Hospital Services (South London)

Bob Stewart Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Bob Stewart (Beckenham) (Con)]

I thank the hon. Lady for giving way, and I will make a short intervention, Dr McCrea, so that I do not get a finger-wagging from you. Frankly, GPs should be in support of these changes; support from GPs is one of the conditions that is a requirement for such changes. If they are not in support of these changes in Lewisham, that is a big problem.

[Heidi Alexander]

The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

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[Heidi Alexander]

My right hon. Friend has consistently made that point in the House, and I totally agree.

It is a fact that maternity services in south London are under enormous pressure. In the 20 months between April 2011 and November 2012 providers of maternity services across south-east London suspended services on 37 occasions. Women in labour were therefore turned away from hospitals and told that they would have to go elsewhere. Of those 37 suspensions, 26 were necessary because of lack of beds. King’s College hospital also tried to suspend services on a further six occasions, but was unable to do so as no other unit had capacity to accept the women it was trying to transfer.

[Bob Stewart]

As the father of six children, I can tell the House from experience that nothing is more upsetting for a lady who is about to give birth than being shipped around when she tries to get into hospital. That is deeply upsetting to someone at such a fraught time in their life.

[Heidi Alexander]

The hon. Gentleman makes his point incredibly well.

Just a few weeks ago, both King’s and Woolwich were sending women to Lewisham to give birth. Women should be able to give birth at their local hospital and should not have to go to one hospital for the antenatal appointments only to have to go somewhere else to give birth. With high numbers of teenage pregnancies and a higher than average proportion of older mums in places such as Lewisham that is doubly important. The proposal for a midwife-led birthing unit at Lewisham is not a genuine option for any woman who wants to give birth safe in the knowledge that she would have back-up obstetric support if it were needed. I am told that that would not be an option for first-time mums. If I were to have a baby in two years’ time, I would not be able to go to Lewisham. The report tries to convince me that I would have greater choice, but that is just a joke.

One of my main concerns about the proposals for maternity services relates to where, and to what extent, capacity will be enhanced at other hospitals to deal with the mums who would otherwise have gone to Lewisham. The proposals before the Secretary of State assume a relatively even redistribution of women from Lewisham to King’s, the Queen Elizabeth hospital Woolwich and the Princess Royal university hospital in Farnborough. However, historically, when Lewisham women have not given birth at Lewisham, their main hospitals of choice have clearly been King’s and St Thomas’s. If more women go to those hospitals, projected births there could exceed 8,000 a year. Those would be really big maternity departments, potentially requiring a double rota of staff and consultants to deal with them. The cost of a double rota in maternity units at King’s and St Thomas’s is not accounted for in the plans before the Secretary of State.

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[Jim Dowd (Lewisham West and Penge) (Lab)]

I will attempt to be brief, Dr McCrea, given your exhortation and out of consideration for my colleagues.

I do not think that the Secretary of State for Health will proceed with the proposed plan, because it is so far off the rails. It is such a ludicrous proposition, so ridiculous in its scope and even its intent and such a shoddy piece of work, frankly, that the Secretary of State will not be so foolish as to proceed with it, even if he can blame his predecessor for lumbering him with it. We have to recognise the threat, however, and to do what we can to make the case against it. That is why, after 10,000 people turned up on the 24 November to march past the hospital to protest against the plan to downgrade—to eviscerate—Lewisham hospital, rather more will be out again this Saturday, marching past the hospital to Mansfield park in Catford, to express what my hon. Friend the Member for Lewisham East (Heidi Alexander) described as anger, although I go beyond that.

My hon. Friend was kind enough to mention that I have been in this place 20—now almost 21—years, but I was also involved with Lewisham council for 20 years before I came here, and, without doubt, the hospital proposal has raised more fury than anger—more so than any other local issue in all the 40-plus years that I have been involved in public life in Lewisham, even more than the madcap scheme of the Department for Transport under the now Lord Parkinson to further the south circular assessment study. That scheme had recommended widening the south circular to six lanes throughout, with eight lanes in some parts, right the way through the middle of Lewisham. People thought that was mad enough, but that pales into insignificance compared with the public response to the proposals that we are discussing.

