Oral Answers to Questions

David Lammy Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Stephen Barclay]

The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.

[Mr David Lammy (Tottenham) (Lab)]

Jack Adcock’s death was a tragedy, but why did the General Medical Council spend £30,000 on getting Dr Hadiza Bawa-Garba struck off, even though she had already faced the consequences of her mistakes in court? Does the Minister think that the GMC needs to sort its act out and that Charlie Massey should resign?

[Stephen Barclay]

As the right hon. Gentleman will be aware, Professor Norman Williams looked at the circumstances of this case and produced a report on it for the Government. As a part of that, we are looking at a number of factors.

North Middlesex University Hospital NHS Trust

David Lammy Excerpts

Tuesday 12th July 2016 Westminster Hall

[Mr David Lammy (Tottenham) (Lab)]

I hesitate to interrupt my right hon. Friend, who is laying out the story so comprehensively. Is she as concerned as I am that many health professionals knew what was going on, but that MPs in the three boroughs covered by the trust were kept in the dark?

[Joan Ryan]

That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.

I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.

In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.

Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.

I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.

The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a

“number of serious incidents…which had raised concerns about the standards of care”.

Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.

The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only

“one commode available in the whole of the ED”—

emergency department—

“to serve over 100 patients.”

Most people reading this will find that shocking.

Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.

In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.

--- Later in debate ---

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to have the opportunity to speak in this debate. The hospital serves almost the entirety of the constituency of Tottenham and has done ever since the closure of the Prince of Wales hospital in my constituency in the 1980s. It is important to emphasise that North Middlesex hospital is located in a strategically essential area. It serves not only the boroughs of Enfield and Haringey, but some of Barnet and Waltham Forest. Many years ago, when I was a Minister for Health, a neighbouring hospital, Whipps Cross, was a general hospital that on occasion struggled considerably with its emergency department, so I cannot emphasise enough that it is critical for the broader health economy of north-east London that the North Middlesex survives, flourishes and does well.

The concern that has been raised in this Chamber is really about how the situation has got to this stage over such a length of time, with so many Members of Parliament ringing alarm bells in a context where all of us have privately said, “We must tread carefully. We don’t want to talk down the hospital.” We say, “The chief exec seems to be…” as we whisper among ourselves. We do not want to talk down the hospital, but it has now got to the point at which we have to be absolutely frank about what has been happening at that trust, as we have heard, and we must ask some very hard questions about what has been going on.

I hope that the Minister will assist me on this point. There have been successive risk summits, meetings have been held, and the chief exec has asked for support, but I am not clear why support was not provided. In the old days, Members of Parliament would have been able to contact the strategic health authority and there would have been a clear line of leadership. We literally had two bodies to deal with: the strategic health authority and the chief executive of the trust. Frankly, chief executives went if they were not up to the job, and emergency teams were brought in to run the hospital. I did that as a Minister responsible for emergency care. I saw it happen in a range of trusts across the country as, under the Tony Blair Government, we pushed for the first targets of four-hour waits. I am struggling to understand how things have got to this level.

Life expectancy in a constituency such as mine is among the lowest in the country: men reach 74, six years behind the average life expectancy. We have homelessness and we have had two riots in a generation. The issues are clear, but what is not clear is who was in strategic charge? Why were meetings held in successive years? What is the role of NHS Improvement? Is it ever the case that anyone there would contact a Member of Parliament to say what they are doing to improve a trust? What is the role of NHS England’s London office? The individuals there are paid a hell of a lot of money—hundreds of thousands of pounds. Have they got a responsibility to contact a Member of Parliament to ask for a meeting or a conference call to speak to us about what is happening in the trust?

What is the role of Health Education England, which has been concerned about training and qualifications? We know the role of the General Medical Council, but has it been nobbled not to withdraw doctors by NHS England or any other body? What we have are numerous quangos. I have not even mentioned the clinical commissioning group. We have CCGs, HEE, NHS Improvement, NHS England London and the chief executive. The Government came into office determined to reduce the number of bureaucrats, but—my God!—each of us has at least 10 or 12. Then there are all the staff that work under them. Meetings have been held, but what has been done?

I have done the Minister’s job, so I feel for him. When I did his job, we did a lot of the running of the NHS from Whitehall. The Minister’s party came in and I understand why they said they could not run it from Whitehall, but we now have all these bodies and I am not clear what they have done. As a former Minister, I want to hear more of what they have been up to. I hope that the Minister will answer the question asked by my right hon. Friend the Member for Enfield North (Joan Ryan). Given that there have been CQC reports—the one that we had on the 6th is not the first—and risk summits, what is the obligation to inform Members of Parliament and therefore our constituents? At what point does that kick in? Or is it expected that that should be done solely by the trust? If it is, that is problematic if it is a failing trust in which the chief executive has been put on emergency leave. I have the CQC report before me and it says that safety at the hospital is inadequate, and so is responsiveness. As to whether it is well led—leadership is also inadequate, which is presumably why the chief executive has been put on emergency leave. Overall the hospital is inadequate. Under the headings of caring and effectiveness, it requires improvement. That is pretty damning. It does not get much worse than that.

Many hon. Members are concerned—and my right hon. Friend the Member for Enfield North, the hon. Member for Enfield, Southgate (Mr Burrowes) and I certainly are, having been around for a few years. We campaigned to get the PFI that put millions—I think it was £150 million—into building a brand new hospital. It is therefore deeply frustrating that we now have such an uphill struggle. Chase Farm has been mentioned and I will not discuss it again, but the Minister will recognise that we all rang alarm bells about the implications of closing emergency there. Money was put into the trust; yet it has got to its present situation.

I heard yesterday about the case of Mrs Alice Morfett, a 92-year-old lady who still went shopping in Morrisons. She had a heart operation in Barts and she was recuperating on the T3 ward. In the morning she told her daughter about her concern about a male nurse’s behaviour; she could not understand why he kept wanting to touch her chest. Her daughter said she did not believe Mrs Morfett and thought the anaesthetic had not worn off, but her mother complained about the nurse rubbing against her chest. After that Mrs Morfett was scared to ask for help. No one was summoned to help her. The next day, after an hour of asking for someone to take her to the toilet, Mrs Morfett tried to get out of bed herself and she fell. She ended up with huge open wounds; my constituent sent me a photo of the terrible wounds her mother suffered. Mrs Morfett died a couple of weeks later, and her daughter believes that she died as a result of her injuries. Mrs Morfett said to her daughter, “Please don’t let them get away with it; they have to pay for what they’ve done to me.” I do not lightly raise constituency case work in this way. I have used this letter because it is the latest one I have in a stream of letters from constituents about what is happening in the trust.

[Joan Ryan]

Such incidents are what the CQC calls “never” events because they should never happen: a patient dies, and it is not necessarily from medical issues or natural causes. I am sure that my right hon. Friend knows that the CQC report notes that one patient lay dead in a cubicle for four and a half hours last December because there were not enough doctors even to do the hourly rounds. It does not get much worse than that.

[Mr Lammy]

No, it does not, and that cuts to the critical issue of safety at the hospital. In fact, the problems at the hospital have been going on for well over two years. What happened to the hon. Member for Enfield, Southgate, who lay in the hospital with a burst appendix and who frankly would not be here but for a stroke of luck, says it all. How have we got to the situation where the local Member of Parliament is about to die of a medical emergency after waiting without being seen for 11 hours? He has been friendly—[Interruption.] Well, that is what happens with a burst appendix. The hon. Gentleman is looking well, but he is not that young. People die of a burst appendix if they are not treated.

[Mr Burrowes]

Perhaps it is an issue of profile, but they did not know I was the Member of Parliament. I kept it quiet and was there as an ordinary patient—which is the point. It was only when they found out 11 hours on, following some communication that I was the Member of Parliament, that, lo and behold, the seniors all came down and had a look, and saw what was going on. It was actually my mother who was banging on the desk saying, “Why aren’t you getting a scan for my son?” That is what it takes—it is the ordinary experience of any patient, who, sadly, may not have their mother there to badger the staff for them. That is the patient safety concern.

[Mr Lammy]

The hon. Gentleman took the business of mystery shopping a little far, but his encounter was well reported locally, and at that time alarm bells were being rung. By my recollection it was a good couple of years ago.

The CQC report confirms what we all long feared—that the closure of the emergency department at Chase Farm hospital in December 2013 had a significant impact on demand at North Middlesex hospital. Concerns were also raised about doctors training in anaesthetics, and they were removed from training in the hospital in April 2015, and have never returned to it because the GMC was so concerned. I wrote to the Secretary of State for Health on 22 March—four months ago. I did not get a reply. I am grateful to have seen the Minister eventually, a couple of weeks ago; but he can see why I am concerned when, after failures of the kind we have heard about in the debate, the Secretary of State did not reply to me in March. I will gently say that a hospital where alarm bells are ringing about such issues would have commanded the attention of the Secretary of State in the past, under successive Governments. Certainly MPs and local authority leaders would have been called together and the issue would have been addressed. I raise the matter in the gentlest of ways, because I am concerned about it.

Many issues have been raised and other hon. Members want to contribute; and we want to hear from the shadow Minister, too. The bottom line is that we are very concerned that the hospital has reached the state it has, given the investment that has gone into it. Week after week there are complaints from constituents. Yes, the leadership has now changed. It is important that local governance and the hospital’s relationship with Enfield and the London Borough of Haringey should be retained; but we want to hear from the Minister that such things cannot happen again. It is a question of who is accountable, and when, and of how Members of Parliament could have been heard much more constructively. Given all that happened at Mid Staffordshire, it is a matter of deep concern that although things are clearly not quite at that stage, they could have reached it had leaks not been published in The Guardian and had MPs such as my hon. Friend the Member for Edmonton (Kate Osamor) and my right hon. Friend the Member for Enfield North not rung alarm bells as they have in the past few weeks.

[Catherine West (Hornsey and Wood Green) (Lab)]

It is an honour to serve under your chairmanship, Ms Vaz. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. It feels a bit like mark 2 for her, I think, given the earlier experiences with Chase Farm. I am pleased about the cross-party nature of the debate; it was interesting to hear the personal experience of the hon. Member for Enfield, Southgate (Mr Burrowes) of care at the hospital.

