Health Care (London)

Glenda Jackson Excerpts

Wednesday 8th January 2014 Westminster Hall

[Mark Field]

That is right to an extent. I know that the hon. Lady spoke in a debate that I led in the House almost a decade ago on Barts, which is located in my constituency and has a special place in the hearts of many millions of Londoners—and, indeed, of people throughout the United Kingdom. The truth is that at that juncture, the private finance initiative was the only funding game in town and we all went along with it, but that £1 billion PFI has now caused major financial issues that, I am afraid, affect not just Barts but hospitals throughout the north-east of London, as the hon. Lady is well aware. We all feel a bit depressed about that knock-on effect.

We have to accept that in London, broadly speaking, we do pretty well as far as hospital care is concerned. Being absolutely candid with everyone, because I know what it is like, in central London we have a very good service, and it is partly outer London that suffers as a result. That is because of the strength of the links to which the hon. Lady rightly referred—the passion that we have for our historic hospitals—and the amount of resource that is pushed into central London because the hospitals there are teaching hospitals with consultants, former consultants and alumni who are willing to make a strong case for the existence of those hospitals. Dare I say it, that makes it easier to make the case for Barts than for a hospital out in Romford or Whipps Cross, or one in the hon. Lady’s constituency.

We all have to face those issues. They have not arisen as a result of the reorganisation of the past three and a half years; this has been the situation in the capital for probably 40 or 50 years. I am aware that even in the latest reconfiguration there has been a sense that central London has got off slightly better than the middle portion of outer western London.

I turn to finance. There was a good outcome before Christmas for north-west London on commissioning allocations, as all of our CCGs received an uplift to offset inflation. However, I want to raise concerns about the funding formula used to determine allocation. The formula fails to take into account the needs of the large homeless population in Westminster, which places massive pressure on acute services. Rough sleepers are far more likely to attend accident and emergency; they attend six times more often than any normal member of the population. They are admitted to hospital four times more often and stay in hospital three times as long.

The formula also ignores the fact that CCGs are responsible for all attendances at urgent care centres or walk-in centres and for the costs of patients covered by reciprocal funding arrangements with other countries. Westminster welcomes more than 1 million commuters and visitors each and every day, many of whom will need health advice and care while they are here. It is important that a future funding formula recognises the impact of that on local health care services.

The proposed formula will exclude spending on community care. That cannot be correct considering the important move to provide more high-quality care at home and in the community rather than simply in hospitals. I welcome the Government’s assurances that the Advisory Council of Resource Allocation formula will not be accepted in its current state and that changes to the funding of CCGs will be fully consulted on in future.

I turn to public health spending. A draft formula for local authorities was set out in the “Healthy Lives, Healthy People” consultation, which was published on 14 June 2012 and recognised that further work was needed on adjustments for age, fixed costs and non-resident populations. However, initial modelling by London councils suggests that Westminster would have a drop of 57% in public health funding. Central London and Westminster have unique population characteristics that make it more difficult to make public health improvements. They include the age structure, with a greater focus on working age and children, and levels of mental health problems and homelessness. Those are not properly reflected in the current formula.

The formula also fails to take account of substance misuse services, many of which fall outside the pooled treatment budget, which focuses on opiates and crack treatment. It also ignores the wider health and local authority investment needed to manage the individual family and community impact of drugs and alcohol on health and well-being.

Westminster experiences a high level of population churn—I accept that many other London boroughs are in that boat—and that leads to additional demands for services, including NHS checks and other screening programmes.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

Will the hon. Gentleman give way?

[Mark Field]

Other hon. Members want to speak so, if the hon. Lady will forgive me, I will finish with a request to the Minister. I would welcome an indication from the Government of when we can expect more clarity on how future public health allocations will be determined. I would also appreciate confirmation that the formula consulted on in June 2012 will not be used to determine public health funding allocation in future.

--- Later in debate ---

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Mrs Main. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this very important debate. I share the concerns expressed by my colleagues earlier, including those about the Secretary of State cancelling the meeting that I and the leader of Ealing council requested. We were looking forward to expressing the views of the residents of our constituencies.

