Five Year Forward View

Heidi Alexander Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

We are looking at the issue very closely, and I think that we have made very good progress. We have introduced maximum waiting time targets for some mental health conditions, which has never been done before, and we have made a clear commitment to applying those targets to all mental health treatment during the next Parliament. However, my hon. Friend is right: ultimately, we need to look at funding differently. We need to look at it holistically. We need to understand that it is a false economy not to invest in proper mental health care, because it will only make the overall costs to the system greater in the long run.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary will know that one of the biggest challenges facing the NHS is our ageing population. Thousands of lonely people are living in unsuitable accommodation and are not receiving the care that they need. What proportion of the NHS land that will be sold off over the next five years will be used to create more suitable accommodation for older people, and to create communities of care where they can be given the service and attention that they need?

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 21st October 2014 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

7. What recent assessment he has made of the adequacy of ambulance response times in London.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

First, I praise the hard-working staff of the London ambulance service, who responded to 100,000 more calls last year. We know that the service is under some pressure, and that is why we are providing extra support to the NHS in London, including £15 million for the ambulance service to help to ensure that the trust meets standards in future.

[Heidi Alexander]

London ambulances are taking, on average, two minutes longer than they did three years ago to respond to the most serious call-outs. The chief executive of the service is quite open about the fact that she does not have enough staff on each shift every day. This is a service in chaos. Will the Minister be explicit about the support her Government are giving to ensure that my constituents, and Londoners, get the service they deserve [Official Report, 27 October 2014, Vol. 587, c. 1-2MC.]

[Jane Ellison]

This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

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[Heidi Alexander (Lewisham East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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

Last week, the Care Quality Commission published its “State of Care” report. This affirmed that the pace and scale of change to improve care in the NHS last year has been unprecedented, but it also contained some hard truths. It found that the variation in the quality of health in adult social care was too wide, and that too many hospitals have not got to grips with the basics of safety. This Government want every NHS patient to have confidence that their care will be both safe and compassionate. We have turned around six hospitals put into special measures, and people saying that their care is safe and compassionate are at record highs. We are determined to change the culture of the NHS away from secrecy towards transparency, and away from targets towards personal care where patients’ needs always come first.

[Heidi Alexander]

In August 2014, 10,616 patients had to wait longer than six weeks for a key cancer test. That is five times the number of people who had to wait that long in May 2010. If the Government do not support Labour’s commitment to a one-week cancer test guarantee, what action will they be taking to reduce waiting times?

[Mr Hunt]

As I said earlier, we welcome the fact that Labour is now interested in cancer policy. If we look at the reason for those delays, which we are working hard to address, it is because the number of cancer referrals—[Interruption.] Labour left this country with the worst cancer survival rate in western Europe; we are doing something about it. The reason for the delays is that the number of people being referred for cancer tests has gone up by 50% since 2010. We are treating record numbers of people with cancer because we want to do something about that survival rate.

Ebola

Heidi Alexander Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

For the month that we looked at, September, we are talking about around 1,000 people arriving from the directly affected countries, which is about 0.03% of all Heathrow travellers for that month. It is important to say that the vast majority of those will be low-risk passengers, but those are the people with whom, initially, we would want to have a conversation, so that we could understand whether they had been in contact with Ebola patients or had been in the areas particularly affected by Ebola, and so that we could decide whether we needed to put in place tracking procedures to allow us to contact them quickly, should they develop symptoms.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be aware that this weekend Lewisham hospital dealt with a suspected Ebola case. Thankfully, tests have shown that the individual is free from the virus, but may I press the Secretary of State further on the advice given to staff on the NHS front line? When was the guidance to NHS hospital and general practitioner receptionists sent out, and what steps have been taken to ensure that the guidance has been read and understood, and will be acted on?

[Mr Hunt]

First, on what happened in Lewisham hospital, the moment the individual was identified as a potential Ebola case, he was put into isolation. We learned, from what happened there, the importance of making sure that the guidance is widely understood. Making sure that everyone on the NHS front line knows what happens is an ongoing process. It is important to say, as I did in my statement, that the chief medical officer is satisfied that the arrangements in place right now are correct for the level of risk. The additional processes that I talked about are to make sure that we are ready for an increase in that risk.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

I will be very happy to discuss the issue with my hon. Friend, if he would like to do so. I pay tribute to the extraordinary work the air ambulance services undertake across our country. I have witnessed that in my own community and I would be very happy to talk further about what more can be done to strengthen the work they do.