What fuels the fury is not the incoherence of the plans, or even the gross financial assumptions—I have heard people call them heroic, but some of the claims are lunatic, and in pursuit of so little—but the sense of injustice, the unfairness of the scheme. Lewisham hospital, as in the recent past, has a strong commitment to safety, quality and patient experience. It has been rated in the top 40 hospitals nationally by CHKS—for clinical effectiveness, patient safety and so on—and has a strong record in achieving national and local performance targets. It is operationally lean, the reference costs index making it the most efficient trust in south-east London, delivering financial surpluses in each of the past six years—Guy’s and St Thomas’s trust, King’s College trust and, obviously, the South London Healthcare NHS Trust have not done that.

Our hospital has achieved the successful integration of acute and community services, fostering strong links with social care, and the people of Lewisham are already reaping the benefits. It has the reputation for strong and successful partnerships, so much so that many of the people at the Queen Elizabeth look forward to Lewisham management taking over to build links with commissioners, local GPs, the local authority, patients and staff.

Lewisham hospital, or University Hospital Lewisham, now part of the Lewisham Healthcare NHS Trust, with NHS London’s encouragement, was actively pursuing a foundation trust application when the process we are discussing interrupted and completely derailing that application. People are furious at the injustice precisely because Lewisham hospital has done everything in the services that it provides that could reasonably be expected of it by the Department and particularly by the people of Lewisham.

I want Lewisham hospital to survive as an institution, but I am not desperately keen on institutions for their own sake, important as they are. I am more interested in the services that they provide for the people they serve, and the hospital’s record is exemplary. To see that destroyed and devastated by the vandalism of the trust special administrator process is more than most reasonable people can stand or accept.

I have been inundated, as I am sure have my colleagues, with information from various quarters, and all has been hostile. One note from a constituent—I will not be too specific as I do not want to identify her, but she is a clinician at Queen Elizabeth hospital—who did not support the closure but does not want Lewisham hospital to be destroyed, said that the position at Queen Elizabeth hospital is dire, and needs strong leadership and a clear sense of direction and purpose, so that it too can provide the services that the people of Bexley, Greenwich and Bromley deserve. If the closure of A and E at Lewisham hospital goes ahead, 750,000 people in Bexley, Greenwich and Lewisham will have a single A and E department available. That would not be safe by any stretch of the imagination.

I can do no better than to quote an e-mail that I received just yesterday from the GP team in neighbourhood 4 of the Lewisham general practitioners clinical commissioning group that makes the case well. The group covers practices in Bellingham Green, Sydenham Green, Sydenham road, the Vale, Wells Park in Woolstone road, and the Jenner, which is in the constituency of my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and just the other side of the south circular road on the boundary between our constituencies. It says that closing

“the A and E will hit the elderly, disabled…and children of single parents disproportionately”

and that

“although an urgent care centre…will persist, its use its use will decline significantly as neither patients nor clinicians will have confidence to use an UCC unsupported by acute medical and surgical care”.

My right hon. Friend made that point elegantly. The e-mail continues:

“Loss of obstetric service will result in women in labour having to attend a different provider from their antenatal care, few women will choose this option, as both patients and clinicians are aware of the increased risk of disjointed maternity care and find it emotionally unsettling.”

It also says:

“The projected flows of patients are inaccurate and therefore so are the costings, our Primary Care survey across Lewisham showed 80%+ of patients would attend Kings, 10% St Thomas, 6%”

Princess Royal university hospital, Farnborough, and that only 4% of those currently attending Lewisham A and E would go to Queen Elizabeth hospital at Woolwich.

[Bob Stewart]

The point about going to Farnborough is that it is a heck of a long way from Lewisham, which makes it difficult. Public transport to Farnborough is not acceptable for people who are weak, disabled or poor.

[Jim Dowd]

I am grateful to the hon. Gentleman. He knows that many of his constituents attend Lewisham hospital, so the effect will be not just on people who are resident in Lewisham.

In view of the time, I will not go through the rest of my points, but suffice it to say that they are compelling, overwhelming and make sense. The problem with the trust special administrator is that he regards antagonism and opposition from local people, particularly clinicians, as a sign of his rectitude. One of our local football teams is Millwall, which is based in Lewisham, although the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) prefers to disguise that fact. It has an unofficial slogan, which is also a song to the tune of “Sailing” by the Sutherland brothers and was made famous by Rod Stewart. The words are:

“We are Millwall, super Millwall”

and

“No one likes us, no one likes us

No one likes us, we don’t care!”

