Health Care (London)

Heidi Alexander Excerpts

Wednesday 8th January 2014 Westminster Hall

[Ms Buck]

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) is completely correct. Lewisham hospital brilliantly exemplifies the argument.

Secondly, there must be effective partnership working between hospitals, primary care providers and local authorities in the delivery of services. It was the failure even to inform partners that elective surgery had already moved from St Mary’s hospital to Charing Cross hospital that prompted my debate some weeks ago, to which the Minister replied, and which subsequently prompted an apology for the breakdown in communication. That was not only a matter of leaving someone off an e-mail circulation list, but a complete unwillingness to collaborate even within the national health service, let alone with outside bodies such as the local council, which is responsible for social care delivery.

Furthermore, those three boroughs—Kensington, Westminster and Hammersmith—are part of a pilot scheme to demonstrate integration, yet what happened in the relationship between the Imperial College trust and those local authorities could not have been further from integration—it was like something written for a comedy sketch.

Even worse, fundamental confusion remains about how north-west London hospitals are to be configured with Hammersmith—my hon. Friend the Member for Hammersmith (Mr Slaughter) is in his place and I am sure will comment—which has a different spin on its hospital provision from Westminster, even though they are joined in a tri-borough arrangement. Even after the Secretary of State has blessed the restructuring of west London hospitals, just weeks before Imperial concludes its outline business case, we cannot even have a clear agreement on the status of Charing Cross hospital or, by extension, of St Mary’s. That goes to the very heart of whether we can have confidence in the new structure of the national health service.

Thirdly, everyone needs to keep focused on the key issues, and that takes me to the devastating impact of the Government’s ill-considered reforms on the strategic management of London’s health service. The service should be focused like a laser on delivering the vision set out by Lord Darzi, but instead it has been fragmented, diverted and injected with rules on competition when integration should be the key objective.

The King’s Fund report of only some months ago, “Leading health care in London”, stated that the recent NHS reorganisation and the abolition of strategic health authorities and primary care trusts have resulted in an “absence” of health care system leadership in London. The report states:

“The NHS reforms have created a much larger number of organisations in London and their purposes are not always well aligned; the risks of incoherence and inconsistency are high…Reorganising the NHS in London in such a fundamental way has made a challenging situation much more difficult”.

That is so significant that the country’s top emergency doctor has said that the current A and E crisis could have been averted two years ago had the Government heeded warnings of a looming collapse in casualty ward staffing.

The president of the College of Emergency Medicine has said that Ministers and health chiefs were “tied in knots” by the challenges of implementing the coalition’s health reforms from 2011 onwards, leading them to ignore the first warnings from the college of imminent crisis—that the NHS was failing to recruit enough A and E doctors. Therefore, London, which possibly has the most complex challenges and the greatest need for integrated strategic leadership, actually has the least such leadership. Had leading health care managers and professionals been able to concentrate on dealing with such tasks, we might have had some opportunity to build public confidence, carry people with us and make the changes. In fact, the exact reverse has happened.

Finally, we need community and social care and other support services that minimise unnecessary admissions, especially for chronic conditions, and facilitate early discharge. Again, we can all agree on the principle. There are some excellent specific examples of integrated practice and of people working hard to deliver it, but there are also some harsh truths of individual experiences and the funding of social care.

The reality is illustrated in letters from my constituents in response to the moving of elective surgery from St Mary’s. One letter states:

“When I had my mastectomy I was sent to Charing Cross Hosp. After the operation I went home by bus and underground holding my drainage…bottle…from my operated breast. In the same way I travelled after my cardiac arrest on my second lumpectomy due to anaphylactic shock!”

That is only one hazard of putting patients with no family far from where they live. A second letter states:

“They took my City of Westminster Taxi card from me and so I have to pay for taxis to take me to St Marys Hospital and…Charing Cross. I pay £6.50 there and the same coming home (£26 one way to Charing Cross). I cannot walk far”—

—she is unable to use public transport—

“as I get out of breath. I am 84 this year”,

diabetic and

“have had one breast removed with cancer.”

Another constituent told me:

“I have lost my…home help”—

due to the cuts in social care—

“If I’m ill, I wait for it to go away.”

London as a whole faces a £1.14 billion shortfall in social care funding as a consequence of the pressures on adult social care and of the extra costs likely to arise because of the cap—in principle, that is a good thing, but obviously revenue is necessary to fund social care costs. That situation is London-wide and has been set out clearly in a London Councils report. My local authority also set the situation out clearly in a report to the health and wellbeing board, which states:

“As a result of reductions in local government funding Adult Social Care…has to deliver substantial savings in 2013/14”—

£4.4 million in Hammersmith and Fulham, £2.1 million in Kensington and Chelsea, and £2.9 million in Westminster. The report continues:

“These are very large savings; the cumulative effects are much bigger than any other savings programme delivered in the local authorities in the past.”

