Hospital Services (South London)

Jim Dowd Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander]

The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

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

I am most grateful to my hon. Friend for giving way, and I join others in congratulating her on securing this extremely timely debate. She said a few moments ago that she did not understand where this plan had come from. Has she considered that it is merely a rehash of the scheme that NHS London tried to get past the “Picture of Health” review four or five years ago but failed miserably, both in the review itself and in the subsequent re-examination by Professor Sir George Alberti, and that in its death throes—NHS London only has a few months before it is extinguished by this Government—it is trying to get through the scheme to reduce hospitals in south London from five to four, and for no other reason than that it thinks that that reduction should happen?

[Heidi Alexander]

My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.

Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.

The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.

As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.

Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.

The statutory guidance to trust special administrators and the written statement that the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.

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[Jim Dowd]

On that very point, does my hon. Friend accept that the trust special administrator has deliberately manipulated the figures, in both the draft and final reports, to mask the fact that the proposal would push King’s at least and probably Queen Elizabeth hospital, Woolwich as well over the 8,000 births a year mark?

[Heidi Alexander]

I do not know whether the trust special administrator has deliberately manipulated figures, but the way that the figures have been presented looks quite suspicious.

The plans are completely unjustified. There has been much talk in recent weeks of the need for things to do what it says on the tin. The metaphorical tin with respect to the recommendations of the trust special administrator presumably says it will resolve the financial problems of the South London Healthcare NHS Trust and put the health economy in south-east London on a stable footing. I do not think the proposals before us do that. It will be necessary to spend £195 million on a one-off basis to make changes at hospitals in south London, to deal with the displaced demand for A and E and maternity care that will result from the closure of services at Lewisham. It is not clear to me where that money is coming from: which Department of Health budget is it to come from? Has the Treasury approved that non-recurrent expenditure? If it has not approved the required capital outlay, the plans fall apart. Perhaps the Minister can deal with that point.

The changes to the Lewisham site would involve demolition of the recently refurbished A and E, so that the land could be sold. Long after the A and E was knocked down, the hospital would still be paying £400,000 a year in loan repayments for the £12 million it borrowed to make the improvements. That is a bit like someone taking out a loan to do up their kitchen and knocking down that part of the house while still paying money back to the bank.

Another big question relates to the continuing year in, year out costs of the changes. The possibility of a double maternity shift at King’s and St Thomas’s, which I have mentioned, is just one example, and would surely add hugely to the bill. How much would it cost to implement a community-based care strategy to reduce the need for hospital services? Where is the money coming from?

If the proposed changes to A and E and maternity care in south-east London cannot be justified financially, do not result in better health outcomes and are unfair and unwanted, why on earth are we here to debate them today? The Government have consistently said that changes will not be made unless four specific tests are met, as my right hon. Friend the Member for Lewisham, Deptford and the hon. Member for Beckenham (Bob Stewart) have mentioned. In the present case, the tests are not met. The chair of the local commissioning group is opposed to the changes, as are virtually all Lewisham GPs. The process should result in strengthened patient and public involvement, but the current process has resulted in strengthened disillusionment among the public, and little else. Proposals should be based on a sound clinical evidence base—but the evidence base in the present case is virtually non-existent. It is also stated that the Government will not make changes to such major services unless doing so will strengthen and improve patient choice; the special administrator’s own report recognises that the proposals will result in a weakening of patient choice.

As I said earlier, the proposals are unwanted, unfair, unsafe and unjustified. Last week the NHS Commissioning Board announced a review of emergency care, to be led by the NHS medical director, Sir Bruce Keogh. I welcome that review, but what is the point of it if the Government are just going to push ahead with their proposals in south London? The chaotic handling of the process in Lewisham cannot be right. It rides roughshod over the wishes of the community and local clinicians. For the life of me, I cannot see how it is in the best interests of my constituents or the people of south London. I urge the Minister to reject these rushed and ill-conceived plans and to do as her party’s manifesto says:

“stop the forced closure of A and E and maternity wards, so that people have better access to local services”.

I am not asking for better access; I am just asking for the access that currently exists for people in Lewisham to be maintained.

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[Jim Dowd]

Should I catch your eye later, Dr McCrea, I will address the four principles in more detail.

