Accident and Emergency Waiting Times

Barry Gardiner Excerpts

Wednesday 5th June 2013 Commons Chamber

[Barry Gardiner (Brent North) (Lab)]

As my hon. Friend knows, Northwick Park is just in my constituency and we share that border. Does he agree that whatever the future configuration of hospitals in north-west London, it is absolutely essential that the A and E unit at Northwick Park is expanded to cope and that that should happen before any reconfiguration?

[Mr Thomas]

rose—

Social Care Funding

Barry Gardiner Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I do not think that there is an implied link in the way that my hon. Friend suggests, but I will reflect on his comment to check that I fully understood his brilliant insight. Automatic indexation is of course a matter for future Governments and future Parliaments, but it is certainly our intention that the proposals we are making will continue to take account of changes in the cost of living.

[Barry Gardiner (Brent North) (Lab)]

I welcome aspects of the Secretary of State’s statement. Does he agree that the security in old age that he is seeking to put in place will not be effective for as long as companies such as Phoenix Life are able to offer people like my constituent, Mr Gerard Burton, £221 a month for the rest of his life, at the age of 84, in return for half his house? Will the Secretary of State speak to his colleagues in the Treasury to ensure that there is great scrutiny of precisely what financial products are being offered in this domain?

[Mr Hunt]

I do not know the details that the hon. Gentleman is talking about, but I would be happy to speak to Treasury colleagues about that issue.

National Health Service

Barry Gardiner Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

I am interested in the argument that the hon. Lady is beginning to develop, which is that she wants to deliver pay cuts to NHS staff across her constituency. Presumably she wants the same as people in the south-west are getting. Is that what she is calling for? It is an interesting argument, and I would be interested to hear her expand on it later.

[Barry Gardiner (Brent North) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

In a moment.

What I found most useful about the book is that it answered a question that has been nagging away in my mind for some time. As a former Health Secretary, I remember clearly the warnings I received from senior civil servants about the sheer scale of the £20 billion efficiency challenge. “It would be a major undertaking,” they said. “The NHS would need to focus all its energy on that alone. To be negotiated safely, new policy initiatives would have to be put on hold.” Over the months that have followed, I have often had cause to recall those words, as I watch the Secretary of State add to the financial challenge with the biggest ever reorganisation in NHS history. Did the same civil servants issue the same apocalyptic warnings to the incoming Secretary of State as they did to me? Finally I have my answer, in a quotation in the book from an unnamed senior civil servant:

“The biggest challenge was trying to get the secretary of state to focus on the money—the £20 billion and the sheer scale of the financial challenge”.

According to that civil servant, however, the Secretary of State’s attitude was:

“I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this”.

Another civil servant is quoted as saying:

“We did point out to him that his plans were written before the big financial challenge, and didn’t that change things? He completely did not see that at all. He completely ignored it”.

Then the question is asked: was the Secretary of State presented by the Department with alternatives to inflicting legislative upheaval on the NHS? A senior civil servant said that

“it was clear that having posed the question of did he want to see other options, that Andrew was not very interested at all in us presenting alternatives.”

A picture is emerging of a Secretary of State with an inability to listen, take advice or heed warnings, who is going to have his Bill regardless of the upheaval that it will cause to the national health service.

[Barry Gardiner]

I am grateful to my right hon. Friend for giving way, although I fear that the moment might have passed. I simply wanted to ask him to reflect on the challenges that the hon. Member for St Albans (Mrs Main) issued to him about doctors and pay. Does he agree that those doctors are now the very people who are in charge of commissioning the services of which they are also the providers? I wonder whether the hon. Lady thinks that that is a good thing or a bad thing.

[Andy Burnham]

At the heart of the defective legislation that the Government rammed through the House of Commons is an unresolved conflict of interest, in which commissioners can also be providers who can remove services from hospitals and then provide them themselves. Under pressure in the other place, the Government came up with a requirement for a statement of such interests, but without introducing any mechanism for enforcement to ensure that decisions in the NHS are being made for the right reasons. I fear that that conflict of interest will return to haunt the Government.