Like my right hon. Friend the Member for Tottenham (Mr Lammy), I am at a loss; I attended the annual general meeting a couple of weeks ago and have written letters to Ministers—indeed, the Minister present today has been kind enough to have a meeting with us. We have had press reports and urgent questions. We have asked questions at Prime Minister’s questions. We have had Adjournment debates, and the Mayor of London has raised the matter with NHS London. I am at a loss to know what we should do next, and which levers can be pulled.

I am pleased that management action has been taken, and that Mr Sloman has now taken an interest and is the accountable officer. I am equally pleased that Ms McManus has been brought in to take over on an emergency basis while the leadership of the hospital is being looked at. However, I have concerns for the long term about a situation in which decision makers in Hampstead would make decisions about a north London hospital whose area is Edmonton, Tottenham, Wood Green, Enfield and Haringey. I am concerned about how remote and out of touch they might be. I look forward to hearing in the spring what the management arrangements will be for the medium to long term. We must ensure that there is proper representation of local people at board level and a proper voice for our area in the hospital management and governance structure.

I will briefly raise two constituency cases. One is about medicines training, which was referred to in the Care Quality Commission’s report. I understand from a constituent that when her father was discharged from the hospital, somehow his name had got mixed up with another patient’s name, and when she got home she had the incorrect medicine for him. That is a basic error, and the wrong medicine could have been fatal for an elderly and frail man.

The second case arose after an anonymous phone call to my office reporting on the condition of an elderly patient. The caller was very distressed, as the patient was his elderly wife. He said, “I’m so worried to tell you, because I am afraid that they actually might kill her if I tell you her name.” There is a level of desperation, and that call was made not so long ago; it was within the last month.

There are some general lessons to be learned from this specific situation about the lack of leadership and lack of quality control in our public services. The first is about the recruitment and retention of properly qualified staff. We desperately need to tackle the low morale of staff, which has been exacerbated by the poor handling of the junior doctors dispute. Morale is low not only at senior level or consultant level but at the middle level, and even at the level of junior doctors. Once the hospital lost the contract for the training of junior doctors, everything went downhill from there. We need to get that training back, and we need to work very hard and very quickly to get back the doctors and experts who want to serve, learn and train in a university hospital.

The second lesson to learn is about the crucial issues in our health economy, one of which is the problems with primary care. I understand that there are immense problems with the current Enfield primary care arrangements. The clinical commissioning group is not in a good place. I would like to hear about any associated issues, and I would like to know what levers the Minister can pull to ensure that proper primary care arrangements are put in place for Enfield and that primary care in Haringey is strengthened.

I understand that Haringey has done some very good things, including putting some extra general practitioners into the accident and emergency department to educate people about where to go when they first come into hospital, and about how they can go and see their GP in the local community. I would be happy to hear about an evaluation of that programme and whether it has been helpful. Rather than rushing in with a band-aid solution, can we hear back about that programme? What has the evaluation been, and what do the experts think? Has that programme stopped the flow of people coming—perhaps incorrectly—to A&E, and has it helped the primary care health economy?

It is well known that Members including my right hon. Friend the Member for Tottenham secured a debate in the main Chamber on mental health in Haringey. At St Ann’s hospital in Haringey, the acute care places are really overloaded, which has led to greater demand for beds at North Middlesex hospital. Once the health economy becomes unbalanced, that can put more strain on A&E departments from general patients who do not have mental health problems.

Furthermore, there is an ambulance crisis. Police officers have told me that there are not enough ambulances and that they have to take patients to the North Middlesex hospital themselves because the ambulances cannot cope. Of course, we know that once the ambulances get to hospital, people are being treated inside the ambulances, which is completely unacceptable.

[Mr Lammy]

My hon. Friend will also appreciate that a major criticism in the CQC report was that after patients have left the ambulance, they are treated solely by nurses at grade 5, with no doctors in sight and no consultants available after 11 o’clock at night. How can there be an emergency department when there are no consultants available on a Friday or Saturday night?

[Catherine West]

My right hon. Friend makes an excellent point about an issue that must be monitored. I look forward to the Minister reporting back on the lack of the leadership and clinical excellence that we expect on behalf of our constituents.

The cuts to public health provision will have an extra impact. I will give just one example, which many Members here have pursued—basic HIV/AIDS care. We are not doing the preventive work, and we are unnecessarily cutting back the public health budget, which will eventually lead to more people turning up at A&E or acute care departments in crisis. These issues in the health economy are all linked, and we need to do much more about all of them.

We are all aware that litigation accounts for a quarter of NHS expenditure. Why do we not get better at doing the proper work first, so that the money we spend on lawyers and expensive court cases when we get things wrong does not add up to so much? The situation is absolutely desperate. We need more investment, and we need to stop making mistakes so that we do not have to pay for litigation and so that instead of litigation there can be front-loading of resources into prevention, mental health and good-quality primary care and basic services. People accessing the NHS could then have confidence that their local service is as good as we should expect it to be.

Finally, we know that in London, there are a number of issues with the cost of living, the cost of transport and the cost of childcare for medical practitioners and nursing staff. Those issues are linked to the others that I have mentioned, and I would like to see a more robust approach from the NHS around London to the needs of those working in our hospitals and our public services. London is not like other areas, where it is cheaper to rent homes and so on. We are unable to recruit the medical practitioners and nurses we need because they cannot afford to live in the area, and we should examine that issue more energetically and not just in a theoretical way.

Thank you very much, Ms Vaz, for calling me to speak. I look forward to hearing the Minister’s conclusions.

--- Later in debate ---

[Ben Gummer]

I promised to explain to the House what we will do to correct the situation. There are two parts to this. First, the short-term rescue plan has been put in place by Health Education England, NHS England and NHS Improvement, with the approval of the General Medical Council, to ensure resilience in the A&E department and for paediatric services. Two consultants have gone on secondment to the department, and a further five are coming this month. The GMC is happy that that will provide the rota resilience we need in the short term.

If we think that will fix things, however, we will quickly end up in the same situation. That is why we need to look at a far more robust plan for the next few years, so that the North Middlesex can become the centre of excellence that hon. Members and I certainly want it to be. A new improvement director will be in place to deliver an improvement plan, which I will ensure is shared with hon. Members. So the plan that the right hon. Member for Tottenham (Mr Lammy) requested will be available for other hon. Members to see. It will have the transparency that has been lacking so far.

I must answer a particular point made by the right hon. Gentleman about the General Medical Council. I do not think that it was silenced in any way. Genuinely, this is more muck-up than conspiracy, and I hope that it will not be repeated, as I have already assured hon. Members.

On the long-term plan, the hon. Member for Hackney North and Stoke Newington was entirely right: the North Middlesex is like many hospitals on the periphery of London, which not only are seeing rapid demographic change, but suffer from the fact that they are not the attractive training places that the central London hospitals are—we have to be blunt about that. I think that is wrong, because many of the challenges that aspiring doctors want are in those hospitals, which are diverse with an extraordinary range of clinical conditions. However, because of the history of the NHS, which I cannot change, a glamour is attached to the central metropolitan hospitals, and that causes challenges for district general hospitals throughout the country, as well as those on the periphery of London.

I want to change that, but we cannot do it by fiddling around. That is why I am excited by the link-up with the Royal Free. That kind of branding, which the right hon. Member for Enfield North pointed to, the strong leadership, which will provide stability, and, I hope, the ability to move consultants and senior nursing points around—some people recruited already into the Royal London and Barts will also work at the North Middlesex—will result in the diversity of career opportunities necessary to attract the kind of clinicians that the right hon. Lady and her colleagues have requested for their hospital.

[Mr Lammy]

To press the Minister on a bit of detail, the CQC’s press release stated:

“We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue...there are moves to appoint more senior doctors—and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.”

That was on 6 July and, clearly, the CQC did not feel that the hospital had got there. Will the Minister therefore confirm what the required number is? If he cannot tell us that, it would be helpful for him to come back to us. What is the golden number that should comfort us? Will he also confirm, because this is important, that nurses are not still reviewing patients who arrive by ambulance, because that is seriously inadequate, and we want to ensure that patients are seen by doctors?

[Ben Gummer]

I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.

Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.

Land Registry

David Lammy Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr David Lammy (Tottenham) (Lab)]

I beg to move,

That this House notes the important role the Land Registry plays in registering the ownership of land and property in England and Wales; further notes that the Land Registry has made a surplus in 19 of the last 20 years and paid back £120 million to the public purse in 2015 alone; believes that any privatisation of the Land Registry will have serious consequences for transparency and accountability in the UK property market and hinder efforts to crack down on corruption and money entering the UK property market via offshore jurisdictions; expresses grave concern that all the potential bidders for the Land Registry have been found to be linked to offshore tax havens; notes that the Government has acknowledged that property can provide a convenient vehicle for hiding the proceeds of criminal activity; notes that the Prime Minister stated in July 2015 that there is no place for dirty money in Britain; regrets the Government’s decision to seek short-term profit at the expense of the public interest; opposes the proposed privatisation of the Land Registry; and calls on the Government to reconsider that proposed privatisation.

I thank the Backbench Business Committee for enabling me to bring this important debate before the House. In supporting this motion, signing the letter I sent to the Business Secretary on 2 June and signing early-day motion 160, well over 100 Members drawn from eight political parties have made clear their opposition to the privatisation of the Land Registry. I hope that the Government take note of the strength of opposition to the proposal before it is too late.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I congratulate my right hon. Friend on securing this important debate. I am sure that, like me and almost every Member of this House, he has been inundated with emails on the subject. Our constituents are up in arms.

[Mr Lammy]

My hon. Friend is absolutely right: the strength of the deep concern felt in the country is expressed in the letters that hon. Members have received. I look forward to hearing what the Minister says, because he will be aware that it is with regret that I must bring the debate to the House today, so soon after the Government last attempted to privatise the Land Registry in 2014.

[Frank Field (Birkenhead) (Lab)]

I thank my right hon. Friend for initiating this debate. Has not the Government’s position moved since they announced the privatisation, in that they say they want to stop properties being used for money laundering? He may know that I and our hon. Friend the Member for Dagenham and Rainham (Jon Cruddas) have a Bill to achieve precisely that, but we need a service that is not corrupted and on which people can rely. Without the Land Registry, where are we going to find a service we can rely on?

