Princess Royal University Hospital

Jim Dowd Excerpts

Wednesday 25th March 2015 Westminster Hall

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

I am grateful both to you, Mr Betts, and to the Minister for agreeing to my proposition that I speak for 10 minutes and my hon. Friend the Member for Lewisham East (Heidi Alexander), who is equally concerned about these matters, may speak for five minutes; the Minister will have the prerogative of the usual arrangements for ministerial responses.

The reason I have raised this matter is that in south-east London generally and in Lewisham in particular we have been around this course before, and know exactly where it wound up then. I will be candid from the off: I am deeply suspicious of the whole process currently being embarked upon by Monitor and of the involvement of the Princess Royal university hospital at Orpington and King’s College hospital trust. I hope the Minister will be able to provide me with some assurances that will assuage my fears about this matter.

I will explain why. On Tuesday 24 July 2012—hardly a day that will live in infamy, but one that certainly remains clear in my mind—we had a meeting at the Department of Health with the then Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley). My hon. Friend the Member for Lewisham East was there, as were Members for constituencies in the boroughs of Greenwich and Bromley, including the hon. and gallant Member for Beckenham (Bob Stewart). I see that the hon. Member for Bromley and Chislehurst (Robert Neill) is in his place today; I cannot remember whether he was also at the meeting, but other Members certainly were. The meeting concerned the future of the South London Healthcare NHS Trust, which then consisted effectively of the Queen Elizabeth hospital in Woolwich, the Princess Royal university hospital in Orpington, which I chose as the title for the debate today, and Queen Mary’s hospital in Sidcup.

Members for constituencies in the boroughs of Bexley, Bromley and Greenwich were quite rightly invited to that meeting. As I said, my hon. Friend the Member for Lewisham East and I were both invited, even though Lewisham hospital was not part of the South London Healthcare trust. No one else from south-east London—no Members for constituencies in Lambeth or Southwark—was invited or present, although, strangely enough, they were included in the later stages of the discussions by the current Secretary of State for Health after Mr Matthew Kershaw, the trust’s special administrator, had made an initial report. His report essentially looked at the considerable downgrading—some would say the destruction—of Lewisham hospital as the answer to the problems at the Princess Royal, Queen Elizabeth and Queen Mary’s hospitals.

--- Later in debate ---

On resuming—

[Jim Dowd]

I was talking about the fabled meeting in July 2012—two and a half years ago. When the Secretary of State and the trust special administrator said that the answers to the problems of the then South London Healthcare NHS Trust did not lie within its own boundaries, I knew that what they had in mind was effectively the evisceration of Lewisham hospital. For reasons that have eluded me for decades and more—I used to be on the health authority of Lambeth, Southwark and Lewisham, and the district health authority for Lewisham and north Southwark—various elements of NHS London have always had Lewisham hospital in their sights. There was once a plan for there to be only four accident and emergency and general hospitals in south-east London: St Thomas’, King’s, PRUH and Queen Elizabeth; there was no room for Lewisham. I do not know why the various NHS powers think Lewisham is such an encumbrance. The service it provides to its residents and the pressure it relieves from the other hospitals around south-east London are proof positive of its value.

The morning of 5 March dawned—I was quite delighted about that, because it was my birthday. At 9.25 am, I received an e-mail from Monitor, explaining that,

“Monitor is opening an investigation at King’s College Hospital NHS Foundation Trust to find a lasting solution to long-standing problems at the Princess Royal University Hospital…The regulator is concerned that some patients are waiting too long for A&E treatment”—

nothing unusual there. Not one of the hospitals in south-east London—not St Thomas’, over the river, not PRUH, not Queen Elizabeth, not Lewisham, not King’s—is currently meeting the 95% targets for seeing attendances at A and E, so that is not surprising. The e-mail went on to say,

“and routine operations…the trust is predicting a deficit of more than £40m this financial year. This deterioration in its operational and financial performance follows the unexpected costs of making urgent improvements to the quality of care at the PRUH.”

Well, Princess Royal was taken over by King’s College hospital as a consequence of the trust special administrator’s recommendations, and that is the problem it has run into.

When the trust special administrator was appointed, the Secretary of State said in a statement to the House:

“The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS.”—[Official Report, 29 October 2012; Vol. 552, c. 3WS.]

