Covid-19: BAME Communities

Dawn Butler Excerpts

Thursday 18th June 2020 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

As I am sure colleagues will have seen, this is a very well-subscribed debate, so I intend to impose a six-minute time limit straight away so that we can get everybody in. I know that the hon. Lady is aware that she has around 15 minutes for her opening speech.

[Dawn Butler (Brent Central) (Lab)]

I beg to move,

That this House is concerned about the level of deaths from covid-19 among Black, Asian and minority ethnic communities; notes that structural inequalities and worse health outcomes for Black, Asian and minority ethnic people go hand in hand; calls on the Government to review the data published by the Office for National Statistics on 11 May 2020 on Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020, the Report published by the Institute for Fiscal Studies in May 2020 entitled, Are some ethnic groups more vulnerable to COVID-19 than others? and the full report by Public Health England on Disparities in the risk and outcomes of covid-19; and further calls on the Government to set out in detail the scope and timeframe of the Government’s review and urgently to put a plan in place to prevent avoidable deaths.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for securing this important debate. Many Members who wanted to speak cannot do so, and it is a shame that they cannot participate remotely. The Government are more focused on subverting democracy than protecting lives, but we will not go into that. Their decisions are increasingly illogical and irrational. They finally did a U-turn the other day and now children will be fed this summer; I am glad the Government are doing U-turns. I thank everyone involved, including the all-party group on school food and Marcus Rashford, who joins celebs such as Raheem Sterling, John Boyega and others who are finding their voice and using their position for change.

This is a sobering debate. We all watched the brutal, very public lynching of George Floyd—our lives were interrupted by the killing—but racism does not just manifest itself in brutal ways that can be caught on camera and shared on social media. “I can’t breathe”, the last words of George Floyd, could apply to the disproportionate numbers of black, African-Caribbean and Asian people dying from coronavirus in this country.

Every time the Government get dragged kicking and screaming to do the right thing, I can’t breathe. I can’t breathe every time the Government hide a report or kick an issue into the long grass by announcing another commission or report. I can’t breathe. My breath is taken away by the lack of care, empathy and emotional intelligence shown by the Government time and again. For months, we stood at our doorways and clapped for our key workers, the ones on the frontline—the doctors, the nurses, the carers, the cleaners, the ones driving the buses, the cabs and the forklift trucks or serving people in supermarkets. The people we clapped for are the ones who are being underpaid and who are, disproportionately, dying.

The death rate for covid-19 has exposed and amplified what has been going on in society for decades. The concentration of deaths in areas where people are just about managing should worry us all. As a country, we are better than this. According to the Office for National Statistics, the burden of covid-19 has been felt more strongly in regions with greater deprivation. In those areas, people are dying from the virus at double the rate of those in more affluent areas. According to the ONS, adjusting for age, black people are more than four times as likely to die from covid as white people. Pakistanis and Bangladeshis are more than three times as likely and Indians more than twice as likely.

BAME people account for 13.4% of the population, but they make up 34% of patients admitted to an intensive care unit. My constituency of Brent sadly has the highest number of registered deaths in London. In line with findings from the Office for National Statistics, those areas of greatest deprivation, such as Harlesden, have the highest number of deaths.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

I thank my hon. Friend for the powerful way in which she makes these crucial points. Does she agree that the approach taken by my constituency colleague and the Welsh Minister for Health and Social Services, Vaughan Gething, on the disproportionate impact of these issues on BAME communities—we have seen tragic deaths in my constituency too—has been in stark contrast to the approach taken by the UK Government? Vaughan Gething has understood this issue, and led on it from the start.

[Dawn Butler]

I thank my hon. Friend for that intervention. We can learn a lot from the approach in Wales, including how people are approaching the disproportionate number of deaths from covid-19 in the BAME community. I thank him for everything he does in his constituency on that issue.

We did not get to this point by accident, and we must make a concerted effort to dismantle the structural and systemic racism that exists in society, and that affects life chances from the moment someone is born.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I spoke to NHS doctors from EveryDoctor, and they told me that 63% of BAME doctors felt pressured to work in wards treating covid patients, compared with 33% of their white counterparts. Does my hon. Friend agree that the Government must do more to address workplace discrimination that affects ethnic minorities?

[Dawn Butler]

I thank my hon. Friend for that important intervention, and I will come to that point later in my remarks. As constituency MPs, it is important for us to talk to doctors, and to understand and learn what is going on. I wish the Government would also take that on board.