[Mr Lammy]

I am hugely grateful to my right hon. Friend for all the work he is doing on the basic issue of transparency. The strength of feeling in the House is largely based on that issue, to which I shall return in the course of my speech.

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate my right hon. Friend on securing this important debate. I too have been inundated with responses, and indeed I met a constituent who was proud to have worked for the Land Registry for many years. Does he agree that public confidence is vital, particularly for our housing industry, and that in these times of real uncertainty about the economy and the future of house building in this country, the Government are taking an unnecessary risk?

[Mr Lammy]

My hon. Friend makes an excellent point. In these troubled times, when confidence in this House and in major political parties is at a low ebb, it is important to recognise the institutions that the public hold dear, of which the Land Registry is certainly one. As a former Minister who had responsibility for the Land Registry, I am well aware of the valuable roles it plays.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Does my right hon. Friend think that the privatisation proposal has been driven by a desire to maintain the professionalism, integrity and impartiality of the Land Registry or by a petty desire for a short-term and dangerous input of cash to the hard-pressed Treasury? Which is it?

[Mr Lammy]

I have a feeling that my hon. Friend is clear about which side of the argument she is on. This Minister is not a bad man. so we will be interested in what he has to say—and which side he will pick in the forthcoming leadership battle.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my right hon. Friend on securing this debate. Does he agree that the proposal is an ideologically driven attempt to reduce transparency?

[Mr Lammy]

My hon. Friend makes a serious point. According to the Government’s answer to my written questions tabled earlier this month,

“No decision has been taken on the future of Land Registry”.

I fully expect that line to be trotted out later today, but the serious questions that hon. Members are raising about transparency in this important institution must be heard.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I congratulate my right hon. Friend on securing this debate. Does he agree that privatisation would give the new owner essentially a monopoly on commercially valuable data, with no incentive to improve access to it? Does he also agree that information about land and property ownership is vital for local communities and that they should have more access to it, not less?

[Mr Lammy]

I entirely agree, and indeed I pay tribute to my hon. Friend, whose party has for a considerable time been one of the custodians of our land. That is why this is such a serious issue.

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

Further to the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas), does my right hon. Friend accept that many businesses that work in property and data are also concerned about the possible privatisation of the Land Registry? They worry that a privatised Land Registry would see the new business owner seeking to extract maximum value from the business, rather than trying to improve access to the data.

[Mr Lammy]

My hon. Friend is absolutely right. There is deep concern about a hike in fees and a profit motive distorting a public institution that we all value. I hope that the Minister will take that on board and give the House some comfort on that in the coming hours. I give way to the right hon. Gentleman.

[Sir Peter Bottomley (Worthing West) (Con)]

My wife is right hon., not me.

Were I not going to a Somme service in my constituency, I would try to take part at length in this debate. Is not the issue this? Whatever safeguards the Government want to build, commercialisation should be the Land Registry’s decision, not the decision of some commercial owner of the Land Registry. The issue is, therefore: can Government understand—I know that my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who is on the Front Bench, understands because I have written to him about it, as my Whip—that many of us here want the Land Registry to have the opportunity of creating innovative, value-creating enterprises? It should not be sold off for that to happen—it is not necessary.

[Mr Lammy]

The hon. Gentleman is demonstrating why he should be a Privy Counsellor and why he has been knighted. The Government should accept the cogent case being made by esteemed Members on the Government Benches. We are aware that there is a general sense that the Government are itching to privatise the Land Registry. Unlike with the 2014 consultation, this time around the status quo is not even being offered as an option. The wording of the consultation document is focused on how, not if, the Land Registry operation should be moved to the private sector. We know that the Government have commissioned bankers at Rothschild to size it up. We also know that potential buyers are linked to offshore tax havens. I am here today, alongside colleagues across the House, to make our opposition known and to call on the Government to think again.

[Valerie Vaz (Walsall South) (Lab)]

I congratulate my right hon. Friend on securing the debate. As a solicitor, I have often had to use the Land Registry. He is making the economic case for non-privatisation. Does he agree that the Land Registry is entirely self-funding? In fact, it has returned £126 million to the Treasury.

[Mr Lammy]

I am grateful to my hon. Friend for her intervention. I will repeat that point later.

[Several hon. Members rose—]

[Mr Lammy]

If the House will forgive me, I will make some progress, because so many Members want to speak.

The recording of land and property ownership is integral to the functioning of our economy and has been carried out with integrity and impartiality by the Land Registry since 1862. Indeed, the Land Registry’s reputation as wholly independent from the influence and pressures of the market is crucial to its work. The current consultation exercise tries to preserve that necessary independence by attempting to create an artificial distinction between “Land Register ownership” and a new company which “delivers Land Registry services”. That is totally meaningless in practice. While the Government claim they will retain “ownership” of the land register, a private company would be free to grant title and make changes to the register as transactions occur. The consultation document talks of putting

“the right protections in place”

to ensure that the Land Registry would continue to deliver an impartial service to customers. However, there is absolutely no detail about what those protections and safeguards might be. In the words of John Manthorpe, former Chief Land Registrar,

“at the heart of this is the nonsense that a private company should have the power to decide the legal land and property title rights for others”.

The Department for Business, Innovation and Skills is yet to publish the responses to the latest consultation, but I have taken the time to read through the responses to the January 2014 consultation. I quote Clifford Chance, the law firm, certainly no stranger to the profit motive or enemy of the private sector, which said that privatisation would create:

“An inherent conflict between a private sector company, whose main purpose is to maximise shareholders’ profits, and the need of consumers for a low cost, high quality and risk free service”.

[Liz Kendall (Leicester West) (Lab)]

Does my right hon. Friend agree that although the Government say that they will retain ownership of the land register, that is completely meaningless while millions of changes are progressively made to it by the private company? Is that not the key issue? In the words of John Manthorpe, the former Chief Land Registrar whom my right hon. Friend has quoted, the proposal does not stand up to “any reasoned scrutiny”.

[Mr Lammy]

I am very grateful to my hon. Friend, who is absolutely right. Most registrars in the country are opposed to this act.

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

My right hon. Friend mentioned the 2014 consultation, in which only 5% of respondents thought that privatisation was a good idea. My right hon. Friend and I are both London MPs, and the market in London is complicated enough as it is. Anything that will complicate things even further cannot be a good idea. If every professional in the sector is condemning these proposals, surely the Government should listen.

[Mr Lammy]

My hon. Friend is exactly right; I agree with her 100%.

[Lilian Greenwood (Nottingham South) (Lab)]

Will my right hon. Friend give way?

[Mr Lammy]

I will once more, but then I must make progress because so many Members want to speak.

[Lilian Greenwood]

I thank my right hon. Friend and congratulate him on securing this debate, which is very much welcomed by the 400 or more people in my constituency who work at the Land Registry. Does he agree that this proposal not only flies in the face of professional opinion, but comes at the worst possible time, demonstrates short-term thinking and represents poor value for money? Is the economic uncertainty created by the referendum result last week not an additional reason for the Government to drop these proposals?

[Mr Lammy]

My hon. Friend makes a very serious point. Even if there were a case for these proposals—I suspect all of us agree that there is no case—now cannot be the time to continue with them. There is no doubt that a private company would seek a profit and become a compulsory monopoly business, driving up the fees charged to users—the point raised by my hon. Friend the Member for Harrow West (Mr Thomas). A sale price of about £100 billion has been mooted in the press. A private company would therefore look to recoup this investment through the fees it charges and then turn a profit for its shareholders.

The argument we often hear in favour of privatisation is that competition will drive prices down, but this completely disregards the fact that the Land Registry is a unique asset in our lives. It is one of a kind, and users are compelled to pay the fees during any transaction involving land or property. There is only one Land Registry; it is a compulsory monopoly and we need to reflect on what would happen if this public monopoly became a private monopoly. We would have profiteering—pure and simple—by ripping off the public with inflated fees.

The Minister refused to answer my written question of 6 June about what steps would be taken to ensure that Land Registry service fees did not increase in the event of privatisation, so I hope we will hear something from him today. We are left to assume that the “protections” and safeguards that the Secretary State mentioned in the foreword to the consultation document do not include any protection from vastly inflated service fees. In time, whatever sum the Government might secure from a sale today will ultimately be paid for by the people and businesses who use and depend on the Land Registry’s services.

[Dr Matthew Offord (Hendon) (Con)]

rose—

[Mr Lammy]

I must make some progress.

We therefore reach the crux of the issue: the Government are looking to sell off the family silver to turn a short-term profit to try to make their sums add up. As the most recent Budget showed, the Government’s plan to close the deficit is dead in the water, so now they are looking around for assets to cash in. This privatisation is purely political, with absolutely no regard for what is right for the Land Registry or indeed the people of this country. The short-term profit derived from any sale will be dwarfed by the increased costs that are ultimately paid by all of us in the form of increased fees, and it will be dwarfed by the lost revenue to the public purse in the medium to long term.

There is no economic rationale for this privatisation. If the Land Registry were making a loss and being subsidised by the taxpayer, I could understand the Government’s enthusiasm for privatisation, but it has made a surplus in 19 of the last 20 years, and it returned over £100 million to the Treasury last year alone. The Land Registry pays rich dividends to the public purse, and there is absolutely no reason why it should pay dividends only to wealthy investors and shareholders in the future.

Satisfaction with the Land Registry is currently running at 96%. Far from being a basket case of public sector inefficiency, it is a shining example of a successful public service being run efficiently and effectively. I must state in the clearest possible terms that privatising it would be daylight robbery and a national scandal. Sadly, we know that this Government have previous: just look at what they did to Royal Mail.

Let me deal briefly with the conclusions of earlier studies. In particular, the Government’s quinquennial review of 2001 found that the privatisation of the Land Registry

“should be firmly rejected”,

and would

“be an act of…considerable folly”.

It is clear from the responses to the consultation on proposals to transfer the Land Registry to a service delivery company in 2014 that the proposed privatisation was decisively rejected by most of the respondents. We are told that

“91% of respondents did not agree that creating a more delivery-focused organisation at arm’s length from Government would enable Land Registry to carry out its operations more efficiently and effectively”,

and that

“89%...not be comfortable with non-civil servants processing land registration information”.

