Cities and Local Government Devolution [Lords] Bill

Gareth Thomas Excerpts

Wednesday 21st October 2015 Commons Chamber

I am making the radical, earth-shattering, civilisation-ending suggestion that what the Scots did could work for England and that the English people are just as capable of benefiting from such a system as the Scottish people are already. We could assign a chunk of income tax, not directly to every individual local authority, because that would become a nightmare, but, in essence, to the equivalent of the Scottish Government, which would be the Department for Communities and Local Government. That chunk would go to the DCLG as a block of, say, 10p in the pound, through the distribution mechanism, as now, with proper equalisation, as now, and no changes in the rates. That would give everybody a really clear line of account. If it was on people’s wage slips that that chunk of their national income tax went to local government, everyone would suddenly start to take much greater interest in their local government because they would see for the first time that they were spending that chunk of their income tax money on it.

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

I agree with my hon. Friend’s argument on income tax. Might the full suite of property taxes, not just business rates, also be worth considering in this context? I draw his attention to my amendment, clearly not as well drafted as his, suggesting that property taxes should be devolved in full to London. I hope to catch Mrs Main’s eye and say a few words on that later.

[Mr Allen]

Our London colleagues have done some fantastic work on how to localise taxation that is currently held by the centre. That has to be done sensitively and carefully, but as I said earlier—I do not think my hon. Friend was present then—every other western democracy manages that difficulty without a problem. In Sweden, America, Canada, Italy, Germany and Holland, it is second nature to retain money locally from business rates, landfill taxes and land taxes such as stamp duty. They get by pretty well. In fact, because that system is institutionalised, their local government has immense power over and above what we have as vassals. In effect, we do what we are commanded to do according to the crumbs left in the begging bowl after the Chancellor has done his bit for the national economy.

It is absolutely open to us to do work similar to that done by my hon. Friend, Professor Tony Travers and consecutive London Mayors to liberate people. Nottingham gets a lot of tourists because of the Robin Hood tradition and the castle, so we could have a hotel tax or a bed tax of £1 a night. That happens in other western democratic countries and the people endorse it. There is a big caveat though: no council should do this unless the people have okayed it and bought into it. Councils should also be able to borrow on the open market on the basis of their credit rating, but they need to have the consent of the people. It is perfectly possible for us to do what my hon. Friend suggests.

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[Mr Allen]

I again agree with my hon. Friend. We are not there yet and it is not a done deal yet. We need to make the points that he very ably makes about equalisation. I will say to him, however, that if it is a choice between being instructed by Whitehall how to spend not very much money and having not very much money to spend locally, I would go for spending it locally every time, because we will maximise value and spend the money sensitively. Whatever money is available, it is better spent by those who know what they are doing, rather than by the man in Whitehall. I totally accept my hon. Friend’s points.

[Mr Gareth Thomas]

Will my hon. Friend give way?

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[Mr Thomas]

Is not a further argument for local taxes being controlled at local level that it allows local government a full range of policy responses to deal with local problems? I offer the example—I hope to catch your eye on this later, Mrs Main—of the housing crisis in London, where an ability to impose higher taxes on empty homes might be one part of the solution to the housing crisis.

[Mr Allen]

The nuance that I would add to my hon. Friend’s excellent point is that local taxation need not necessarily always be collected locally. Income tax is a very good example. Provided that it is distributed fairly from the centre, it makes a lot of sense for collection to be a central function, with Her Majesty’s Revenue and Customs simply continuing to do what it does, openly and transparently. Other things—he mentioned a hotel tax, business rates and so on—are much more amenable to local decision making, but we are long way from that.

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[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

[Mr Gareth Thomas]

My hon. Friend’s point about poorer areas and the full devolution of business rates is apposite. Is the Chancellor’s suggestion to axe completely the revenue support grant for local authorities—that was in the same speech as plans for the full devolution of business rates—likely to have a dramatic impact on increasing inequality of income between areas? Will my hon. Friend’s Committee be considering that?

[Mr Betts]

We will certainly want to consider that issue. From reading what has been said, and the written statement that was presented to the House on the first day back after the recess, there does not seem to be a commitment simply to leave the amount of business rates collected in an area with that local authority. Instead there was a move to allow the full retention of the growth of business rates, and then a decision about what to do with the rest. I think that is the position, but Ministers will have to explain it further in due course. I am sure that the Committee will want to explore that.

The Minister and I have slightly different views about whether elected mayors should be a requirement for full devolution, but the Minister won the vote and that measure is back in the Bill. I am still concerned to have a level playing field, however, and I am surprised about one element in the Bill that Ministers have not sought to explain. Amendment 60 would delete from clause 5(1)(7) words that would devolve to a mayor who is exercising powers independently, any powers that are

“similar to any power exercisable by the mayoral combined authority…but the power conferred on the mayor may not include a power to borrow money.”

When a combined authority is set up, it can have the power to borrow money. In the Sheffield city region, the combined authority has to borrow money for the functions of economic development, skills and matters devolved to it. The mayor will effectively become the transport authority and exercise transport functions. In exercising those functions, however, the mayor will not be able to borrow money. Somebody else will have to do that if, for example, a new tram system is going to be developed. The mayor will have to go to somebody else and say, “Will you borrow money for me?”

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[Scott Mann (North Cornwall) (Con)]

It is my view that there are no problems with the Bill. I championed it last week because I believed the Government were right to give more powers to councils, which can better address the issues in their areas. Cornwall does not have an elected mayor, but it does have a rather unique sense of identity and a desire to get its traditional low-wage economy functioning as a high-wage, high-skill one and to secure the lifestyle benefits that brings.

