Mount Vernon Cancer Centre

Gareth Thomas Excerpts

Wednesday 4th March 2020 Westminster Hall

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

I beg to move,

That this House has considered the future of Mount Vernon Cancer Centre.

A devastating report last summer into the future of Mount Vernon Cancer Centre by a clinical advisory panel led by Professor Nick Slevin at the instigation of NHS England stated that there was

“increasing concern as to whether high quality, safe and sustainable oncology services can continue to be delivered…and there is an urgent need to address this concern.”

If media reports are to be believed, that was the first time in the NHS’s 71-year history that a major hospital specialising in such an important disease had been deemed to pose a risk to patients and declared unfit for purpose. The panel went on to note that many of the existing buildings and much of the estate used by the cancer centre was

“dilapidated and not fit for purpose. There is a need for considerable investment in buildings, equipment replacement and IT connectivity”,

as well as staff.

Mount Vernon is a nationally recognised specialist cancer service, up there alongside the likes of the Royal Marsden or the Christie in Manchester, so for it to be so dilapidated and so short-staffed when cancer diagnoses are rising is deeply worrying. The panel recommended a change in the trust managing the service and, crucially, that some parts of the service—it would appear in practice to be most—be relocated to a hospital with comprehensive acute services. The report insisted that significant capital investment should be made available to address the need for a full or even partial move of the service. It argued that the buildings and wider estate used for cancer services should then be managed by the NHS trust actually providing the services to strengthen operational control.

Professor Slevin made it clear that he and his colleagues were greatly impressed by the determination of staff to continue to provide the best quality care that they could in the difficult circumstances they were working under. He also noted the consistently positive feedback from patients about the care they receive at Mount Vernon—a point that many of my constituents who have used the service have underlined to me.

Mount Vernon is a part of the NHS that I have known for a long time, having used the minor injuries centre a number of times and having campaigned to save its then accident and emergency department in the mid-1990s. More than 1,000 residents in Harrow use the service each year, and I have yet to hear a negative view of the professionals there. My constituents and I are keen to ensure that the service is maintained to a high standard and that it stays on the Mount Vernon site, or in the next best scenario, in an area local to Mount Vernon. Critically, we need a sustained period of investment in staff, buildings and equipment. I now believe that despite University College London Hospitals coming on board, there is no plan to shift Mount Vernon’s cancer service to central London, but it would be good to hear that confirmed by the Minister.

Professor Slevin’s report set out a short-term action plan involving the transfer of the leadership, governance and management of Mount Vernon’s cancer services to an experienced tertiary or leading cancer service provider from London—that apparently is now sorted—as well as the appointment of additional staff and urgent backlog maintenance work to existing clinical facilities. I would welcome clarity from the Minister on the progress made in implementing that short-term action plan. In particular, will he publish the list of urgent backlog maintenance work that Professor Slevin and the rest of the clinical advisory panel noted was essential? Crucially, what progress has been made in tackling that work?

I tabled a written parliamentary question that the Minister answered on 11 February, suggesting that removing asbestos from Mount Vernon would alone cost £12 million, while the answer to another written parliamentary question that I tabled, published on 21 October last year, stated:

“Challenges remain around sourcing capital funding for backlog maintenance and long-term solutions for the service.”

On staffing, will the Minister set out how many additional staff needed to be appointed to the acute oncology service in July last year, when the report was published, and the progress that has been made in tackling those staffing shortages? I understand from the answer that I received on 21 October in response to another written parliamentary question that I tabled that a business case for additional staff in that area was developed and approved. Will the Minister release the business case and confirm how many of the staff positions approved for recruitment have been filled?

The short-term action plan noted that robust implementation of policies concerning admission criteria, daily consultant rounds and patient reviews was necessary, which would require additional medical staffing. Again, it would be good for the number of extra clinicians needed from July last year to be published, and to know what progress has been made in tackling those staffing shortages. The answer to my written parliamentary question suggested that a proposal for an enhanced seven-days-a-week consultant model and robust outreach medical acute oncology service provision had been developed. Was it approved? Can the business case be released, and the House informed of progress on its implementation?

I tabled a further written parliamentary question, which was answered on 10 February. That answer did not give me confidence that enough action was being taken to tackle the immediate critical vacancies. The Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), said in her answer that there was a 25% vacancy rate for nurses at Mount Vernon Cancer Centre, an almost 10% vacancy rate for medical staff, an almost 30% vacancy rate for clinical support staff, and an 8% vacancy gap for scientific, therapeutic and technical staff. Given the seriousness of the findings in Professor Slevin’s report, I am surprised that more progress has not been made in reducing those vacancy rates.

It is the long-term future of Mount Vernon Cancer Centre that most exercises my constituents, and no doubt many others in surrounding areas who depend on its service. The impact of the lack of capital investment is obvious to any visitor or patient. The acid test of the commitment of Ministers to the future of Mount Vernon Cancer Centre is whether they will invest in the new linear accelerators that the service needs. Linear accelerators are fundamental to the delivery of radiotherapy services, but are costly to put in place. Mount Vernon has seven, six of which are due to reach the end of their normal operational lives over the next three years.

Professor Slevin’s report last summer noted the age of the linear accelerators, or LINACs, and an answer to another written parliamentary question on 11 February noted some of the costs of replacing LINACs, particularly if they were being moved to a new site. A day earlier, an answer to another written parliamentary question noted that three of the seven linear accelerators were due to be replaced this year, with three more due in 2022. Will the three linear accelerators due for replacement this year be replaced and, if not, why not?

Professor Slevin’s report noted that the brachytherapy service at Mount Vernon Cancer Centre is nationally recognised, but access to theatres for treatment is “constrained”. What is the long-term plan to sort that issue? The report also noted the desire of East and North Hertfordshire NHS Trust and the Hertfordshire sustainability and transformation partnership to see Mount Vernon Cancer Centre’s services re-provided in fit-for-purpose buildings, replacing the oldest facilities.

Indeed, so old and decrepit are the buildings that leaking roofs have forced “adjustments in service provision”. Nine months on, I ask the Minister whether there are still leaking roofs at Mount Vernon, forcing more of the cancer centre’s services to be moved. There are insufficient rooms for medical staff, specialist nurses, dieticians and speech and language therapists, inadequate electronic systems and poor IT connectivity, slowing the clinical process. There is no direct real-time connection of the X-ray systems between Mount Vernon Cancer Centre and hospitals in its catchment area, undermining the effectiveness of clinical management.

