services, most independent analysis—whether from the King’s Fund or the Mansfield review, which specifically looked at west London—shows that that is not likely to happen in the foreseeable future. The precious little additional investment in primary and social care is barely keeping up with the pressure on those services. That is where the lack of confidence comes from. However pious and laudable the aspirations, what is hoped for is simply not happening in fact.

I welcome the announcement that nothing will happen in the current sustainability and transformation partnership period, which runs to 2020. That is an admission by the Government that the pressure on services is so great that one could not possibly think about the proposed downgradings at the moment, but that is simply to put off a wrong decision. It means that nothing can happen physically to the Charing Cross site, other than maintenance, until 2021. I have been told privately that it probably means a number of years beyond that, because the eastern part of north-west London, which includes the three Imperial hospitals, has now been put in the slow lane behind what is happening in the western half, so it is unlikely that any changes will happen before 2025. That is 13 years after the first proposals were put forward; that is a very long time in politics, but it is a very long time in the NHS as well.

I am looking for something of more substance from the Government. We have had virtually nothing in writing, or in terms of consultation or engagement with the public, since those announcements back in 2013. Substantial expertise in the community has sprung up in the vacuum that has been created by the health service simply not engaging—expertise through the hospitals movement, trade unions and local people generally. An independent survey conducted by a polling organisation recently showed that 90% of people in the west London area opposed the proposals—that has been borne out in every other survey that I have seen—and 82% think that they have not been involved properly in the decisions. I urge the Minister to listen to that, to turn over a page and to engage with the community on these matters.

Going back to the point made by my hon. Friend the Member for Ealing Central and Acton, last month the four-hour waiting time target was achieved only in 70% of cases for the two hospitals in Imperial. Figures are not disaggregated, so I cannot give them exactly for Charing Cross—only for St Mary’s and Charing Cross combined. That has been a regular pattern over the previous months and years, in particular since the closure of the A&E departments at the Central Middlesex and Hammersmith Hospitals.

The population is growing hugely—as are the health demands, because the area’s population is not only ageing, but mobile and diverse, and those are not on the whole people who do not need acute care. For many years Charing Cross has had good practice: people who arrive at that hospital and have something that can be dealt with by a nurse, a GP or an urgent care centre—in some way other than through consultant care—are simply filtered off, because all those services are available on site. This is not a case of unsuitable use; this is a case of growing demand, and lack of resources to deal with that demand.

I will sit down in a moment, because I want to give the Minister a proper opportunity to respond. I urge him not to read out the brief again because, with respect, I have heard it a number of times over the past five years. I genuinely wish to engage in reassessing what has happened. I welcomed the debate in the other place on 18 October, which was called by my friend Lord Dubs, a Hammersmith resident. More eloquently than I could, he too led a debate specifically on Charing Cross, in which a number of peers took part. The Minister there responded:

“there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved”.—[Official Report, House of Lords, 18 October 2017; Vol. 785, c. 659.]

Those are very welcome words to have put on the record. I am sure that the Minister here will not resile from that today, but will there therefore be an assessment of whether the changes are likely to happen in the foreseeable future? If they are not going to happen for another four, eight or 12 years, or however long, I put it to him that the Government cannot persist in saying simply, “We will do this when the time is right.” That creates uncertainty, demoralisation among staff, and a motivation for management not to maintain or keep up services because they are in effect throwing good money into a building that they believe will not be there in the foreseeable future.

That is my first request to the Minister: that we have a proper assessment of whether those “Shaping a healthier future” proposals are still fit for purpose, as the Government believed in 2012—although I did not. My second request involves the land on the hospital site, because none of it has been designated as surplus land for redevelopment. I push the Minister to say what exactly is meant by that. In 2012 and 2013 we were told in terms that the land not used for health service purposes would be disposed of privately to subsidise the cost of building on the land that would remain within the health service. Will that not now happen, or is it simply that no formal proposals have yet been brought forward?

As I said, this has been a hospital site for well over a century, and the hospital has existed for two centuries. It would be a great pity if that were to change on my watch and the Minister’s, particularly when the hospital is needed most by people in my constituency and others who have used it throughout their life and their family’s lives.

--- Later in debate ---

[Mr Dunne]

I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.

It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities—in this case Charing Cross Hospital— have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.

[Andy Slaughter]

The Minister is being generous in giving way. What I said was that I applaud the aims of improving community services. My CCG faces having to make £17 million of further savings—that creates great difficulty for maintaining services, let alone improving them. The Imperial trust has huge deficits and, as far as I can see, most of the sustainability transformation funds for last year have gone to addressing those deficits. That is the difficulty, which is why I asked for a review of where we are going—because hopes are not being fulfilled.