As many Members are aware, the Bill was preceded by the Cornwall deal, which, as a Cornwall MP and local councillor, I was proud to see signed off by the separate bodies and the Minister. Devolution for Cornwall recognises the needs of its people. The Government are saying to the people of Cornwall, “If you want more power, you can have it.” It is no secret that Cornwall has been a very deprived area. This is not just recognised nationally; it is also recognised on the continent. Cornwall has received European funding to improve this situation, but the last round created only 3,500 jobs out of the 10,000 planned. This is in a county of only 500,000 people. Those 10,000 jobs would have been of huge benefit to us, but the funding was not properly utilised. Cornwall has now been granted intermediate body status and so gets to take control of such money. That is the best way to make businesses grow. Let us give business the opportunities to invest.

As a rural area, Cornwall struggles with the reliability and frequency of transport links. In my constituency, there are no main line railways—there is not one passing anywhere near the constituency—so I know how important bus links are to communities. I am glad, therefore, that bus links were part of the deal. Not everyone has a car or driving licence, so it is buses that help them to commute to and from work. The Cornwall deal now gives us greater control over those bus links, and with the introduction of smart ticketing, like that in London, we can move Cornwall into the 21st century.

Cornwall and local health organisations plan to introduce a business plan for the integration of health and social care, meaning that Cornwall will have a greater say over how healthcare is provided to our elderly, sick and vulnerable constituents. With the empowerment of local government, however, comes great responsibility, and my constituents want to hold local government to account. This deal makes that possible. It gives the power to local people to hold their politicians and boards accountable. I feel proud to be MP for an area that has seen these devolved powers. It is a historic deal for Cornwall, and I hope that many of my right hon. and hon. Friends will feel the same way when the same powers are devolved to their areas.

[Mr Gareth Thomas]

I rise to make the case for new clauses 10 and 11, which stand in my name, but first, I should preface my comments by supporting the remarks of my hon. Friend the Member for Nottingham North (Mr Allen) about a constitutional settlement. That is an entirely sensible way forward. I do not know whether he has considered the distinctiveness of London as part of that settlement, but I think that any such convention should recognise its difference, the scale of the challenges facing it and the significant contribution it makes to the wealth of the UK as a whole.

I read new clause 22, debated in the previous group, with interest, and I commend my hon. Friend the Member for Croydon North (Mr Reed), whom I understand was its genesis. I hesitate to commend him more fully, in case it damages his career, but I am encouraged that the Labour Front-Bench team recognise the need to argue quickly for more devolution to London. I hope to persuade him and the Committee that my new clauses contain the substance of what needs to be devolved to London.

The substance of new clause 11, referred to by my hon. Friend the Member for Sheffield South East (Mr Betts), secured cross-party support in London as a result of the London Finance Commission, which Tony Travers chaired and which was established by the Mayor of London, the hon. Member for Uxbridge and South Ruislip (Boris Johnson). That commission recommended that the full sweep of property taxes—not just business rates, but council tax, stamp duty, capital gains, property development tax and the annual tax on enveloped dwellings—should be devolved to London.

High property prices in London mean that the capital contributes a disproportionate amount to the Treasury through property taxes. Last year alone, some £3 billion was paid in stamp duty in London—40% of the total, more than was paid in Scotland, Wales and Northern Ireland put together.

It is right that much of the wealth generated in London is redistributed around the UK. There should be continuing equalisation measures, as my hon. Friend the Member for North Durham (Mr Jones) rightly said, perhaps through the revenue support grant or other means. There should also be a corresponding reduction in grant income to London to ensure that devolution of property taxes is fiscally neutral to the Treasury.

My point, however, is that London needs to control more of the wealth that we create to solve the challenges that our city faces. We have the most severe housing crisis of any part of the UK, the highest cost of living, and the starkest levels of inequality. Our transport infrastructure is under huge pressure, and we have stubbornly high levels of child poverty and deprivation. I say that not in any way to dispute the fact that other parts of the UK face significant challenges as well, but merely to underline the argument that London needs to be able to control more of the levers to shape our responses to these challenges.

I thus support the instinct to retain 100% of business rates, but it is the full devolution of all property taxes that is needed to help us in London to tackle our challenges, with a pound-for-pound reduction in London’s revenue support grant as the quid pro quo going forward. There is widespread support among the business community for the devolution of property taxes because that community recognises that it is key to developing the necessary infrastructure to promote economic growth.

I use as my example the 40 years it has taken to start work on Crossrail. Given the pressures that London’s rapidly growing population is creating for further investment in infrastructure, it is vital for big infrastructure decisions to be brought to resolution more quickly and for the control of property and taxation to be exercised at London-wide levels, which would increase the Mayor’s ability—and, indeed, that of local councils—to put the financing together for the infrastructure schemes necessary for the future. Greater control over property taxes would ease the borrowing constraints on London’s local councils so that they could invest in vital infrastructure such as affordable housing.

As the London Finance Commission set out, London currently controls only 7% of the taxes that are paid here, compared with more than 50% in New York. Property taxes are set locally in Paris, Berlin, Madrid and Tokyo. Such control would not only enable London to plan infrastructure projects better, but allow greater scope to ensure that the property taxes that are levied suit London’s property and land markets. For example, the introduction of a hotel occupancy tax, as successfully levied in New York, could raise up to £50 million a year for London. Even if the Minister is not minded to support my new clause 11 at this juncture, he might give some indication of being tempted to develop a feeling of courage in taking on the Treasury and advocate further devolution of more property taxes to London.

