Accident and Emergency Departments

Jim Dowd Excerpts

Thursday 7th February 2013 Commons Chamber

[Stephen Lloyd]

I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.

Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:

“Delays in surgery for the elderly are associated with poor outcomes”.

The letter to the Prime Minister also backed this view:

“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”

Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.

That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.

[Jim Dowd (Lewisham West and Penge) (Lab)]

How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

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[Jim Dowd (Lewisham West and Penge) (Lab)]

I am pleased to follow the hon. Member for Eastbourne (Stephen Lloyd). I thank him, the hon. Member for Newark (Patrick Mercer) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate and the Backbench Business Committee for agreeing to their representations.

I will return in a moment to a few things that the hon. Member for Eastbourne said, because he got to the thrust and the kernel of a lot of the problems with the four tests, although his attitude towards them is a good deal more generous than mine.

[Mr Love]

The four tests were invented for the reconfiguration of Chase Farm hospital, which predates everything that we are discussing today. If we look back at what happened there, it is clear that it did not matter what local opinion was, what local medical opinion was, or that everyone at Chase Farm was opposed—there was a determination to go ahead regardless. So the whole thing becomes a farce and a complete sham, and the four tests do not really add up to anything in terms of protecting local services.

[Jim Dowd]

My hon. Friend has it exactly. That is precisely our experience in Lewisham, which I will elaborate on in a few moments, where we have seen that the four tests are a fig leaf and entirely inconsequential, and, more than anything else, that the Secretary of State can blithely announce that he has decided that they have been met and that that is all that counts. There is no review, no appeal, no objective analysis, no consideration of alternative views: it is just a case of the Secretary of State saying yes. It is precisely as Humpty Dumpty said: “Words mean exactly what I choose them to mean, and that is it.” That is the position of the Secretary of State.

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) went over a lot of the ground that is concerning us in Lewisham regarding the outrageous proposals by the trust special administrator appointed in South London Healthcare NHS Trust. Let me emphasise that the reason for the anger, the outrage, the fury and the sense of seething injustice in Lewisham is not that people there are particularly prone to believe scare stories—it is that they know exactly what is going on. They know that they are being punished for the failings of others at a time when Lewisham hospital has made every effort to meet the financial targets and, more particularly, the service targets, and to retain the confidence of local people.

I would therefore say this to anybody whose local trust is performing badly: fear not, for under this Government you will be rewarded. What people really need to be careful of is being anywhere near a trust that is doing badly, because even though their local trust may be doing well, the Secretary of State will appoint his henchmen—and women, for that matter—to go in there, jackboot their way around the place, spend millions of pounds of public money, and then come up with a scheme that does not do much to achieve the purpose for which they were appointed but rather deals with others who have played the game and played by the rules: and under this Government, more fool them.

[Gavin Barwell (Croydon Central) (Con)]

I have quite a bit of sympathy with some of the points that the hon. Gentleman is making because some of my constituents work at Lewisham hospital and have contacted me about this issue. However, he has to make his argument in a balanced way. Is it not the case that under the previous Government, when there was a problem in one PCT neighbouring PCTs were required to subsidise it, and that that, to a degree, unfair as it seems to people, is the consequence of having a national health service rather than separate individual units?

[Jim Dowd]

No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will the hon. Gentleman give way?

[Jim Dowd]

I certainly will; I need the extra minute.

[Anna Soubry]

Is the hon. Gentleman saying that the trust special administrator was given a brief and did not act independently? Does he recognise that he had two hospitals in PFI agreements that were losing £1 million of taxpayers’ money in those agreements—money that should have been spent on health services?

[Jim Dowd]

That is not true; we do not have that. That is in South London Healthcare NHS Trust. Lewisham Healthcare NHS Trust is in balance—[Interruption.] I am saying that a trust special administrator was given a remit to close Lewisham hospital. Why on earth were Lewisham Members invited to the meeting to discuss South London Healthcare back in July? This scheme has been hatched in the Department of Health, and the Minister does herself no credit by attempting to defend the indefensible.

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[Mike Gapes]

I do not personally blame Averil Dongworth, the new chief executive at Barking, Havering and Redbridge University Hospitals NHS Trust, for the current situation. She has not been there long enough. There are a number of predecessors who were party to the proposal. I also blame Ruth Carnall and the people in NHS London who were behind the original proposals. They and Heather Mullin, along with others in the NHS in London, have been determined for six or seven years to close the A and E unit at King George regardless of the petitions, the protests or the fact that the public overwhelmingly rejected their proposal, even in their rigged consultation.

[Jim Dowd]

On the malign influence of NHS London, let me tell my hon. Friend that its policy director—one Hannah Farrar—was appointed as number two and chief assistant to the special administrator of South London Healthcare NHS Trust, precisely to achieve what had always been wanted: the closures at Lewisham.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.

I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.

[Jim Dowd]

Will the Minister give way?

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.