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[Andrew George]

The hon. Lady makes an important point. Lezli Boswell, the chief executive of the Royal Cornwall Hospitals Trust, wrote to me on behalf of the consortium about concerns that have been raised, including by the unions, saying that once the national pay review has concluded under “Agenda for Change” it would then be appropriate, if it is at all appropriate, for any further local discussions to proceed. Without union involvement in the work of the consortium, I agree with the hon. Lady that the proposal is irrelevant and potentially disruptive and dangerous, given its impact on staff morale throughout the NHS in the south-west. My hon. Friends will be listening closely to this debate, and to the concerns that have been raised by many Members and, indeed, by staff across the south-west about the consequences for staff morale and the impact on NHS services. I certainly hope that the Secretary of State will address those issues when he concludes the debate.

A key issue is one that dare not speak its name—it affected staff morale under the previous Government as well—but it is the increasing pressure on front-line NHS staff. The staffing levels at the coal face have never been sufficient to provide a safe staff to patient ratio. Many people have been critical of nursing and care standards in the NHS, but they often overlook staffing ratios.

I have also expressed concerns about the out-of-hours service in Cornwall—I know that we will not have time to discuss that—and the Care Quality Commission will produce a report as a result of those concerns, which were also voiced by the hon. Member for Truro and Falmouth (Sarah Newton).

On pay for staff in the south-west, the chief executive of the Royal Cornwall Hospitals Trust said to me in a letter:

“In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor…has also estimated that NHS organisations with a turnover of around £200m will need to produce savings of around £9m a year for each year until 2016/17 to remain in financial health.”

She goes on to say that the consortium, which consists of 20 organisations in the south-west,

“is looking at how pay costs may be reduced, whilst maintaining a transparent and fair system that is better able to reward high performance, incentivise the workforce and support the continued delivery of high quality healthcare.”

Does the Secretary of State agree with that, and how does he intend that that should proceed? How will he protect staff and staff morale, because the consequences will, I fear, derail national negotiations on “Agenda for Change” and drive down pay and morale, particularly in an area of very low wages? I hope that he is listening.

[Barry Gardiner (Brent North) (Lab)]

rose—

[Alex Cunningham (Stockton North) (Lab)]

rose—

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[Barry Gardiner]

Thank you, Sir. I shall try to respect your advice.

In November 2011, the following announcement appeared on the Central Middlesex hospital website:

“A and E at Central Middx Hospital is temporarily closing overnight between 7 pm and 8 am starting from Monday 14 November 2011.

The urgent care centre next to A and E will remain open 24 hrs a day 7 days a week to treat patients with minor injuries and illness.

We are making this temporary change to ensure we continue to provide a safe service to patients during the winter months.”

In those three paragraphs, we hear twice over that that overnight closure is temporary, which gave minimal comfort to my constituents in Brent who used the facility. The overnight closure is indeed temporary. On 2 July, a consultation entitled “Shaping a healthier future” was launched in north-west London, and residents can submit their views until 8 October this year. The consultation, promoted by a transitional body called NHS North West London, aims to centralise and rationalise hospital services in the area. Each proposal outlined in the consultation includes the closure of the A and E at Central Middlesex—not overnight provision, but the 24-hour facility—for good.

The motion speaks of

“the growing gap between Ministers’ statements and what is happening in the NHS”.

I may have trouble agreeing with that, because it depends on which Minister and which statements. The Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), received an e-mail from me today advising her that, if called to speak, I would quote her in this evening’s debate. I wanted to do so, because she made the following three statements. First:

“The Tories would be a disaster for the NHS, they plan a part privatised service”.

The second quotation:

“These cuts will hit the poorest and most vulnerable hardest”.