Structural and systemic racism is also a health issue, and the Institute for Fiscal Studies revealed that the jobs that are most at risk are over-populated by African, Caribbean, Asian, and minority ethnic people. We must be honest with ourselves and ask why that is. The higher BAME death rate is apparent across all grades of the NHS, even in the highest socioeconomic groups. We must be honest with ourselves and ask why that is. If we shy away from the truth, nothing will change. The publication of the first report on this issue stated that 17 doctors died, 16 of whom were BAME. Eastern Eye then reported that, since 2 June, when that report was published, another 18 doctors died after saving lives, 17 of whom were BAME. We must be honest with ourselves and ask why that is.

The Public Health England report that the Government tried to hide states that, as my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) said, there were numerous examples of doctors who were not able to access appropriate PPE to protect themselves adequately. It also stated that requests for risk assessments or additional PPE from BAME workers were more likely to be refused, and that requests were less likely to be made because of the fear of adverse treatment.

Mary Agyeiwaa Agyapong, a nurse, was still working at a hospital while heavily pregnant. She sadly died of covid-19. They managed to save her baby girl by emergency caesarean. That is so tragic, and we must ask ourselves why she was forced to work. Let me give a couple more examples. Two black employees in London, a taxi driver and one transport worker, Belly Mujinga, died after allegedly being spat at by somebody who claimed they had covid-19. Belly had an underlying health condition and should not have been put in danger. She requested to work in the ticket office, but that was refused. We must ask ourselves why such things are happening. The Government must urgently implore and ensure that all employers carry out risk assessments in all workplaces. As lockdown is eased, those most at risk are in greater danger unless the Government introduce structural requirements for employers.

[Chris Stephens (Glasgow South West) (SNP)]

I thank the hon. Lady for what she has said so far. She talks about employers carrying out risk assessments. It is important that that includes Government Departments and the Government’s outside contractors, because, as she will be aware, many of the workers in these outside contractors—cleaners, for example—are from the BAME community.

[Dawn Butler]

I thank the hon. Gentleman for that intervention. It is not one rule for Government Departments or Parliament and one rule for the rest of the country: we have seen that play out way too often. He is absolutely right that that has to be taken into consideration.

More than two in 10 black African women are employed in health and social care roles, Indian men are 150% more likely to work in health or social care roles, and 14% of doctors in England and Wales are Indians. Covid-19 does not prefer one person’s lungs to those of other ethnicities. It is not the pandemic that discriminates—it is society. It is almost as though being black is a pre-existing condition that results in worse outcomes for health, employment and education. That does not for one moment mean that it cannot be overcome. It is not a victim mentality that has put us in this situation, any more than it was indolence that put British citizens on planes and deported them during the Windrush scandal or bad sportsmanship that subjects our players to abuse on the field. We must call it what it is, because if we do not call it what it is, how can we identify it, how can we cure it, how can we stop it? It is racism, and it has become more structural and systemic. It is not just about individuals. Structural and systemic racism can exist without individual acts of racism, but it is an unfair, unequal discriminatory system—and it is literally killing us.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

Does my hon. Friend agree that at the heart of Government there is huge ignorance about this agenda, and we need the Government to learn from what has happened? As we ease lockdown, the Government urgently need to do the risk assessments so that families who are at risk through inter-generational living and all those issues are taken into account and action is taken to protect people from further risks of dying.

[Dawn Butler]

I thank my hon. Friend for that intervention. It is absolutely vital that the Government ensure that risk assessments are carried out in workplaces so as to have fewer deaths.

As I say, this is literally killing us, and just like the killing of George Floyd, we can all see it. If anyone does not believe me—if anyone does not believe that structural racism exists—believe the body count.

Incremental changes are no good if structural barriers still exist. Breaking down systemic and structural barriers will build a society that is better for everyone. Every life matters—of course it does, but not all lives are treated equally. Interestingly, some of the things that would most benefit and save black and Asian lives are the same things that will save everybody: risk assessments, test and trace, and easy access to in-date PPE. What the country needs now is a Government who are going to deliver fast and decisive action. Everyone in this House should stand up and say, “No longer should discrimination, cultural exclusion, poverty and class be allowed to determine whether you live or whether you die.”