The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) says that the Secretary of State’s predecessor set up the four tests, but does he not accept that one of the previous Secretary of State’s first acts just after the 2010 general election was to suspend the implementation of the “A Picture of Health” process that the South London Healthcare NHS Trust was undertaking? I am not saying that the process would necessarily have led to success, but its suspension undeniably made the trust’s task unbelievably more difficult.

[Simon Hughes]

I do not dispute that. I am not as close to the process as the hon. Gentleman. I did not follow those issues as closely, because the process did not directly affect my borough, although it directly affected his. I have taken advice from someone who has been involved over the years at Lewisham hospital and in NHS management, and the history of financial poor management in the South London Healthcare NHS Trust stretches back over 10 years. The advice I have received is that poor management should have been gripped seven or eight years ago, but the problems escalated. We are in our present position because of a legacy of poor decisions made over effectively a decade. Things might have been rescued by the Government at the beginning of this Parliament, but they clearly were not and we are left in our present position.

I have a few comments, and I do not want to take time from other colleagues who have a direct interest. I responded to the consultation to make clear the interests of my constituents. The Secretary of State invited those of us with an interest to see him, and we are grateful for that invitation, which we used, I hope, to put our case effectively. The right hon. and learned Member for Camberwell and Peckham and I, and those MPs whose constituents use King’s, have written to the Secretary of State further to that meeting to make clear our concerns about the impact on King’s of any closure of Lewisham A and E, irrespective of the change in maternity services.

There is an alternative approach, which I commend to the Secretary of State. I hope he understands the benefit of going down the alternative route, rather than following the trust special administrator’s recommendations. The alternative, which we explored at our meeting and which I do not believe was adequately answered by the trust special administrator or his colleagues, is that five of the six recommendations—excluding recommendation 5 on the site configuration—leave open the option of amalgamating NHS management between Lewisham and Greenwich. NHS management could then be allowed to work out the best configuration of services across the two boroughs in consultation with, and with the confidence of, the local authorities in question, which now have direct responsibility through health and wellbeing boards under the Health and Social Care Act 2012, and in conjunction with GPs to seek GP commissioning endorsement and support. I hope there would be much more public support than for the present proposal, as is understandable.

I hope that the Secretary of State will find that to be an appropriate solution. It may have a small financial disadvantage over the present proposals but, as the hon. Member for Lewisham East said in her speech and as she and her colleagues from Lewisham have made clear in their letters to the Secretary of State, the TSA’s figures show a financial gap of only £1.7 million from a break-even position if recommendation 5 were not to be followed, compared with a financial gap of £75.6 million if the recommendations were followed. There are knock-on effects, but we seem to be talking about a sufficiently small amount of money, with little risk of any other financially adverse impact, and if people are motivated to reach a conclusion quickly, that must be a much more satisfactory way of proceeding and much more in line with the four tests set out.

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

I will attempt to be brief, Dr McCrea, given your exhortation and out of consideration for my colleagues.

I do not think that the Secretary of State for Health will proceed with the proposed plan, because it is so far off the rails. It is such a ludicrous proposition, so ridiculous in its scope and even its intent and such a shoddy piece of work, frankly, that the Secretary of State will not be so foolish as to proceed with it, even if he can blame his predecessor for lumbering him with it. We have to recognise the threat, however, and to do what we can to make the case against it. That is why, after 10,000 people turned up on the 24 November to march past the hospital to protest against the plan to downgrade—to eviscerate—Lewisham hospital, rather more will be out again this Saturday, marching past the hospital to Mansfield park in Catford, to express what my hon. Friend the Member for Lewisham East (Heidi Alexander) described as anger, although I go beyond that.

My hon. Friend was kind enough to mention that I have been in this place 20—now almost 21—years, but I was also involved with Lewisham council for 20 years before I came here, and, without doubt, the hospital proposal has raised more fury than anger—more so than any other local issue in all the 40-plus years that I have been involved in public life in Lewisham, even more than the madcap scheme of the Department for Transport under the now Lord Parkinson to further the south circular assessment study. That scheme had recommended widening the south circular to six lanes throughout, with eight lanes in some parts, right the way through the middle of Lewisham. People thought that was mad enough, but that pales into insignificance compared with the public response to the proposals that we are discussing.