The report stresses that the impact of poor IT infrastructure should not be underestimated. Duplicate paper records, a lack of access to complete scanning images out of hours, and an inability to view a comprehensive patient record lead to clinical risk. In short, doctors cannot access the results of critical CT and MRI scans out of hours. In the short term, according to the answer to a written parliamentary question that I received on 11 February, a plan to digitise patient care records at Mount Vernon is expected to be ready for implementation in May this year. Has the funding been identified to allow that to happen or will it have to wait for a full review of the future of Mount Vernon Cancer Centre to be completed? I hope that it is the former.

Professor Slevin’s report left the exact long-term future for Mount Vernon unresolved. A strategic review of Mount Vernon Cancer Centre to resolve that question is expected to be completed sometime this year, according to the answer given on 11 February to my written parliamentary question. Who will lead that review, what clinical expertise will they have, and how can we be sure that they will see it through to completion? What is the timeline for that review?

Part of the problem for Mount Vernon Cancer Centre is that the Mount Vernon site is owned by Hillingdon Hospitals NHS Foundation Trust, while East Herts NHS Trust runs the cancer service. Add in the confusion regarding which part of NHS England is responsible for owning the future of Mount Vernon, and it is not hard to understand why, despite two concerning Care Quality Commission reports in the past five years, there might have been a lack of NHS focus until now on Mount Vernon’s future.

I understand too that a further transfer of responsibility for Mount Vernon’s future from NHS East of England to NHS London is inevitable when University College London Hospitals NHS Foundation Trust takes over direct responsibility for the cancer centre. Given that, and given the number of Ministers in the Department of Health and Social Care who have answered my questions about Mount Vernon so far—answers for which I am very grateful—it would be good to know who among the Secretary of State’s ministerial team will continue to have immediate and ongoing responsibility for the project. If it is the Minister present today, given his seniority within the Department, I am sure that my constituents and I would welcome that news.

This 117-year-old hospital is not one of the six named for rebuilding or one of the 40 for which a rebuild or upgrade appears to be on the cards over the next five years. Unsurprisingly, I have been asked whether Mount Vernon Cancer Centre is set to close. The omens certainly do not look good, but assuming that that is not Ministers’ intentions, and that central London is not their intention for a move either, that would suggest a local move—to Hillingdon Hospital or Watford General Hospital, where I understand that upgrades have been announced or are planned. Failing those two options, either Northwick Park Hospital or Stevenage, Cambridge or Luton is likely.

My constituents and others deserve to know that the problems of Mount Vernon Cancer Centre are being sorted out. To give confidence to that end, transparency for the local community is essential. Given the seriousness of Mount Vernon’s situation, regular quarterly updates that are easy to understand and that offer a route to track progress are surely not much to ask for all those who use the cancer centre. To make such updates helpful, they should include consistent answers to three fundamental continuing questions. First, what extra staff does Mount Vernon need and what is being done to fill the vacancies? Secondly, will the three linear accelerators due to be replaced this year be replaced? Thirdly, when will a decision be made on Mount Vernon’s future, who will have a say in it, and how can they be influenced? I hope that the Minister will agree to give those updates.

Lastly, it would be remiss of me not to mention the fact that, earlier this week, a clinician at Mount Vernon Cancer Centre was suspected of having coronavirus. I understand that, after testing by Public Health England, the member of staff has fortunately proven to be negative for the virus. Inevitably, that initial concern will have been profoundly worrying for staff and patients. It is a further tribute to the professionalism of the staff at Mount Vernon Cancer Centre that they have maintained care and the high standards for which they have a deserved reputation. I look forward to the Minister’s response.

NHS Funding Bill

Gareth Thomas Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Justin Madders]

I thank the hon. Gentleman for his intervention. I understand his frustration absolutely. I think he has a very fair point, Dame Rosie, that because of the Barnett consequentials there is a role for SNP Members—indeed, all Scottish and Welsh Members—in this debate. Clearly, that is a separate issue to the whole English votes for English laws process, but the fact is clear that on the face of the Bill there are Barnett consequentials, which mean that the devolved nations ought to have a say.

It is really no wonder, given the background I have just set out, that children are reaching a crisis point before getting the support they need, and that the number of children attending accident and emergency for their mental health in a situation of crisis is increasing year on year. That is not inevitable. With real investment, we could reverse the trend of long waits, rationed treatment and inadequate care if we allocated more of the NHS budget to mental health. As we know, mental health illnesses represent 23% of the total disease burden on the NHS, but just 11% of the NHS England budget. That is a long way off the parity of esteem that we all seek to achieve.

We know that the Government plan to put in an extra £2.3 billion a year by 2023-24, but that is not enough. The Institute for Public Policy Research has said that to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average not just next year, but over the next decade. The NHS plans to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that that needs to reach 16.1 billion by 2023-24 alone.

Of course, we support the increased funding for mental health in the Bill, but we know the NHS has to live within the 3.3% uplift provided under the Bill. The Institute for Fiscal Studies, the Health Foundation, NHS providers, the British Medical Association and many of the royal colleges say that health expenditure should rise across the board by 3.4% just to maintain current standards of care. By definition, there will actually be less money for funding in other areas. That means there is a risk of further raids on the mental health budget. In previous years, money allocated to mental health services, particularly children and adolescent mental health services, has been diverted back to hospitals to deal with the crisis there.

Labour would have done what was desperately needed. We would have put in an extra £1.6 billion a year immediately into mental health services, ring-fenced mental health budgets and more than doubled spending on children’s mental health. That is why we are seeking to amend the Bill to ensure mental health services do not lose out because of other financial pressures in the system. We are calling on the Government to ensure that guarantees for mental health funding are protected by ring-fencing mental health funding. We also seek to require the Secretary of State to come to the House annually to report on the amounts and proportion of funding allocated to mental health services, and on their plans to achieve parity of esteem for mental health services.

On the Labour Benches we are not convinced that mental health is a priority for this Government, despite what they say. They may want to position themselves as the party of the NHS, but as long as they continue to neglect mental health and push services deeper into crisis, they will not come near that aim. We intend to push amendment 2 to a Division, because we want to hold the Government to account. We want transparency on mental health spending and we want a clear road map from the Secretary of State on how he intends to make parity of esteem a reality.

