Independent Reconfiguration Panel

Edward Argar Excerpts

Thursday 19th November 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this important debate. I recognise her continued interest in local health matters and her championing of her constituents’ interests. She knows that I have considerable respect for her and her work in this House on behalf of her constituents. However, she will perhaps not be surprised that I cannot fully agree with the picture that she painted to the House today.

Before I get into the meat of the debate, let me pay tribute to all the staff at the trust and across our entire NHS for the amazing work they do day in, day out, particularly at this time. I know that is a sentiment that the hon. Lady would share.

As the hon. Lady said, all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients and should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate patient and public engagement, and consider patient choice. It is right that these matters are addressed at a level where the local healthcare needs are best understood, rather than emanating from Whitehall. I should point out that in cases where these proposals are referred to Ministers, they are considered impartially and on their merits, and that is what has happened in this case.

Without recounting all the background that the hon. Lady has set out for the House this evening and on previous occasions, in December 2017, the “Improving Healthcare Together 2020-2030” programme was established to address the significant estate quality and finance challenges that Epsom and St Helier University Hospitals NHS Trust is currently facing. NHS Surrey Heartlands and NHS South-West London clinical commissioning groups are the organisations responsible for making decisions about local healthcare. They led the development of proposals for any potential service changes, and it is right that they did so at that local level, including appropriate consultation. As she set out, following a period of sustained engagement and options development, on 3 July 2020 local NHS leaders approved plans that will see a brand new state-of-the-art hospital built in Sutton to treat the sickest patients and most services staying put in modernised buildings at Epsom and St Helier hospitals.

The hon. Lady raised a number of concerns about this decision—in particular, around transport and travel, bed numbers, acute services, and the impact on more deprived communities and health inequalities. As she said, she also raised these issues at our meeting in July, which it was a pleasure to undertake with her. When the decision was made, measures to address these issues were also set out, including extending the H1 Epsom and St Helier hospital bus route into Merton and further south into Surrey, beyond Epsom, and increasing the frequency of travel between the three hospital sites; reviewing car parking on all three sites; increased bed capacity to care for an extra 1,300 in-patients a year; advances in technology and treatment; closer working with community services so that fewer patients will need an overnight stay and will be able to get home sooner; exploring further opportunities for primary care services at Epsom and St Helier hospitals; and expanding child and adolescent mental health services on the St Helier site. Under the proposals, about 85% of current services would stay put at Epsom and St Helier, with six major services being brought together in the new specialist emergency care hospital, including A&E, critical care, and emergency surgery. The capital investment for those proposals is not only to fund the new hospital but to invest in and improve the current sites at both Epsom and St Helier, including funding for the A&Es.

I can reassure the hon. Lady that the Treasury is and will remain fully engaged with not only this proposal but all 40 of the Government’s hospital proposals. As she would expect and know from her long career in the House, the Treasury takes a close interest in any proposals that entail the spending of significant amounts of public money. This is a significant investment in improving healthcare across the communities served by these hospitals, which is why my hon. Friends the Members for Carshalton and Wallington (Elliot Colburn) and for Wimbledon (Stephen Hammond) have recently set out their and their communities’ strong support for these proposals.

The Independent Reconfiguration Panel was at the crux of the case made by the hon. Member for Mitcham and Morden. As she set out, the IRP is the non-departmental public body set up in 2003 to provide the Secretary of State with expert independent advice on contested NHS service changes and reconfiguration. There are currently 15 panel members who review referral cases. They have a mix of clinical, lay, patient representative or engagement, specialist and managerial backgrounds. The IRP has provided independent advice more than 80 times since it was established. With reconfigurations referred to the IRP, there is an open and transparent process, which people expect to be carried out to the most rigorous standards of integrity, honesty and impartiality. We must adhere visibly to those standards, and I believe, on the evidence I have seen, that those standards were met in this case.

As the hon. Lady will know, local authorities have a power to refer certain proposals to the Secretary of State where they consider that there has been inadequate consultation, where reasons given for non-consultation are inadequate or where they believe that the proposal is not in the interests of their area and communities. The Secretary of State can then choose whether to commission advice from the IRP, which is normally provided in 20 working days, and Ministers are clear about the need for that advice to be swiftly and efficiently given. Following collection of evidence, the IRP submits its report either with advice not to proceed or containing recommendations to the Secretary of State on specific proposals. I emphasise that the IRP’s role is advisory, and the Secretary of State ultimately makes the decision.

In July—at roughly the same time as my meeting with the hon. Lady, which slightly limited the conversation we were able to have—Merton Council referred the scheme to the Secretary of State, who referred it to the IRP, which provided its advice on 28 October. Following thorough consideration of that advice, the Secretary of State accepted the IRP’s impartial advice, which was that there was no reason to contradict the proposed choice of Sutton—Belmont—as the location for the new specialist emergency care hospital. I know that there have been some noises locally about the possibility of subsequent legal review or legal action, so I will not dwell on that aspect. I do not believe that any judicial review has been tabled at this point, so I feel that I can comment a little further on the issues she raised. I must emphasise that the IRP provides impartial, independent advice.

I turn to the specific points that the hon. Lady made about Sir Norman. It is up front and totally clear in the IRP report that Sir Norman Williams, the chair of the IRP, declared openly to IRP members what was already a matter of public record: that between May 2016 and September 2019, he had been a non-executive director of St George’s University Hospitals NHS Foundation Trust, which neighbours the Epsom and St Helier University Hospitals NHS Trust, and he made it clear to the panel that that was a linkage. However, Sir Norman clearly left some time before the proposals were considered by the panel and, indeed, before the March date of this year that the hon. Lady referred to. As she said, independent panel members considered that matter and the issues that she had raised, and confirmed that in their view the historic connections with the case did not represent a conflict of interest and agreed that they were not relevant to Sir Norman’s role in chairing the formulation of the advice.

I have to say that I think it would be wrong to question in any way the integrity, impartiality or independence of the panel or the chair, who I believe is more than capable, rightly fulfilled his previous role to the best of his ability and fulfils his current role entirely to the best of his ability, recognising and fulfilling the requirement to be independent in the view he takes. I have seen no reason—or no compelling reason—to suggest that his behaviour has in any way contradicted that need for independence and objective guidance.

It is of course right that all reconfiguration decisions are taken in the best interests of patients and the local population, following due process. The people affected by the changes need to be involved in making the key decisions, and the IRP advice concluded:

“Patients and the public will need to be engaged in shaping and understanding the new landscape of services to gain maximum benefit from them.”

I believe that they will be.

I know that the hon. Lady’s constituents are and will continue to be strongly represented by her. I recognise the strength of her views, but I do believe that the process has been carried out fairly, independently and appropriately, in seeking to reach the best decision for the people who use the hospitals.

Question put and agreed to.