What fuels the fury is not the incoherence of the plans, or even the gross financial assumptions—I have heard people call them heroic, but some of the claims are lunatic, and in pursuit of so little—but the sense of injustice, the unfairness of the scheme. Lewisham hospital, as in the recent past, has a strong commitment to safety, quality and patient experience. It has been rated in the top 40 hospitals nationally by CHKS—for clinical effectiveness, patient safety and so on—and has a strong record in achieving national and local performance targets. It is operationally lean, the reference costs index making it the most efficient trust in south-east London, delivering financial surpluses in each of the past six years—Guy’s and St Thomas’s trust, King’s College trust and, obviously, the South London Healthcare NHS Trust have not done that.

Our hospital has achieved the successful integration of acute and community services, fostering strong links with social care, and the people of Lewisham are already reaping the benefits. It has the reputation for strong and successful partnerships, so much so that many of the people at the Queen Elizabeth look forward to Lewisham management taking over to build links with commissioners, local GPs, the local authority, patients and staff.

Lewisham hospital, or University Hospital Lewisham, now part of the Lewisham Healthcare NHS Trust, with NHS London’s encouragement, was actively pursuing a foundation trust application when the process we are discussing interrupted and completely derailing that application. People are furious at the injustice precisely because Lewisham hospital has done everything in the services that it provides that could reasonably be expected of it by the Department and particularly by the people of Lewisham.

I want Lewisham hospital to survive as an institution, but I am not desperately keen on institutions for their own sake, important as they are. I am more interested in the services that they provide for the people they serve, and the hospital’s record is exemplary. To see that destroyed and devastated by the vandalism of the trust special administrator process is more than most reasonable people can stand or accept.

I have been inundated, as I am sure have my colleagues, with information from various quarters, and all has been hostile. One note from a constituent—I will not be too specific as I do not want to identify her, but she is a clinician at Queen Elizabeth hospital—who did not support the closure but does not want Lewisham hospital to be destroyed, said that the position at Queen Elizabeth hospital is dire, and needs strong leadership and a clear sense of direction and purpose, so that it too can provide the services that the people of Bexley, Greenwich and Bromley deserve. If the closure of A and E at Lewisham hospital goes ahead, 750,000 people in Bexley, Greenwich and Lewisham will have a single A and E department available. That would not be safe by any stretch of the imagination.

I can do no better than to quote an e-mail that I received just yesterday from the GP team in neighbourhood 4 of the Lewisham general practitioners clinical commissioning group that makes the case well. The group covers practices in Bellingham Green, Sydenham Green, Sydenham road, the Vale, Wells Park in Woolstone road, and the Jenner, which is in the constituency of my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and just the other side of the south circular road on the boundary between our constituencies. It says that closing

“the A and E will hit the elderly, disabled…and children of single parents disproportionately”

and that

“although an urgent care centre…will persist, its use its use will decline significantly as neither patients nor clinicians will have confidence to use an UCC unsupported by acute medical and surgical care”.

My right hon. Friend made that point elegantly. The e-mail continues:

“Loss of obstetric service will result in women in labour having to attend a different provider from their antenatal care, few women will choose this option, as both patients and clinicians are aware of the increased risk of disjointed maternity care and find it emotionally unsettling.”

It also says:

“The projected flows of patients are inaccurate and therefore so are the costings, our Primary Care survey across Lewisham showed 80%+ of patients would attend Kings, 10% St Thomas, 6%”

Princess Royal university hospital, Farnborough, and that only 4% of those currently attending Lewisham A and E would go to Queen Elizabeth hospital at Woolwich.

[Bob Stewart]

The point about going to Farnborough is that it is a heck of a long way from Lewisham, which makes it difficult. Public transport to Farnborough is not acceptable for people who are weak, disabled or poor.

[Jim Dowd]

I am grateful to the hon. Gentleman. He knows that many of his constituents attend Lewisham hospital, so the effect will be not just on people who are resident in Lewisham.

In view of the time, I will not go through the rest of my points, but suffice it to say that they are compelling, overwhelming and make sense. The problem with the trust special administrator is that he regards antagonism and opposition from local people, particularly clinicians, as a sign of his rectitude. One of our local football teams is Millwall, which is based in Lewisham, although the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) prefers to disguise that fact. It has an unofficial slogan, which is also a song to the tune of “Sailing” by the Sutherland brothers and was made famous by Rod Stewart. The words are:

“We are Millwall, super Millwall”

and

“No one likes us, no one likes us

No one likes us, we don’t care!”