That is on top of £8 million in cuts to the adult social care budget already coming into effect since 2011. The report states:

“Amongst big reductions to back office and support functions, the savings programmes also include reductions in the use of packages and placements, the greatest area of spend for ASC.”

Rather sweetly, it adds:

“Some of the savings projects may be difficult to deliver or may take longer than anticipated.”

It continues:

“Funding growth for packages and placements arises mainly in the Learning Disabilities, Mental Health and the Young Disabled care groups where client numbers are growing, but also in Older People, as people live longer and are supported in the community.”

There is an important point. There is an integration care fund, which is shifting money from the NHS into social care, but, as Westminster council’s report on the pressures on social care funding states, that funding will mainly be used for purposes that include:

“To sustain services, otherwise at risk from savings plans”.

We are in an extraordinary position. There is a transformation fund designed to put in place the services that would allow us to make changes in hospital care, with which in principle we agree—we would argue in some specific cases—but that funding is simply going to fill the gaps caused by the cuts in social care, which are the result of cuts to local authority budgets. In London, as we know, there has been a 25% cut in local authority funding, with a further 10% cut as a result of the Chancellor’s autumn statement. Much of that new money is simply sustaining services that would otherwise be at risk from savings.

[Heidi Alexander (Lewisham East) (Lab)]

Is my hon. Friend aware of the estimate made by London Councils for the future? Between 2016 and 2020, we might see adult social care departments facing budget pressures of £1.1 billion, owing to rising demand and some of the changes proposed by the Government. Does she agree that the future looks extremely bleak?

[Ms Buck]

I agree totally. A thoughtful and planned process throughout London that would allow us to build up community and primary services, reduce unnecessary A and E admissions, speed up unnecessary discharges and concentrate some of our specialist services in fewer sites is sensible, but the means to realise it have been pulled out because of the pressures on social care funding. Furthermore, the strategic leadership that would allow us to make changes has been undermined by a completely unnecessary, £3-billion, top-down reorganisation that we were promised would not happen.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful for the opportunity to speak in this debate. We have already heard that the NHS in London is most definitely straining under the weight of demand for services. The problem is related to the constrained financial environment, but fundamentally it is about the increasing needs of our population. The population of London has grown by 12% in the past decade and is likely to grow by another million in the coming decade. That is why the plans to downgrade and close desperately needed and often very successful emergency and maternity departments in London are met with such incredulity and anger.

I would like to make a few points to the Minister today. First, I ask her to consider the overall shape of maternity services in London. Much of the debate focuses on big arguments about the reconfiguration of emergency departments, but maternity services are often a victim of those reorganisations, because as soon as an intensive care unit is taken away from a hospital, it is unable to provide full maternity services. Does the Minister really want to ask women in the capital to travel even greater distances to give birth to their children, when they want to be close to home and family? Will she look at some of the sacred cows that have built up in the wisdom on maternity services?

I know there is an aspiration to provide 168 hours of consultant cover every week in maternity departments, but I understand that that currently happens at only one trust in the whole country. I ask the Minister whether it is achievable, affordable, or necessarily in the best interests of women to continue to aspire to reach that standard in all our hospitals in London.

Another point I want to make to the Minister—it has already been made—is on the crucial importance of the public being involved and having a genuine say when hospital services are being reconfigured. In Lewisham, we saw the exact opposite of that, with the unsustainable providers regime. The Government are trying to augment that process and apply it more widely, which has very serious implications for trust in politics and in our health service.

I am very conscious of time and that two other Members wish to speak. I ask the Minister to look very hard at the existing evidence on centralising all hospital services in London. I know there is a lot of evidence for creating centres of excellence for stroke, trauma, and vascular disease in big hospitals. However, I wonder whether the same evidence exists for other acute medical emergencies and whether there is evidence, for example, for centralising mental health services or maternity services.

I have one final point—I will sit down very shortly. There are currently plans at many hospitals in London to flog off hospital sites. That land should not be used to create playgrounds for the rich and the international jet set. Public land is a very precious asset in London, and if we are going to use it for anything, could we please explore the possibility of using it for housing for elderly people, providing communities of care? Provision of suitable accommodation is one of the crucial things we need to get right if we are to tackle some of the underlying problems in the NHS.

[Several hon. Members]

rose—