The third quotation:

“The government must take urgent steps to safeguard our local NHS”.

Those three quotes date respectively from 2003, 2007 and 2007, when the hon. Lady was campaigning to keep open the accident and emergency centre at Central Middlesex hospital—campaigning for something which she, in her government, is now closing. No wonder her latest comment is:

“This flawed consultation, which does not allow residents to say that they want to save the A and E, is a kick in the teeth for all local people.”

I do not speak Parseltongue—I do not understand it—but I deplore the pretence of opposing a policy that you are pushing through in government. That is really disgraceful.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Mr Cunningham, you have until 7.10 pm before the Minister responds.

Southern Cross Care Homes

Barry Gardiner Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman has been raising those concerns in the way that he has, and I will certainly look at the points he has raised in the past. Local authorities have certain statutory powers in respect of their ability to respond to the closure of a care home by managing and resourcing that. We have been, and continue to be, in discussion with local authorities on that, so that they are able to respond in the event of a closure. I return to my key point, however, and the key reassurance we have not only from the company, but from the landlords: this is a solvent restructuring of the business, so that the care homes continue to operate and to provide homes for their residents.

[Barry Gardiner (Brent North) (Lab)]

It is not only the residents of the Birchwood Grange and Coplands homes in my constituency who are concerned about their future; so, too, are the people who work in those homes. Can the Minister guarantee that the new operators will honour the terms and conditions of those workers, so that they can see that their future is also secure?

[Paul Burstow]

There is an undertaking that the TUPE regulations would apply: there would be a transfer on the current conditions. That is what all the staff have been told, and I am certainly happy to repeat the undertakings that have been given by those responsible for those undertakings.

NHS Reform

Barry Gardiner Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

Yes, I can indeed confirm that. Having joined my hon. Friend in Banbury in the past and met GPs there, I know and can say that, if they had been more fully engaged, as our plans would have meant, in the design of clinical services in Banbury or in the future of the Horton general hospital, for example, we would have had better and earlier outcomes than was in fact the case.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State, in his letter to me of 23 March, dismissed my request that he discuss with the Comptroller and Auditor General concerns about the conflicts of interest which might arise from GP commissioning. The Secretary of State, in his statement today, refers to the concerns about those specific conflicts of interest. Will he now engage in a discussion with the Comptroller and Auditor General to receive best advice on methods of Government procurement?

[Mr Lansley]

I do not think I dismiss anybody; I might not agree with people, but I do not dismiss them. If I recall correctly, I did not agree with the hon. Gentleman’s suggestion because he misunderstood the fact that the consortia are separate statutory bodies, not private bodies, and separate from GP practices, which are individual contractors to the NHS. The confusion between those two things meant that his point was not valid.

Northwick Park Hospital

Barry Gardiner Excerpts

Tuesday 22nd June 2010 Westminster Hall

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I am grateful for the opportunity to raise the future of Northwick Park hospital on the Floor of the House today. Although I have no financial interest to declare, I should declare that the hospital has looked after me and my family and friends at many points in my life, dealing with things ranging from running injuries through to dislocated shoulders as a result of canoeing accidents. I continue to be extremely grateful to the staff of Northwick Park hospital. Although no speech in the House could ever be regarded as anything other than political, I hope that this one will at least be judged to be not partisan. I have sought to give the Minister and my parliamentary neighbours notice of the issues that I intend to raise. I see in their places my hon. Friend the Member for Brent North (Barry Gardiner) and my immediate neighbour, the hon. Member for Harrow East (Bob Blackman).

Northwick Park hospital is the primary hospital serving my constituents. Mount Vernon and the Royal National Orthopaedic hospitals are nearby, but Northwick Park sees the vast majority of work involving Harrow NHS hospital patients. I want to raise with the Minister four issues: the case for capital investment for the rebuilding of the hospital; the ongoing revenue budget of the hospital; the hospital’s move towards foundation hospital status; and whether the hospital will be designated as a major acute centre for north-west London.