New clause 10 devolves responsibility for housing law to the Mayor and Assembly. That matches arrangements for Scotland and Wales and would allow Londoners themselves to decide whether to extend the right to buy and whether or not to cut rents. It is the scale of the housing crisis that provides the overarching rationale for this new clause. We have seen a huge drop in owner-occupation in London. An average home in London costs nine times the average wage of a police officer, 21 times the average wage of a chef and 35 times the wage of a Foreign Office cleaner. Rents have rocketed, and are not expected to bottom out any time soon. Homelessness has also increased rapidly: there has been a 50% increase in my own borough over the past five years. Meanwhile, Ministers—and I say this with all due respect to the Minister who is present—sit on their hands doing very little about a crisis which, given that we are building fewer than half the homes a year that London needs, is likely to become more rather than less acute unless radical steps are taken.

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[James Wharton]

The hon. Gentleman is articulate and persuasive, but he will not tempt me to elaborate further.

New clause 11, tabled by the hon. Member for Harrow West, provides for the devolution to London of the receipts from taxes on property. I know the Mayor’s ambitions for London and we have announced the local retention of business rates, but devolving taxes such as stamp duty to London could create a distortive effect. There would be a significant increase in administration costs for both the Greater London Authority and businesses that purchase properties both in and outside London. I have heard what the hon. Gentleman has said, and I will consider his comments further, but I do not want to give him the false expectation that they are likely to be reflected in the Bill or to make a commitment that I cannot fulfil at this time. He has, however, made his case very effectively.

[Mr Gareth Thomas]

I am grateful to the Minister for his smooth words. I gently suggest that his argument against the further devolution of property taxes as distortionary does not fit with his argument for devolving business rates, which will arguably be just as distortionary, as my hon. Friend the Member for North Durham (Mr Jones) said. There seems to be a slight lack of consistency in the Minister’s position, which may be because of what the Treasury has bequeathed him. I encourage him to go back to the Treasury and press it further before Report.

[James Wharton]

I hear the hon. Gentleman’s comments. The announcement that we will devolve business rates was made in the way it was exactly because we wanted to ensure that we talked to local government about how it should be done to make sure it works properly and effectively and meets our policy desires. To devolve certain taxes to just one area is a different proposition. He clearly supports it and argues for it effectively, but it does not have a place in this Bill at this time.

Amendment 1, which was tabled by the hon. Member for Nottingham North, clarifies that the persons who may be invited to attend an overview scrutiny committee meeting may include

“representatives of parish, neighbourhood, community and other councils in the area of the combined authority”.

I understand the hon. Gentleman’s intention and commend him for pursuing openness in the process, but the Bill already allows people to attend. To define them in a list risks the provision being narrowly interpreted, rather than broadly interpreted, which is what we want.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.

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

As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?

[Dr Poulter]

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.

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

3. How many patients waited longer than four hours in A and E departments in 2013-14.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Of the 21.7 million attendances at all A and E departments in England in 2013-14, 939,000 were not seen and treated within four hours, meaning that 95.7%—0.7% above the national target—were. I am pleased to inform the House that hospitals will have an extra 260 A and E doctors this winter, bringing emergency medics in the NHS to a record high.

[Mr Thomas]

The reason for the big rise in A and E admissions in my area is the weekday closure of the hugely popular Alexandra Avenue polyclinic. Will the Secretary of State look again at Harrow’s NHS funding formula to determine whether that popular service could be reopened?

[Mr Hunt]

I am happy to look at the point that the hon. Gentleman raises. I have visited the Northwick Park A and E department, where the clinicians on the front line are working incredibly hard. As he knows, the funding formula is decided independently—at arm’s length from politicians—but we have ensured that everyone gets a real-terms rise.

NHS Funding (Ageing)

Gareth Thomas Excerpts

Tuesday 25th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward, and to follow the hon. Member for Suffolk Coastal (Dr Coffey). I apologise to the House and in particular to the Front-Bench spokesmen for the fact that, because of a long-standing commitment, I shall have to read their responses to the debate in Hansard.

I want to raise a concern similar to the one raised by the hon. Member for Suffolk Coastal, about the funding formula, although there are constituency differences. Many health professionals in my constituency are concerned that Harrow does not receive an appropriate share of NHS funding and that that is already affecting elderly people there, and may affect many others. The context is that both the key hospital serving my constituency, Northwick Park hospital, and its parent trust, the North West London hospitals NHS trust, have been in a challenging financial position for many years.

In 2010-11, the trust made a tiny operating surplus; in 2011-12, it had an operating deficit of some £7.5 million; and in 2012-13, the operating deficit had increased to £20.5 million, approximately. Figures in papers submitted to the NHS Trust Development Authority’s recent board meeting suggest that the trust is again heading for a sizeable deficit this financial year, of about £20 million. Although final 2013-14 accounts are clearly not yet available for Harrow’s clinical commissioning group, the prediction, from NHS England information, is for an end-of-year deficit of £10.4 million. Indeed, Harrow clinical commissioning group is one of only four in London where there is significant concern about financial performance.

By setting out that information, I do not mean to criticise the trust management, the clinical commissioning group or their staffs. I have been treated at Northwick Park hospital several times, and I think the staff and management do a first-class job. I know the chair and many of those who serve on the board of the Harrow clinical commissioning group, and they, too, do a first-class job in extremely difficult circumstances. Those circumstances are made difficult by the amount of funding that Harrow receives from the NHS.