However, although the overwhelming majority of respondents made it clear that the Land Registry must remain publicly owned, the Government are back, disregarding what was said just two years ago and making their case again.

A further issue of vital significance is the impact that a privatised Land Registry would have on the transparency of our property market. The Panama papers leak earlier this year brought to light the industrial use of tax haven shell companies by tax evaders, oligarchs, corrupt crooks, drug traffickers and arms dealers seeking to conceal their wealth. More than half the 214,000 companies whose details were leaked were incorporated in the British Virgin Islands, and many channel their money into the UK property market. A total of 100,000 properties worth £170 billion have been registered by shady and opaque overseas entities in the UK to hide their true owners.

Meanwhile, the Prime Minister and Members of his Government have consistently spoken of a crackdown on offshore tax evasion and dirty money. Indeed, the Prime Minister himself declared last year:

"There is no place for dirty money in Britain... London is not a place to stash your dodgy cash.”

How, then, can we be in this situation? I noted with interest the Prime Minister's article in The Guardian, in which he said:

“We know that some high-value properties—particularly in London—are being bought by people overseas through anonymous shell companies”

using

“plundered or laundered cash.”

The Department for Business, Innovation and Skills has also said that it is aware of the problem. Perhaps the team who wrote its consultation document could let the Minister know.

I listened with interest to this year’s Queen's Speech, which promised that

“legislation will be introduced to tackle corruption, money laundering and tax evasion.”

I say this is in the strongest possible terms, and I say it as a warning to the Government.

We are faced with a severe housing crisis and institutional tax avoidance on a huge scale. First, we need serious steps that will make it harder for shady offshore entities to buy up property in this country, and secondly, we need to make it harder for opaque shell companies to shield themselves from scrutiny and investigation. Privatising the Land Registry would achieve the complete opposite. Surely the most basic common sense tells us that the first step in any crackdown on tax evasion, money laundering and corruption should be to ensure that data about who owns what are made public and are not privately held. As recently as last month, the Minister for the Cabinet Office told the Open Government Partnership in South Africa:

“The UK is a leader on transparency...Increasing openness and tackling corruption are 2 sides of the same coin.”

A public Land Registry could open up its data to support efforts to tackle the endemic corruption and abuse of the property market.

Currently, the average fee for the searching and provision of Land Registry data is £3. Journalists and campaigners have made use of that function to lay bare the true scale of offshore ownership of UK property, much of it derived from shell companies set up to avoid tax or to launder dirty money. A private organisation would have no obligation to open its data and would be able to charge whatever it liked for providing such data. Crucially a private company would not necessarily be subject to the Freedom of Information Act, so would have no duty to supply such data when asked.

Confidence in land and property in our society depends on a land registration system that is administered with integrity, neutrality and absolutely no conflict of interest.

It is a nonsense that a private company should be given an adjudicatory role on the land rights of citizens, other companies and the Government. It is a nonsense that a publicly owned Land Registry that is performing well and returning healthy dividends to the public purse should be turned over to a private owner. And it is a nonsense that this is being forced through by a Government apparently committed to tackling offshore tax evasion and corruption in this country.

This privatisation is not only woefully misguided, but plain wrong and should be abandoned before the public interest is sacrificed in favour of a short-term profit. I look forward to what the Minister has to say and the many contributions from Members in this House this morning.

[Several hon. Members rose—]

--- Later in debate ---

[George Freeman]

I suggest that the best indication of our commitment is what I am saying at the Dispatch Box right now. I will comment in a moment on events going on outside this Chamber, which will determine how this is ultimately taken forward.

I was making the point that the Government have carried out a consultation. It is right that, as a responsible Government, we keep under review whether and how functions that are currently the monopoly responsibility of the state can be better financed and thrive more with new freedoms, and by so doing put the public finances on a stronger footing. I merely set out the rationale on which such matters have been addressed in the past and confirm once again that the Government have no plans. This is merely a consultation. We have received no bids; no decision has been made.

[Mr Lammy]

When the Minister says the Government have no plans, is he in fact pronouncing on the consultation? He has heard the House this afternoon: no one has risen to speak in favour of privatisation. Obviously, one is reflecting carefully on whether to test the strength of feeling by putting the matter to a vote. It is important to understand what the Minister is saying, because the real concern is that this is a Treasury-driven proposal—that was one of the reasons he gave. If that is the case, it probably is right that the House of Commons demonstrates to the Treasury that it probably would not get the privatisation through.

[George Freeman]

The right hon. Gentleman is a canny parliamentary operator. Let me continue my speech and deal with the various points that have been raised, because in so doing I may be able to reassure him that this Business Minister is listening and has heard what has been said loud and clear.

--- Later in debate ---

[Mr Lammy]

This afternoon, the strength of feeling in the House has been conveyed. Across the House, there is opposition to the privatisation of the Land Registry. I think we can describe the Minister as one of the Government’s more eloquent junior Ministers. I think he acknowledged that he was making a case for looking at the matter, but that he clearly had not made a compelling case for privatising it. He used phrases such as “listening very carefully to the House” and “merely looking at it.” On that basis, those who read the debate in Hansard and reflect on what he has said and on what he has not been able to say in any convincing form might conclude that it is unlikely that the Government will move forward in this way. Certainly with the majority as it is, it is clear that the Government would not command the strength of the House. I hope that the debate gives some comfort to those deeply concerned across the country and to those who work for this great institution. With that, we can perhaps move on to the next debate.

Question put and agreed to.

Resolved,

That this House notes the important role the Land Registry plays in registering the ownership of land and property in England and Wales; further notes that the Land Registry has made a surplus in 19 of the last 20 years and paid back £120 million to the public purse in 2015 alone; believes that any privatisation of the Land Registry will have serious consequences for transparency and accountability in the UK property market and hinder efforts to crack down on corruption and money entering the UK property market via offshore jurisdictions; expresses grave concern that all the potential bidders for the Land Registry have been found to be linked to offshore tax havens; notes that the Government has acknowledged that property can provide a convenient vehicle for hiding the proceeds of criminal activity; notes that the Prime Minister stated in July 2015 that there is no place for dirty money in Britain; regrets the Government’s decision to seek short-term profit at the expense of the public interest; opposes the proposed privatisation of the Land Registry; and calls on the Government to reconsider that proposed privatisation.

Mental Health Services: Haringey

David Lammy Excerpts

Thursday 28th April 2016 Commons Chamber

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to have the opportunity of this debate on this very serious subject. I am pleased to be joined by my hon. Friend the Member for Hornsey and Wood Green (Catherine West), who stands with me on this debate and also wants to speak about our mental health services in Haringey.

Let me state from the outset that I have the utmost respect for and gratitude towards all the staff working within Barnet, Enfield and Haringey Mental Health NHS Trust, who tirelessly care for some of the most vulnerable members of our community. Not least among those is the trust’s chief executive, Maria Kane, who has been recognised by the Health Service Journal as a top NHS chief executive who was shown to be doing a stellar job in the recent BBC “Panorama” film, “Britain’s Mental Health Crisis”. They have all been asked to do, frankly, an impossible job in the constituency and in the London borough of Haringey, which has 12 of the most deprived wards in the country where 2,284 people are receiving personal independence payments, over 270 different languages are spoken, 1,334 people have had their benefits sanctioned, and 826 households have found themselves homeless in the past year. Social tensions are high, funds are tight, and there is an ever-increasing need for urgent help, from mental health services for children and young people to dementia services for the old.

I bring this debate to the House today because it is unacceptable that, despite the fact that mental health problems cost the economy £100 billion per year, three out of every four people with mental health problems in England receive little or no help for their condition. I suspect that that figure is far higher in my constituency, given the high level of need. Today in this country mental health problems are not just some form of rare disease. The truth is that one in every four people will suffer from mental health problems during the course of this year.

For the most greatly affected, mental health problems are fatal. It simply cannot be right that in our country in 2016 those who suffer from the most severe mental illnesses die, on average, 15 to 20 years earlier than the general population. I have already brought to the attention of this House the fact that, on average, an adult male in my constituency can expect to live to just under 75 years of age. It is a sobering picture, then, that the average age of a male suffering from a severe mental health problem in my constituency may be under 55. But premature death is not the only complication for my constituents suffering from mental health problems. The Mental Health Taskforce commissioned by NHS England in February this year found that men of African and Caribbean heritage are up to 6.6 times more likely to be admitted as in-patients or detained under the Mental Health Act 1983, indicating a systemic failure to provide effective crisis care for these groups. The taskforce’s draft report also revealed that men from these groups are, on average, detained for five times longer.

As mental health problems affect so many lives, 23% of the UK’s burden of disease is mental health. That figure is higher than the burden of disease in cancer or in cardiovascular disease, which stands at 16.2%. Why then do mental health services receive only 11% of the NHS’s budget? It is clear that institutional bias against providing proper care for people suffering from mental health problems persists in 2016.

It was as far back as February 2011 that the coalition Government published their strategy for improving the nation’s mental health, which stated the now much-trumpeted concept of parity of esteem—an idea that began with a Lords amendment from Labour peers in the other place. Then, the very first section of the coalition Government’s infamous Health and Social Care Act 2012, which contained the central duty imposed on the Secretary of State in relation to our treasured national health service, was amended to put these services on an apparently equal footing. However, the reality already facing mental health patients across the country in 2014 was something different: mental health funding was cut for the first time in 10 years, and there were fewer services for children and young people, fewer beds, and more people on acute psychiatric wards.

Many other strategies and documents were published, promising an improvement in services and repeating the mantra of parity of esteem, until the Prime Minister himself returned to the issue at the beginning of the year and finally announced some funding. However, given that the budget had previously been cut, I find it difficult to see how it was a net increase, not least given the pressures of an ageing population. The Prime Minister announced that those particular funds would be targeted towards helping new and expectant mothers with poor mental health and towards liaison between mental health services, A&E departments and crisis teams, but that is not what I am seeing on the ground.

