South London Healthcare NHS Trust

Baroness Royall of Blaisdon Excerpts

Thursday 31st January 2013 Lords Chamber

[Baroness Royall of Blaisdon]

My Lords, I am grateful to the Minister for repeating the Statement made in the other place by the Secretary of State for Health.

Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of the South London Healthcare NHS Trust. I am, of course, relieved that he has rejected an outrageous proposal that Lewisham Hospital should lose its A&E—a proposal that should never have been made in the first place, but which cost over £5 million of precious NHS cash on accountants in the process. That is enough to give some of the 5,000 nurses they have sacked their jobs back.

However, I deeply regret that he has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. It is simply not good enough for the Secretary of State to say that he respects and recognises the sense of unfairness that people feel because their hospital has been caught up in the financial problems of its neighbour.

The Secretary of State today crossed a line and set a dangerous precedent: that in his new market-driven NHS, finance takes precedence, and any hospital, no matter how successful, is vulnerable to changes; that success can be punished and failure rewarded; and that a community can see its A&E and maternity services downgraded without a proper consultation or clinical justification. I fear that fragile public trust in the way that the NHS manages changes to hospitals will be damaged by this announcement. It will send a chill wind through any community worried about its hospital services.

There is also now utter confusion about the Government’s policy on hospital reconfiguration. Across the country, half-baked, cost-driven proposals to close A&Es and maternity units are being foisted on local communities without evidence of how they can be done safely and without putting lives at risk. Yet, at the same time, A&Es everywhere are under severe pressure. Thousands more patients are waiting more than four hours to be seen, and there are queues of ambulances lined up outside.

In this context it is simply not tenable to downgrade any A&E department without first establishing a clear clinical case for how it can be done without compromising patient safety. However, that is being done in this case. This seems to have been a financially driven process. I would suggest that the clinical justification was patently not independent but was drawn up by the Department of Health, leaving the Secretary of State’s so-called four tests in tatters.

The fourth test is that any proposal for change must have “demonstrable support from commissioners”. I will quote a letter to the Secretary of State from the chair of Lewisham CCG, Dr Helen Tattersfield, who wrote:

“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham”.

Is it the case that these proposals, which will lead to a reduction in quality and provision in Lewisham, are opposed by the doctors whom the Secretary of State promised to put in charge, and therefore that they fail his fourth test?

Is the noble Earl confident that what has been announced is legal? We have warned the Secretary of State that he is going beyond the powers in the 2009 Act by bringing a neighbouring trust into scope. He said that he was commissioning fresh legal advice on this point. Will the department publish it today so that there can be a proper debate on the legal position?

The Government need to learn some hard lessons from this fiasco, and urgently need to restore some public trust. They need to get back to some first principles on managing change in the NHS. I ask the noble Earl to address some fundamental questions today. Will he confirm that, in future, no proposal to close or downgrade A&E or maternity services will be embarked on if it does not have a proper clinical case to support it? My party will not stand in the way of difficult decisions to close A&E services where lives can be saved. But we will not put our name to financially-driven proposals that take risks with patient safety. Will the noble Earl commit that in future, the rights of any community to a proper consultation and appeal process will not be short-circuited in this way?

Finally, will the Government today issue an apology to the people of Lewisham who have been caused unnecessary distress by this debacle? Thousands of people have put their lives on hold to fund-raise, lobby and campaign. Some 52,000 names are on a petition and 25,000 people went on the march. A community that includes some of my noble friends has rallied together to defend its local hospital and fought valiantly for everyone worried about this Government’s cavalier approach to our country’s most valued institution. It is a community that has stood up to an out-of-touch Government who think they can treat some of the more deprived parts of our country with disdain. The community has achieved something today, but it will continue to fight and it will have our support.