To humanise the consequences of those statistics on the financial situation that Northwick Park hospital and Harrow clinical commissioning group face, I should make it clear that there are increasing concerns about cancelled operations and longer waiting times in the A and E department at Northwick Park. Given the cuts to local government funding, there are fears that Harrow council’s social care budgets, which are already hard hit, will be cut further by an estimated £70 million over the next three years. The concern is that the NHS in Harrow will come under even greater pressure to meet the needs of elderly people in our area because of an inevitable lack of access to social care.

Additionally, the popular Alexandra Avenue polyclinic, which was open from 8 am to 8 pm for 365 days a year and provided an excellent walk-in service, has for some time been closed to patients without an appointment for all but a short period on Saturdays and Sundays. Again, the service was heavily used by elderly people, as well as by many others in my constituency. The closure of large parts of the Alexandra Avenue polyclinic’s service is particularly galling because health professionals in Harrow accept that the polyclinic was making a difference by helping to improve health care opportunities and access to health care for elderly people and many others in my constituency. That is the context of my participation in this debate, and I am concerned about whether the funding formula properly reflects the needs of the NHS and my constituents.

The hon. Member for Suffolk Coastal set out some of the funding formula issues, and I will present them in a slightly different way; that is perhaps a reflection not only of our different political parties but of the different nature of the seats we represent. The Minister and the shadow Minister, my hon. Friend the Member for Copeland (Mr Reed), will be far more aware of the debate on changes to the funding formula than I am. Like the hon. Member for Suffolk Coastal, I understand that a weighted capitation formula based on population, the local cost of providing health services, the level of health care need and health inequality is used to determine allocations to each clinical commissioning group. I also understand, as she set out, that the Advisory Committee on Resource Allocation was charged with developing a revised funding formula based on the standardised mortality ratio for those aged under 75—the so-called fair shares formula.

After substantial consultation—the hon. Lady made this point—the board of NHS England decided not to adopt the fair shares formula, and clinical commissioning group allocations were initially uprated based on their estimated share of previous primary care trust allocations. In December 2013, the board of NHS England decided on CCG funding allocations for 2014-15 and 2015-16. I understand that, again, the board decided to reject proposals for a faster move towards CCG allocation targets. I do not intend to make a party political speech, but I gently insert the point that perhaps the board might have felt differently if it had had access to the £3 billion that has been spent on reorganising the NHS, about which Opposition Members are somewhat sceptical.

The hon. Lady alluded to distances from target figures for 2014-15 and 2015-16. The figures indicate that Harrow’s allocation was almost 10% away from the target for 2014-15 and almost 9% away from the target for 2015-16. The total estimated funding shortfall for Harrow is some £23.4 million over the next two financial years. That information was provided to me by statisticians from the House of Commons Library based on estimates using the closing target allocations per head and our estimated CCG population.

I recognise that, as the Minister will presumably point out, the figure is not completely settled and that there may be movement given how far Harrow clinical commissioning group is from receiving its target allocation, but I hope that I can persuade the Minister today to scrutinise the Harrow figures. I hope he will ask his officials to talk to Harrow clinical commissioning group to see whether there is more information that might justify a further funding increase for the NHS in Harrow, to close the funding gap that has been identified.

A little like the hon. Member for Suffolk Coastal, I have tried not to be party political in this debate, although she will understand that I think I have managed it better than she did. In that spirit, I hope the Minister will take seriously my concerns about the NHS in Harrow and will ensure that his officials talk to those who do an excellent job working for Harrow clinical commissioning group.

[Sir Edward Leigh (in the Chair)]

When the Minister replies, I have no doubt that he will refer to Harrow’s ageing population.

Accident and Emergency

Gareth Thomas Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.

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

My right hon. Friend’s description of rising waiting times in A and E and ambulances queuing outside A and E will be recognisable to my constituents who use Northwick Park hospital. What is his view of the Government’s proposed new funding formula, which, I hear, might mean that £20 million will be cut from Harrow’s NHS budget?

[Andy Burnham]

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

Accident and Emergency Waiting Times

Gareth Thomas Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

I remember debating that with the hon. Gentleman when I was the Secretary of State. Those problems rightly needed to be addressed, and the particular issue he raises today should be investigated. I hope, however, that he will also understand the problem that I am describing to the House. If we go down the path of fragmenting services—if we take a successful national service such as NHS Direct, for example, which was trusted by the public, and then break it up into a patchwork of fragmented, some privatised, services—this sort of chaos will be the result.

A report has emerged this afternoon, showing that the viability of NHS Direct is in serious question. The headline states, “Leaked report casts doubt over NHS Direct’s ‘overall viability’ in the wake of NHS 111 failings”. This is a warning that NHS Direct may well go down altogether. What an indictment that would be of this Government’s mismanagement.

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

rose—

[Andy Burnham]

I shall give way one last time before concluding.

[Mr Thomas]

Are the closures and restricted opening hours of many walk-in centres not having an impact on the increasing A and E crisis? Alexandra Avenue polyclinic, which serves my constituents, now restricts its opening hours to weekends.

[Andy Burnham]

I entirely agree, and I shall say more about that issue shortly.

Let me return to the subject of the 111 service. Will the Secretary of State review the contracts with the aim of negotiating changes so that more calls can be handled by nurses? The use of the computer algorithm should be reviewed as a matter of urgency, and the full roll-out of 111 should be delayed until the problems have been solved.

