NHS in London

Debate between Heidi Alexander and Jane Ellison

Thursday 24th March 2016 Westminster Hall

[Heidi Alexander]

Will the Minister give way?

[Jane Ellison]

No, I will press on, particularly as the hon. Member for Ealing Central and Acton, who introduced the debate, took half an hour for her opening speech. I will give way if I have time towards the end. It is a matter of record that we committed—[Interruption.] All right, I give way to the shadow Secretary of State, if she would like to remind us of what the Labour party pledged at the election.

[Heidi Alexander]

I am grateful that, when making a political point, the Minister is happy to give way to the shadow Front Bencher.

We have been clear that we would always have given the NHS every penny that it needs. However, the calculations for the five-year forward view were predicated on social care being properly funded and there being no further cuts to the public health budget. I think Simon Stevens would say that those two things are essential if we are to deliver a sustainable NHS. Will the Minister therefore tell me how much money her Government took out of adult social care in the previous Parliament?

[Jane Ellison]

We have been clear that we have given a large amount: £3.5 billion has been made available to local authorities for social care. Ditto on public health—we will spend £16 billion over the next five years. If I have time, I will come to the good point that was made earlier about the move to business rates retention. It is matter of record that the Government committed at the election to what the NHS had asked for in the five-year forward view, and we will continue to make that commitment.

The London health system—CCGs and provider trusts—has planned for a deficit in 2015-16 of about £350 million, and overall the system is expected to be in that position. Some recovery is expected during 2016-17, and I am sure we will debate that again. In addition, a £1.8 billion sustainability and transformation fund is available, designed to address provider deficits in 2016-17. However, I think all Members would accept that additional Government spending is not the only answer to the challenges faced by the NHS. We have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits, but much of the change Members have talked about is driven by desire to get better healthcare rather than to make savings. If we can make savings as well, that is all to the good, because we can reinvest them in great healthcare.

In London, from early April, the new NHS Improvement body will be providing additional expert support and capacity to trusts experiencing particular financial challenges. That support will include identifying and implementing financial improvement and helping them to identify savings to put them in a stronger position to maintain those savings.

Let me talk about the pressures on urgent and emergency care. It is acknowledged that the urgent and emergency care system faces increasing pressure. More and more people are visiting A&E departments and minor injury units, which is stretching their ability to cope. Members listed some reasons for that in their speeches. A lot of visits are unavoidable, but some people are visiting because of inconsistent management of long-term health conditions, difficulty in getting a GP appointment or insufficient information on where to go.

Winter sees an even bigger rise in visitor numbers and pressure on staff. Although the debate inevitably dwelled on Members’ concerns about their local healthcare systems and problems in them, I am sure we all want to place on record our huge thanks and praise, as many have, to the staff of London’s NHS, who work extremely hard under a lot of pressure and delivering some really good results against that backdrop. I will come on to that.

London’s A&E units have been significantly challenged this winter, and that has been reflected in performance. However, despite those pressures, the capital’s urgent and emergency care system has proved its resilience, with fewer serious incidents declared than in previous years. This winter, London accounted for just three out of 625 serious incidents declared across England. It is important to praise the staff in saying that.

In January, London’s performance was significantly higher than all other regions, with 90% of patients seen within the four-hour A&E standard. London is also the highest-performing region in England this year to date, with 93.1% of patients seen within the four-hour standard. My thanks and congratulations on that improved performance go to the hard-working staff of London’s services.

Reconfiguration schemes have loomed large in the debate. The health needs of people in London are changing and demands on health services are increasing. The hon. Member for Ilford South in his excellent speech illustrated through his personal stories some of the reasons for the changes in the shape of our health service in terms of how we are investing in specialist services and centres of excellence. The work done to centralise stroke expertise was brought up earlier in the debate. I remind Members, although many will remember, that those changes were bitterly opposed by many people. I am not sure whether that includes anyone in the Chamber, but it certainly includes campaign groups. However, all our London clinicians now say with certainty that those changes, with centralised expertise and specialist care, have saved many lives. That is always worth reflecting on.

People are living longer, the population as a whole is getting older and there are more patients with chronic conditions. We often say that people are living longer, but we forget to say that they are living with chronic conditions for longer, and that presents a longer-term challenge than might be seen at first sight. Heart disease, diabetes and dementia will all increase as they are conditions associated with an ageing population.