As demonstrated so vividly in BBC’s “Panorama”, the truth on the ground could not be more different. Far from the level of funding being equal between physical and mental health services, or the gap decreasing, mental health hospitals have had far deeper cuts imposed on them. The reality is that 3,000 mental health beds have been cut across the country in the past five to six years.

However bleak the national picture, it does not get anywhere close to the gaping holes in funding for mental health services that face the patients of Barnet, Enfield and Haringey Mental Health NHS Trust. Despite the obvious and ever-increasing need, that trust, on top of the vast inequality between physical and mental health services, receives a lower share of income proportionately than any other mental health provider in London. It is hard to understand how an area that includes Tottenham gets the lowest level of funding in London.

The trust has already done so much cost-cutting over the years that it is the most efficient NHS mental health provider in London. It already has the lowest number of acute mental health in-patient beds in London and higher productivity than other providers. It has also been proven to be underfunded over the course of not one or two, but three independent reports. The first of those reports was back in early 2014, the second in late 2014, and the third in October 2015. The independent evidence is that the trust needs £4 million a year, but it has not received a penny extra in funds, and no firm plan has been established to address the funding gap, which means that the trust now anticipates a deficit of £12.9 million in 2016-17.

The reality locally is that St Ann’s hospital in my constituency has lost a third of its beds in the past eight years alone, and this is a hospital that is obliged under section 136 of the Mental Health Act 1983 to find a bed for every patient detained under that section because they pose a risk to their own life or to the lives of others. We are not talking about varicose veins or wisdom teeth; losing beds in these circumstances has a dire impact.

My hon. Friend the Member for Hornsey and Wood Green will be aware of a recent case in the constituency. A young man whom I have known all his life attempted suicide and it has had a life-changing physical effect on his body. My hon. Friend might say a little more about that case, but it happened directly because there was no bed for him.

St Ann’s hospital is constantly running at over 100% capacity, while other mental health providers in London run at 85% to 90%. With each new admission, St Ann’s wards each have to nominate their “least ill patients” for discharge back into the community. Despite the efforts of staff, does that really present a safe outcome for those vulnerable patients and their families? Is that really a safe outcome for the community that requires the trust to serve it as best it can?

The shortfall in income is not the only problem the trust faces. Far from the Government’s rhetoric of parity of esteem, the truth in Haringey is that patients are condemned to treatment in a hospital that was designed to meet the needs of 19th-century fever patients, long before the discovery of antibiotics, rather than the delivery of therapeutic interventions appropriate to current patients’ needs.

Indeed, the most recent Care Quality Commission inspection found that

“the physical environment of the three inpatient…wards”

on the St Ann’s site was

“not fit for purpose due to its age and layout. This impacts on the trusts ability to deliver safe services within this environment.”

That is a problem that the site has tried to resolve on the 28-acre St Ann’s site over the last decade.

Finally, the trust submitted plans to develop the site last year. It hopes to fund a new hospital and other health services on one third of the site by building homes on the remaining land. I have to say that I oppose those proposals, because they include only 14% affordable housing, even though London has a housing crisis. Despite my objections, the trust was granted planning permission in March last year.

There is an alternative proposal—it is a great proposal, which needs support—to build a community land trust. That is exactly what successive Mayors of London have said they want to see. It would result in affordable homes being built on the site, it would be holistic and it would fit with the mental health plan. I hope that the Minister might take an interest in it and that the next Mayor of London, whoever that is, will also take an interest.

The trust’s plan would not require any capital from NHS England. I have to ask why, on this site and in this constituency, and given the circumstances in which the trust finds itself, no capital is forthcoming from NHS England. It seems that the decision about whether to build a new hospital has, once again, been pushed by the Government into the long grass, and we have been given no date at all.

This debate about mental health comes on the back of a debate that I secured about the situation of primary care in the borough. I have raised both those subjects because I am seriously worried about health in the London borough of Haringey and in my constituency. Despite myriad problems, only 16 months ago the independent Carnell Farrar review of the affordability of mental health services provided by the trust found that there was no compelling evidence to support merging the trust with any other organisation; that the trust is relatively efficient; and that there is a clear case for clinical commissioning groups to invest in it.

I had hoped that that would mark the end of the speculation about the trust’s future, but the CQC report, published in March this year, of the routine inspection conducted in December 2015 gave the trust an overall rating of “requires improvement”. It is no surprise to me that that is the case, despite the efforts of staff and leadership, when funding is so tight and the level of need is so high. The CQC report stated that out of 11 areas, five required improvement, five were good and one was outstanding.

The report concluded that mental health admission wards for adults required improvement, community-based mental health services required improvement, child and adolescent mental health required improvement, specialist community health services for children and young people required improvement and crisis mental health, including home treatment teams, required improvement. Many detailed recommendations have been made by the CQC to improve services, but no extra money has been put on the table to enable the trust to comply.

I am grateful to the Minister for last week agreeing to my November request for a cross-party delegation of local MPs to come and discuss our concerns about the trust. Let me put on record what I call on him to do to help the trust, to ensure that the services that it provides are safe and that work begins to ensure true equality between physical and mental health services in Haringey. The context is important, not just because of the suicide rate in England—the number of suicides recently soared to 4,881 in 2014—but, most disturbingly, because the draft version of that report stated that had just £10 million extra been spent on services for people who were suicidal, 400 extra lives would have been saved. For the sake of £25,000, which is less than the national average salary, each of those lives could have been saved.

I call on the Minister urgently to look at the plans for the redevelopment of the St Ann’s site. I understand that the north London estates plan will be finalised by the end of June, and I seek an assurance that a decision, including consideration of the community land trust’s proposal, will now be made. I ask the Minister to visit the St Ann’s site to see the problems for himself, and I ask him to earmark appropriate funding for the crisis team and children’s mental health services.

I must warn the Minister that we have seen some terrible cases in my constituency. A young boy was injured and died outside his secondary school as he left with three friends. Police officers were assaulted with a machete. We have seen suicide and attempted suicide, with catastrophic consequences, in the recent past. I trust the Minister will ensure that the trust receives the funding it needs, and that he will recognise the CQC recommendations. By having this debate, I am putting him on notice of the real concerns about the development of the St Ann’s site and the real need to bear down on the pressures that the trust is under, in this pretty tough part of north London.

Primary Care: Tottenham

David Lammy Excerpts

Wednesday 16th December 2015 Westminster Hall

[Mr David Lammy (Tottenham) (Lab)]

I beg to move,

That this House has considered primary care in Tottenham.

I am grateful, Sir Roger, for the opportunity to introduce the debate. It is now 67 years since my party introduced the national health service. At that time, living to 100 would have been a newsworthy event, but today more than half the children being born in our country can expect to reach that age. This is clearly a sign of great progress and the quality of our healthcare system. However, that progress has not been the same across the board. There remain in this country huge discrepancies and a postcode lottery that determines the quality of healthcare people can expect to receive. I am particularly worried that the life expectancy of many children in Tottenham is nowhere near the national average.

The current situation paints a worrying picture. Today, average life expectancy for a male in this country stands at more than 80 years, but in my constituency, in the wealthiest city in one of the richest countries in the world, a male can expect to reach an average age of just 74. That is some five years lower than the national average, lower than Cuba where the average wage is £15 a month, and lower than Slovenia, Colombia, Bosnia and Peru. Perhaps most worrying, it is more than eight years lower than the life expectancy of men just a couple of miles away in Crouch End, in a wealthier part of the London borough of Haringey. That is a troubling and stark difference within the same London borough, and the same is true for women.

Primary care is the first point of contact in the healthcare system. In this country, that usually means GPs. They are the very frontline of our health services, the entry point for all our healthcare needs and the means by which we access a whole array of treatments. Primary care is, therefore, the linchpin of our healthcare system. In fact, it accounts for 90% of patients’ interaction with the NHS. Because of that, NHS England’s five-year forward view stated that in future a much higher proportion of its budget would be spent on GP services.

Both this Government and their coalition predecessor claimed to understand the importance of primary care, and to some extent matched their words with funding. For example, £550 million was earmarked in March 2015 to improve GP access, to modernise facilities and to provide better care outside hospitals. Then in May 2015, the Prime Minister announced the “seven-day NHS”, proudly stating that by next April 18 million patients will be able to see a GP in the mornings, evenings and at weekends, with everyone being able to do so by 2020. One would therefore be forgiven for thinking that primary care provision on an average weekday is securely in place, given the £8 billion of extra funding earmarked in a time of austerity to provide additional services outside the current working week. That may be true in some areas of our country, but it is not true in mine.

Recent research paints a stark picture of primary care in Tottenham. The data come not from NHS England or from the Department of Health, which does not seem to be monitoring the situation adequately, but from a small local organisation, Healthwatch Haringey. With no extra funding or support, it went out and listened to local people about the problems they were facing in accessing primary care, and it found something quite disturbing. Some 86% of the patients at one GP surgery were either unhappy or very unhappy with their surgery. That surgery is ranked in the bottom 10 practices in England, with 41% of patients reporting they were unable to get an appointment.

That is apposite because, on Monday this week, Rob Clarke in my constituency tried to access his surgery, Bridge House surgery, with his three-year-old. He tried repeatedly for many hours and was ultimately told to go to A&E. That is not what we want in Britain, where A&E is always overrun, and it was appropriate in that circumstance for the child to be treated at the GP surgery.

Across Tottenham, there are currently 1,300 too few appointments a week, which equates to 52,000 appointments a year fewer than the NHS benchmark. In just one ward of my constituency—Tottenham Hale—there is a shortfall of 18,000 GP appointments a year. Tottenham Hale is undergoing significant regeneration and now has several large blocks of apartments, a sizeable retail park, 500 more properties under construction and a further 1,900 planned for the medium term. It is one of the Mayor of London’s designated housing zones, but despite the influx of thousands of new residents, no new GP surgery was planned. It was only when the desperate need was pointed out by Healthwatch that NHS England’s task and finish group eventually arrived to complete a planning exercise. I note that a final decision on a new surgery will be made on Friday 18 December.

Our treasured national health service has been fractured by this Government and their coalition predecessor, but even with the best will in the world and even when clear need is established, nothing can be achieved quickly. I want to press the Minister on how fast we can and need to move in the circumstances I am outlining. It will have taken over a year for a decision to be made and, if that decision is positive, nearly 18 months for the surgery to finally open. During that period—I put this starkly—people are dying as a result of not being able to get an appointment, and children are being born unregistered. They are the truly dispossessed in our city. Will the Minister look closely at the issue and do all in his power to make the process as swift as possible?