There are more general questions to be asked about the scale and pace of NHS privatisation. NHS Direct offers an illustration of what happens when services are broken up. Those who attended last week’s summit heard that in some areas there had been a huge increase in the provision of 999 ambulances by private companies. It was said that on a single day in Yorkshire, 50% of 999 calls had been responded to by private operators. I think that the public would be surprised to know that. It shows that there is no part of our NHS that cannot be put up for sale by this Government.

Is the Secretary of State satisfied that those private crews are appropriately trained and have the right equipment? Is there not a danger that because contractors are operating in isolation from the rest of the system, they will all too often simply transport people to A and E? Does the Secretary of State envisage any limits to private 999 services? Given that the issue raises fundamental questions about emergency services, should there not be a debate about it before this goes any further?

Fourthly—I come now to the point raised by my hon. Friend the Member for Harrow West (Mr Thomas)—there is good evidence to show that NHS walk-in centres have diverted pressure from A and E units. In 2010-11, there were about 2.5 million visits to such centres from people who might otherwise have gone to A and E. Analysis by the House of Commons Library shows that 26 of them closed in the last year alone, and that the number is down by a quarter. The Government have let that happen, but at least Monitor has intervened and set up a review of the loss of walk-in centres. Will the Secretary of State halt all further closures while the review is taking place?

That brings me to my fifth and final point, which concerns A and E closures and downgrades. At least 25 A and E units—one in 10—are under threat or have recently closed. The trouble with these plans is that they were drawn up in a different context, when A and E was not under the pressure that it is under today. Let me say this to the Secretary of State: if a clinical case can be made in support of closures—if there is evidence that lives can be saved—the Opposition will not oppose the plans. However, we cannot accept the pushing through of proposals that have not taken enough account of the latest evidence, and cannot show that extra pressure can be safely absorbed by neighbouring units. That is important, because the public will rightly ask this simple question: how can it make sense to close A and Es in the middle of an A and E crisis? To reassure people, will the Secretary of State personally review all the ongoing A and E closure or downgrade proposals on a case-by-case basis, in the light of the very latest evidence of pressure in the local health economy?

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

I am grateful for the opportunity to follow the hon. Member for Bracknell (Dr Lee). Given the views he articulated, I hope he will come and canvass for my opponent at the next general election; we would be very happy to have him there. I say that in the context of the situation in the North West London Hospitals NHS Trust, which in 2010-11 was well within the waiting times targets for A and E. Just 2.9% of patients waited more than four hours, but by 2011-12, that figure had risen to some 10.8% at the end of the year, while for the whole of the last financial year the figure is 12.2%—the second worst set of statistics in London, surpassed only by the Barking, Havering and Redbridge University Hospitals NHS Trust, where almost 16% of patients had to wait over four hours.

[Stephen Pound]

I am grateful to my hon. Friend and neighbour for giving way. In view of what he has just said, does he think that the best possible prescription is that currently recommended by the Government whereby the existing A and E departments at Ealing, Park Royal, Hammersmith and Charing Cross all close? Does he think that will improve waiting times in A and E departments?

[Mr Thomas]

My hon. Friend, as ever, is ahead of me. He makes the perfectly reasonable point that if the Northwick Park and Central Middlesex A and E departments are not achieving the 95% target now, how can our constituents have any more confidence about reaching that target should the Central Middlesex and Ealing hospitals close?

[Barry Gardiner (Brent North) (Lab)]

As my hon. Friend knows, Northwick Park is just in my constituency and we share that border. Does he agree that whatever the future configuration of hospitals in north-west London, it is absolutely essential that the A and E unit at Northwick Park is expanded to cope and that that should happen before any reconfiguration?

[Mr Thomas]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I remind the House that there are nine speakers still to be called, and that the winding-up speeches will begin at 6.40 pm. That means that some Members who have been sitting in the Chamber will not be able to contribute. I therefore ask Members to be sparing with interventions, and to make them only when they are absolutely crucial. I also remind them that interventions must be short, and must relate to the point that the speaker was making at the time rather than be an extra debating point.

[Mr Thomas]

I share the view of my neighbour and hon. Friend the Member for Brent North (Barry Gardiner). We need that expansion to go ahead, and to go ahead soon.

In an intervention during the speech of my right hon. Friend the Member for Leigh (Andy Burnham), I raised the plight of many of my constituents who formerly used Alexandra Avenue polyclinic, an extremely popular walk-in centre which used to be open from 8 am until 8 pm, 365 days a year, to people who were genuinely concerned about their health and did not feel that they could wait to see their GPs. It was opened by Ara Darzi some five years ago. Amazingly, its opening was opposed by my political opponents in Harrow, but it quickly came to be greatly appreciated by, in particular, people living in the south Harrow and Rayners Lane area. Those people have noted with considerable regret that, after the last general election, the primary care trust decided to restrict the opening hours of their walk-in centre, but not those of the walk-in centre in Pinner, in the constituency of my other neighbour, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd).

As a result of the cuts that the primary care trust decided to make, the walk-in service now operates only between 9 am and 3pm on Saturdays and Sundays. The fact that it remains open at all is entirely due to the scale and strength of feeling about the loss of what was an excellent service, and the campaign that we were able to run in order to save it. Perhaps some of the £3 billion that the Prime Minister spent on what was—as others have already pointed out—a completely unnecessary reorganisation of the NHS could have been invested in keeping Alexandra Avenue polyclinic open, and some of the pressure that my constituents are imposing on Northwick Park hospital’s accident and emergency unit could have been alleviated.