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

I wonder if I could raise with my hon. Friend an example that I think makes his point, which is the state of NHS finances in north-west London, in particular of the acute hospital that serves my constituents, Northwick Park Hospital, and the clinical commissioning group. Both the trust and the CCG are over £30 million in deficit. As a result, they have cut back on community mental health services and, indeed, on a range of other things. Unless there is parity of esteem and unless there is a significantly higher funding boost for the NHS in north-west London than that currently being suggested by the Conservative party, I fear that mental health services, as he so rightly says, are likely to be cut even further.

[Justin Madders]

My hon. Friend sets out very clearly the challenge that the Government face from the debt situation in the NHS. Both in-year deficits and total debt to Government have not been addressed adequately or taken into account in the Bill and that is clearly of huge concern.

Amendment 5 deals with patient safety, which should be front and centre in the NHS. When things go wrong, as they sadly do from time to time, it can have tragic consequences for patients and their loved ones. When three in four baby deaths and injuries are preventable with different care, it seems particularly tragic when things go wrong during birth, leaving families devastated by the loss of a child or having to cope with the long-term impact. There have been many things over the years that I have disagreed with the previous Secretary of State—the right hon. Member for South West Surrey (Jeremy Hunt)—about, but on Second Reading he raised the important issue of maternity safety training, calling on the current Health Secretary to reinstate the maternity safety fund. We absolutely agree with him on that, which is why we have tabled amendment 5.

Improved maternal health is one of four priority areas in the long-term plan for care quality and improved outcomes, and it includes action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by the middle of the decade. As a party, we have pledged to legislate for safe staffing and to increase funding for NHS staff training, including reinstating the maternity training fund to help to improve maternity safety in our hospitals. The leaked interim report of the Ockenden review last year exposed widespread failures in maternity care at Shrewsbury and Telford hospital trusts and demonstrated, sadly, that Morecambe Bay was not a one-off.

An evaluation of maternity safety training from 2016 found that it had made a difference and improved patient safety, yet it was still axed. Just two years later, the “Mind the Gap” report found that fewer than 8% of trusts were providing all training elements and care needs in the “Saving Babies’ Lives” bundle and called for the maternity safety training fund to be immediately reinstated to address, as it said, the

“clear…inadequate funding for training”.

Given the clear evidence of the need for the training fund’s reinstatement, I very much regret that it is not within the scope of the Bill for us to submit an amendment to include its reinstatement. However, with the amendment we seek to put a greater spotlight on the issue, and hopefully, that will require the Government to set out how much they are spending on improving maternity safety and care for mothers and babies each year in order for them to demonstrate their commitment to improving maternity and foetal safety. I believe that that will enable us to judge and evaluate their commitment to those aims.

--- Later in debate ---

[Gareth Thomas]

In support of the case that my hon. Friend is making, I again mention Northwick Park Hospital, which serves my constituents. It has a huge maintenance backlog. Since the cancellation of the Government’s “Shaping a Healthier Future” NHS reform plan for north-west London in June last year—that programme of reform had been going on for seven years —there has also been no replacement money identified for investment in intensive treatment beds, an extra 30 of which are needed to help to tackle some of the problems in A&E at Northwick Park Hospital.

[Justin Madders]

My hon. Friend is again showing what an assiduous and determined constituency MP he is. He might want to look at the NHS providers’ report today, which sets out some of the challenges from the lack of a long-term capital investment programme. As we have heard, including from him and in relation to other various examples around the country, this is not just about a lick of paint, but about really vital work that impacts on patient care.

--- Later in debate ---

[Justin Madders]

Across the piece, some areas in Wales are actually performing better than areas in England. The direction of travel is the right one. If the right hon. Member is so interested in the performance in Wales, he should stand for the Welsh Assembly; he will have the opportunity to do so in the not-too-distant future. I am sure he was aware when he stood for this place that health was a devolved issue.

[Gareth Thomas]

I want to raise again the example of Northwick Park Hospital, which serves my constituents. It has not met the four-hour A&E target since August 2015. One of the latest issues responsible for the increasing pressure on waiting times at Northwick Park is the closure of our walk-in services, which were one of the great reforms of the previous Labour Government. Alexandra Avenue, which served my constituency, closed in November 2018, and Belmont health centre, which served the constituency of Harrow East, closed in November 2019. The last walk-in service in the London Borough of Harrow, the Pinn medical centre, which currently is in the constituency of the hon. Member for Ruislip, Northwood and Pinner (David Simmonds), is also due to close, and yet it is increasingly difficult to get an answer to a request for a meeting to discuss that closure with Ministers or the chief executive of NHS England.

[Justin Madders]

There has to be a correlation between the number of closures my hon. Friend is seeing and his CCG’s debts, which he was referring to earlier. The pressure on frontline services is making these decisions, which it is more and more likely can only impact on performance. I hope that when the Minister responds he will be able to give him the satisfaction of at least a meeting to discuss the issue further.

The funding in the Bill is insufficient to reverse the decline in recent years, let alone deliver the aspirations set out in the long-term plan. It is not just the opinion of Her Majesty’s Opposition that the performance targets cannot be met; NHS England has also made it clear that the core treatment targets cannot be met because of the funding settlement imposed by the Government. And who loses out month after month when performance targets are missed? It is patients. Whether for pre-planned surgery, cancer treatment, diagnostic tests or emergency care, our constituents are waiting longer and longer, often in pain and distress, to access the health services they need. The figures do not lie.

We must remember that the figures are also real people. They are real people stuck on waiting lists: the total number of people on waiting lists in England is now 4.41 million, which is the highest since records began, and up from 4.1 million, when the right hon. Member for West Suffolk first became the Secretary of State. They are real people waiting for treatment: the target to treat 92% of patients within 18 weeks has not been met for four years—not since February 2016—and obviously has never been met by the current Secretary of State. They are real people waiting for cancer treatment: the Prime Minister himself agreed last month that it was unacceptable that the target for treating cancer patients within 62 days of urgent GP referrals had not been met for five years. That is five years of failure. They are people waiting on hospital trolleys: the number of people waiting four hours or more on hospital trolleys reached 98,452 last December, which is not only a 65% increase on the same point the previous year, but the highest on record.