[Heidi Alexander (Lewisham East) (Lab)]

15. What recent assessment he has made of the adequacy of child and adolescent mental health services.

[The Minister of State, Department of Health (Norman Lamb)]

We know that there is a varied picture of services across the country, where decisions on spend and allocation of resources are made by local commissioners. NHS England is preparing to publish a report based on its recent analysis of tier 4 child and adolescent mental health services, along with a service improvement plan. We expect these to be published in the coming weeks.

[Heidi Alexander]

A recent survey conducted by the Royal College of Psychiatrists found that over a quarter of trainee psychiatrists have had to send a child or young person more than 200 miles away from their family in order to access an appropriate bed. What is the Minister going to do about this totally unacceptable situation?

[Norman Lamb]

I agree, and that is why NHS England undertook the work to analyse exactly what the position is across the country. In fact it is very varied. There are some regions where it is fine, and others where it is not acceptable. I think we would all agree that it is completely unacceptable for children to be sent sometimes hundreds of miles away from home. When it publishes its report, it—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would just listen, when it publishes its report, it will be publishing an action plan of the steps it will take very soon to meet any shortfalls in provision.

Care Bill [Lords]

Heidi Alexander Excerpts

Tuesday 11th March 2014 Commons Chamber

[Andy Burnham]

My right hon. Friend makes a very important point. The community came forward, with clinicians standing beside ordinary people on the streets of Lewisham, to say, “This is not acceptable.” My right hon. Friend and others gave voice to that concern and brought it to this House. That incredible campaign gave heart to campaigners everywhere. She was right to put that point on the record.

[Heidi Alexander (Lewisham East) (Lab)]

The Save Lewisham Hospital campaign was terrifically important, but there was also a protection written into law in relation to the trust special administration regime. Does my right hon. Friend agree that clause 119 will today remove that legal protection?

[Andy Burnham]

I agree with my hon. Friend. That is the point that the Minister revealed in his intervention. The original power was designed for something entirely different. It was designed to deal with financial failure in a trust. It put in place measures to dissolve and rescue that trust through administrative reconfiguration. It was never intended as a vehicle for back-door reconfiguration across a whole health economy. That is where the Government got themselves into trouble. The fact that they cannot see that now, after the court has told them that they went way beyond Parliament’s original intention, reflects badly on their ability to listen.

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[Paul Burstow]

I am grateful for that intervention. As I develop my argument, I think the right hon. Gentleman will hear where I sit on the spectrum of viewpoints. He may be interested in what I am about to say.

The second principle is that commissioners who have successfully managed the quality and demand in their area should not have decision making taken away from them. Decision making can be removed from the trusts that are failing, and this may mean that commissioners of such bodies have to accept unwelcome changes. But local decision making should remain in place where a local commissioner and provider are working successfully together. Thus the first purpose of my new clause is to seek to place with the commissioners of services at NHS foundation trusts and NHS trusts that are not in special administration the same decision-making powers as are given to commissioners of services of NHS trusts that have been found to fail and are in special administration.

At present the Bill creates two classes of commissioner. Where there is a trust in special administration, the clause provides that commissioners of services at that trust are able to define the services that the failing trust should continue to provide. The commissioners are thus entitled to ring-fence certain services that they feel must be preserved for the benefit of local patients. They are, in effect, given a veto on the extent of changes that can be made to a troubled trust because of the statutory objectives set for the administrator. The commissioners are thus able to act to preserve local services.

However, the present text of section 65DA does not give the same rights to the commissioners of adjoining trusts. They are relegated to second-class status. Clause 119 as drafted envisages that a special administrator is entitled to make recommendations for changes at trusts other than the trust in special administration which are not approved by local commissioners. In its present form clause 119 does not provide that the commissioners of the services at trusts other than the trust in special administration enjoy the same veto over the extent of any changes as the commissioners of a trust in special administration. There is a fundamental lack of parity of esteem between the different organisations and the different commissioners in a locality. It is that inequality that I am seeking to change.

[Heidi Alexander]

rose—

[Paul Burstow]

I give way finally to the hon. Lady.