I suspect that Mr Kershaw has taken that local aphorism as his inspiration because he could not have gone further out of his way to antagonise all the people of south-east London. The problem is that most Millwall football fans sing it as a joke, but Mr Kershaw clearly believes it. He has succeeded in antagonising and alienating not just the medical community, but everyone in south-east London, because the whole scheme is a shambles. He said that no one came forward with a viable alternative to his plan, which is why the final report is as it is. I can tell him that if they had £5.2 million and rising and the services of McKinsey, Deloitte, Ipsos MORI and other consultants, year 6 at Dalmain road primary school could have come up with a better scheme than his. I suspect that the Secretary of State has enough sense to reject it. Action needs to be taken to secure health services across south-east London, but this is not the way.

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[Bob Stewart (Beckenham) (Con)]

I thank the previous speakers for allowing me to speak. I was not going to speak, but I felt induced to do so by the excellence of the debate. My constituency is bracketed: on one hand, we have Lewisham hospital, and on the other, the Princess Royal university hospital in Farnborough, so I feel very much like the piggy in the middle. However, we have the Beckenham Beacon, and if I have time, I will mention that at the end.

Lewisham hospital is excellent. Working within its budget, it has a good reputation and serves the local community, which includes people from my constituency. I really am against the idea of its role being changed. The idea that it becomes an urgent care centre is fine. When I asked the special administrator about that, he suggested to me that it was not much of a change, and the only real change was that people would not be admitted into the general hospital. That is not quite as I understood it. Now we do not have the specialist back-up, and there will be a big reduction in people being seen locally. Lewisham requires a hospital, and it should keep its hospital.

Travelling around south London is notoriously difficult, as we have heard. All the routes go in to the epicentre. The eye of the octopus is round about here, and so trying to cross London to go to various hospitals—particularly for those who do not have an easy transport option—is extremely difficult. I am thinking of the elderly, as it is very difficult for them to achieve what they want and get to a hospital—say, if they are sent somewhere other than Lewisham, when they live in Lewisham. I am very concerned about the idea that we can do away with maternity services in Lewisham. Some 4,000 babies is a heck of a lot of babies to cart off somewhere else, as I mentioned in an earlier intervention.

I finish by reminding Members that we have the Beckenham Beacon, which is only 70% used at the moment. It is an outstanding facility, and from what I have heard, I understand that the clinical commissioning group for Bromley intends to take up the services that are there now. However, I also commend the people looking at this problem to think about increasing the services of the Beckenham Beacon, to help not only my constituents but the people of Lewisham. I know that I have to stop now, Dr McCrea, so as I am a very good boy, I will sit down.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Dr McCrea. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this incredibly important debate. The future of accident and emergency and maternity services across south London is of genuine concern to a great many of her constituents and, indeed, for the wider area, as this is definitely an issue of real significance across the capital. I know from a meeting that I chaired with Labour colleagues before Christmas that it goes to the heart of their communities. I applaud the way in which my hon. Friend the Member for Lewisham East, our right hon. and hon. Friends and others from across the party divide have put together a campaign that highlights their constituents’ concerns in such a high-profile and persuasive manner.

It has long been accepted that difficult decisions might well be needed to secure the sustainability of health services in south-east London, as the challenges facing South London Healthcare NHS Trust are complex and of long standing. As we have heard, the proposals to close the A and E and downgrade the maternity unit at Lewisham hospital are intended to assist a neighbouring hospital trust to find its way out of significant debt problems. It is a highly controversial procedure, to say the least, because Lewisham hospital, as we have heard, is well respected and well managed and recently underwent a £12 million refurbishment.

The proposals also introduce wider considerations that could affect the whole of south London’s health care. At the same time as the trust special administrator has been reviewing services at South London Healthcare NHS Trust, plans for changes to management structures and the merger of services have been progressing, led by King’s Health Partners and three foundation trusts—King’s College hospital, Guy’s and St Thomas’s and the South London and Maudsley—in conjunction with King’s college London.

Any plans for the whole area need to take full account of all the potential knock-on effects on the quality of care that people receive, and they need to consider how the merger plans will affect the health economy right across south-east London and potentially limit other long-term options for changes in south-east London. The figures provided by my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) illustrate the real problems associated with some of the changes being presented today: a 45% increase in emergency admissions and a 54% increase in births at King’s if Lewisham closes. Those huge capacity issues would need to be resolved. The Minister needs to look carefully at those figures.