As we heard on Second Reading, the failure to meet these targets has real consequences. Research from the Royal College of Emergency Medicine shows that almost 5,000 patients have died in the past three years because they spent so long on a trolley waiting for a bed in an overcrowded hospital. As we have said several times during our consideration of the Bill, the true increase in funding is about 4.1%—I will not list again all the bodies that agree with that figure—yet the money in the Bill will not be enough.

This is all before last week’s news about the Chancellor looking for 5% savings in all Departments, including this one. That might not affect the figures in the Bill, but there might be cuts across the wider Department that do have a knock-on impact on service delivery. Let us take a look at A&E. There is increased demand on our A&E services, for many reasons, including the years of cuts to social care, but that is not covered in the Bill. Will the 5% cut come from there—if it does, more and more people will be forced into A&E by a collapsing social care system—or from public health, as we have heard previously, which would inevitably store up problems in the short and longer term?

None of this can be said to be likely to have no impact on performance targets, which for too long have been treated as a poor relation by this Government. The Government have widely ignored them, to the extent that they are spending more time dreaming up ways to get rid of them than to meet them. We say that patients deserve better. We will push the new clause to a vote, because we believe it is clear that the Secretary of State will not be able to drive down waiting lists or drive up performance with the level of health expenditure that he proposes to enshrine in law.

Rather than presenting the Bill as a panacea, let us ensure that the Secretary of State and the Prime Minister are held to account for the promises that they make, and that the Secretary of State comes to this place every year to tell us whether, in the Government’s opinion, the funding allocated for that year will be sufficient to meet those performance targets. If it is not, the Government must set out what they are going to do about it. It is simply not good enough to continue, year after year, to have a Government who treat the targets as an inconvenience. If those standards are to mean anything to patients, and if the Government are serious about persuading us that they mean something to them as well, they will have to come here every single year and tell us, unambiguously and with reference to the funding package for this year, how they intend to meet those targets.

--- Later in debate ---

[Edward Argar]

My hon. Friend is a sound and vocal champion for her constituents in Stafford. I am sure that she will continue to champion their cause, and I am happy to meet her to discuss the specific issue she raised.

I turn to amendment 3, in respect of capital-to-revenue transfers. Clause 1(2) ensures that the funding specified in the Bill can only be used for NHSE revenue spending, meaning that day-to-day spending for the NHS is protected. As we have highlighted in the House previously, the Government have made a range of capital commitments to the NHS, including the commitment to 40 new hospitals. Nevertheless, going to the point in the amendment itself, we have been clear that the transfers from capital revenue should have only been seen as short-term measures that were rightly being phased out, and we are doing so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, did, however, set out why a degree of flexibility is required, and we would not believe that a blanket ban set in legislation was the right approach.

[Gareth Thomas]

Will the Minister give way?

[Edward Argar]

I will not, if the hon. Gentleman will forgive me, as I only have 10 minutes or so left.

There are sometimes very good and logical reasons why adjustments between capital and revenue are needed. As the former Secretary of State highlighted, in some cases, for perfectly good reasons a capital pot may not be spent fully within a year and there is an opportunity to achieve patient good from transferring it. While I take his point and believe it is right that we should continue to move away from such transfers, I would not wish to see that rigidly set in legislation.

Amendments 2 and 1, and new clauses 1, 2, 3 and 9, relate to mental health services both for children and adults, and accountability to Parliament and reporting mechanisms. We have rightly seen considerable interest in mental health in this debate, so I will seek to address both those points together. I begin by paying tribute to Paul Farmer of Mind, Sir Simon Wessely, Professor Louis Appleby, the Mental Health Foundation, Rethink Mental Illness, YoungMinds, the Royal College of Psychiatrists, and a host of other individuals and organisations up and down the country, for their fantastic work in making mental health such a feature in our debates and in the public consciousness. It is absolutely right that they have done so.

I pay tribute to the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), and her predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who brought to the role of mental health Minister passion, dedication and a determination to make a difference. I should also reference some former Members of this House: Norman Lamb, who did so much in this area; the former Prime Minister, David Cameron; and of course my right hon. Friends the Members for South West Surrey and for Maidenhead (Mrs May), who ensured that it was front and centre of this Government’s commitment.

I want to be totally clear that the Government are fully committed to transforming mental health services. That is why we enshrined in law our commitment to achieving parity of esteem for mental health in the Health and Social Care Act 2012. As my right hon. Friend the Member for South West Surrey said, that is driving real change on the ground. We have also committed to reforming the Mental Health Act 1983 to provide modernised legislation. I would also highlight that at £12.5 billion in 2018-19, spending on mental health services is at its highest ever level.

We have made huge strides in moving towards parity, but there is still so much more to do. We are ensuring, through the NHS long-term plan, that spending on mental health services will increase by an additional £2.3 billion by 2023-24. This historic level of investment in mental health is ensuring that we can drive forward one of the most ambitious reform programmes in Europe. It will ensure that hundreds of thousands of additional people get access to the services they need in the lifetime of the plan. I flag that up because we can and will always strive to do more, and it is right that we are always pressed by this House to do so. While proposals for a ring fence in mental health spending are understandable, the approach that this Government have already set out, with long-term commitments to funding, is already driving the results we wish to see.

I now turn to new clause 9, tabled by my hon. Friend the Member for Newton Abbot (Anne Marie Morris). If I may, I will also address new clause 2 in this context because there is a degree of overlap. I welcome my hon. Friend’s new clause. Although I hope that, as she indicated, she will not press it to a vote—and I heard what the hon. Member for Twickenham (Munira Wilson) said in respect of hers—the sentiment behind it is a good one, particularly the focus on outcomes and outputs rather than simply inputs and the amount of money going in, and on adopting a holistic approach. I know that my hon. Friend the Member for Newton Abbot recently met the Secretary of State to discuss the matter, and I am happy to meet both her and the hon. Member for Twickenham. While we do not believe it is the right approach to set additional reporting mechanisms in legislation over and above the different reports that NHS England and the Secretary of State already make to Parliament, which offer opportunities for debate, we are happy to consider whether, within the existing reporting mechanisms, there is a way to better convey to the House and the public more widely the progress we are making against those targets.