[Heidi Alexander]

I am grateful to the right hon. Gentleman. Will he explain to me whether, if his new clause had been on the statute book at the time of the south London TSA process, only Lewisham clinical commissioning group would have had a veto over services at Lewisham hospital that it was proposed to change, or whether commissioners of services at Lewisham hospital, such as Greenwich, Bexley or Southwark CCGs, would also have had such a veto? Exactly who is he talking about?

[Paul Burstow]

What I am saying is that in a situation where trusts that are not themselves in special administration are being brought into the process, the commissioners of those trusts should be given equal standing in the process. At present they are not given the same standing as the commissioner of the failing service. The commissioner of the failing service is given a greater role in determining the outcome of the process. I want to ensure that if we use this process in future, in the way the Government intend, there is a parity of esteem between all commissioners, representing the clinical interests in the area and the interests of patients.

[Heidi Alexander]

Will the right hon. Gentleman give way?

[Paul Burstow]

Forgive me, but I will not give way. I want to ensure that others have a chance to debate the clause and my new clause, and I need to make some progress.

Why therefore should responsible commissioners who have worked successfully with their local NHS trusts to produce a sustainable set of NHS services be prejudiced by the failure of a commissioner who has not secured such an outcome? Clause 119 risks penalising responsible co-operation between commissioners and providers, and it gives a veto to the potentially irresponsible. My new clause removes that inequality by providing that commissioners of services at an NHS trust that is affected by any proposed changes should be placed in the same position as the commissioner of those services covered by the administration process.

Secondly, my new clause makes it clear that, if the special administrator issues a final report recommending changes at a trust that is not in special administration, the decision makers to decide whether those changes ought to be accepted should be the commissioners of services at the successful trust and not the trust special administrator, the Secretary of State or Monitor. Clause 119 envisages that the TSA can recommend changes at an NHS foundation trust which is not in special administration, but fails to provide any mechanism to put those changes into effect. It follows that the recommendation from the TSA is left hanging in the air. The TSA cannot impose decisions on a reluctant CCG, because the Secretary of State is unable to direct CCGs and cannot, through Monitor, require changes to the services by the foundation trusts.

When making submissions to the Court of Appeal in the Lewisham case, leading counsel for the Government accepted that chapter 5A of the Health Act 2009 was a purely procedural statute. Chapter 5A does not provide any additional powers for the Secretary of State or Monitor. It simply defines the process that must be followed before existing powers may be exercised. The TSA takes over the role of the board of the trust in administration, so that it can make decisions about that organisation. The Secretary of State and Monitor have powers to dissolve NHS bodies, but the TSA does not have a role with regard to any trust that it is not administering. There is therefore a fundamental problem with clause 119 in that particular case, and that is what my new clause attempts to address.

I am proposing a new clause that would make it clear that a TSA report is to be provided to commissioners of services at any affected trust who are the decision makers as to whether they wish to accept or reject the recommendations. They are the relevant decision makers —in other words, the local commissioners.

[Heidi Alexander]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will conclude, because I want to ensure that there is time for other people to speak. I am sure that the hon. Lady will make a speech. If she comments on my remarks, she might be gracious enough to allow me to intervene to clarify if she is still unclear.

Obviously, if the local commissioners decide that they are minded to accept recommendations, local people who use services provided by trusts that are not deemed to be failing should not have changes foisted on them without proper consultation.

In conclusion, I am grateful to the Government for what they have already done by including Healthwatch and local authorities as consultees in the process, but we need to go further to ensure that all the commissioners who we in this House, under the 2012 Act, said should be the primary decision makers in arranging health care should be treated the same and have a genuine say in any trust special administration process. That is an essential safeguard, but it is not clear at the moment; it needs to be clear in the future, so that we ensure that this process works in the interests of patients and the local public.

[Heidi Alexander]

I want to do two things in my contribution: first, to speak in support of amendment 30, which would delete clause 119; and, secondly, to make a few comments on new clause 16, which was tabled by the right hon. Member for Sutton and Cheam (Paul Burstow). I would be content to support the right hon. Gentleman’s new clause, but I have some reservations and some questions that I would like his assistance in answering.

I do not want to rehearse everything that has been said about the case of Lewisham and the trust special administration process that took place in south London. My hon. Friend the Member for Lewisham West and Penge (Jim Dowd) summed up well the feelings of frustration and anger that existed in Lewisham at the time. Like him, I do not wish to inflict that process on other communities across the country.