The hospital is 40 years old, having been opened by Her Majesty the Queen in 1970. It has a certain celebrity status, having featured in, for example, the Channel 4 comedy “Green Wing”, in “Prime Suspect” and—I suspect this will worry my constituents a little—in the 1970s horror film “The Omen”. More recently, the hospital merged in 1994 with St Mark’s hospital, a national centre that is world renowned for gastrointestinal medicine. Northwick Park is also home to the British Olympic Association’s Olympic Medical Institute and, together with Central Middlesex hospital, forms part of the North West London Hospitals NHS Trust.

Northwick Park is in general extremely well run. After 13 years of substantial investment in the NHS, I now rarely receive complaints about the quality of care at Northwick Park. Its mortality rate—a crucial indicator of quality—shows Northwick Park to be one of the best hospitals in the UK. I pay tribute to its current management team and the trust board for a job that I think they are doing well.

The hospital provides a range of services that straddle acute and community care. It also provides a large range of important regional services, including maxillofacial services for all of north-west London and parts of the NHS Eastern and South Central regions; a neuro-rehabilitation medical in-patient centre for NHS London and the east of England; bowel cancer screening; clinical genetics; and a dedicated infectious diseases centre. If it is not the largest acute hospital in north-west London as a whole, it is certainly the largest in outer north-west London. It has a very busy accident and emergency department, is a key part of the Imperial College Healthcare NHS Trust trauma network and, crucially, was recently designated as one of eight hyper-acute stroke units in London. The decision to have an acute stroke unit there enabled the hospital to take a significant step towards formally securing designation as a major acute centre for north-west London. First, therefore, I formally ask the Minister, can he confirm that a journey that the hospital has been on towards designation as a major acute centre is complete and that crucial status has been secured?

Secondly, the trust board has faced and still faces a challenging financial picture, in part, as I understand it, because of the level of usage of the Central Middlesex site. The trust has succeeded in meeting many of its financial targets, but has faced pressure in part because of the impact of the polyclinic model of care and, more generally, the steady move of out-patient services from hospital settings into the community. I should make it clear that my constituents and I are strong supporters of the Rayners Lane polyclinic, run by the excellent Ridgeway Surgery group of GPs. Can the Minister confirm that there will be no cuts to Government funding for NHS London or, crucially, to NHS Harrow—the chief although not the exclusive source of funding for the hospital? Can he set out to the House how he sees the hospital’s financial future?

[Barry Gardiner (Brent North) (Lab)]

I applaud my hon. Friend for securing the debate and for all the remarks that he has made. Does he share my concern that we should hear from the Minister about the business case for £23 million that has been presented to the Department for a series of essential works as a result of the Arup review in 2009? Does he agree that it would be extremely helpful if the Minister could give us some indication about the outcome of that to settle the minds of our constituents?

[Mr Thomas]

I certainly agree with my hon. Friend. That maintenance work is essential, as I shall come on to say, and it would certainly be good to hear the Minister’s reaction to that bid.

The third and most important of the issues that I shall raise today relates to the issue alluded to by my hon. Friend—the case for additional investment out of the NHS’s capital budget for the redevelopment of the hospital. A fire in the hospital’s basement in February last year led to the trust board commissioning a report into the maintenance situation at Northwick Park. It recommended up to £65 million of improvements to the infrastructure on the site to ensure that it remains fit for purpose. Indeed, on the basis of annual NHS estate returns, the trust has one of the largest backlogs of maintenance in London. It has been clear for a considerable time that a major redevelopment process is required.

In November 2004, a strategic outline case for redevelopment of the whole site was approved, and private finance initiative credits of more than £300 million were made available the following March. However, redevelopment did not start, on the grounds of the project’s affordability. Various reviews of the PFI project, all crucially linked to an ongoing debate about levels of usage of both hospitals in the trust and therefore likely levels of income, have not yet led to enough clarity about how redevelopment of the hospital might proceed. I believe that it was not until February 2009 that the PFI project was formally cancelled.