[Mr Dunne]

It is fair to say that part of the STP’s objective is to help the NHS in a particular area to work more co-operatively, to encourage better public health for the population as a whole, and thereby work within the available budgets that have been allocated by NHS England. We think that creating a coherent plan for the entire area is the most logical way to try to ensure that that happens.

As I have said, the service change is a matter for the local NHS, which has been clear that there will be no changes at Charing Cross before 2021, as the hon. Gentleman has acknowledged. He did not mention that, in the meantime, NHS England has confirmed its commitment to Charing Cross Hospital and invested £8 million in the hospital in the last year alone. That funding enabled refurbishment of urgent and emergency care wards, theatres, out-patient clinics and lifts, as well as the creation of a patient service centre and the main new facility for north-west London pathology. Further significant investments are also planned, notwithstanding what the hon. Gentleman says about the current financial situation of the Imperial trust.

It remains the case that the STP is planning, in due course, a phased new build across north-west London rather than refurbishing existing buildings, including on the Charing Cross site, but it is not yet at the point of finalising that plan. I can confirm, as the hon. Gentleman asked me, that no hospital run by Imperial College Healthcare NHS Trust, including Charing Cross, has declared any site surplus land. He asked what commitment that means for the future; clearly, until the plans are completely finalised it would be wrong of me to give any further indication of what that might mean in relation to land, because that will depend on the configuration of the buildings, which have yet to be designed. It would be an unrealistic expectation to be definitive about that today.

I am glad that the hon. Member for Ealing Central and Acton (Dr Huq) raised the point about the workforce. It is unsurprising that discussions about proposed service change have created some uncertainty for staff, patients and other stakeholders, including local residents. However, there has been a very clear position on the future development of Charing Cross since the STP plan for north-west London was published a year ago. This position has been shared widely with staff and all stakeholders. As I said earlier, I sincerely hope that my remarks can help to reassure staff working at the hospital that there will be no changes to service levels until 2021 at the very earliest, and that the local NHS commitment to Charing Cross Hospital has been reaffirmed.

In August, the trust leadership undertook a review to more fully understand staff morale at Charing Cross and to develop actions in response. The conclusion was that site-level data do not indicate that Charing Cross is affected by poor morale or that it has more difficulty than other sites in the trust in recruiting and retaining staff. However, there are higher vacancy levels in a few specific staff groups in certain areas, such as elderly care. In response to that review, the trust leadership team has established an action plan, including organising a succession of staff briefings. This week, the trust announced a public meeting for local residents on 27 November to ensure clarity on the future position of Charing Cross and to share information about recent and planned investments on the site. I strongly encourage the hon. Member for Hammersmith to attend that meeting, if he is able to do so, to understand what the trust is saying and to provide reassurance to local residents on the state of the hospital.

The trust has been in correspondence with the leader of Hammersmith and Fulham Council regarding mailings that the council has sent to residents that do not reflect the evolving position at Charing Cross. As well as raising constituents’ concerns, we have a responsibility to allay fears when discussing this subject. We can best do that by being clear about what is and is not in prospect, and by encouraging constituents to take up the offers of engagement made by local decision makers. I understand that the council has expressed some concern about doing that.

The Government remain committed to supporting the local NHS in engaging well with its local population and local clinicians, to ensure that decisions about services in north-west London are made in the best interests of patients, now and in the future. I hope that the hon. Gentleman’s constituents, who are paying attention to this debate, will make the most of the opportunities to participate in future public engagement on the design of services in their area, and that as many as possible will attend the meeting at the hospital on 27 November.

Question put and agreed to.

Contaminated Blood

Andy Slaughter Excerpts

Tuesday 11th July 2017 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

Like my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), I became engaged in this issue after 2010, when constituents contacted me, and one constituent in particular—a remarkable man called Andrew March, whom I shall say a little about in a moment.

I feel slightly ashamed that I did not fully understand the utter tragedy of contaminated blood, which has not been with us for seven years; it has been with us for more than 30 years. As a country, we need to own up to the fact that we do not do these things very well. The same is true of Hillsborough and, in many ways, of Grenfell. These are not matters that have happened and then been dealt with appropriately. They are things that we have failed to address over years, if not decades.