That is why this debate is so important. It is said that if a house is on fire in a street, of course all the houses in the street are important, but the focus needs to be on the house that is burning—and right now this situation needs fixing for the BAME community. Right now we have a group of people who are dying at four times the rate of anybody else. It is the same demographic as the people who died in Grenfell Tower just three years ago. It is the same group of people who were subjected to the hostile environment just eight years ago. It is the same people who have been told to stop being victims. There is a pattern here, and we need the Government to show some urgency to address the racial inequalities that exist in the UK.

At first the Government said, “We will not publish the PHE report because it is too sensitive in relation to Black Lives Matter.” On 4 June, the Minister stood up and said, “We’ve asked Professor Kevin Fenton, a black surgeon, to lead on this review”, but apparently he did not lead on it. The Minister then said that the review was not part of the report. Confused? I know I am.

The Minister also stated that PHE did not make recommendations because it was not able to do so, but we know she was aware of the second set of recommendations made by PHE. When she gets to her feet, will she apologise on behalf of the Government for misleading the House? Why did the Government try to bury the PHE report? I was not the only one who was trying to get to the bottom of it. Eastern Eye, Channel 4 and Sky have doggedly pursued the issue because something just did not feel right. That is why people have taken to the streets—they are tired of the dishonesty.

The Government have form on whitewashing reports. Baroness McGregor-Smith’s review has seen very little progress. The Lammy review has not had any recommendations implemented. The 2018 race disparity audit has not been acted upon. The Windrush lessons learned review was edited and delayed for a year. It was published, had sections deleted and it was still not acted upon. The Government need to stop trying to erase from their reports the injustices towards black and brown people and working-class people. It is a disgrace.

The Government announce reviews and consultations to get themselves out of trouble, and then think that everybody will just forget as we stumble into the next crisis. We see what they are doing and we are calling them out on it, because they produced a document a few years ago that talked about “explain or change”. The Government said:

“When significant disparities between ethnic groups cannot be explained by wider factors, we will commit ourselves to working with partners to change them.”

I ask the Minister: what is stopping the Government from acting? The murder of George Floyd and the death toll of covid have forced us to have these overdue, open and, hopefully, honest conversations about race, so that we can ensure a fairer and more equal society.

As a member of the Science and Technology Committee, I have listened to many scientists talk about covid-19, and it is not genetics that have resulted in a higher death rate. It is not internal, and that means it is external. To back up the findings of the PHE report—the one that the Government tried to hide—it is noted that covid-19 potentially has had a less severe impact in the Caribbean, Africa and the Indian subcontinent. That raises questions as to why BAME communities in England are so severely affected. It is suggested that issues such as structural racism and discrimination and a failure to adequately protect key workers may have contributed disproportionately.

I am pleased that I have a covid testing centre in my constituency in Harlesden, which has been so hard-hit. If anyone is interested, they should register with Brent Council. As we build a better life after covid, we must do better. The UN found that the

“structural socio-economic exclusion of racial and ethnic minority communities in the United Kingdom is striking.”

The Minister and the Government should be embarrassed.

Some people have always had worse health outcomes—that is not new. Poor people have always had worse health outcomes, but the virus has magnified the scale of the inequality. Colour of skin, economic background and social and structural racial barriers and infrastructure are all factors as to whether someone has a good chance of surviving this pandemic.

The killing of George Floyd in the middle of a pandemic is a pivotal moment for the world. “I can’t breathe” is as true for covid-19 as it is for racism. History will judge each and every one of us in time on that moment when the world stood still for 8 minutes and 46 seconds. History will judge us on our actions and history will judge the Minister on her response. Minister, before you get to your feet to respond, ask yourself what will be written by your name.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Lady knows that she must not address the Minister directly. She speaks through the Chair. She does know that.

--- Later in debate ---

[Dawn Butler]

Apologies, Madam Deputy Speaker.

History will judge each and every one of us. Before the Minister gets to her feet to respond, she must ask herself what will be written by her name.

Government Ministers are revealing trauma on one hand and then saying that racism does not exist on the other; it is cruel. I do not think the Minister should not give a speech. I think the Minister should list actions. What will the Government do and when will they do it? She should tell the House and the country when the Government will start to implement the 150-plus outstanding recommendations from previous reports and reviews, not focus on the new commission that the Prime Minister mentioned. We know that that is designed to agitate and gaslight us, just like the Foreign Secretary’s comments on taking the knee.