The issues surrounding primary care in Tottenham relate not just to the number of GP places, but to quality and accessibility. According to NHS England, three quarters of GP buildings there do not meet legal compliance, and there are not enough consulting rooms. Some of the facilities in use in the fifth largest economy in the world are shocking. Healthwatch found that 20% of young mothers were not registered with a GP at all.

The consequences of not being able to obtain a GP appointment are stark: more avoidable deaths from cancer, worse life chances for children, and a lack of antenatal and postnatal care when women and, of course, their infant children are at their most vulnerable. My constituency is where Victoria Climbié and Baby P met their tragic end. The ability to obtain an appointment is important if we want to safeguard children. If people cannot do so, it raises serious concerns for mothers and their unborn children, and has led to the grave situation of three unregistered births in my constituency, one of which was of a disabled child whose mother gave birth at home with no one to help her.

Furthermore, Healthwatch discovered clear health inequalities between the west and the east of the Haringey borough, where my constituency is located.

[Catherine West (Hornsey and Wood Green) (Lab)]

My right hon. Friend is making an excellent speech with some good points about the disparity between those who live well and live long lives in the London borough of Haringey and those who do not. Does he accept that it is not solely Tottenham where there is a lack of primary health care? Parts of my constituency—for example, Noel Park—have similar problems with provision of basic, high-quality primary healthcare. Will he give that some consideration?

[Mr Lammy]

My hon. Friend is absolutely right. Her constituency includes Wood Green, and there are pockets of deprivation across Crouch End and Muswell Hill. She is absolutely right to make that point. In a way, this debate stands in both our names, because the crisis affects the borough of Haringey. It is not a coincidence that life expectancy of a male in the far west of the borough and the east correlates with the statistics that I have given, especially when so many mothers of infants are unable to register children in the constituency.

None of us should accept the situation. It is the sort of thing we associate with parts of urban America where there is no universal health provision. In the UK, we have a proud history of our national health service with its own constitution, which states clearly that people have the right to access NHS services. I fear that that is not the reality for many of my constituents.

These issues are not a reflection on the doctors in Tottenham, the vast majority of whom do an excellent job on behalf of the local community. I have recently met, for example, Dr Muhammed Akunjee of West Green surgery and Dr John Rohan of Lawrence House surgery, and I am very grateful for the work that they and their colleagues do in the constituency. As usual, the problems arise much higher up the chain of command. However hard GPs in Tottenham work, there are simply not enough of them and not enough facilities to serve our growing community. That leads me to wonder what it will take for the Government to address the crisis.

We know that there is a well documented link between poverty and ill health; we know that social conditions such as unemployment, overcrowding and inadequate housing make illness more likely; and we know that deprivation increases health problems and therefore pressures on the health system. Given that, I ask the Minister why one of the poorest constituencies in the UK receives significantly less health funding than wealthier areas nearby. Given the greater pressures, it should be receiving more. It is clear that the way to alleviate the GP crisis in Tottenham is to attract new GPs to the area and to retain the ones we already have. However, it is impossible to do that, because despite the huge workload, the urgent pressures and the ceaseless demand, GPs in my constituency are paid significantly less than those in wealthier areas just a few miles away.

For example, a GP in Holborn and St Pancras, the 126th most deprived constituency in the UK, receives £154.64 per registered patient, whereas their counterparts in Bethnal Green and Bow, the 36th most deprived community, receive less—£144.48 per patient. Despite the huge pressures on GPs operating in Tottenham, the 23rd most deprived constituency in the whole country, they receive only £124.94 per patient. That is a full 20% less than in Holborn and St Pancras. Clearly there are fundamental problems with the Carr-Hill formula, which is used to calculate GP funding. There are also real concerns about the impact that withdrawing minimum practice income guarantee payments has had on GP practices in deprived areas such as my constituency. I urge the Minister to look at what he can do to incentivise new GPs to come to areas such as mine.

If the GP situation in my constituency is to improve, GPs in Tottenham must be paid at least the same as their colleagues working nearby. That is an urgent need, given that one third of GPs in the borough are over 60 and therefore due to retire. Things could get considerably worse before they get better. Clearly, younger GPs are being attracted to work in other London boroughs because of the price differential.

It was this Government who wanted the NHS run on market principles, yet they have failed to grasp the obvious problem that for a GP to set up a business in Tottenham, he has to do more work, in worse facilities, for lower pay. Any 12-year-old fan of “The Apprentice” knows that that is not the way to run a successful business. It clearly demonstrates the inherent problem with trying to force a market on the health service, yet we are stuck with this Government’s NHS market framework, so I ask the Minister this: will market rules be applied so that GPs are given proper incentives to set up practices in Tottenham? Also, will he ask the chief executive of NHS England to finally take an interest? I am not clear whether it is Simon Stevens I should talk to or his London lead, but I would quite like the London lead at least to come down to the constituency for herself. I would have thought, given the work that Healthwatch has done, that she would have sought to do that.

I understand that following Healthwatch’s report, NHS England has started to take the problems in Haringey seriously and has produced a detailed 10-year capacity plan, which sets out how many full-time GPs and clinical and treatment rooms are required. Growth is predicted in four key areas: Green Lanes, Northumberland Park, Tottenham Hale and Noel Park, which is in the constituency of my hon. Friend the Member for Hornsey and Wood Green (Catherine West). Three of the four areas are exclusively within my constituency. NHS England has identified a need for five extra GPs in the Green Lanes area, six in Northumberland Park, 16 in Tottenham Hale and eight in Noel Park over the next 10 years. That is 35 extra full-time GPs, 27 of whom are needed exclusively on my side of the borough.

There are a few questions that I want to ask. Does the Minister agree that it is unacceptable that 20% of my constituents in Tottenham Hale do not have access to a GP? Is he concerned that the gaping holes in primary care provision in Tottenham have contributed to the fact that the average life expectancy of a man in Tottenham is just 74—below that of Cuba? Will he explain how, within the NHS market framework, he will attract more than 27 GPs to my constituency, where, despite the far higher workload, GPs are paid significantly less than those in leafy areas just a few miles away?

Will the Minister give me his word that there will be a transparent process to increase the funding per patient in Tottenham by 20%, so that it is brought up to the level of its far wealthier neighbour, Camden? Does he agree that it is disgraceful that the Government have committed themselves to providing a “seven-day NHS”, with weekend GP appointments for 18 million patients, many of whom are in the richest areas of the country, whereas in my constituency 20% of new mothers and their infant children have no access to a GP at all? I look forward to hearing what the Minister, the Government and NHS England, which I hope is paying attention, have to say.

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for Tottenham (Mr Lammy) on securing the debate and thank him for his great courtesy in sending me and my officials a copy of his speech, which will enable me to address in my remarks some of his questions. I appreciate that.

I have some knowledge of the area. I was a member of Haringey Council between 1982 and 1984. I represented Archway ward at that time, and I was on the governing body of a school in Tottenham, so I have some feel for the area and I am grateful to it for giving me a start. I sat on benches opposite the right hon. Member for Islington North (Jeremy Corbyn). I think I am now the only Member of Parliament who served on the council with him, so we have a long-standing relationship and friendship. My time in Haringey taught me that it was an outer London borough with inner-London characteristics. I saw at that time colleagues on the Labour-run council wrestling with very difficult issues and problems and I have never forgotten that.

I will tackle some of the issues that the right hon. Member for Tottenham raised. I do not follow all his argument. Yes, there is some element of market principles in the NHS, but I think Mr Blair had something to do with that as well as us. If the right hon. Gentleman would really like to reorganise the national health service completely, I am keen to hear the proposals from those on the Labour Front Bench in relation to that. The structure that we have is one we will have for some time. It does not stop the work being done but enhances the localisation of making sure that the right things are done.

The right hon. Gentleman is right on poverty and inequality. The tragedy of the United Kingdom is that this is not a short-term issue. If we laid a map of poverty in Victorian Britain over a map of the United Kingdom today, we would find remarkable similarities between the two. The issue that all Governments wrestle with is that Government in, Government out, and socialism in or liberal capitalism in, we still have not cracked all the issues of inequality that we want to crack, and everyone has given it a lot of effort. We have to do better and we have to try different things. That is at the heart of some of the different things that the Government have been trying in health service reform. It is a process that will go on, but none of the issues that the right hon. Gentleman mentioned—length of life and inequality issues—has arisen in the past six years. They are long-standing issues that go back many years, which is why it is always essential to work at new initiatives and look for things that are different, to try to make a difference.

The right hon. Gentleman raised very straightforward and serious issues. All of us in the Chamber pay tribute to those who work in front-line services—the primary care staff. GPs are the first point of contact. Of course, it is not just GPs, but nurses, physiotherapists, occupational therapists, pharmacists and many other healthcare professionals who play a part in delivering high-quality care to patients in practices and in the community every day through the NHS.

In relation to the right hon. Gentleman’s constituency, he quoted extensively from the report by Healthwatch Haringey. Healthwatch nationally is actually funded and part-supported by Government. It is part of the monitoring process that the Government use. I understand that the report “GP Access in Tottenham Hale”, published in September 2014, highlighted a number of serious issues around accessing GP services in that part of his constituency. I thank Healthwatch and all associated with it for all the work that they do.

I am aware that access to GP services is a long-standing issue for local people. I am also aware that many local practices are single handed, and that some premises are not suited to the needs of primary care in 2015. Haringey clinical commissioning group has developed a primary care strategy to address just the sorts of issues that we have heard about this afternoon. That strategy focuses on encouraging practices to work together to run services more effectively, funding initiatives for practices to improve their appointment and triage systems, and encouraging a mix of professionals to work together as part of local networks: for example, welfare advisers, nurseries and healthcare assistants.