Staff at the excellent Pinner ambulance station in Rayners Lane do an extremely good job, generally spending all their shifts out on the road. It is clear that they, like the rest of the staff of the London Ambulance Service, are under extremely heavy pressure. On occasion, ambulances have been used as temporary reception or holding areas at Northwick Park when patients cannot be admitted to A and E as they arrive because of the pressure on that department.

There is also concern about the district nursing service in Harrow. My personal experience of that service has been mixed. An elderly relative and, more important, that person’s carer have found it difficult to gain access to it by telephone when problems have developed. It has been slow to respond, and has demonstrated poor co-ordination with other parts of the local health care system. Again, funding was cut by the primary care trust.

The new clinical commissioning group has given notice to the local trust which runs the service that it may outsource the contract, but I am not convinced that that is the answer. Investment in staff—trained staff—and, crucially, investment in management time by the local trust seems to be the immediate requirement if the problems in the service are to be sorted out. Meanwhile, to those who are aware—as many of my constituents are—that the district nursing service is far from brilliant, it is hardly surprising that family members should want to delay the discharge of elderly patients from Northwick Park.

It is telling that the number of cancelled operations is rising fast at Northwick Park. So far, it has risen by some 13%. That is a further symptom of the crisis in the national health service, as evidenced by others—

[Madam Deputy Speaker]

Order. The hon. Gentleman’s time is up.

Mental Health

Gareth Thomas Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.

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

Does the right hon. Gentleman accept that, in addition to the need for continued investment in the so-called medical facilities and services that are part of treating mental health, there is a need for continued investment in the so-called talking therapies, and the opportunity to invest and grow the social services’ response to mental health services as well?

[Paul Burstow]

I am grateful to the hon. Gentleman for that question. He is absolutely right that access to talking therapies—begun as a result of Lord Layard’s initiatives before the general election, which the coalition Government continued to support and which is being rolled out—is very important in enabling people to recover socially, get back into work and get on with their life. At the best performance rates, as many as half the people that go through talking therapy services recover, and that can make a huge difference to them, their families and the figures I was talking about earlier. I shall return to the subject of talking therapies in a moment.

Last year I took part in the debate from a slightly different position—I spoke from the Dispatch Box. I was able to report some important progress. We had a new mental health strategy. We had the continued roll-out of talking therapies, which the hon. Member for Harrow West (Mr Thomas) just asked about. Groundbreaking work was being done to reinvent child and adolescent mental health services from the inside out, to offer access to talking therapies for children and young people. We had the flowering of a new movement to establish social recovery as a goal for mental health, with the establishment of recovery colleges channelling the lived experience of mental illness into practical learning and skills, and resilience to enable people to get on with their lives.

There was the good news that the Government had backed financially the task of Time to Change, the charity sponsored by Rethink and Mind, really motoring to tackle issues of social stigma in our country. Reports since then show that the first phase of that programme has materially altered public views about mental health in this country, but the programme needs to be sustained.

--- Later in debate ---

[Paul Burstow]

Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.

It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.

[Mr Thomas]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way one last time, but then I really must conclude.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way a second time. Will he underline the importance of mental health trusts such as Central and North West London NHS Foundation Trust, which serves my constituents, working with the local voluntary sector such as the Mind groups in Harrow and Brent? Will he therefore encourage his Front-Bench colleague to look with particular interest at the letter I am about to write to him, raising the concerns of Mind in Harrow and in Brent about the trust’s failure to work properly with the services it is providing?

[Paul Burstow]

I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.

I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.

Accident and Emergency Departments

Gareth Thomas Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Sharma]

I thank my right hon. Friend for putting that case so strongly. I do not think anyone—inside or outside the House—would fail to agree with that suggestion.

In North West London NHS, the proposal translates into a £1 billion cut to budgets over the same time scale. The medical director of North West London NHS said that it would

“literally run out of money”

unless the closures proceeded. The scale of change driven by this financial pressure is unacceptable. It is targeting the poorest and most vulnerable, and it is unfair on the hospitals that have been financially solvent. That last point was graphically illustrated last week at Lewisham hospital, whose A and E was unjustly proposed for closure because of a neighbouring trust’s financial insolvency. That brought tens of thousands of incensed protesters on to the streets.

Sadly, this is happening in Ealing, too, whose hospital is faced with losing its A and E department, yet it is financially viable and has been for many years. It is being sacrificed on account of financial problems in other neighbouring hospital trusts. This threat of closure in Ealing exists even after the Prime Minister assured me, in a response to my question, that there was no such threat.

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

Although this is a debate about the closure of A and E departments across the country, does my hon. Friend accept that it seems particularly unfair that London, with nine accident and emergency departments apparently set for closure, is being hit so hard in losing vital NHS services?

[Mr Sharma]

I agree with my hon. Friend, and I shall definitely cover that point later in my speech.

As in Lewisham, the people of Ealing took to the streets in huge numbers last autumn in protest at the proposals from North West London NHS whereby if the preferred option A is chosen on 19 February, it would mean the closure of four A and E departments in west London: in Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals. The campaign to save our hospitals has been broad and deep, bringing together MPs and councillors of all political parties, and organisations and individuals from all segments of society.

--- Later in debate ---

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

I greatly enjoyed the speech of the hon. Member for Ealing Central and Acton (Angie Bray) and share many of her sentiments, but I hope she will forgive me for saying that her contribution lacked a sense of regional and national context. Despite the pretence of a national review, to which my hon. Friend the Member for Ealing, Southall (Mr Sharma) alluded, closing substantial numbers of A and E units is clearly now Government policy. Professor Matthew Cooke has been advising the Department of Health on A and E issues—he did so last year, at least. He has spoken to NHS North West London, supporting its plans to close four of our nine A and E departments, and he was reported in the Daily Mail as saying that those plans were in line with national Government policy.