There has been and remains, in my view, little doubt that major redevelopment of the whole site is required. Indeed, senior figures in NHS London have consistently accepted the need for a major rebuild. There is unfinished business on the redevelopment of the hospital. I therefore ask the Minister, does he accept that the case for a rebuild is strong, and on what timeline does he envisage such a redevelopment taking place?

To be fair, the NHS has certainly not ignored Northwick Park. There has been significant capital investment in clinical and IT equipment; in reducing the backlog in maintenance and ward refurbishments, particularly in refurbishing maternity services; in a new children’s centre and paediatric accident and emergency; in oral maxillofacial services; in bowel cancer screening; and, as I mentioned, in the new stroke unit. Indeed, more than £85 million of capital investment has been put into Northwick Park since 2005. There have also been more than 300 extra staff at Northwick Park, the bulk of them clinical, since 2005. However, the need for capital investment remains.

I should make it clear that I remain a very strong supporter of foundation hospital status. Its governance model will, I think, help to bring the hospital closer to those who use it. The mutual element of foundation hospitals has long been championed by the Co-op party, of which I am lucky enough to be the chair. In particular, I welcome the role of the board or council of governors that foundation hospitals have. The council of governors comes from staff, patients and members of the public and from other local nominating partner organisations, who together form a local membership base for such hospitals and can introduce a hugely important local level of accountability into NHS decision making. They also help to draw local people closer to what can sometimes seem a remote, albeit local, institution. There are other benefits to foundation hospital status, but it is that greater access to senior figures within the hospital, and therefore the greater sense of ownership of their local hospital, that will be of most long-term benefit to my constituents.

I therefore ask lastly of the Minister, when will my constituents be able to sign up to become members of the North West London Hospitals NHS trust? I have welcomed the opportunity given to me by the Speaker to put an issue of profound concern to my constituents before the House, and I look forward to the hon. Gentleman’s response.

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[Mr Burns]

I can categorically give the hon. Gentleman an assurance that at the appropriate time, before the announcement, I will make sure that my office contacts all three hon. Gentlemen present to ensure that they have advance notice of it.

On the question of foundation status, the hon. Member for Harrow West raised the possibility of North West London Hospitals NHS Trust attaining foundation status. The Government strongly support all trusts that aspire to that aim. Foundation-trust status enables the local NHS to develop stronger connections with communities, so that health care better reflects patient needs. It also creates the conditions for improving performance, which can only benefit patient care. More than half of all eligible NHS trusts are now foundation trusts, but we want to go further. We want to reduce Government control over the health service and set trusts free to innovate and take decisions based on what is right for their local populations. That includes North West London Hospitals NHS Trust.

The trust serves its population well and delivers good-quality care, as the hon. Member for Harrow West mentioned, but to step up to this new challenge, the trust needs to establish a solid financial foundation and needs to gain the support of GPs and commissioners. Bearing that in mind, I understand that the trust is likely to apply to become a foundation trust in 2012, and I wish it well in its application.

[Barry Gardiner]

I am grateful to the Minister for giving way; he has been most generous. He talked about building the confidence of local commissioning GPs. My understanding is that under his Department’s new arrangements, the ring-holder for the GP commissioning groups set up under the auspices of Brent primary care trust—I am sure the same applies in Harrow also—will no longer be the primary care trust. How does he propose that those groups of private businesses avoid the risk of being providers of services that they commission? Who will hold the ring, as the PCTs used to do?