I suspect that Mr Kershaw has taken that local aphorism as his inspiration because he could not have gone further out of his way to antagonise all the people of south-east London. The problem is that most Millwall football fans sing it as a joke, but Mr Kershaw clearly believes it. He has succeeded in antagonising and alienating not just the medical community, but everyone in south-east London, because the whole scheme is a shambles. He said that no one came forward with a viable alternative to his plan, which is why the final report is as it is. I can tell him that if they had £5.2 million and rising and the services of McKinsey, Deloitte, Ipsos MORI and other consultants, year 6 at Dalmain road primary school could have come up with a better scheme than his. I suspect that the Secretary of State has enough sense to reject it. Action needs to be taken to secure health services across south-east London, but this is not the way.

[Clive Efford (Eltham) (Lab)]

It is a pleasure, Dr McCrea, to speak under your chairmanship. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this important debate. I want to start by defending South London Healthcare NHS Trust. Its financial difficulties are enormous and there is no disguising that, so people have tended to roll up its performance into something that is failing on all fronts, but that is clearly not the case.

When the hospitals—Bromley hospital, Princess Royal University hospital, Queen Elizabeth hospital in Woolwich and Queen Mary’s hospital at Sidcup—were merged approximately four years ago into one healthcare trust, there were serious difficulties with clinical performance, but very quickly the trust improved its performance significantly, and so much so that it was one of the best performing on many indicators. That is why it was so sad that when the trust was put into administration, unattributable sources in the Department of Health put out rumours that that was about not just financial mismanagement, but the fact that standards of care were failing. That was completely and utterly untrue.

I go back several years, and I am on my fifth chief executive at my local hospital. All have gone through the same scenario as Mr Kershaw, and all have given me assurances about the areas—I will not go into them because I do not have enough time—where financial performance needed to improve and efficiencies needed to be made. Always, they made the point about the need to treat people close to where they live in the community and reduce pressure on acute services.

All have made that point, and all have needed to improve clinical performance. Just over a year ago, the South London Healthcare NHS Trust had only one case of blood-borne MRSA, which was the best performance in the country. The improvement in the quality of care under the new trust was significant indeed. Waiting times in A and E improved, and Dr Foster reported on a significant and consistent improvement in the standardised mortality ratios over a couple of years. On those performance indicators, it outperformed Lewisham hospital.

When the decision was made to put the trust into administration, its performance on quality of care for local patients was improving. Anyone who was concerned about care for local patients would have worked through the financial difficulties with the trust. It was a big ask in that short period to improve clinical performance as it did, to merge the hospitals as it did, and to improve financial performance as it was required to do. It was always a big ask, and I think it was impossible. That should have been recognised, and the Government should have worked with that hospital trust to work through those difficulties.

We all know that PFI has not caused this problem, but it has added to it. PFI accounts for roughly a third of the deficit, which is not to be ignored, but one issue that has come to light recently, in relation to PFI in general—not just in relation to South London Healthcare NHS Trust—is the effect that the manipulation of LIBOR has had on the rates that hospital trusts have had to pay, in terms of interest, as a consequence. I do not expect the Minister to have an answer to this question, but will she go away and consider what the cost implications of LIBOR manipulation have been for every PFI in the NHS? Are the Government considering taking legal action to retrieve any of that money, as is being considered in the USA?

I am conscious of time and I want to let the hon. Member for Beckenham (Bob Stewart) speak, so I shall move on. As has been said, the recommendations fail several tests, and they clearly fail the test of satisfying local GPs and receiving local GP support. The chair of the local GP commissioning body, Helen Tattersfield, wrote an article in The Guardian under the headline: “GPs are already wise to the scam of new commissioning groups”. She absolutely lampooned what is being proposed by the Government.

[Jim Dowd]

Does my hon. Friend realise that the Government have shifted ground on that? In the response that the Prime Minister gave to my hon. Friend the Member for Lewisham East, he said that the first test was

“the support of local GPs.”—[Official Report, 31 October 2012; Vol. 552, c. 230.]

However, the Secretary of State’s written statement, following the publication of the final report said that the first test was “support from GP commissioners”. The word “local” has disappeared, and what the TSA is trying to do is claim the support of commissioners from outside Lewisham to meet that test.

[Clive Efford]

The point made by my hon. Friend is self-evident, but if I may, I will not be drawn down the road, because I want to get the next point on record.