At the 2010 general election, the Conservative party manifesto promised to stop the closure of A and E departments. Indeed, I think the Prime Minister insisted there would be a moratorium to stop further A and E closures. If I remember rightly, during the election campaign the Prime Minister visited Chase Farm A and E department in London and Queen Mary’s A and E department in Sidcup, promising to stop their closure.

[Siobhain McDonagh]

And Kingston, too.

[Mr Thomas]

Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.

My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.

We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.

[Heidi Alexander (Lewisham East) (Lab)]

My hon. Friend mentioned the hospitals the Prime Minister visited before the election whose A and Es he promised to retain. Of course, in 2007 he also said that he would get into a bare-knuckle fight over the future of Lewisham hospital. Does my hon. Friend agree that the Government’s A and E policy seems somewhat hypocritical?

--- Later in debate ---

[Mr Thomas]

There certainly seems to be little obvious sign of any bare-knuckle fighting on the Prime Minister’s part to stop the closure of Lewisham A and E or, indeed, the other eight departments set for closure in London.

I want to concentrate the rest of my speech on the plans at North West London Hospitals NHS Trust. As the hon. Member for Ealing Central and Acton said, there are plans to shut Ealing, Charing Cross, Hammersmith—it is good to see my hon. Friend the Member for Hammersmith (Mr Slaughter) here—and Central Middlesex A and E departments. My constituency is served by Northwick Park hospital A and E department, and my constituents are worried about the pressure that the closure of the four other A and E departments in the area will put on Northwick Park when all the extra people turn up there needing treatment.

Clinical teams at the north-west London trust have noted that the strategy behind the proposed closure of the four A and E departments assumes that thousands of people can be persuaded not to go to A and E but instead to use their GPs and other community services. I am a little sceptical about the idea that that will work, not least because the numbers using Northwick Park A and E are already significantly greater than before the 2010 election.

One element of the strategy, to prevent the possibility of patients who shift to Northwick Park not getting the services they need, is, as I said, to use community services. The decision to downgrade the Alexandra Avenue polyclinic, a walk-in service open 8 am to 8 pm, 365 days a year in the south Harrow part of my constituency, to just Saturday and Sunday opening, 9 am to 3 pm, has led to greater use of Northwick Park hospital A and E, as a number of doctors have said. So the decision to close that polyclinic, supported, incidentally, by the Conservative party in Harrow, seems particularly surprising, given the appetite for community services to solve the problem of lots of people potentially going to Northwick Park A and E.

[Nick de Bois]

To put this in context, it is clear, having read Hansard, that both this Government and the previous Government supported reconfiguration on the basis of more people being served in the community, and that is probably not a bad thing. However, it is not just a question of having the infrastructure, the buildings and the clinical staff, but of imploring people to make a cultural change. One cannot do that easily and quickly, particularly between generations. So although both this and the previous Government agree that reconfiguration is important, my concern is that they have not taken the people with them.

[Mr Thomas]

On that very specific point, I agree with the hon. Gentleman. What feels different about the context in which we are having this debate is the sheer number of A and E departments whose closure is envisaged.

If the hon. Gentleman and others will forgive me, I will return to the issue of Alexandra Avenue polyclinic and how it helped to divert people from using the A and E department at Northwick Park. I urge the new Harrow clinical commissioning group to reopen Alexandra Avenue as a proper walk-in service, or to find an alternative site for such a facility in order to reduce the pressure on Northwick Park. The last figures that I saw showed that in fewer than 12 months, from April 2011 to February 2012, the number of people waiting more than four hours at Northwick Park and Central Middlesex hospitals’ A and E departments had risen to more than 9,000. A total of 9,137 people in that 10-month period had waited more than four hours for treatment. What is far from clear is whether there is a clear clinical strategy across London that has the confidence of doctors and of the public—that point was raised by the hon. Member for Enfield North (Nick de Bois)—to really drive down the pressure on A and E departments in the future.

Already, too many people in London have had to wait in ambulances for longer than 30 minutes; that happened to 42,248 people in 2011-12, a rise of almost 50% on the previous year. Some 10,000 people had to wait more than 45 minutes to get into the A and E departments across London; they were sitting in the ambulance waiting. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said, the UK Statistics Authority has pointed out that the Prime Minister has broken his promise to protect NHS spending. It is clear that the NHS in London is under unprecedented pressure, because of the Conservative party’s squeeze on NHS funding. A Prime Minister who once promised to stop A and E closures is allowing nine to go ahead across London. Once again, that old adage is being proved true, “Same old Conservatives. You can’t trust the Tories with the NHS.”

[Several hon. Members]

rose—

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

Yes, since the election we have pushed forward with offering access to a personal care budget to those who are in receipt of care and support. At the time of the last election, about 168,000 people were exercising that right. The figure now is over 432,000, and we are extending the scheme so that, for example, people in receipt of continuing health care through the NHS will not lose the opportunity for personal care when the NHS takes over that responsibility; instead, that will continue as a personal budget under the NHS.

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

Does the Secretary of State think any of the steps he set out in his original answer will lead to a repeat of the shock rise in the number of cancelled operations in the local hospitals serving my constituents, the figures for which were recently set out in a written answer to me by his Minister of State, the right hon. Member for Chelmsford (Mr Burns)?