The NHS long-term plan represents the largest expansion of mental health services in a generation, renewing our commitment to increase investment faster than the overall NHS budget in each of the next five years. Not only will spending on mental health services increase faster than the overall NHS budget as a proportion, but spending on CAMHS will increase at an even faster rate. The hon. Member for Twickenham was right to highlight the importance of CAMHS. In our surgeries, we have all had constituents come to see us who are deeply worried and concerned about the mental health and welfare of their children, be that in relation to eating disorders, which I focused on when I came to this place, or a range of other factors. We are committed to delivering the NHS long-term plan to transform children and young people’s mental health services, with an additional 345,000 children and young people being able to access those services.

While we are deeply sympathetic to the spirit behind the amendments on mental health spending, we do not believe that putting a ring fence into the Bill is the appropriate way forward, given the work already being done, the money already being spent and the outcomes already being delivered. We believe that the reporting requirements are already extensive and varied. They already give the public and Parliament the opportunity to scrutinise the work of the Department and NHS England. We are happy to look at ways in which those reports might be more accessible and include different metrics, but we believe it would be wrong to legislate on them at this point.

As I said on Second Reading, this is a simple Bill. It has two clauses, of which one is substantive. It has a single, simple aim: to enshrine the funding settlement behind the NHS long-term plan in law. It delivers the funding that the NHS said it needed and wanted, and it delivers on this Government’s pledge to do so within three months of the election. In the light of that, while the amendments are clearly well intentioned and we appreciate the spirit behind them, they are unnecessary additions to the Bill, and I urge their proposers not to press them to a vote. I appreciate that Members have indicated their intention to press some amendments to a vote, I urge them, in the short period remaining before Committee ends, to reflect a little longer on whether they might reconsider and not move their amendments to a vote.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 29th October 2019 Commons Chamber

[Mr Speaker]

Order. We are running late, but I will take a one-sentence question from Gareth Thomas.

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

The three walk-in centres that provide a seven-day-a-week service in my constituency are closed or closing. Why?

[Ms Dorries]

I did not hear the hon. Gentleman’s question in full, but I would be happy to meet him afterwards to talk about the matter in more detail.

The National Health Service

Gareth Thomas Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

Absolutely. There appear to be blockages in the system, however, and my offer to the Secretary of State is this: if those blockages are there because of legislative or regulatory issues that need resolving in this House, I will co-operate with him to get those resolved. If it is not about regulatory issues in this House, I will continue to reinforce the issues that the right hon. Gentleman is putting to him and urge him to intervene using his good offices.

Many vulnerable people are waiting longer for treatment or being denied treatment, sometimes, sadly, with devasting and tragic consequences. The standards of care enshrined in the NHS constitution are simply not being delivered. A&E waits in September were the worst they have been outside of winter since 2010. Our hospitals have just been through a summer crisis, and with flu outbreaks in Australia expected to hit us here, our NHS is bracing itself for a winter of enormous strain yet again.

Last year, 2.9 million people waited beyond four hours in A&E. Since 2010, over 15,000 beds have been cut from the NHS and bed occupancy levels have risen to 98% under this Government. The number of patients moved from cubicles to corridors and left languishing on trolleys has ballooned under this Government. When Labour left office, around 62,000 patients were designated as trolley waits, which was unacceptable, but today under this Government that number is 629,000.

What about cancer?

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

Before my hon. Friend moves on from the situation in A&E departments, can I bring to his attention the situation at Northwick Park Hospital, which serves my constituents? The last time it met the four-hour target was in August 2014 —over five years ago now. Does he have any sense that the Government are still committed to that four-hour target, or will it be another five years before my constituents can expect that target to be met in our hospital?

[Jonathan Ashworth]

My hon. Friend makes a very good point. The targets were routinely met under the last Labour Government—and they were stricter targets as well.

The Secretary of State looked surprised when I mentioned cancer, but he should not be, because we have the worst waiting times on record under this Secretary of State. Every single measure of performance is worse than last year. Shamefully, 34,200 patients are waiting longer than two months for cancer treatment. What about the waiting lists for consultant-led treatment? We now have 4.4 million people waiting for treatment—an ever-growing list of our constituents waiting longer for knee replacements, hip replacements, valve operations or cataract removals. Clinical commissioning groups are rationing more and trusts delaying surgery, which is leaving patients in pain and distress.

--- Later in debate ---

[Matt Hancock]

Yes, I am trying to take as many interventions as is reasonable. I feel as though I have been sitting down for most of the half hour that I have technically been speaking for—

[Gareth Thomas]

rose—

[Matt Hancock]

Hold on, I have not even answered the previous intervention. The truth is that the NHS has proposed measures that will make it easier to run the NHS, to reduce bureaucracy and to change the procurement rules that we discussed. Ultimately, these responses—there have been nearly 190,000 responses to the consultation—have the support of the royal colleges, the Local Government Association and the unions. They have all supported these legislative proposals, and we are working on the detailed plans. They do change some of the measures put forward in the Health and Social Care Act 2012. We will make sure we cut out that red tape and bureaucracy, streamline the procurement, support integration and make sure that the record investment we are putting in gets as much as possible to the frontline. They also help us with recruitment, and I can announce to the House the latest figures for GP recruitment, a matter that I know is of interest to lots of colleagues. Building on the record numbers in training last year, this year we have 3,530 GPs in training, which is the highest number in history. That is all part of our long-term plan.

The measures in the long-term plan Bill would also strengthen our approach to capital. We have discussed the 40 new hospitals in the health infrastructure plan, but I can also tell the House that the plan will not contain a single penny of funding by PFI—we have cancelled that. I have been doing a little research into the history and I want to let the House into a little secret that I have discovered. Who was working in Downing Street driving through Gordon Brown’s doomed PFI schemes, which have hampered hospitals for decades? I am talking about the PFI schemes that led to a £300 cost to change a lightbulb and that have meant millions being spent on debt, not on the frontline. Who was it, tucked away at the Treasury, hamstringing the hospitals? It was the hon. Member for Leicester South. So when we hear about privatisation in the NHS, we have culprit No. 1 sitting opposite us, who wasted all that money. We are cancelling PFI, and we are funding the new hospitals properly.

Baby Loss Awareness Week

Gareth Thomas Excerpts

Tuesday 8th October 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is right, and so much of what the Government have been working on in recent years is about making sure we have the right facilities, skills and knowledge right across our NHS estate.

Let me reiterate what I mentioned a moment ago, which is that we have seen a 21% reduction in stillbirths two years ahead of our ambitious plans. Of course every stillbirth is a tragedy, but I am sure the House will want to join me in paying tribute to midwives, obstetricians and other members of multi-disciplinary maternity and neonatal teams across the NHS for embracing the maternity safety ambition that we set, and for their incredible hard work in achieving this milestone two years ahead of target—that is remarkable. However, there is no room for any complacency, because there is so much more to do.