Black Lives has more in common with white working-class people, the LGBT+ community and people who are under-represented than this cruel Government do. In the words of the late, amazing Jo Cox, we have

“more in common than that which divides us.”—[Official Report, 3 June 2015; Vol. 596, c. 674-75.]

I stand to tell the Government that we are done with the games, we are done with the platitudes and we are done with kicking this issue into the long grass. Enough is enough. Now is the time to act. Now is the time for action. Now is the time to get the Government’s knee off the neck of the black, African, Caribbean, Asian, minority ethnic communities.

--- Later in debate ---

[Dawn Butler]

In the words of my hon. Friend the Member for Vauxhall (Florence Eshalomi), I am disappointed but not surprised. The Minister may not have all the answers, but she has some of the answers, which span back to 2010. All the Government need to do is start implementing those answers. If they want to run a review in parallel—fine, do that. But they should implement the nearly 200 recommendations that already exist. There is no excuse for the Government not to act.

We have been in agreement across the House in this debate. I am sure that if this motion were put to a vote, we would win against the Government. The motion states that this House

“calls on the Government to set out in detail the scope and timeframe of the Government’s review”,

which the Minister has not done, and

“urgently to put a plan in place to prevent avoidable deaths.”

The Minister has not done that. The Government will be responsible, because they know what is happening and they have failed to act. The Minister should be ashamed of her Government.

Question put and agreed to.

Resolved,

That this House is concerned about the level of deaths from covid-19 among Black, Asian and minority ethnic communities; notes that structural inequalities and worse health outcomes for Black, Asian and minority ethnic people go hand in hand; calls on the Government to review the data published by the Office for National Statistics on 11 May 2020 on Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020, the Report published by the Institute for Fiscal Studies in May 2020 entitled, Are some ethnic groups more vulnerable to COVID-19 than others? and the full report by Public Health England on Disparities in the risk and outcomes of covid-19; and further calls on the Government to set out in detail the scope and timeframe of the Government’s review and urgently to put a plan in place to prevent avoidable deaths.

NHS in London

Dawn Butler Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

My hon. Friend makes an excellent point that I believe deserved to be made at length. She anticipates a point I will come on to about the business case and the capacity problem. There is a problem with the way these things are organised. The north-west London area does not include West Middlesex hospital, which she mentioned, but that is more proximate to some parts of my constituency than Northwick Park hospital, to which my constituents are being diverted even though it is miles away. That just shows that people do not think in terms of these boundaries.

[Dawn Butler (Brent Central) (Lab)]

I congratulate my hon. Friend on securing this debate. My local A&E at Central Middlesex hospital, which was classified as good, was closed, and now the people from the poorest part of my constituency have to travel to the A&E at Northwick Park hospital, which was ill equipped and ill prepared for the closure of the Central Middlesex services and is often rated below par.

[Dr Huq]

My hon. Friend puts it very well. Ealing has also been hit by the closure. I have no hospitals within my constituency boundary, but Central Middlesex was one of the nearest. It was performing well and had had lots of investment—it was a brand new shiny thing. I used to be a hospital radio DJ there in the ’80s. We were not allowed to play certain songs, including “My Way” by Frank Sinatra, because it is too much about the end for terminally ill people to listen to. Anyway, the hospital is now completely different from what it was like in the ’80s. It is tragic that the A&E there is being downgraded in favour of Northwick Park.

I saw the Minister’s brow furrow when I mentioned the boundaries. The hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), is in south-west London. Perhaps we can think more creatively about crossing boundaries, because an ambulance will not usually take someone there even if it is nearer than Northwick Park. That was the point I was trying to make.

--- Later in debate ---

[Dr Huq]

I thought interventions were not allowed to be lengthy.

[Dawn Butler]

On my hon. Friend’s behalf, I thank the Minister for that intervention. The Government’s language over the past few months, saying that we do not have a seven-day NHS, has been alarming and destabilising for a number of people, who have failed to attend services. Perhaps the Minister should take her own medicine.

[Dr Huq]

My hon. Friend puts it excellently. I have some figures that illustrate the adverse consequences. Ealing mums were promised access to 24/7 consultant cover—168 hours per week—for a better, safer service. That has not materialised. Eight months after the closure, the only hospital to come close to that figure is West Middlesex, in the constituency of my hon. Friend the Member for Brentford and Isleworth—it is not even in north-west London. St Mary’s has fallen short at 98 hours. Queen Charlotte’s—the hospital where I was born, although it was somewhere else in those days—offers 116 hours; Chelsea and Westminster, 115 hours; Northwick Park, 108 hours; and Hillingdon, 112 hours. They all missed. There has been nothing concrete. Only on a wing and a prayer will they reach that nirvana any time soon. So much for a better service.