The difference between the £1 million a week then and the predicted £40 million a year at PRUH alone now clearly demonstrates that the trust’s special administration process did not address the right problems. Clearly, the problem was predominantly at Princess Royal.

Queen Elizabeth is now part of a very successful partnership with University hospital Lewisham, and it is doing quite well. It is not without difficulties, but that is the case for any organisations that come together under difficult circumstances. However, it is making progress in clinical and financial affairs, and is well on the way to building a solid and reliable NHS entity in our part of south-east London. That demonstrates that the entire TSA process was substantially illegal, because as we know, the High Court—and subsequently the Court of Appeal—found the trust special administrator’s recommendation with regard to Lewisham hospital, and the current Secretary of State’s stubborn refusal to accept anything other than those proposals, to be illegal. The Secretary of State did not have the powers he assumed he had and could not reorganise in the way that was suggested. He even had the hubris to try and test it at the Court of Appeal, which found similarly that that was the case. Thankfully, sense prevailed at that stage and he left it there, deciding not to waste any more taxpayers’ money by going to the Supreme Court.

However, the Government introduced an amendment to the Bill that became the Care Act 2014, giving them the power that they thought they originally had to do whatever they liked by appointing a trust special administrator. This is where we come to the key worry about the future of Princess Royal and King’s. It is not just about the services that are provided there, which are critically important to all the constituents of Members here today, but about the fear that Monitor, using the powers that the Government put into that Act, will try to engineer another back-door reorganisation involving Lewisham hospital. As I say, that was originally declared illegal, but Lewisham could be dragged into it by other means, so the Government can achieve what they originally meant to achieve and were stopped from so doing.

[Robert Neill (Bromley and Chislehurst) (Con)]

I understand the hon. Gentleman’s point. Do I gather that his principal concern is the impact on Lewisham, and not the fact that Monitor is looking at accepted issues at the Princess Royal and King’s? From his point of view, it is the Lewisham dimension, rather than what it is necessary to do at the Princess Royal. Am I right in that?

[Jim Dowd]

I broadly agree with the hon. Gentleman’s point. Clearly, financial management is an important part of running the NHS. Everybody knows that, whether it is in our part of south-east London or more broadly.

[Bob Stewart (Beckenham) (Con)]

I totally agree with everything that the hon. Gentleman has said. My worry is that the Secretary of State negated the bill. It was wiped clean, and £44 million is a huge amount of money in the very short time that King’s has apparently been mismanaging the PRUH.

[Jim Dowd]

I understand the hon. Gentleman’s point. I do not think that would be King’s view. I hold no particular brief for King’s college hospital, other than the fact that I had a heart bypass there a few years ago, so I owe them my life. However, beyond that, I have no particular indebtedness to them. I know that there is a strong feeling that it was misled about what taking on the PRUH would actually mean, and the operational and financial consequences.

[Bob Stewart]

I accept that point.

[Jim Dowd]

That is very gracious—characteristically so—of the hon. Gentleman. I have four points to make briefly: three are questions, and I would also like an assurance from the Minister.

First, I would like an indication about the time scale. How long will Monitor take to report and what is the process following the report? Who will get to review it and how will it be taken beyond that? Secondly, what are the requirements/benefits and the consequences of what Monitor and the letter I received from King’s later that day—5 March—say, which is that the legal powers that Monitor possesses are needed to underpin the changes that are necessary to King’s foundation trust and the PRUH? Thirdly, how much consultation will there be with other providers and commissioners across south-east London outside King’s College Hospital NHS Foundation Trust? Finally, I want an absolute guarantee that University hospital Lewisham and Queen Elizabeth hospital Woolwich, now the Lewisham and Greenwich trust, will not be adversely affected by any decisions that Monitor makes.

--- Later in debate ---

[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.

[Jim Dowd]

I detect that the Minister has almost concluded her remarks, and I will not have the opportunity to intervene once she has sat down. I am grateful for what she has said, and I will look at the Official Report most carefully. I would be grateful to be copied in on any information that is sent to other Members.

I would like to make another point, out of courtesy, as much as anything else. The hon. Member for Bromley and Chislehurst welcomed the appointment of the new chair of King’s trust, Lord Kerslake. May I put on record a huge vote of gratitude to Sir George Alberti, who is standing down as the chair of the trust, for the service that he has given to King’s and the health service more generally?

[Jane Ellison]

That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.

I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.