A number of practical steps to improve primary care locally have already been taken. In north-east Haringey, a shared call centre has been set up so that staff can respond to patients more quickly. In the south-east of the borough, GPs have worked together to provide telephone consultations for patients between 6.30 pm and 8 pm. In central and western areas of Haringey, Saturday clinics have been established. I understand that the CCG plans to have Saturday clinics and evening appointments available across the whole of Haringey in the new year. The CCG has funded two part-time practice managers to support practices that are struggling to meet access demands, and it is working to increase the number of practice nurses in Haringey through a recruitment programme to enable nurses from other settings to transfer into primary care.

On the important matter of GP premises, I am advised that the CCG and the local council have worked with NHS England to develop a strategic premises plan. The right hon. Gentleman is correct in saying that those have not been adequate, and he is right—as was Healthwatch—to draw attention to that. The premises plan was completed in July 2015. It highlights a shortfall in GP provision and in premises capacity in Haringey. The shortfall was particularly noted in Tottenham Hale and, to a lesser extent, in Northumberland Park. The plan makes a number of recommendations for short and medium-term action.

To date, NHS England London has appointed a local provider of temporary services for up to 6,000 patients in Tottenham Hale. It has also, together with Haringey CCG, sought national approval to use capital funding from NHS England’s primary care transformation fund to purchase the temporary premises. It has done so because capital funding is seen as representing best value and minimising annual revenue costs. As the right hon. Gentleman said, NHS England London and Haringey CCG hope to obtain approval for capital funding of the premises on 18 December, which is Friday of this week. However, I understand that, in the event of NHS England not agreeing to provide funds from the primary care transformation fund, the purchase of the premises will still be secured by means of revenue funding. NHS England will continue to work with Haringey CCG to find a permanent site for the practice in Tottenham Hale.

The new GP practice in Hale Village is due to open in the new year. It will start with a zero list and will have the capacity to register up to 7,000 new patients. That development has been welcomed by Healthwatch Haringey as representing a positive outcome for local residents. NHS England has also asked CCGs to set out an overarching estates strategy to ensure that estates resources are used across all of health and social care. As part of that work, Haringey CCG is looking closely at how else it can help to ensure that GP local premises are fit to meet current and future primary care needs, particularly in the light of the regeneration in Tottenham that the right hon. Gentleman mentioned and projected population growth in the area.

The right hon. Gentleman made clear his concerns about the levels of primary care funding in areas of relative deprivation. The national formula is currently under review, and the possibility of giving greater weight to deprivation is one factor being considered. I can reassure him about GPs’ salaries, however. GPs are not paid differential salaries in different areas. The capitation is different, because capitation covers things other than GPs’ salaries, but clearly it could not work if GPs in one area were deliberately paid less than those in another. That is not at the heart of the problem. When it comes to capitation and things that are considered in the national formula, deprivation is being considered as an issue to be looked at further.

Getting more people into primary care is really important. The Secretary of State set out in June details of a new deal for general practice, in line with the five-year forward view, recognising the pressures that GPs are under. We are training, and plan to train, more GPs. In the last Parliament, we increased the number of GPs working and training in the NHS by some 1,700, which is a 5% increase, but we still need more. That is why we have announced plans to increase the primary and community care workforce by at least 10,000 by 2020. That figure includes an estimated 5,000 more doctors working in general practice. That will be a 14% increase in the overall number of GPs working and training in the NHS.

We have established some work to try to reduce the level of workload. Having visited a number of practices in urban deprived areas and others, I can say that there is very much a sense in some practices that GPs are worn down, that they are on a treadmill and that they are worried about bringing new people in. In others, however, sometimes not very far away, GPs are trying something different. They are working with the Prime Minister’s challenge fund pilots or the vanguard sites on different ways of providing their services. Such work can often be the trigger for more doctors being interested in coming into work.

There is a different side to the pressures on GPs. I am clear that, in practices that are very much under pressure, by reducing bureaucracy and working with them to provide support, we can lift them up from their present difficulties. The transformation fund of £1 billion that will be used to improve premises over the next few years will also make a difference, and it will ensure that premises are fit for purpose when it comes to what we want from primary care in future.

If we are to address the health inequalities that the right hon. Gentleman rightly mentioned at the beginning of his speech, it will be essential for that work to be carried out in the most deprived parts of the country, as in any other. It has been interesting to visit those pilots and look at what has been done. The reorganisation of resources in primary care and the establishment of more contacts with those who provide allied health professional services—relieving some of the pressure on GPs—can have a marked impact, as can the closer integration between the NHS and local authority services in the same area.

We are all trying to lever up standards and deal with the inequalities, as the right hon. Gentleman has mentioned. There are plans, proposals, new initiatives and new ideas, and some of those are demonstrated in London. I hope some of the practices involved, particularly the new ones, will take those opportunities to do something different where they are and try to meet the challenges that they face.

To conclude, as well as the investment in primary care that I have detailed, a number of approaches are making a difference to access to GP services: longer opening hours, to increase the sense of access; better use of telecare and health apps, which are really working and beginning to have an impact on populations that are much more used than some others to using such things; and more innovative ways to access services by video call, email or telephone. Schemes are integrating services in order to offer a single point of contact to co-ordinate patient services across health and social care. Some 2,500 practices have taken part in the access fund schemes, covering more than 18 million patients, so a third of the country will have benefited from improved access to primary care by March 2016. We want to continue to roll out such initiatives to 2020, investing in primary care and making sure that investment is made in the areas where most work is needed. It is clear from what the right hon. Gentleman said that Haringey is right up there.

[Mr Lammy]

Can the Minister get NHS England to take a greater interest, at leadership level, in Tottenham?

[Alistair Burt]

I will ask exactly that. I do not doubt that it is doing that already. Clearly, the right hon. Gentleman needs to be reassured, and we shall do so.

National Health Service

David Lammy Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr David Lammy (Tottenham) (Lab)]

Two years ago, a friend of mine collapsed on a football playing field and an ambulance was called. The ambulance should have reached this major emergency within eight minutes, but it took 17 minutes and my friend died of a heart attack on that field. The seriousness of this debate for many families beyond this Chamber—I am thinking of the wife and three children that he left behind—cannot be conveyed. It is right to begin by saying that the £700 million that has been found and the £150 million for the challenge fund are absolutely desirable and necessary at this time. I remember, as a former Minister in the Department dealing with the winter crisis, that those funds are very important.

I want to take the House back to a dark time for the NHS, when it was routine to wait in A and E for six, eight or 12 hours, and to what it took to change that system. It was a great privilege for me to begin my ministerial career in the Department of Health. The then Member for Darlington was busy, controversially, dealing with foundation hospitals. The then Member for Barrow and Furness was busy at that time, controversially dealing with nurses’ pay and increases we wanted, and with the GP contract. I found myself leading on emergency care, and I was the Minister who took through the changes for that A and E target.

We brought in Professor Sir George Alberti. For a number of reasons, it was hugely important that we had a clinician leading the charge across the NHS. We needed to persuade the GPs about access if this was to work. We brought in the target—48 hours, since abolished —and a lot of practice at the front door of A and E. The phrase we used all the time at that point was “See and treat and triage”, but it worked only if we looked at the system as a whole system. Important targets in the rest of the hospital—in cancer, in cardiac care—were necessary. Frankly, it is a crying shame that seven of the 15 major targets were missed under this Government.

We also needed to deal with social care, of course. If £3.53 billion is taken out of social care, there must be consequences. We should remember that much of this debate has been in the past tense. There are further cuts to come, with day centres to be closed. We see phrases pop up in local authorities such as “New pathways for the elderly”. New pathways to what? New pathways to isolation; new pathways to falling over at home alone; new pathways to going without food; and new pathways to ending up at the door of A and E.

We also introduced NHS Direct to ensure that nurses could deal with calls promptly and move on. I never conceived that we would get rid of the nurses in NHS Direct, and that we would move solely to a system of algorithm. Is it surprising that NHS Direct staff are directing people to the door of A and E? Our system worked because before people went to A and E they could go to a walk-in centre. We can call them urgent care centres if we want, but they are essential—they are part of the triage, a part of the see and treat method that we need. Again, however, one in four of them has been lost, resulting in the crisis we see before us.

Here in London it is worse, because we are losing A and Es—gone at Chase Farm, gone at Hammersmith, gone at Central Middlesex, going perhaps at Epsom and St Helier, gone at Charing Cross—and with a population rising to 10 million. This is a serious debate because it is about to get worse. No wonder the chief executive of the London ambulance service resigned yesterday. She is leaving a sinking ship under this Government’s watch, and this House and the people will remember that, because it is specious of the Secretary of State to come to this Chamber and say the debate is solely about more nurses and more doctors. It is not. It is about the system—the NHS.

Who is accountable under this new structure? Is it NHS England? Is it the CCGs? Is it the CQC? Is it another jargon organisation? No one is responsible—certainly the Secretary of State is not, because he gave up those responsibilities in 2012. That is the mess this Government have got into without even putting it in the manifesto. It is a disgrace.

A and E (Major Incidents)

David Lammy Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am happy to explore that. All these suggestions need to be considered very carefully. That trust has had 40 extra doctors and nearly 300 extra nurses and £4.5 million to help with its winter pressures this year. Perhaps some of that money could be used for that purpose. I am happy to look into it.

[Mr David Lammy (Tottenham) (Lab)]

As the Minister who introduced the precursor A and E target, may I say that the Secretary of State was right to continue with the target? Making the target work was dependent on NHS Direct, delayed discharges, the integration of social care, and targets in the rest of the hospital, particularly on cancer. He has demolished that whole system. Will he now apologise for the absence of those targets, the problems in delayed discharge and the scrapping of NHS Direct?

[Mr Hunt]

I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure, but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.

Accident and Emergency

David Lammy Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

Since the change of Government, the previous Secretary of State and this one have talked about a formula based predominantly on need, not deprivation. The worrying thing about that is that it means that we have a formula based on the use of NHS services as opposed to the need to improve health. NHS England has been debating that issue this week and I hope that it has taken heed of what has been said in this House, because to do this to the NHS alongside the local government cuts mentioned by my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) will be catastrophic for the communities in this country with the greatest need.

[Mr David Lammy (Tottenham) (Lab)]

Does my right hon. Friend recognise the perversity of our having a debate about airport expansion, with the London population rising to 10 million, while at the same time closing A and Es in west London, experiencing problems at St Helier in south London, closing Chase Farm and making changes in the east? Does that make sense with a rising population? Will it not lead to chaos?