Many Members will be aware that the neonatal mortality rate in 2017 was only 4.6% lower than it was in 2010, and that headline figure hides the fact that the ONS data show that the number of live births at very low gestational ages, most of whom die soon after birth, increased significantly between 2014 and 2017. In fact, the neonatal mortality rate in babies born at term—that is, after at least 37 weeks’ gestation—decreased by 19% and the stillbirth rate in term babies decreased by 31.6% between 2010 and 2018. The pre-term birth rate remains 8%. Clearly, the achievement of our ambition depends significantly on reducing those pre-term births.

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

I apologise to the Minister and to the House for missing the early part of her remarks. On the statistics she has just commented on, is it not the case that we are going backwards in our progress on neonatal deaths? Is it not also true that there is a marked difference in more socially deprived areas since 2014? Does that not suggest that significantly more investment in this policy area is needed urgently, particularly in those areas where social deprivation is most stark?

[Caroline Dinenage]

The hon. Gentleman is right. We are still going forwards, although nowhere near as quickly as we would want to be going, but there have been some backward steps along the way. A lot of the changes that we have introduced have not yet had the opportunity to take full effect, and I am hopeful that as we move forward we will begin to see neonatal death rates reduce. As I just mentioned, when babies are born at or close to full term, the rate has dropped significantly. It is pre-term births that are causing a lot of concern for us, which is why we are putting continued effort into this issue.

In the long-term plan that was published in January, the NHS committed to accelerate action to achieve the national maternity safety ambition. Maternity services will be supported to implement fully an expanded “Saving Babies’ Lives” care bundle across every maternity unit in England by 2020. The development of specialist pre-term birth clinics will be encouraged in England, which should help very much.

NHS England and NHS Improvement will continue to work with midwives, mothers and families to implement the continuity of carer model, so that by March 2021 most women will have a named individual caring for them during pregnancy and birth and postnatally. That will help to reduce pre-term births, hospital admissions and the need for intervention during labour. It will also improve women’s experience of care.

Let me return to bereavement care. Members will be aware that for three years the Department of Health and Social Care has provided funding to the charity Sands for it to work collaboratively with other baby loss charities and the NHS to develop and pilot the roll-out of a standardised national bereavement care pathway for parents who have experienced baby loss, whether through miscarriage, termination after receiving a diagnosis of foetal abnormality, stillbirth, neonatal death or, indeed, sudden infant death. The pathway sets out nine standards for good bereavement care and has so far been adopted by 40 trusts. I hope that many more will follow.

--- Later in debate ---

[Patricia Gibson]

I thank the hon. Lady for her intervention. That is the kind of support we need to put in place, and I am about to talk about wraparound care.

We know that bereaved parents are more likely to develop depression and other mental health issues, perhaps turning to drink or other forms of self-medication, because we know that those who experience stillbirth or baby loss are at a higher risk of mental health challenges. Given what we know, there is really no excuse not to have measures in place in this awful eventuality for those affected by baby loss. The aftermath of baby loss is no more or less traumatic for those affected than living through the immediate experience and the years following it.

[Gareth Thomas]

I thank the hon. Lady for giving way. She is making a powerful speech, and I strongly support her call for better access to mental health support. I think of the difference that the four-hour target made to quality of care and access to accident and emergency doctors and nurses where needed, and I wonder whether we need a similar target in place, to ensure that trusts and the NHS in general can be accountable for whether access to mental health support is given quickly enough to people who are bereaved in these circumstances.

[Patricia Gibson]

I thank the hon. Gentleman for his intervention. The point I am trying to make is that because we know that these mental health challenges very often arise following baby loss, there is no reason why the infrastructure should not be in place for when these issues arise. Sometimes the demand is immediate, and sometimes it is months or years after. Sometimes people will choose not to call on these services, but the infrastructure needs to be there to ensure that people have access to it in a timely fashion.

Someone pointed out to me today a comment on social media from a chap who spoke about “awareness day fatigue”, but he also acknowledged the importance of those with lived experience feeling able and willing to speak about their experience of baby loss, because this can encourage others to talk of their own loss and perhaps seek the support and help they need. We with lived experience who choose to talk about it can also prevent others from going through the awful experience we had by raising that awareness, to stop other people joining the terrible club of which no one would ever wish to be a member.

Raising awareness is very important. It is not and must not ever become some trite stock phrase, although it may sometimes sound so. It is important because every day I wish to God that I had had some more awareness of pre-eclampsia and HELLP syndrome. I may then have been in a better position—I am sure many mothers would say the same—to articulate what was happening to me, instead of being told by the Southern General Hospital that I was wasting their time when I turned up on the day I was due to deliver my baby and that the terrible pain I was in was normal. What did I expect? It wasn’t labour—go home and lie down. Could I not see they were busy? Had I known more about pre-eclampsia, I would have been able to ask to be checked specifically for that condition, because I was not tested for it. I would have been more assertive, instead of being made to feel like an hysterical older expectant mother.

Raising awareness really does matter. Information matters because it can make a difference between life and death. We know that, too often, mothers are not listened to. Raising awareness cannot be seen as a trite phrase or a box-ticking exercise, and I know that many who have lived with the loss of their baby would say exactly the same.

The chap commenting on these matters on social media is right to say that the lack of mental health support must be addressed. We cannot be discharging mums to send them home to their partners and families and leave them to get on with it. They must have the mental health support they need to help them navigate as best they can the biggest loss and the most appalling experience it is possible for them to have.

We have, over the years, come a distance in the realms of baby loss. We have, with some success, shone a light on it and worked to remove the taboo, but we still need to do more to ensure that the isolation of grief does not swallow up those affected by this loss, which goes against everything that nature would suggest. We need to continue to work to break down the isolation, and we can do that with the proper mental health support to help those affected to find their way back to some semblance of normality and find a path through their fog of grief, so that they can rebuild their lives, albeit around the loss that they have suffered.