As we have heard today, there are real concerns among the local Members of Parliament about the future of services at Lewisham hospital, so much so that recently a delegation of local doctors and my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East presented a petition against the closure of Lewisham’s A and E and maternity departments to 10 Downing street. In only five weeks, the petition against the changes has been signed by more than 32,000 people, and the numbers are still growing.

We have also heard that, as part of the campaign, there have been a number of protest marches against the closures. I believe that there will be one this weekend. I am sure that that will attract equally heavy support as the earlier ones, which I believe from my right hon. Friend the Member for Lewisham, Deptford took place in rather grotty weather. Notwithstanding the snow that there may be this weekend, I am sure that the good folk of Lewisham will still be out in force.

[Bob Stewart]

I am intervening quickly to support what my friend—I call him that despite his being on the Opposition Benches—the hon. Member for Lewisham West and Penge (Jim Dowd) has said. This is a matter of fairness. It seems extraordinary that failing hospitals are being supported and allowed to continue essentially as they are, but Lewisham—a wonderful hospital that is within budget and is gaining an increasing reputation— is being kicked, slashed and destroyed. I just do not see that as right. It is a matter of fairness.

[Andrew Gwynne]

The hon. Gentleman is absolutely right. It is also telling that a very substantial number of GPs, including the chair of the new clinical commissioning group and the head of every single clinical area in the hospital, have written to the Prime Minister to express their concerns about the proposals. That clearly shows that the proposals do not have the support of local clinicians. I urge the Minister to read the very passionate article in Saturday’s Guardian online by Lucy Mangan as well. That helps to address some of those points.

As we have heard, more than 120,000 people visit the A and E at Lewisham hospital each year and more than 4,000 babies are born in the maternity department. With the prospect of the A and E being closed and the maternity unit being downgraded, a number of worries have quite rightly been expressed, not least because, as we have heard from my hon. Friend the Member for Lewisham East in the debate, Lewisham’s population is estimated to rise significantly in the next few years as a result of the huge increase in the birth rate.

As I have said previously, there is no doubt whatever about the unanimity among the professionals and the population about the importance of maintaining services at Lewisham hospital—something that Ministers have always stressed they would fully take on board. As we have heard in the debate today, the right hon. and hon. Members who represent the areas affected believe that the plans are based on inaccurate data and flawed assumptions and that the whole issue has been misunderstood and largely mishandled.

We have the final report from the trust special administrator, urging this closure at Lewisham, and the Secretary of State is to make the final decision by 1 February. However, it is difficult to understand how the Government can consider that that report constitutes a full strategic review of the sustainability of services across south-east London. Labour Members believe that the trust special administrator has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital. In addition, the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.

It is quite concerning when the rules on making changes to hospitals seem to have been changed to allow back-door reconfigurations in the way that I have described, without the proper scrutiny and consultation that would ordinarily take place. Indeed, the trust special administrator used powers passed by the Labour Government in a way that was never intended. I take the point made by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). Nevertheless, what has happened sets a worrying precedent whereby the normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services could be pushed through. This is a worrying situation, as it takes the NHS over a very dangerous line and is potentially the first back-door reconfiguration in that manner. If it is allowed to go ahead in that way, it could mean that any hospital services could be changed for purely financial reasons, which has never been the case in the past. We need to ask where the clinical case for change is in these proposals.

The 2009 Act clearly says that administrators must make recommendations relating to the trust that is failing. That has not happened in this case. Reconfigurations need to be based on solid clinical evidence that they will save lives. Where there is a clear clinical case, I think that that is right, and we should look carefully at changes before deciding whether we should oppose them. However, the TSA’s actions are leaving a very confusing and worrying situation surrounding hospital reconfigurations.

My hon. Friend the Member for Lewisham West and Penge got it right. We are starting to see a situation in which primary care trusts are moving quickly to try to secure service changes before the clinical commissioning groups take over, and it is becoming all too clear that it is financial pressures that are starting to lead to closures and health service changes. That is clearly wrong.

On the four tests for reconfigurations, does the Minister really think that they have been fully met and does she believe that this change has the support of local commissioners?