Paediatrics is next for the chop. On 30 June, there will be no children’s wing at Ealing hospital. I have a lot of figures, but people are often numbed by statistics, and other Members want to speak. According to the Office for National Statistics’ 2014 population estimates, Ealing is a very young borough—23.5% of the population is under the age of 18—so we need a children’s wing.

It is worrying. People can be treated quickly and effectively for accident and emergency cases at Ealing hospital at the moment, but the consequence of the changes will be that ambulances will have to take people to Hillingdon and other places miles away. It is unclear who is going to fund that. A lot of those who are admitted to the children’s wing are not taken in an ambulance; they come under their own steam. Will a nurse or a doctor accompany everyone who uses patient transport service, to ensure child safety? There are a lot of question marks.

--- Later in debate ---

[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Turner, and to be called early in the debate. I thank the Backbench Business Committee for giving us this long and generous slot on the last day before the recess. Given that it is the last day, there is a good turnout from London Labour Members, and one or two London Conservative Members. Indeed, we had the whole of the Liberal Democrat representation for London, but he has gone now.

I particularly thank my neighbour and hon. Friend the hon. Member for Ealing Central and Acton (Dr Huq) for introducing this debate in a comprehensive manner, which permits me to make my contribution shorter than it otherwise would have been, because I am going to deal with some of the same issues. I preface my remarks by saying that London Members deal with a great many health service issues—on the whole successfully—through their clinical commissioning groups, hospital trusts and the other myriad health service bodies that the Government inflicted on us in the last top-down reorganisation.

We have heard about primary care, mental health and community pharmacies. The reason why we—particularly the 11 Labour MPs for north and west London—keep returning again and again to the issue of acute hospitals and the “Shaping a Healthier Future” programme is not only that it is such a major reorganisation of services but that it has become very politicised. Of course, all these issues are political—money spent on the health service is always political—but we feel that we are either not being given information or being given the wrong information.

I must disagree with the hon. Member for Harrow East (Bob Blackman). My memory goes back a long way. I was part of the campaign against the closure of Charing Cross hospital in the early 1990s. It was successful, obviously, but it was a long and hard-fought campaign, and again, the grounds for closure were entirely spurious. I remember the former Member for Brentford and Isleworth, who was a Health Minister, leading that campaign when she was the head of nursing there.

[Dawn Butler]

I remember leading a campaign in 2006 to save Central Middlesex hospital’s A&E, which was successful. Unfortunately, it then closed when I was not an MP in, I think, 2011.

[Andy Slaughter]

We all bear these scars. I am grateful for all the efforts that Members have made to protect their local health services.

The next time that Charing Cross hospital came up, it was in the context of the 2005 election campaign, when a Conservative candidate, now the right hon. Member for Chelsea and Fulham (Greg Hands), shamelessly said that it was going to close, with no evidence whatever; there were no plans to close it. The candidate running against me in 2010 did exactly the same in relation to the hospital in my constituency. The difference was that immediately after the 2010 election, plans began to be drawn up—we did not see them until 2012—by McKinsey and others. The reference to consultants was well made by the hon. Member for Harrow East, because the spend on consultants on “Shaping a Healthier Future” alone is running at something like £20 million per annum at the moment.

I did not recognise, in what the hon. Gentleman said, what has actually happened. The brief history is as follows. Those plans were presented. They were kept under wraps and took us all by surprise with the dramatic changes they contained—the downgrading of the four A&Es and what was going to happen to Ealing and Charing Cross hospitals. However, that was a long time ago now, in the summer of 2012. The only revision to those published proposals was at the end of the so-called consultation process in February 2013. Apart from references in board papers and other statements, we have not had a formal upgrade to the process since then. That is more than three years ago, yet the proposals affect about 2 million people across the whole of west and north-west London.

I accept that there can be faults on all sides and that in the run-up to elections, people get quite emotional and political about these issues, but that is partly because they matter so much to our constituents. At the 2015 election, at least we were getting emotional and political about something that was actually proposed, rather than something that was invented. Since the election last year, we have attempted—certainly I have, and I think this goes for a number of my colleagues—to engage in the process with Ministers and officials, partly to find out what is going on and partly to try to influence the outcome. The Minister met a group of MPs last summer and said that there would be a great deal of engagement and transparency. I have not given up on that, but it has not happened so far.