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[Jeremy Lefroy]

In our case, we had a public meeting where about 400 people were outside trying to get into a meeting of 1,500 people.

[Heidi Alexander]

The experiences in Stafford and in Lewisham have probably been very similar. Multiple public meetings were run in a chaotic and haphazard fashion, and if I had not intervened in this particular meeting in Catford to try to calm the audience down and enable them to ask questions, I am not sure whether it would have been able to proceed.

We have heard about the quality of the consultation in Lewisham. The fact that the online consultation did not include a direct question about the closure of accident and emergency services and maternity services at Lewisham hospital beggars belief. My constituents were asked whether they agreed that acute services should be consolidated on four instead of five sites in south-east London. It is no wonder they came to me asking, “Where is the question about Lewisham A and E?” As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, the consultation contained no direct question about the sale of two thirds of the land. There was a question about the sale of land at the hospitals that were placed in administration, but there was no such question about Lewisham hospital. We must be under no illusion that if clause 119 had been on the statute book at the time the administrator made recommendations about Lewisham hospital, its full A and E, its full maternity service and its excellent paediatric unit would now be closing.

Many people have said to me that I am somehow against change in the NHS, but nothing could be further from the truth. We have already heard about the successful changes to stroke care in the capital. They did not come about overnight, or over 45 nights or 75 nights; they came about as a result of clear and calm consultation and communication with residents. They came about as a result of clinicians, not accountants, being in the driving seat. The public rightly care about their NHS and the local health services to which they have access. As I said on Second Reading, that is because people experience the best and the worst moment of their lives in our hospitals. It is right that they have their say in a process that is fit for purpose, but an extended and augmented TSA process, which the Government propose through clause 119, is not the right way to take decisions of such significance and which excite such public interest.

The Government have tried to spin clause 119 as some sort of clarification of existing policy. That is nonsense. It is a direct result of the Lewisham hospital case that was heard in the courts. We know that the previous Government produced guidance that said that the TSA regime should not be used as a back-door approach to reconfiguration. This is a fundamental change in policy. It removes the legal protection that currently exists for successful hospitals located adjacent to failing hospitals that have been placed into administration.

The Government also claim that such a process would be used only in exceptional circumstances, but how do we know how often it will be used in future? I press the Minister to respond to the point made by the shadow Health Secretary about whether he has had any discussions with his officials about other hospital trusts being placed into administration and about applying the unsustainable provider regime elsewhere.

[Dr Poulter]

Let me place it on the record that, as far as I am aware, there have been no discussions involving either me or my ministerial colleagues about applying the TSA regime elsewhere.

[Heidi Alexander]

That is useful. I am sure that Members are grateful to hear that from the Minister, but we know that there are many trusts in serious financial difficulties. Given the huge pressures on the NHS at the moment, this regime could be applied in many more places in the future. The truth of the matter is that the TSA regime will be used as a steamroller to force through the closure and downgrading of hospital services with limited public consultation, using a process that is set up in a way that creates public scepticism and mistrust from the word go.

The Government want to change the law to allow them to do elsewhere what the courts told them they could not do in Lewisham. As I have said already, I would not want to inflict that chaos on anyone else. It damages trust not only in NHS leaders who are meant to be leading change but in our democracy.

I wish to say a few words about new clause 16. As I have already said, I will vote for the new clause if the right hon. Member for Sutton and Cheam pushes it to a vote this evening, because it offers a limited improvement on clause 119. None the less, it raises its own set of questions. The new clause leaves clause 119 in the Bill, so it still allows an administrator appointed to a failing hospital trust to make recommendations about services provided at successful neighbouring hospitals, which are not part of the trust to which the administrator has been appointed.

As I understand it, the right hon. Gentleman’s new clause would give power to the commissioners of such services at the affected hospital outside the failing trust to have some sort of veto over whether the recommendations go any further. It suggests that if the commissioners of services at the affected hospital, such as Lewisham, agree with the changes being proposed, full public and patient consultation would kick in, consistent with the normal levels of communication and engagement that are required in full-service reconfigurations. If the local commissioners disagree with the recommendations, they can, if I understand his new clause correctly, call the process to a complete halt. I can see why that has some attractions, because it seems to provide some kind of brake on the all-encompassing powers of an administrator, and for that reason I am content to support it. However, it does not provide an entirely coherent solution to the problem that lies at the heart of clause 119.