I would say one or two things on the remit and type of inquiry, because these are multiple failings. Yes, of course, there is the failing that led to the infections and the multiple infections in the first place, but, until recently the Government would not even mention the word “negligence”. Now, I am pleased to say, due in large part to what Andy Burnham has done, we are talking about criminality, but it has taken a long time to get there. On how the victims have been treated by the establishment, again, one could make comparisons with what happened with Hillsborough over many years, such as the way that they have been ignored and badly treated. In relation to recompense and financing, that includes the fact that the various trusts and schemes, as well as the quantum involved and the administration, have been appalling.

I have said to Minister after Minister over the past seven years that a bespoke solution is needed. We are talking about a finite and decreasing number of people, and we need a bespoke solution for each of those individuals and families, because everybody is in a different position according to their circumstances, health and personal needs.

I again pay tribute to my hon. Friend the Member for Kingston upon Hull North, and to many other Members—I am surprised that the all-party group does not have 650 members, rather than 111—but the real credit goes to the victims themselves, who had to fight and fight and fight to get very little.

I have felt frustration taking part in every debate on the subject over the past seven years and during the endless meetings with Ministers through the all-party group, so I am glad that the Minister has said that his mind is open on the type of inquiry. We need an inquiry with powers, such as an inquiry held under the Inquiries Act 2005 with powers to call witnesses and interrogate them under oath. We need the forensic skills that a judge would bring, but at the same time the inquiry needs to have credibility and trust. We do not want to start making the same mistakes that we made with the sex abuse inquiries and are beginning to make, I am afraid, in the Grenfell inquiry.

The other day, I was listening to Dr Richard Stone on the radio. He assisted the Macpherson inquiry and was trusted by the local community. We need here a combination of those forensic skills and people who know the issues and know the people involved, and are trusted by them. We have to have full access to documentation. We have to have proper rights of audience for the victims and their families. We have to have full representation. That means legal aid. I hope that in the same way that the Government are now discovering their neglect of social housing over many years has been a mistake, they will discover that the cuts in legal aid are also a mistake and are false economies.

I say that while paying tribute to what the Minister has said today, but remembering that in the previous debate, which Andy Burnham held in this House only some two months ago, we were told that a public inquiry was not appropriate. Let us consider just some of the issues that are being dealt with here: non-consensual testing; victims not being informed of the results of that testing; non-consensual research involving previously untested patients; people being informed, if they were informed, in hospital corridors or through the post; and minors being told without their parents being present. All this was happening in our country in the relatively recent past.

Then there is the cover up—the allegations in relation to documents being destroyed and people not being prepared even to answer questions. All that has to be addressed through this inquiry.

Given the time, may I end by talking about Andrew March, as a large part of my involvement in the investigation is down to him? With his consent, I shall discuss personal details, which, courageously, he wants in the public realm because he wants us to get to the bottom of this. In a letter to me earlier today, he wrote:

“I have been looking at my medical notes, and have discovered that essentially, I am one of the patients who was not informed by their hospital (in my case Coventry and Warwick Hospital) that I had non-A non-B hepatitis throughout the 80s, and similarly, I was not informed that I had Hepatitis C when the hospital tested me without myself or my parents knowing”—

he was a minor at the time—

“despite testing me years earlier, without myself or my parents knowing. I only found out ‘by accident’ in October 1992, when I transferred my care to the Royal Free in London”.

Andrew quotes from the letter from the consultant at the Royal Free, who said:

“On further discussion he did not seem to be aware that he was Hepatitis C antibody positive and we therefore spent some considerable time discussing our understanding of Hepatitis C infection and the implications of antibody positivity.”

Andrew says:

“I am a severe haemophiliac, and one of only 250 HIV positive haemophiliacs who remain alive today. Of those originally infected in the 1980s, more than three-quarters have died during the course of the past 3 decades. Many of them were my friends.

I was also infected with hepatitis B and C, and despite treatment, I continue to live with the adverse effects of cirrhosis of the liver…I am also one of the 3,872 haemophiliacs (and persons with bleeding disorders), who have been notified as being considered ‘At-Risk’ of vCJD (the human form of Mad Cow Disease).”

This avoidable tragedy has completely transformed Andrew’s life and put him at huge disadvantage. He has never received a proper explanation. He has never been properly recompensed. Despite that, he has devoted his life to ensuring justice for all the victims. We owe it to him and to all those other victims—many of them, unfortunately, already dead—to drill down forensically into this tragedy, and to do so reasonably speedily and in a way that leaves nothing unexposed. If we do not do that, a reducing number of people will get justice.

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.