The key document in the “Shaping a Healthier Future” programme—the implementation business plan—is still under wraps. We have been asking for it for the best part of three years, formally, informally or through freedom of information requests. Different reasons have been given at different times—“It’s a work in progress,” or “It’s commercially confidential”; all the usual reasons. It becomes a bit ridiculous after a while. I am not sure it is very helpful to the Government or the NHS, because in the end we have to rely on what information we can scrape together.

Of course, the world has changed a lot in those three years. Let me give some examples. The London head of NHS England, Anne Rainsberry, came to brief Labour London Members earlier this week and gave us some quite interesting information. First, “Shaping a Healthier Future” alone will not deal with the financial problems, which have got substantially worse. My trust, Imperial College Healthcare NHS Trust, last reported that it was running a £25 million deficit, but I know that other trusts, including London North West Healthcare Trust, have higher deficits than that.

The position has got markedly worse. I know the Government say there is a clinical basis for “Shaping a Healthier Future”, but it is interesting that there has been a concession that there is a financial basis to it; it is about saving money. Opposition Members would say that it is mainly about saving money, but the Government might say that that is an ancillary purpose. We are now being told that even if “Shaping a Healthier Future” were implemented, it would not save enough money given the deteriorating situation.

The shadow Secretary of State, my hon. Friend the Member for Lewisham East (Heidi Alexander), mentioned the shift from capital to revenue, partly as a bail-out. That may be a crisis move to offset the immediate financial crisis, but it has implications, particularly for a grandiloquent project such as “Shaping a Healthier Future”, which is about a major redesign of hospital sites—particularly the Charing Cross and St Mary’s sites, which are taking the bulk of the money.

We know—the NHS is now being slightly more candid about this—that the Treasury is getting cold feet about the programme, and the date is being pushed back and back. That is good in a way, because originally we were told that Charing Cross was going to be demolished in 2016-17, and now we are talking about 2020 at the earliest. I am delighted by that, because the longer it is pushed back, the less likely it is to happen, but it reflects serious concerns in the Treasury, and possibly in the Department of Health, about where the programme is going.

[Dawn Butler]

My hon. Friend is being generous with his time. Is he concerned, as I am, by the letter from Clare Parker, the senior responsible officer for “Shaping a Healthier Future”? Brent has been trying to get hold of the latest version of the implementation business case. She notes the request, but states:

“Unfortunately this document is in draft form and not currently suitable to be shared.”

Does he wonder, as Brent and I do, when we will be able to have sight of that document?

[Andy Slaughter]

That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.

Junior Doctors: Industrial Action

Dawn Butler Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

I say gently to my hon. Friend that meaningful discussions require both good faith and a will to talk from both sides. That is consistently the case on the Government side, but it has not been consistently the case for the junior doctors committee of the BMA. The fact is that this contract is better for patients, the patients he seeks to represent. It is better for doctors, the same doctors he seeks to represent. Therefore, any further delay would be bad for patients and bad for doctors. That is why we must move ahead with the implementation of this contract.

[Dawn Butler (Brent Central) (Lab)]

The Minister’s tone, language and approach today show how and why he has failed in these negotiations. I am sure my hon. Friend the Member for Lewisham East (Heidi Alexander) could easily teach him how to negotiate and how to avert the strike. Will the Minister please explain how he proposes to have more junior doctors working at the weekends, without having fewer working during the week?

[Ben Gummer]

The point of the new contract has, in part, been to try to achieve fairer rostering through the week and weekend. It is in response to the doctors and dentists pay review body, which took evidence from managers and senior clinicians within the service. It is their judgment that we, as Ministers, have to respect. It is not for us to make up new terms; it is to listen to those who have experience. We have been talking for three and a half years. Part of those talks were led by Sir David Dalton, who is one of the most respected people in the NHS. If he could not achieve a conclusion, I doubt very much that I, or any other Minister, would be able to do so.

Junior Doctors Contracts

Dawn Butler Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I am afraid that, regrettably, there are some political elements inside the BMA. The great irony is that, without the austerity measures that those same people opposed in the previous Parliament, we would not have been able to give the NHS its sixth biggest funding increase ever.