[Paul Burstow]

The hon. Lady is helpfully setting out her concerns and her support for the new clause. The first proposition must be that we should never even get to that stage, so we need to have much better processes in place beforehand, and I hope that we will hear something about that from the Minister. More importantly, the commissioners, all of whom have a stake in a local health economy—the different trusts—ought to be around the table to sign off on what a TSA will actually do.

[Heidi Alexander]

I am grateful to the right hon. Gentleman for that answer, but I am still not clear whether the new clause would provide a direct veto to commissioners of services at a hospital located outside the trust to which an administrator has been appointed.

[Paul Burstow]

That is the intention, so the new clause has been drafted to have that effect. We will hear shortly whether the Government find it to be technically deficient.

[Heidi Alexander]

I am sorry to be down in the detail of the new clause, but I think that it is very important, not least because many of us have received hundreds of e-mails about this. We need clarity on which commissioners are being given an effective power of veto by the new clause. Is it just the primary commissioner of services at a hospital, or does it go wider than that? To take the Lewisham example, it is not clear whether the power of veto would be given only to Lewisham CCG or also to the commissioners of services at Lewisham hospital, such as Greenwich or Bexley CCGs.

It is also not clear from new clause 16 whether there is a definite guarantee that full consultation would kick in if commissioners agreed to the recommendations of the TSA, because with reference to commissioners it includes the words

“if they are so minded”.

It is not clear what would happen if they were not so minded. Where is the redress for the public in that?

Another concern about new clause 16 is that if commissioners of services at a trust outside the failing trust disagree with the TSA’s proposals, potentially millions could have been spent bringing in the administrator and the management consultants and working up a whole series of proposals, but it could then be brought to a halt by a group of commissioners. I cannot help but question whether it would not be better either to apply the TSA regime to one individual trust or to go through a proper reconfiguration process, with all the safeguards that would include.

I am also intrigued as to why the right hon. Member for Sutton and Cheam tabled new clause 16 at this time. It is quite detailed, and given that he was a member of the Public Bill Committee, it might have been wise to introduce it in Committee and thrash out the detail there. I would like to add that he has always struck me as a man of principle. He has a deep understanding of how the NHS works and, I believe, a deep commitment to tackling the care crisis we face. However, tabling the new clause as some kind of alternative to voting against clause 119 seems to me to be tinkering at the edges. What we really need to do is vote to remove that clause from the Bill, because it poses a significant danger to hospitals across the country.

I am conscious that I have spoken for a long time, so I will say just a few words in conclusion. We know that the Conservatives stated in their manifesto that they would stop the forced closure of A and E departments and maternity wards. We know that in the coalition agreement both the Liberal Democrats and the Conservatives talked about stopping the centrally dictated closure of A and E departments and maternity wards. The truth is that neither the Lib Dems nor the Conservatives are stopping these closures; instead, they are legislating for them. They are paving the way for a wholesale programme of hospital closures and downgrades. We might stop them if we vote for new clause 16, but for me “might” is not good enough. In my view, amendment 30, which would delete clause 119, is our best hope for putting the Lewisham debacle behind us and providing the public with a fair and transparent means of making decisions about the public service that matters most to people—the NHS.

[Mr Dorrell]

I want briefly to explain why I intend to support clause 119 in the Lobby this evening and to say that I have some sympathy with the points that my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) made about new clause 16. I hope that the Minister will address his specific points about the importance of equivalence between the commissioners of unaffected hospitals and the commissioners of key services. This is not about a veto, I suggest to the hon. Member for Lewisham East (Heidi Alexander); it is about the right of commissioners out of area to safeguard essential services in a parallel way to commissioners in the core area of the affected trust that is subject to the trust special administrator regime.

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—

Care Bill [Lords]

Heidi Alexander Excerpts

Monday 16th December 2013 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State has come here to introduce the Second Reading of a very important Bill, yet it has taken him only two minutes to start casting aspersions on the previous Labour Government. When is he going to start acting like a Secretary of State?

[Mr Hunt]

The reason I am talking about this is that the hon. Lady’s party has decided to oppose the Bill. Let us look at the measures in the Bill that Labour is opposing.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to follow the hon. Member for Newton Abbot (Anne Marie Morris), who made a measured, thoughtful speech. It is sad that the Secretary of State did not strike the same tone at the beginning of the debate. I want to speak briefly about the proposals for the funding of elderly care and express my deep concerns about the Government’s proposed changes to the trust special administration process.