It is shocking to learn that the majority of bereaved parents who need help cannot access it in an appropriate place and at an appropriate time. This is because perinatal mental health services are focused on women who are pregnant or have a live baby. Last week in the debate on women’s mental health, many of us spoke about new mums needing mental health support—and that is true: they do—but this need not mean and must not mean that those mums whose babies have died are forgotten. They must not be forgotten; they must be given the support they need because we know that they are at risk of developing mental health challenges. We need to do more to ensure that the mental health infrastructure they need is in place to support them. Women who have experienced stillbirth, miscarriage or ectopic pregnancy are at a higher risk of post-traumatic stress disorder, anxiety and depression than those who have not. They also display clinically significant levels of post-traumatic stress symptoms from five to 18 years after stillbirth.

As I was reading some of the testimony from the Lullaby Trust in preparation for this debate, from women who had suffered stillbirth and described walking out of the hospital with no further contact about the support they might need, I recognised that because that, too, was my experience. I did not feel able to discuss my experience or participate in counselling, but that was just as well because it was never offered. In my case, the hospital was trying to dodge questions and withhold information about how my baby died.

In response to the point made by the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, the demand for coroners’ inquests—or, in Scotland, fatal accident inquiries—into stillbirths, where they are deemed to be in the public interest, has risen only because of hospital trusts and health boards pulling down the shutters when things go wrong. That is where that demand comes from, and that has to stop: it has to change. Parents do not want to consult a lawyer when their baby dies; they just want to know what went wrong and how it can be avoided. That is something health boards and health trusts really need to do more to get their head around.

I am pleased that in Scotland there has been new investment in perinatal mental health to ensure that there is support for bereaved parents prior to discharge and that there is appropriate signposting to third sector services that can provide bereavement and other mental health support. We can no longer turn a blind eye to or overlook those who fall through the gaps in our health system. There must be psychological support for those affected by the death of a baby if they need it.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

Absolutely. We will continue with the emphasis on work being good for people’s health. We need to look at what we can do to make it easier for employers to help their employees, which is good for everybody—it means that everyone can still make an economic contribution, and that we retain the existing workforce, and it is good for people’s wellbeing. We absolutely will look at what we can do to incentivise best practice.

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

It is difficult to see how lives will be improved and people supported to stay in work by NHS England’s decision, supported by Ministers, to encourage CCGs to phase out their walk-in centres—I am thinking, in particular, of the three walk-in centres that serve my constituents. I urge Ministers, even at this late stage, to set aside new funding streams so that Alexandra Avenue, the Pinn and Belmont Health Centre can continue to provide a 365-day, 8 am to 8 pm walk-in service to my constituents.

[Jackie Doyle-Price]

I do not share the hon. Gentleman’s view on this. Clearly, it is important for CCGs to have the freedom to determine their best primary care arrangements. Walk-in centres are convenient for people who are in work and who perhaps work away from home, but ultimately, we keep people with disabilities in work by having bespoke support for them, and that is better organised by having good primary care services near the home.

NHS: North-West London

Gareth Thomas Excerpts

Wednesday 24th April 2019 Westminster Hall

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

Six months ago, at the beginning of November, the walk-in centre at Alexandra Avenue in my constituency closed its doors for the last time. If there was ever a much-loved and vital service that told the story of the NHS funding crisis in north-west London, it was Alexandra Avenue. Its opening 10 years ago was strongly opposed by the Harrow West Conservative party and its then parliamentary candidate. She and the Harrow West Conservatives were not immediately successful in getting it closed, but in 2013 it was closed during weekdays; it was kept open at weekends, although only as a result of local campaigning. In November, the Conservatives finally got their way: a service that, at its height, provided a valuable walk-in service from 8 am to 8 pm, 365 days a year, to 40,000 people in my constituency and the surrounding constituencies, finally shut its doors.

Bluntly, the centre’s closure was a result of the clinical commissioning group’s lack of funding. The CCG has been put into special measures because its forecast deficit is £40 million, according to a written answer that I received in February from the then Minister, the hon. Member for Winchester (Steve Brine). Not surprisingly, it is under pressure to make a huge range of cuts, so not only is there no prospect that the Alexandra Avenue walk-in centre will be reopened, but other walk-in centres that serve Harrow are vulnerable to the threat of closure at a moment’s notice.

Nor is it surprising that the situation has had an impact on Northwick Park Hospital, which serves my constituency. It has not met the A&E waiting target for some considerable time: over the past five years, 25% of patients in A&E have not been seen within four hours, which gives a further indication of the decline in quality across the national health service in north-west London.

I am grateful to my hon. Friend the Member for Hammersmith (Andy Slaughter) for securing this debate and allowing me to ask the Minister a number of questions. When will the north-west London NHS be properly funded? When will there be an end to the sorry tale of the clinical commissioning group always finding itself in deficit? It is not that it cannot manage its books. It has had excellent chairs and an excellent board; I pay tribute to the outgoing chair, Dr Amol Kelshiker, and the new chair, Dr Genevieve Small, for their willingness and commitment, but they deserve to know that their CCG will be properly funded.

When will Northwick Park Hospital no longer have to face inadequate funding, like the other hospitals in the trust? When will those hospitals get the support that they need to get the consultants and nurses in place to meet their A&E targets? My hon. Friend mentioned the closure of Central Middlesex Hospital’s A&E service, which has had a huge impact on services in north-west London, including the services at Northwick Park Hospital that my constituents depend on. Frankly, it should be reopened, because we need that acute capacity. It would be good to hear whether the Minister could ever foresee such a scenario.

It is now clear that cancer waiting times are also under pressure in our community. For the first time, the maximum two-week wait for a first consultant appointment after an urgent GP referral is not being met, according to the latest data on our area.

Harrow clinical commissioning group needs to be properly funded, funding for the NHS in north-west London needs to be significantly increased, and—in my view—England’s national health service needs a dedicated national fund for walk-in services in communities, such as my own, in which there is strong evidence of demand. I look forward to some positive reassurance from the Minister that the Conservative party has changed its attitude to walk-in services such as those at Alexandra Avenue in Rayners Lane.

Baby Loss Awareness Week

Gareth Thomas Excerpts

Tuesday 9th October 2018 Commons Chamber

[Antoinette Sandbach]

I know that across the House there is a great interest in the need for coroners’ investigations, and I believe that the hon. Member for East Worthing and Shoreham (Tim Loughton) will be introducing a private Member’s Bill. I think that the idea has support from the Government. It is incredibly important for parents to give consent to post-mortems—that can be a very sensitive area, particularly for parents from ethnic minority backgrounds—because very often, medical findings assist with the research to discover the causes of stillbirth and neonatal death. The hon. Lady makes a very good point.