Multiple A and E departments in the capital have been under threat of closure or set for closure, from Lewisham, where a hard-fought campaign has saved the hospital from closure, to south-west London, Ilford, and the four A and Es in west London, two of which have been marked for closure and two of which are still effectively closed—they are being called A and Es when they are not. One of them is in my constituency in Ealing hospital. In a city of more than 8 million inhabitants, where the population growth is twice the national average, those closures and downgrades will have a huge impact on the lives and safety of local residents, leaving many residents miles from their local A and E.

Accident and emergency services are already under tremendous pressure and will be subject to increased strain with local closures. We know that the number of blue-light ambulance diverts increased drastically in London, by almost a quarter, proving that A and Es in London are over capacity. One of the hospitals that has regularly turned away ambulances is Northwick Park. With the closure of A and Es at Central Middlesex and Hammersmith hospitals, and with Ealing and Charing Cross hospitals seemingly unable to receive blue-light ambulances in north-west London, Northwick Park will be under even more strain as patients are sent there for emergency treatment.

Northwick Park is already overburdened and is one of the worst-performing A and Es in the country. It will simply not be able to cope with the four other local A and Es closing and will be unable to accept blue-light ambulances. Journey times for patients will be longer and they face the risk of travelling elsewhere if the ambulance is turned away. That will be the difference between life and death for emergency patients—an unacceptable situation.

Back at the end of October, the Secretary of State confirmed the closure of A and Es at Central Middlesex and Hammersmith hospitals, and announced that A and Es would remain at Charing Cross hospital and Ealing hospital, in my constituency, the shape and size of which would be subject to a review. His statement, which was supposed to remove uncertainty about the future of our local hospitals, only further increased confusion.

It has, however, been made clear, through the Keogh review and Dr Mark Spencer’s subsequent comments, that the review would in fact reduce the size of Ealing’s A and E, and that Ealing would be unable to receive blue-light ambulances. The Secretary of State, who pledged to keep the A and E services, has in fact downgraded Ealing hospital, while keeping the A and E in name only. The Secretary of State promised an A and E for Ealing, but delivered only more disappointment to local residents. There are many other concerns, not least of which is the fact that many of my constituents in Southall are the poorest and most vulnerable members of society, with specific health needs that are met by nearby Ealing hospital. They will have to travel considerable distances, putting their lives at risk.

With the population of west London growing, those decisions seem, at best, unsafe and, at worst, dangerous. The concerns that we have in my constituency and in west London will obviously be replicated across London with the threat of more closures in the midst of an A and E crisis. There needs to be more of a concerted effort from the Secretary of State and the Department of Health to help Londoners receive the best health care, rather than making this existing crisis worse.

[Glenda Jackson]

rose—

[Mrs Anne Main (in the Chair)]

Order. I call Ms Glenda Jackson—you have one and a half minutes.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

Thank you very much, Mrs Main. I had intended to talk for slightly longer than two minutes, but the central thing I wish to say is about mental health. Other contributors to this very important debate have touched on that, but it seems to me that for us, as a nation, it is essentially a Cinderella service, and certainly has been all the time that I have been in the House.

The hon. Member for Cities of London and Westminster (Mark Field) referred to the pressures on central London. That is not only to do with the churn of people moving into London and moving out, but, as he rightly said, it is most markedly about people who are dependent, or over-dependent, on drugs and alcohol, and people with mental health issues. A peripatetic patient cohort—I hate that word, but I cannot think of anything else at the moment—is virtually not being regarded, let alone something on which the multifarious bodies and boards that are now responsible for delivering health care in London are working together.

I hope the Minister will take that away and put it at the top of her list, because the enormous damage that is done to individuals when they are allowed to go over the cliff of their crisis is reflected in the damage inflicted on their families and their wider community. I am firmly of the opinion that the right provision, as we have had in my own constituency, is a house that is open 24/7, 365 days a year. People who felt that they were going to go over the edge of their mental health crisis could walk in through the door. There were people there all the time to care for them. Yes, such facilities are expensive to set up, but I am firmly of the opinion that the money we save by having them could be put towards the sharp end of delivering a high-quality health service to people who are not suffering from mental health problems.