We did not dwell on the prevention agenda, but I was delighted that the hon. Member for Edmonton (Kate Osamor) spoke about it. The shadow Secretary of State also touched on it when she mentioned dementia and the problems we all know of older people in hospitals. I urge her to look at the dementia implementation plan we published on 6 March, which is a detailed response to the Prime Minister’s 2020 challenge. Dementia has sat in my portfolio since the election, and that plan is a detailed look at how we deliver against that challenge and in particular at the joined-up care that is key to ensuring that people with dementia have safer and better care in our system and are kept out of the acute sector whenever that is possible.

In a number of areas across the capital, the local NHS has concluded that the way it has organised its hospitals and primary care in the past will not best meet the needs of the future. We are clear that the reconfiguration of front-line health services is a matter for the local NHS, tailored to meet the local population’s needs.

I was glad to hear that Members recently met with Anne Rainsberry. The Members who came to the cross-party “Shaping a Healthier Future” meeting last summer will know it is vital that officials at all levels and NHS managers engage with elected Members. I was therefore disappointed to hear what the hon. Member for Eltham (Clive Efford) said. I will ask my officials to look into that. A number of Members asked reasonable questions about why they could not have certain bits of information. I have some specific answers and it may be that we can take a moment after the debate and I will point them in the right direction.

Oral Answers to Questions

Debate between Heidi Alexander and Jane Ellison

Tuesday 17th November 2015 Commons Chamber

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

Obviously, tackling drink-driving remains a priority for the Government. We will be interested to see a robust and comprehensive evaluation of the change to the Scottish drink-driving limit, and I can confirm that Public Health England’s review of the public health impacts of alcohol will include drink-driving. Obviously, some of the issues my hon. Friend raises are for the Department for Transport, but I can confirm that we will be looking at this issue, and I will be interested to see the evidence.

[Heidi Alexander (Lewisham East) (Lab)]

On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:

“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”

Are they all wrong?

Princess Royal University Hospital

Debate between Heidi Alexander and Jane Ellison

Wednesday 25th March 2015 Westminster Hall

[Jane Ellison]

I have just made clear for the record what Monitor’s powers are and are not. I hope that that gives Members on both sides of the Chamber greater clarity than they had when we started. Monitor is in the process of concluding its investigation. It will announce in due course the outcome and whether it will take any further action. Key findings and any next steps will be announced by means of a press notice. Colleagues from Monitor are here in the House, and I would like to put them on notice that I expect—I am sure that they also expect this—Monitor to engage fully with local Members. Clearly, we are entering a more tricky period from that point of view, but on the other side of the election I expect there to be full engagement with local Members, particularly as the solution lies, as I think it will in other health economies that are challenged, in the whole local health economy coming together to understand how to work through the problems. That is laid out in NHS England’s “Five Year Forward View”.

[Heidi Alexander]

The Minister talks about further support that may be available to King’s and the PRUH when Monitor has concluded its investigation. Will she give some examples of the form that that support may take?

[Jane Ellison]

If it is acceptable to the hon. Lady, I will write to her to provide some clarity on that. It might be helpful, for example, for Monitor to give examples from other investigations of the sorts of things that it undertook and the changes that it requested through the formal process. I will write to her with some examples to give her a sense of that. I have sought to give a degree of reassurance to Members, and I hope that I have managed to do so.

Barts Health NHS Trust

Debate between Heidi Alexander and Jane Ellison

Thursday 19th March 2015 Commons Chamber

[Jane Ellison]

The bullying of NHS staff who are trying to draw attention to poor care is never acceptable, and this Government have taken a lot of measures to make sure that NHS staff are protected. The trust’s chief executive has said the following about the report:

“We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead.”

Part of that big challenge will be in restoring staff morale, and making sure that that culture of openness and support for staff is in place.

[Heidi Alexander (Lewisham East) (Lab)]

The placing of Barts into special measures this week confirms what many of us already know: London hospitals are under enormous pressure, some simply cannot cope and too many patients are not getting the care they deserve. In the light of that, can the Minister confirm that the recently announced Monitor investigation into the Princess Royal hospital at Farnborough will not result in another attempt by her Government to take the axe to Lewisham hospital and to services in south-east London more generally?

[Jane Ellison]

I believe we may well be addressing that issue in an Adjournment debate next week. There will be a chance to discuss it in more detail then.

Health

Debate between Heidi Alexander and Jane Ellison

Monday 27th October 2014 Ministerial Corrections

[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?

[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.

[Official Report, 21 October 2014, Vol. 586, c. 748.]

Letter of correction from Jane Ellison:

An error has been identified in the response I gave to the hon. Member for Lewisham East (Heidi Alexander) during Questions to the Secretary of State for Health.