[Dawn Butler (Brent Central) (Lab)]

When I watched the Secretary of State on the TV on Sunday, two things struck me: first, he got paler as the letters from junior doctors were read out; and secondly, he made it clear that it was the senior doctors not being present that was the barrier to a full seven-day NHS. Why is it then that he is picking a fight with junior doctors?

[Mr Hunt]

We need senior decision-makers to be present. They are the most important people when it comes to delivering seven-day care. Most of the medical royal colleges accept that a junior doctor who has had a substantial amount of training does qualify as a senior decision-maker, which is why we need them more.

Junior Doctors Contract

Dawn Butler Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

No one knows more about campaigning for patients than my hon. Friend, as he has done in his constituency, and I congratulate him on that. He is right. There does not need to be an argument on a matter such as this, because it unites the Government in what we want to do to make the NHS the provider of the safest care in the world with what doctors themselves want to do. The best way forward is to put aside suspicion and for both sides to recognise that we are trying to do the right thing for patients, for doctors, and for the NHS.

[Dawn Butler (Brent Central) (Lab)]

The Secretary of State has failed. He has failed patients, he has failed junior doctors, and he has failed his Government. He says that people should put aside suspicion. I suspect that the reason he did not agree to meet ACAS sooner was so that he could sneak in the announcement during the autumn statement.

[Mr Hunt]

Let me tell the hon. Lady what the failure was: it was setting up a contract for junior doctors in 2003 that has made it impossible for hospitals to roster proper care at weekends. The duty of a Secretary of State is to put right those historical wrongs so that patients are safe.

Junior Doctors’ Contracts

Dawn Butler Excerpts

Wednesday 28th October 2015 Commons Chamber

[Dr Whitford]

There is no doubt that we require dialogue, but it must involve sitting down at a table without preconditions. What we had in July and through the summer was a threat of imposing a contract, instead of proper negotiation. That is where we should be trying to get to: both sides negotiating in good faith across a blank sheet of paper. The threat of imposition is what has hurt the junior doctors.

There has also been talk of taking away the guaranteed income protection of GP trainees, there to try to keep them at the same level as they were, and replacing it with a discretionary payment. Such a payment can be taken away at any time—it can be cut and it can be changed. The Secretary of State aspires to have 5,000 extra GPs by 2020. We know from the BMA that one third of GPs—10,000 out of just over 30,000—are planning to leave, which means we need to find 15,000 extra GPs. Anything that is a disincentive for people to go into that profession is not serving the NHS.

[Dawn Butler (Brent Central) (Lab)]

Does the hon. Lady think the Secretary of State is an incentive or a disincentive to junior doctors?

[Dr Whitford]

Sorry, I did not hear that. [Interruption.]

[Dawn Butler]

Conservative Members do not want me to repeat the question. Does the hon. Lady think the Secretary of State is an incentive or a disincentive to doctors?

[Dr Whitford]

I think that how this has been handled is a total disincentive, but that could change. We could simply take the decision to move to negotiations without preconditions—without the threat of imposition. We are talking about a threat to impose changes to the terms and conditions of people who, in the past, routinely worked more than 100 hours a week, as I did. That is a ghost that haunts the NHS and it really frightens junior doctors.

A&E Services

Dawn Butler Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

My hon. Friend is absolutely right. The lesson that the Prime Minister and Secretary of State drew from those episodes was, “When you get beaten in the courts, change the law”—a completely different approach from that of the previous Labour Government.

[Dawn Butler (Brent Central) (Lab)]

My hon. Friend the Member for Brent North (Barry Gardiner) mentioned the distressing figures at Northwick Park hospital, but the Government’s solution was to close Central Middlesex hospital’s A&E. Does my hon. Friend the Member for Copeland (Mr Reed) think that that added to the crisis or made it better?

[Mr Reed]

Everything that transpired in my hon. Friend’s constituency made the situation much worse, as many medical professionals have said.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is obviously a lively debate on both sides of the House. As someone who is not long from being on the front line, as a surgeon in the NHS, I find it a bit sad to listen to how angry this debate is. The four-hour target should be a tool and not an end in itself. It is used to take the temperature and to understand what is happening underneath. We would not shove a patient in a bath of ice water if they had a temperature; we would look for the infection, try to understand it and try to treat it. Unfortunately, the four-hour target has simply become a stick, and today that stick just seemed to be being thrown backwards and forwards.