I have spoken before in this place about the care crisis in this country, not least because of my own family’s direct experience. When my nan had to move out of her home seven years ago, my family had no idea what was about to happen to the very modest assets she had built up over her lifetime. My nan was not an extravagant woman. She never once went abroad. She simply worked hard and brought up her family. When vascular dementia took hold of her mind and her body, she could no longer stay in the semi-detached house in Swindon she had bought with my grandfather. She had to sell it. She moved to sheltered accommodation but, after a few years, she deteriorated rapidly and soon had to move to a nursing home. Before she died, she spent £130,000 on care in that home over three to four years, using up all but £23,000 of her lifetime assets. If she had known that, it would have broken her heart. She would not have thought it fair that everything she and my grandfather had worked for could not in any meaningful way be passed down to her children. My family are neither rich nor poor; we are like families up and down the country for whom the hand of fate intervened resulting in catastrophic care costs for their loved ones.

The Bill’s proposals to cap those costs and to raise the amount of money that an individual’s family can keep after paying for care should be welcomed, but we should welcome them cautiously. The cap does not cover all care costs, and the complexity of the process of valuing people’s assets and calculating their personal contribution means that many people will still end up paying very significant sums. Presenting the proposals as the answer to the country’s care crisis is disingenuous and risks spreading even more confusion about what support from the state families can expect.

If individuals are to pay less, the state will pick up more of the tab, and the financial front line in that respect will be local authorities. They are already buckling under the strain of providing social care. London Councils, the body representing the capital’s local authorities, estimates that the costs of resetting the means-test threshold, added to the rising demand for care, will see social services departments facing a shortfall of more than £1 billion in the years between 2016 and 2020. The money set aside by the Government to deal with that is inadequate. Be it this Government or the next one, we have to wake up to the scale of the financial challenge and answer the tough questions about where the money is going to come from.

I could speak for much longer about the care proposals in the Bill, many of which I welcome, but I now wish to address part 3, chapter 4, which extends the powers of special administrators appointed to failing hospital trusts. The changes are only a small part of the Bill, but they have serious implications for hospitals and the health service across the country. The introduction of even more draconian powers for special administrators will hamper the public’s ability to have their say on key hospital services and could lead to a chaotic and rushed system of hospital reorganisations that will not be in the best interests of patients or our democracy.

[Grahame M. Morris]

My hon. Friend is making important points about clause 118, which has become known as the “Lewisham clause”. Given the recent experiences of the length of time the trust special administrator has to consult the general population, does she think that 100 days is long enough?

[Heidi Alexander]

In my experience, it is wholly inadequate. The consultation period is being slightly extended through this Bill, but I still do not believe it can lead to a genuine, open and honest debate between the people trying to lead change and the public, who have a right to make their voice and views heard.

I wish to discuss our experience in south-east London of the first ever use of the trust special administrator regime when the South London Healthcare NHS Trust was placed into administration last year. It is important for the House to understand that this process is totally different from any other hospital reconfiguration. It is a very fast process—roughly six months from start to finish—led by an administrator who is brought in from outside the organisation primarily to balance the books. The administrator is appointed to a specific failing trust, but what happened in our corner of London was that the administrator determined that in order to sort out the financial problems of the failing trust he needed to look beyond its confines, and that is where Lewisham hospital came in: a separate, successful, neighbouring hospital was told that its full accident and emergency department, its maternity service and its excellent paediatric department would have to go to solve the financial problems elsewhere.

The people of Lewisham did not think that that was very fair. The case was fought in the courts and the Secretary of State was told, not once, but twice, that he was acting unlawfully—hence clause 118; he fought the law and lost, so he is now trying to change it. He wants administrators to be able to specify and force through massive service changes at hospitals that are not part of the trust to which an administrator has been appointed. In effect, he wants to do elsewhere what the courts told him he could not do in Lewisham. When the trust special administrator regime was first legislated for, guidance was issued by the Department of Health stating that the process should not be used as a “backdoor approach” to reconfiguration. That is precisely how it was used in Lewisham, and had the law not been on our side, our full A and E and maternity service would now be closing, and half our hospital would be up for sale.