The correct response should have been:

Oral Answers to Questions

Debate between Heidi Alexander and Jane Ellison

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.

Tobacco Packaging

Debate between Heidi Alexander and Jane Ellison

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.

Social Housing in London

Debate between Heidi Alexander and Jane Ellison

Thursday 5th May 2011 Commons Chamber

[Jane Ellison]

I am not sure I entirely agree with that, if we are talking about older people and pensioners, in particular. Nevertheless, the housing associations are considering the matter, and it is something that we could all look to encourage as well.

I want to deal with another matter that I feel strongly about and that has been alluded to already. I think that the hon. Member for Eltham (Clive Efford) asked why people are not angry or marching on Parliament and so on, given that so many people sign petitions about other things. There is a genuine problem in how we democratically represent the housing problem. One of the biggest challenges we face is that we often do not speak on behalf of the people who are not yet living in an area. The voices to which MPs and councillors listen—rightly—are those of the people already living in their areas. However, there remains a democrat deficit when it comes to speaking up for the people who want to live in an area but are not yet there. Naturally representatives will tend to voice the concerns of local residents.

MPs and councillors have to set themselves a challenge. It was slightly naughty of the hon. Member for Lewisham East (Heidi Alexander) to suggest that nimbys are limited to any one party. I do not think that is true; there are nimbys across all parties, and probably, if we look to our own consciences, everyone at some point in their political lives has thought in their heart of hearts, “Hang on, actually there is a real need for this housing, but there is a huge local campaign against it.” Sometimes we have to take courage and say to someone, “No, I’m sorry, but there is a real housing need.” I did it recently at an exhibition on my patch. A lady was saying, “Oh, there are going to be too many houses and so on”, and I said, “I’m sorry, but there is a terrific housing need in London, and this is an urban area with brilliant transport links. This is a really great place to build some new homes. So I do support this building.” We have all got to be prepared to do that from time to time.

On a tangential point in relation to what is happening today around the country, I voted no in the AV referendum this morning, mainly because I worry about encouraging blandness and people’s desire to try to please everybody. Sometimes we have to show leadership and be prepared occasionally to be unpopular, perhaps in the short term or with a particular group of residents. Giving political leadership means that occasionally we have to be prepared to go against the grain, and housing is a good example of an issue in which we should be prepared to do that. There are things we can do. We have to encourage great design and sensitive interaction with local residents. I have seen the amazing difference that it can make if the people who want to build have in place a good programme of communication, but I have also seen terrible programmes with really bad models and representations and in which people have been treated with arrogance. I have seen good and bad examples.

We have to do much to convince people about designing out antisocial behaviour and crime. We all know that when we talk about building new blocks of social housing, some people worry that it will bring a disproportionate amount of antisocial behaviour.

[Heidi Alexander]

The hon. Lady has made a thoughtful and persuasive speech. On some of the understandable concerns that her constituents express about new developments, what assessment has she made of the provisions in the Localism Bill for neighbourhood forums? Does she think that those forums will come forward with plans to build new housing, including suitable housing for older people?

[Jane Ellison]

That is a fair question, and it takes us back to my point about leadership. We will have to engage with the problem, put the case to people and be a voice for those who have not yet got a home in our areas. People’s natural instinct is to be wary, and I acknowledge that it will not be easy, but I think we have a role there. There are sensible ways of proceeding—such as by presenting some of the benefits to the local area—although sometimes someone who objects to new houses being built might take one view as a resident, but will see things from another perspective when we talk to them about their children or grandchildren struggling to get on to the housing ladder or to find a home close to where the family has always lived. We all have a leadership role to play, although sometimes the objections will be entirely valid, as we all know. However, we have to be equally prepared to engage with the process and speak up on behalf of those who really are voiceless—people in great housing need or those who are sofa-surfing. They have fallen down the cracks of the democratic system, and we have to be imaginative on their behalf.

To finish, let me say that infrastructure planning is incredibly important, because as the hon. Lady said, people often object when they look at a scheme and ask, “Well where’s the school? Where’s the post office? Where are the car parking spaces? How will my local train or tube station cope?” It is important not to divorce the two, particularly in London—my view is that London is almost a mini-economy of its own. I am glad that many of the big infrastructure programmes have continued to go ahead and I welcome the fact that the Mayor is pressing ahead with some of those important transport capacity expansion projects. If we go to local communities with a plan that makes sense and that shows that we have thought through all the issues, we are more likely to find that people will engage willingly with the need to create more housing and expand our communities to meet the need that we all acknowledge exists in this amazing city that we all represent.