In closing, I hope that colleagues will recognise that this year has been one of significant policy wins.

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

I echo the point that my hon. Friend the Member for Nottingham South (Lilian Greenwood) made by commending the hon. Member for Eddisbury (Antoinette Sandbach) on her joint leadership of the all-party group on baby loss and her support for the charities that have come together once again to initiate Baby Loss Awareness Week. Will she praise the intervention of a councillor in my constituency, Sarah Butterworth, and her husband Jon, whose baby, Tiger Lily, was stillborn in June 2005? They have joined in the support for Baby Loss Awareness Week to encourage more debate about this sensitive issue.

[Antoinette Sandbach]

I certainly join the hon. Gentleman in praising his constituents’ work in memory of Tiger Lily. Let me also refer to the story of Fiona Crack and her daughter Willow. Fiona went to speak to the hon. Gentleman’s constituents, and there is a detailed account on the BBC’s website, highlighting the way in which they have turned a negative into a positive in commemorating the memory of Tiger Lily and the steps that they are taking to help other parents in their grief. I believe that they help with the memory boxes; I have a memory box at home, and I know how valuable that is.

I think that there has been a real uptick and a real positive story to tell this year, given the policy wins that have come from the Government. We know that we must address these challenges, but we have come a huge way in the last three years, and we have won important changes in policy.

Members may be wondering what they can do to drive the changes that we need. First and foremost, they can join me in encouraging the Minister to fully fund the national bereavement care pathway into 2019-20, so that it is embedded and becomes the national standard for best practice. I hope that the Minister will have something to say about that when he winds up the debate. Secondly, Members on both sides of the House can engage with their local charities who help those who have lost a child, as, indeed, many of their constituents have. I know that many Members are present because of the work that their constituents have done, or because of their own experiences.

Members can also help to promote the national bereavement care pathway in their constituencies. We have seen from the pilot that it works, but political support and public awareness are crucial to ensuring that it is embedded throughout the UK. If Members leave this debate with one thing in their minds, let it be the testimony of a grieving parent who experienced the pathway:

“I was shocked at the level of care. I thought ‘this is the NHS, why are they making such an effort for me?’ I didn’t know care like this existed and I was blown away by it—my expectations were exceeded in every way”.

We have all benefited from amazing care from our NHS, but sometimes it does not have all the tools that it needs. The national bereavement care pathway gives it the tools that it needs to deal with this very difficult issue, and we must work to ensure that it is put in place throughout the country.

NHS Outsourcing and Privatisation

Gareth Thomas Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move,

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care Committee: written submissions received by Ministers since 8 June 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister’s Office.

In six weeks’ time, we will celebrate the 70th anniversary of the national health service, a great civilising moment for the nation, which the Secretary of State’s predecessor, Nye Bevan, described in the House on Second Reading of the National Health Service Bill. He said of the creation of the NHS that

“it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]

They are certainly stirring and inspirational words, but as we approach the celebrations and the 70th anniversary of the NHS, we see a service in crisis, underfunded and understaffed, and patient care is suffering.

After eight years of the biggest financial squeeze in its history, and at a time when England’s population has increased by 4 million, when the falling real value of tariff payments for hospital care means that trusts now lose 5% of costs for every treatment, and when the Government have refused time and again to give the NHS the funding required, we see patients suffering every day in our constituencies. That is why we have just suffered the worst winter in the history of the NHS, when our hospitals were overcrowded and our A&E departments were logjammed. The number of hospitals operating at the highest emergency alert level—the OPEL 4 level—was nearly double what it was the year before, which itself was branded a humanitarian crisis.

In the first week of January 2018, there was a point when 133 out of 137 hospital trusts in England had an unsafe number of patients on their wards. Sixty-eight senior accident and emergency doctors wrote in January to the Prime Minister raising

“the very serious concerns we have for the safety of our patients.”

In response, we had a blanket cancellation of elective operations and cancellations of more than 1,000 emergency operations, causing misery for patients and financial difficulties for trusts already in deficit.

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

My hon. Friend should also be aware that many walk-in centres have closed. In my constituency, the superb Alexandra Avenue centre has had a 20,000 cap imposed on the number of patients it can see. This service is run by popular GPs, but it faces the risk of being outsourced, to a Virgin healthcare or someone else. It originally served 40,000 patients, and many of my constituents are genuinely worried for its future.

NHS Sustainability and Transformation Plans

Gareth Thomas Excerpts

Wednesday 14th September 2016 Commons Chamber

[Mr Dunne]

I am going to make some progress.

I turn now to the timetable and the progress that has been made so far. Each area was asked to work together over the first six months to draw up its initial thinking into a first draft plan by the end of June. Those plans were individually reviewed by senior leaders from NHS England and NHS Improvement during July and August. Each area is now in the process of developing its STP, with a view to submitting a worked-up plan to NHS England in October. The plans, as one would expect, will vary in their proposals, but all are expected to demonstrate a shared understanding of where an area is in relation to the three challenges set out in the five year forward view and where they need to be by 2020-21.

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

I am grateful to the Minister for giving way. He was very generous the last time I had an opportunity to intervene on him.

Part of the concern in my constituency about the north-west London STP relates to the fact that Harrow receives less NHS funding per patient than any other part of London. For some months we have sought a meeting with a Health Minister to discuss that issue. Is the Minister prepared to receive a delegation from our clinical commissioning group?

[Mr Dunne]

I am grateful to the hon. Gentleman for his kind words about my willingness to take interventions from both sides of the House.

I am interested that the hon. Gentleman should mention funding allocations. Across the NHS, the allocations are a legacy of the formulas that were set in place by the Labour Government, of which he was a member. People across the country, not least in rural areas such as Shropshire, cannot understand why the funding per capita is much less generous in some parts of the country than in others. I am taking an interest in that and would be willing to sit down with him and other colleagues to understand the particular circumstances in north-west London, which we will have to do after the coming recess.

Returning to the progress that is being made, all the plans are expected to present an overall strategy for their area and to identify the top three to five priorities required. In the most advanced plans, we are also expecting areas to set out how they will deliver a number of national priorities, including on mental health and diabetes. Some will build on the early work of vanguard or Success Regime joint working, which has been developing better co-ordinated care models over the past year or so.