The TSA process is a brutal and rushed one. It starts with the need to save money, with questionable clinician input. When the starting point is the accountant’s bottom line, the public are understandably sceptical about whether the medical and clinical input has just been shaped to suit the desired financial end point. The speed at which the process takes place leads to shoddy and haphazard work. The administrator in south London recommended to the Secretary of State that he make decisions about Lewisham hospital based on an understanding that the whole process would cost £266 million and would take three years to implement. After the Secretary of State took his decision, it emerged, from the office of the trust special administrator, that it would cost twice that and take twice as long. The quality of the condensed public consultation was atrocious: people were struggling to find copies of the consultation document in local libraries; we had an online response form that did not even contain a direct question about Lewisham’s A and E; and hundreds of people had to stand outside packed public consultation meetings because they could not get in. That is not the way to deal with a subject that understandably arouses such passions in people. People care so much about the health service because it is often where they experience the worst and best moments of their life. They want to have their say in how their services are organised, and giving even more draconian powers to special administrators erodes their ability to do that.

I understand that hospital services have to evolve—some services will have to close or be relocated—but to get public support for change, we have to get the process right for persuading people of the case for change. An augmented special administrator process, acting as a steamroller for the closure of hospital services, makes it less likely that those arguments are won, not more. These changes are at complete odds with the Conservative party’s manifesto commitment to

“stop the forced closure of A&E and maternity wards”.

The changes take power from the very doctors the Government say they are giving power to and could destroy trust in those who are central to leading the case for change and improvement in our NHS. For that reason, as well as others, I will be voting for the Opposition amendment, and it is why I believe that clause 118 should be deleted from this Bill as it progresses through Parliament.

Tobacco Packaging

Heidi Alexander Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

That is certainly the objective of the timetable that has been drafted, once the Government have received the review and made a decision. I see no reason why what my hon. Friend suggests could not be the case.

[Heidi Alexander (Lewisham East) (Lab)]

The Minister said that she had not held a review, but had carried out a consultation. Is that not just a pathetic excuse for inaction, and does she not accept that for every day she delays this policy, another 570 children start smoking?

[Jane Ellison]

We have had a consultation and now we are having a short review of the emerging evidence base. I think that that is sensible. We want to make good policy that is robust, and this is the right way to do it.

Urgent and Emergency Care Review

Heidi Alexander Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

We will absolutely ensure that there is no iron curtain, but I must say that the increasing number of people coming from Labour-run Wales to seek treatment in England is an indication that people are voting with their feet because they know where the NHS is being better run.

[Heidi Alexander (Lewisham East) (Lab)]

On repeated occasions in this place, the Health Secretary has claimed to be saving A and Es when his proposals would remove intensive care units in many hospitals and allow blue-light ambulances to go sailing past their doors. Will the Health Secretary tell me what his definition of an A and E is?

[Mr Hunt]

That is exactly what tomorrow’s report is designed to clarify. It is not for me—[Interruption.] Let me say very straightforwardly—[Interruption.]

Changes to Health Services in London

Heidi Alexander Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I can absolutely confirm that A and Es will remain at Charing Cross and Ealing hospitals, thanks in no small part to the remarkable campaigning that my hon. Friend has done for her constituents, both in public and in private. I commend her for that. The process that has to happen is clearly set out in what the IRP says and in my reply. There must be full consultation. There will be changes to the way in which services are provided, but they will be changes made in the interests of patients. Whatever those changes are, A and Es will remain at those two hospitals.

[Heidi Alexander (Lewisham East) (Lab)]

It is a bit rich for the Secretary of State to accuse the Opposition of being desperate when he has been told by the court not once, but twice that he acted unlawfully in relation to Lewisham. The Secretary of State’s amendment to the Care Bill would enable him to do to other hospitals what the courts said yesterday he could not do in south London. Will he admit that under those changes no hospital would be safe, and that in fact he wants to inflict the blatant injustice that he tried to inflict on Lewisham on hospitals not only across London, but up and down the country?

[Mr Hunt]

I understand why the hon. Lady is rightly representing the concerns of her constituents, but she must also understand that I have to look at their interests as patients, as well as at the interests of the broader south London population. It is important to make that amendment to the Care Bill because hospitals are not islands on their own. We have a very interconnected health economy, and what happens in Lewisham has a direct impact on what happens in Woolwich and vice versa. If we are to turn around failing hospitals quickly—something that the last Government sadly did not do—we need to have the ability to look at the whole health economy, not at problems in isolation.