[Mr Lansley]

The number of cancelled operations rises at certain times during the winter, and it did so during last winter. We are clear about the necessity of ensuring that patients do not have cancelled operations if we can avoid that, and, in particular, that those whose operations are cancelled have access to treatment rapidly thereafter. The key is to make sure, as we have done, that patients have timely access to treatment under the referral to treatment times guidelines, and as the hon. Gentleman will be aware, the average waiting time for treatment in the NHS has fallen since the election, as has the number of people waiting a long time for treatment. That is the strongest measure for ensuring all patients get timely to access to care.

Hospital Services (West London)

Gareth Thomas Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Slaughter]

There has already been significant change in hospital services in north-west London. That has been for clinical and financial reasons. It has involved within Imperial the centralising of services, including renal, paediatric, oncology and vascular specialisms. More of that was anticipated. Other proposals for savings have been leaking out of Imperial for the past six months. Further moves away from hospital to community or GP services were expected—but nothing on the current scale.

This review is driven by the need to cut costs and is unrestrained because the chaotic reorganisation in the NHS, for which the Minister must answer, means that there is no accountability on the part of those who are making decisions. The Joint Committee of Primary Care Trusts, itself a body artificially created to make these cuts, is neither their author, nor will it survive to see their execution.

I would like to say a little about the history of hospital services in my part of west London, the scale of the changes proposed and the flawed process under which they are being made. I would then like to summarise the emerging public and professional views on the proposals, before finally asking the Minister for his response. Given that many in the NHS see the north-west London proposals as a prototype for what will happen elsewhere, it is not satisfactory for him to disown interest. He must either justify or be prepared to criticise the loss of front-line hospital services.

Each of the hospitals now under threat has a long and distinguished history. I am afraid I am old enough to remember when Charing Cross was Fulham hospital and when Chelsea and Westminster was St Stephen’s. Hospitals have stood on the Hammersmith campus since 1905 and at Charing Cross since 1884. Originally, these were workhouse infirmaries, fever hospitals or military hospitals. They have evolved into the world-class treatment centres that they are today. I do not want to take up a great deal of time with the history, but while preparing for the debate, I did come across this interesting paragraph on the opening of Hammersmith hospital:

“Immediately on opening, there was an outcry about the cost of the…building…£261,000…and its lavishness. The vestibule was paved with mosaic and was surrounded with a dado of the most expensive encaustic tiles. The dining hall was ‘of baronial splendour’. The press dubbed it the ‘Paupers’ Paradise’ and the ‘Palace on the Scrubs’.”

I did not know the Daily Express was going in 1905, but clearly it was. I am not sure that that was a completely accurate representation of the hospital, because its annual report for 1957 illustrated a granite block—part of the last consignment to the workhouse for breaking up by the inmates of the casual ward. I do not want to give the Minister any ideas about reintroducing rock breaking for out-patients, but that does show that we have come a long way over that time.

The Minister may say that I am being nostalgic in looking at the history of Hammersmith’s hospitals or that it is evidence that change in the health service is nothing new, but that misses the point. These hospitals have grown up on their current sites and changed in response to local need. These are some of the most densely populated parts of the UK. There is intensive residential development in the area: tens of thousands of new homes are planned for the next decade. This is a population with complex health needs and high turnover. This is an area with major transport infrastructure—air, road and rail—and with risks ranging from major trauma accidents to tropical and infectious diseases.

The accident and emergency departments under threat are always busy. They are trusted by my constituents. They have evolved to work side by side with GP practices, walk-in clinics and urgent care centres. However, they work, because the level of clinical expertise available can be adapted to cases ranging from the relatively minor to the very serious. I understand the debate about having fewer major trauma centres—the trade-off between travelling further and losing critical treatment time against the quality of care on arrival. I do not think that that argument is settled, not least because of the unpredictable and congested road system in west London, but also because of the conflicting opinions as to how crucial minutes can be in reaching specialist care in different trauma cases. What is unarguable is that the vast majority of patients currently attending A and E will potentially receive a worse service. They will not be sure whether their condition merits a longer trip to a hospital that still has A and E services, or whether seeing a GP at an urgent care centre will suffice. There will certainly be confusion and delay, and overall standards in quality of care will fall.

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

I apologise for missing the first couple of minutes of my hon. Friend’s remarks. Does he accept that, notwithstanding the proposed closure programme, there is already growing concern about the length of waiting times in A and E? Many of my constituents will be worried that their wait at Northwick Park hospital A and E unit will increase as a result of this closure programme.

[Mr Slaughter]

My hon. Friend missed the point that I made at the beginning: this affects all MPs and all communities in north-west London, not only those expecting the closure of services. The closures go against the thrust of the changes in the health service over the past five to 10 years, which have seen the huge pressure on A and Es relieved by the addition of urgent care centres, not the replacement of A and Es by them.

--- Later in debate ---

[Mr Burns]

rose—

[Mr Thomas]

rose—

[Mr Slaughter]

I will not give way to the Minister again yet. I want to make some progress. We shall see what happens in a few moments, but after I give way to my hon. Friend, I really must move on.

--- Later in debate ---

[Mr Thomas]

I am grateful to my hon. Friend for giving way. I do not know whether the Minister’s intervention was prompted by the recent answers he gave to my parliamentary questions. He will be aware of the approximately 180,000 people who waited more than four hours from arrival in A and E to departure. Will my hon. Friend ask the Minister for an assurance in his final remarks that the figure is not likely to rise for the 2011-12 period?

[Mr Slaughter]

I am happy to trade statistics with the Minister, but the debate is not about incremental performance, but the fundamental change to services.