Lamenting the fact that local commissioners have not been listened to, Helen Tattersfield says in her article:

“No argument has any weight, however, against the needs of a failing trust, foundation trusts and potential private companies eager to expand their areas of influence, and NHS managers convinced of the merits of their model of fewer larger hospitals. Those of us who have spent hours acquiring the skills supposedly to lead commissioning have been shown that, in fact, decision-making and influence remains where it always was: with central managers, computer-derived models and reasoning that takes no account whatsoever of human behaviour in real life. We are little more than window-dressing for central planning geared to the needs of large foundation trusts, and open to the interests of the private sector.”

That comment alone just about sums up where we are.

I will finish soon to allow the hon. Member for Beckenham to speak, but I just want to ask the Minister whether she will consider a review of proposed A and E closures across London. We are seeing a piecemeal, salami-slicing of A and E services, which is putting the safety of Londoners at risk. As we know, we have seen a 50% increase in people waiting in ambulances for 30 minutes or more outside A and Es to gain access, and we have seen a 26% increase in those waiting for 45 minutes. We know that they are under pressure, so before we see any closures, that review must take place.

We can pray in aid what the Lord Chancellor and Secretary of State for Justice said. The headline on the relevant article read: “Hunt faces Cabinet split over A and E closure after Justice Secretary blasts plans as ‘sticking two fingers up’ to patients”. We also have the right hon. Member for Sutton and Cheam (Paul Burstow)—the former Minister of State, Department of Health—who lamented, when he was still a Minister, the proposed closure of St Helier:

“This is a flawed conclusion from a flawed process. There is still a lot of water to flow under the bridge before final decisions are made. The panel have ignored the pressure on all the A and Es and maternity units in south west London.”

We can pray those people in aid to defend our A and Es, and the Government should go back and look again.

To make one last point, we have seen the closure of an A and E, despite the promises of local Conservatives. The Leader of the House of Commons, when he was shadow Secretary of State, was going to save the A and E at Queen Mary’s, Sidcup, but it never came about. Under “A Picture of Health”, there was a proposal to have overnight stay, elective surgery at that hospital. It was promised to my constituents, who welcomed it and wanted to see it. I ask the Minister to reconsider removing that planned service from that hospital, because it was beginning to work and people welcomed it. It will be a serious cut to the quality of health care.

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

As ever, it is a great pleasure to serve under your chairmanship, Dr McCrea. I congratulate the hon. Member for Lewisham East (Heidi Alexander) on securing this debate. I have about 10 minutes to respond to all the points. In the normal terms of any debate, there is an airing of conflicting views, different ideas and different points of views, but today there has been no such disagreement; we have had an outbreak of complete agreement among all the speakers and all those who have intervened. Everyone who has spoken this morning has done so with great passion and sometimes with ferocity in defence of the maternity unit and the A and E department at Lewisham hospital.

Let me make it absolutely clear that we are not in this position because of a Government decision or proposal, or as a result of some set of Government cuts. I made that same point a couple of weeks ago in an Adjournment debate that was called by the hon. Member for Lewisham West and Penge (Jim Dowd). I hope that those in the public domain who report these matters make that point very clearly, too. Anyone who seeks to make political capital out of this exercise does so at their peril, because, in many ways, this transcends party political divide and should not be used for party political advantage.

The trust’s special administrator published his report on 8 January, and a decision will be made by the Secretary of State for Health on 1 February.

[Jim Dowd]

rose—

[Anna Soubry]

Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

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[Anna Soubry]

I agree. In such cases, it is imperative that a decision is made sooner rather than later. What is most important—

[Jim Dowd]

rose—

[Anna Soubry]

I have not finished my sentence; do forgive me. What is most important is that the right decision is made after careful consideration. I am pleased that the Secretary of State was true to his word and had a meeting with Members who are rightly concerned about the future of Lewisham hospital on 14 January. I know that it was effectively a listening exercise, because he could not express an opinion. That meeting was held with Matthew Kershaw, who is the TSA, and his officials.

[Jim Dowd]

The Minister mentioned that a decision is to be made on 1 February, which is a sitting Friday. Statements can be made on a Friday, as we saw with the urgent matter last week. Sometimes, statements about issues relating to London can be made, but will the Minister accept that this is an issue of national import? Will she prevail on the Secretary of State to ensure that, whenever the statement is made, it is not on Friday 1 February? Will she give us that assurance now, or seek one from the Secretary of State?

[Anna Soubry]

That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.