[Mr Burns]

The hon. Gentleman is tempting me to go down a path that it would be unwise to go down at this stage. The reason I say that, and why I will not be tempted, is that as he is probably aware, my right hon. Friend the Secretary of State and my ministerial colleagues are doing a considerable amount of work putting together and fleshing out our vision for the NHS, not only for the next five years but thereafter—a vision that puts patients at the heart of the NHS and that is driven by the needs and improved care standards of patients. It would be inappropriate and wrong of me to succumb to temptation and to start to unveil, in this august debate, what my right hon. Friend the Secretary of State will announce in due course. The only good news that I can give the hon. Gentleman is that he will not have long to wait before all these mysteries are explained to him, and I am confident that he will be reassured and pleased by what my right hon. Friend the Secretary of State has to say.

[Mr Burns]

My hon. Friend raises an interesting point. It is true, as I hope I have explained, that there have been challenges for the North West London Hospitals NHS Trust with regard to its finances in recent years. However, as I explained—I will go into more detail on this later—measures are being put in place to seek to minimise the problems. I can assure my hon. Friend that when it comes to dealing with PCTs, trusts and the finances, I do not recognise the word “manipulate” as being in the lexicon. Everything is done to ensure that the maximum amount of money is made available to PCTs and trusts, to ensure that we protect front-line services, and to provide the best health care possible for my hon. Friend’s constituents and those of all hon. Members throughout the country.

[Barry Gardiner]

I wish to correct any suggestion that Brent PCT is in any way financially embarrassed. [Interruption.] My hon. Friend the Member for Harrow West (Mr Thomas) wishes to correct any such suggestion for Harrow as well. Three years ago, Brent PCT was running a deficit of more than £20 million. It took the necessary measures, and that deficit has now been turned into a surplus of £12 million.

[Mr Burns]

I appreciate what the hon. Gentleman says. I am sure that my hon. Friend the Parliamentary Secretary, Cabinet Office, will have taken that on board, and the record will certainly reflect the accurate assessment that the hon. Member for Brent North makes of the situation. However, it is fair to say, particularly in the case of the constituency of the hon. Member for Harrow West, that there has been a problem with the finances. As I said earlier, the requests for a loan and for money that are being considered reflect a need to bring finances into better alignment without affecting front-line services. I am hopeful—probably a bit more than that—that, with the actions that have been taken and the proposals that are awaiting decisions, there will be positive movement.

I come to the point raised by the hon. Member for Harrow West about new hospital build. He mentioned his desire to see completely new build at Northwick Park. As he knows, plans were put forward in 2004 to build a brand new £305-million hospital for his constituents. In 2005, at an early stage of the business case and planning application processes, the plans for the scheme were put on hold by the trust and the local PCTs due to concerns about their affordability. After more than a year on hold, the proposals were formally cancelled by the Department in the summer of 2008. That is standard procedure for schemes that are not progressing and that have been put on hold for a specified period of time. I am afraid that those limitations remain. While the trust is working hard to achieve financial stability, I regret to say that it is still a long way from realistically being able to afford such a large building project.

The hon. Gentleman also raised the issue of designating Northwick Park hospital a major acute centre within the context of the north-west London sector review. The proposals, which I understand are still at a very early stage of development, would need to pass the Secretary of State’s four tests. They would need the support of GP commissioners; the support of the local community; to be evidence-based; and to develop patient choice. That relates to the decision that the Secretary of State took a few weeks ago to strengthen the criteria for considering any reconfiguration by placing more emphasis on gaining support following full consultations with GPs, clinicians and local stakeholders. I am sure that the hon. Gentleman, being a reasonable man, would accept that that is a sensible improvement, with regard to seeking to reconfigure health patterns throughout the country and to ensure that the local community and the clinicians and GPs who deliver the services have more say and influence over what happens.

The hon. Gentleman requested a commitment from me, but there is not a lot that I can tell him at present, because the proposals are at such an early stage. What I can tell him—I hope this will go some way towards reassuring him—is that all proposals, when put together as a final package for consideration, will be fully considered in the context of the Secretary of State’s criteria, and a decision will be taken at the appropriate time.