People working in A&E face great difficulty, which is why we are not recruiting trainees to A&E and why we are losing senior doctors at an incredible rate from A&E. Instead of being one of the most rewarding places to work, people see it as the most miserable.

[Dawn Butler]

Although the target is used as a measure, or to take the temperature, does the hon. Lady not feel that the fact that it has gone up 401% since 2009-10 is something to be worried about?

[Dr Whitford]

Did the hon. Lady say that the target has gone up 401%?

[Dawn Butler]

The time that people have had to wait for four hours has gone up—

[Madam Deputy Speaker (Natascha Engel)]

Order. Interventions should be kept to a minimum. The hon. Member for Central Ayrshire (Dr Whitford) is not on a time limit, but please be aware that many Members are coming in to speak. Thank you.

Health and Social Care

Dawn Butler Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Dawn Butler (Brent Central) (Lab)]

It is a privilege to speak on a day when we have heard so many great maiden speeches. I want to thank God and thank the people of Brent Central for returning me to this place, and not only as a Labour gain, but with a majority that makes me blush. I know that a Member of this place can be a maiden only once, but I would like to follow in the tradition of maiden speeches by thanking my predecessor for her congratulatory card and her warm words. She worked very hard for Brent Central and said that it was a privilege to serve.

Brent Central was created in 2010, from the leafy Mapesbury to the lovely Harlesden, but in 2015 it sent a clear message: having suffered under a Lib Dem-Tory coalition, it wanted no more. Unfortunately, Labour failed to win the general election, and lessons will need to be learnt, but as we listen to the Conservatives we could almost be forgiven for thinking that they were not responsible for the bedroom tax, which saw hundreds of people move out of my constituency; or for the young people who decided not to go to university because of the increase in tuition fees; or for the people who do not have enough money to pay for the expensive pre-pay meters installed in their homes; or for the people who cannot afford legal representation; or for the closure of our A&E at Central Middlesex hospital, which means the poorest people of Brent Central have to travel the furthest for emergency care—£25 in a taxi or an hour on a couple of buses—at the A&E at Northwick Park hospital, where last week 575 patients waited more than four hours to be seen.

It has been a tough five years, and I fear for the next five. As one of the founding members of People Against Austerity, I know that I am going to be really busy, because unlike the previous MP, I am not a member of the Government, so I will stand up to them and hold them to account. Just imagine that in the year Magna Carta celebrates its 800th birthday, it falls to the Labour party to stand up for those important freedoms. As a former trustee of Citizens Advice and a magistrate, I see the devastation when rights are taken away. We in the Labour party need to be an effective Opposition. Rev. Oliver of St Mark’s, Kensal Rise, talks about three R’s: reserve, regrets and retreat. We must hold nothing in reserve, have no regrets and not retreat from our founding principle of a country fair for all.

The people of Brent Central have given me this chance to serve them as their Labour MP. They were so sad on 8 May when Labour did not win the election, and they wonder what lies ahead. Of course, we have tax cuts for millionaires while poor people and the elderly are freezing in their homes. We have the bedroom tax for the poor and disabled, zero-hours contracts, food banks, tax avoidance by the richest corporations, and charities are restrained by gagging laws while professional lobbyists roam free and unfettered around the lobbies of Westminster. While all that is going on, the Government are painting the trade unions as organisations in need of reform. In reality, trade unions defend and protect people who are on zero-hours contracts or who cannot afford legal representation. At that point, Brent Central is going to become the reggae capital of Europe. As a woman with locks, I feel compelled to quote Robert Neston Marley to the Government:

“You can fool some people some of the time, but you cannot fool all the people all of the time.”

I will hold true to the promises I made on the doorsteps of Brent Central. I will fight for all of you, not just the few. For those in Tokyngton, Stonebridge, Harlesden, Kensal Green, Willesden Green, Dollis Hill, Dudden Hill, Welsh Harp and Mapesbury, I pledge to work on the issues that are important to you, from pre-pay meters to the NHS and legal aid, to name just a few. I will be unstinting in my efforts to represent Brent Central.

Under a Labour Government, my mother’s breast cancer was caught early, and for that I am grateful to the NHS. Three years ago my father died from an infection in hospital. I hope that we can work together with the Government to make the NHS a place that is fair and free for all, but be assured that I will work to hold them to account and ensure that we save the NHS. There may be more Members on the Government side of the House than on the Opposition side—almost, and not today—but on the Opposition side we aim to help the many, not the few.