Accident and Emergency Waiting Times

David Lammy Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King’s Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.

Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend the Member for Charnwood (Mr Dorrell) said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?

[Dr Wollaston]

The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.

But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.

--- Later in debate ---

[Mr Ben Bradshaw (Exeter) (Lab)]

I associate myself absolutely with the remarks made by the hon. Member for Totnes (Dr Wollaston) about tariff reform, but given the time constraints, I will restrict my remarks to one particular issue that is putting pressure on the A and E crisis. I am talking about access to GPs.

I want to share testimony that I have recently received from people in Exeter. The first comes from a young teacher:

“Again and again, whenever I want to see a doctor there are no appointments available for as long as a week away, in addition to appointments not being made available at accessible times. Being a teacher, I am unable to easily pop out for a doctor’s appointment.”

Another constituent wrote to me last month about the A and E crisis:

“I believe one of the main reasons for this is that it has become very difficult to see your own GP unless you are prepared to wait three weeks for an appointment. I have personal experience of this, as do many of my friends and colleagues, and this is making people with minor ailments attend A and E in order to be seen.”

You will remember, Madam Deputy Speaker, that when Labour was in government, we introduced a requirement on GPs to grant appointments to their patients within 48 hours. We also introduced incentives in the GP contract for GPs to open at weekends and in the evenings, and we established GP walk-in centres in every primary care trust in England—in some areas, we established more than that. It worked. By the end of our Government, complaints from the public about GP access had declined significantly, as had pressure on A and Es that resulted from people not being able to see a GP.

By May 2010 more than 75% of GP practices in England were opening in the evenings and at weekends. Under this Government, however, 500 of those practices have reduced their opening times again. By May 2010, there were walk-in centres in every area offering quick, easy access to a GP, seven days a week and 12 hours a day. Since 2011, 25% of those centres have closed, and scrapping the requirement for GPs to offer an appointment within 48 hours has led to a return of the bad old days of people waiting days or weeks to see a GP, and therefore going to A and E instead.

[Mr Lammy]

Will my right hon. Friend give way?

[Mr Bradshaw]

I regret I will not do so because I have so little time.

When I wrote to the Health Secretary with the cases from Exeter that I referred to earlier, his colleague, Earl Howe, replied:

“It is our view that 48-hour access did not focus on outcomes, and specifying a particular model to deliver better services for patients misses the point about local needs, local services and local accountability.”

That, I am afraid, is gobbledegook. My hard-working constituents, who pay for the NHS, want to be able to see a GP when they need to and at a time convenient for them. Earl Howe’s letter went on to say that as this was a local issue, I should raise my concerns with the clinical commissioning group, which I promptly did. It replied stating:

“As this relates to GP services, the letter should be sent to NHS England.”

I await its response with interest.

Will the Minister help the House by making clear in her response who is responsible for ensuring that the public can see a GP quickly and conveniently? I was encouraged to hear the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tell the “World at One” yesterday that he wanted to improved GP access, including opening times, in response to the A and E crisis. Hallelujah! May I suggest, however, that he and he colleagues start by stopping the closure of walk-in centres, and reintroduce Labour’s requirements and incentives for GPs to give appointments within 48 hours and to open their surgeries at weekends and in the evenings? Without such measures, I am afraid that current pressures on A and Es will simply get worse.

--- Later in debate ---

[Ann Clwyd (Cynon Valley) (Lab)]

As colleagues will know, over the past few months I have read from the direct experiences of the 2,500 people who have written to me about their treatment in the health service. This time, I am going to speak about my husband, who died in October last year. That is because I have had the 117-page report from the hospital, which I asked a GP friend to have a look at because a lot of it is gobbledegook to any ordinary person.

My husband died from hospital-acquired pneumonia. One of the concerns that I have talked about is upheld by University Hospital of Wales in Cardiff. The report says:

“A delay in review by medical staff did occur in AU. Mr Y”—

it is anonymised, ridiculously—

“remained in EU for 6 hours longer than the target timescale of 4 hours. Mr Y then remained in EU for approximately 21 hours, significantly longer than the target time of 8 hours for this type of area.

Mr Y should not have been nursed in the EU/AU for the length of time he remained there. The length of time Mr Y spent in EU and AU fell significantly below the standard expected, and this is unacceptable.

The distress this poor experience caused is acknowledged and the Health Board apologises that the standard experienced by Mr and Mrs Y was below that expected.

This concern is upheld.”

There are many other things I would have liked to talk about, but there is not enough time. I asked my GP friend to look at the hospital’s record, and she said:

“I don’t think that the notes you were given are supposed to be a complete record that Owen was properly investigated or treated.”

She goes on to say:

“Of course Owen spent too long in Casualty. The analogy with a ‘battery hen’ is apt: cooped up on a too small trolley for 27 hours, pressed against the bars…no record of adequate food or water and unclothed.”

She goes on to ask:

“Why ever not? In 27 hours Owen is recorded as drinking 150 ml and eating one ice-cream—and he was dehydrated when he came in.”

There was apparently a “Do not resuscitate” notice. She goes on:

“The DNR notice and records are lamentable, and reinforce my impression that because Owen’s care plan on 11 October could not be fulfilled, there was no other clear care plan in place for him…But I am not surprised you did not fully comprehend what they were not going to do. The enquiry papers state UHW does not follow the Liverpool Care Pathway; this is a pity as they wrote Owen up for the LCP recommended medication after antibiotics were stopped yet failed to attend to the spiritual needs of the patient in this critical juncture.”

[Mr Lammy]

Will my right hon. Friend give way?

[Ann Clwyd]

No, I am sorry, I cannot.

Finally, my GP friend said:

“These matters and the ways you expressed your concerns are so similar to the events described in the many many letters you have received from others who have described similar misgivings. It must be very difficult to have to ‘use’ your own very personal experience as a prompt to drive the response and search for answers that so many want from you. But that is your job as Member of Parliament, to identify what, if anything—”

Accident and Emergency Departments

David Lammy Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr David Lammy (Tottenham) (Lab)]

Twelve years ago I sat where the Minister is sitting, when I was the Under-Secretary of State for Health. I had responsibility for accident and emergency services in particular, and I want to impress on her that she has power to respond to what is being said in the House today.

All Members will understand that the NHS does not stand still. Reconfigurations are necessary. Changes are necessary. I was born in a constituency that had a wonderful hospital called the Prince of Wales; it no longer exists. In the Roehampton part of London, there was a hospital; it no longer exists. Things change. In London we have seen changes to stroke services. It is possible that someone in an ambulance, having been unfortunate enough to have a stroke, will drive past a hospital to get to another hospital, a centre of excellence. That was a configuration that was carried out with great consensus across London. I pay tribute to Richard Sumray, who was chair of the primary care trust in Haringey and led the consultation on changing stroke services in London.

The Minister has heard deep concerns expressed about the changes proposed in every area of our capital city—deep concerns about King George hospital in the east and about the much loved hospital in Lewisham in the south. No one can understand why Lewisham should pay for problems in an adjoining area, as currently proposed. We raised concerns about the problems in the north. I will refer briefly to the Whittington, although my hon. Friend the Member for Islington North (Jeremy Corbyn) is in his seat and will major on that. We have heard about Chase Farm and about pressures deep in the south, in St Helier and the Croydon area, which were described by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). We have also heard about concerns in the west of London around Ealing. That is unprecedented.

[Jeremy Corbyn (Islington North) (Lab)]

Does my right hon. Friend accept that one problem is that London’s population is rising, health inequalities are rising, and health demands are rising among poorer people? Although I understand all the arguments about putting services in the community, if hospitals are closed, many desperately poor and ill people will not be properly served.

[Mr Lammy]

My hon. Friend makes the point beautifully. Let us look at the demographics of London. The Mayor’s London plan estimated London’s population to be 7.8 million. The census later showed us that it was 8.17 million at least. The London plan assumed that the population would break 8.5 million in 2027. We now believe that it will exceed that figure in 2016. By 2031 there will be 9.5 million people living in our capital city. The areas marked for growth are the upper Lea valley—Chase Farm; the Metropolitan line corridor, with nine A and E units now turning into five; and the south-east of London, where Lewisham is based. There will be 9.5 million people using services that the Health Secretary is seeing shut down. There are huge concerns.

I sat in the Minister’s seat. That was after the terrible winter flu epidemics in the late 1990s. At that point the Whittington hospital in north London was at the epicentre of a public storm because of the bed waits and other long waits. My job, set by the former Member for Darlington who was then Secretary of State for Health, was to ensure that that four-hour wait was a reality across our country. I would sit with chief execs and we would go through the so-called sitreps to ensure that those hospitals were meeting the four-hour waiting target. That was the key element of my job.

I decided to look at the sitrep for the past four weeks across London. There is a target, and if hospitals are doing badly they are flagged as red, while if they are doing well and meeting the target, they are marked as green. I was startled. Ealing, Hillingdon, Imperial, North West London Hospitals, West Middlesex, Barnet and Chase, Whittington, Barking, Guy’s and St Thomas’, King’s College, Lewisham, South London, Epsom and St Helier, Kingston, Croydon and St George all currently fail. Yet it is proposed that we can lose many of our A and E departments—eight across London—at this time. It does not make sense.

This is a health service in London that we look to when a helicopter falls out of the sky or when bombs go off in Canary Wharf or on the underground. This is an A and E service that we look to following riots. I remember the A and E serving our police officers on the first night of riots in my constituency. Londoners will be very concerned indeed that this debate is being framed and structured in this way at this time, with the lack of consultation described so well by my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock).

I was staggered when I found out about the proposed changes to Whittington hospital in Camden New Journal. In November, I had a meeting with the chair and the chief executive, with other Members of Parliament, and we found out that a third of the hospital was to be sold off, that it was apparently to be totally reliant on community services, that it was to lose 500 jobs, and that the people of north London would again have to fight to retain the hospital that they loved—a hospital in my constituency in which my two sons and I were born, and which has been served particularly by nurses from the Caribbean.

Londoners are concerned and Londoners will fight. The Minister has the power to act to put an end to the disarray that we are now seeing across London, and I ask her to do so.