Hospital Services (South London)

Joan Ruddock Excerpts

Tuesday 22nd January 2013 Westminster Hall

[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.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I congratulate my hon. Friend on securing a debate on the hospital, which my constituents share with hers. When I brought the current Secretary of State for Health to the House to answer an urgent question, he seemed to imply that, in fact, reconfiguration is a major consideration. He said that giving details at that stage

“would prejudice my duty to consider the recommendations with care and reach a decision…I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister…with respect to any major reconfigurations”.—[Official Report, 8 January 2013; Vol. 556, c. 169.]

The Secretary of State clearly does believe that reconfiguration is a major consideration. The next day, I asked the Prime Minister about the four tests, and he said:

“I specifically promised…there should be no closures or reorganisations unless they had support from the GP commissioners, unless there was proper public and patient engagement and unless there was an evidence base.”—[Official Report, 9 January 2013; Vol. 556, c. 313-14.]

My hon. Friend will agree that none of those tests is met in the trust special administrator’s proposals.

[Heidi Alexander]

I do agree, and it would be incredibly helpful if the Minister confirmed when she responds to the debate that the four tests would apply to any changes made as a result of the TSA’s recommendations.

The thing that really sticks in my throat about the proposals to shut Lewisham’s A and E and maternity departments is that they are fundamentally driven by money. If we start by saying that a process is being set up to sort out the financial woes of part of the NHS, how can people ever have any confidence that the clinical input and so-called clinical evidence that come later have not just been moulded to suit the accountants’ bottom line, which was there from the off?

I appreciate that there are financial pressures in the NHS, and I accept that it cannot be preserved in aspic for ever. For example, I support the recent changes to the way in which emergency care in London is provided for major trauma, heart attacks and stroke. However, where is the evidence that the changes on the table will result in more lives being saved and better health care overall?

That brings me to my second main point: the changes are not only unwanted and unfair but unsafe. It is proposed to replace the A and E at Lewisham with an urgent care centre. Initially, the special administrator told us that the centre would see 77% of the people who currently go to the A and E. In his final report, that was revised down to 50%. Based on an analysis of their case load, doctors at Lewisham suggest that the figure would be closer to 30%, so who is right? GPs in Lewisham, including the chair of the clinical commissioning group, suggest that the number of people who would go to an urgent care centre at Lewisham has been overestimated. They suggest that they would be inclined to send people to hospitals where they knew specialist opinion was available.

If I was a mum and my five-year-old woke up in the middle of the night in dreadful pain, where would I go? Would I go to a place that I was not sure had the appropriate staff and equipment to deal with my son or daughter, or would I go to an all-singing, all-dancing unit in central London or at King’s? I am not a mum, but I know where I would go. If people do not use the urgent care centre, the extra demands placed on neighbouring A and Es will exceed the numbers forecast in the plans before the Health Secretary. Ultimately, there may not be enough capacity elsewhere for people to be seen and to be seen quickly.

I should add to that the heroic assumptions in the proposals about reducing the need for acute care in the first place. I am all for tackling the reasons why so many people turn up at hospitals, but I know how hard it is to change people’s behaviour and to organise adequate community-based care to reduce the need for acute admissions.

[Dame Joan Ruddock]

One hallmark of the work at Lewisham hospital is that extremely important steps have been taken to integrate with community care. That is relevant for the elderly, who may have to be admitted for a short time before going back into the community, and for the young people with mental health problems, who need there to be integration between those who see them when they have an episode and those who receive them back into the community. All that will be lost if the proposals go ahead.

[Heidi Alexander]

My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

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[Dame Joan Ruddock]

My right hon. Friend the Member for Leigh (Andy Burnham), who was Secretary of State when the Health Act 2009 was passed, has made it clear that there was never any intention to use the legislation to address major reconfigurations. The legislation was meant to address a financial problem in a specific trust and not to encompass other trusts. Does the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) agree that we need to consider the NHS London-wide? That is where we must find solutions to the financial problems of one trust, quite differently from this particular case. The trust special administrator clearly could not find a solution by considering just the South London Healthcare NHS Trust, but we cannot have the inappropriate procedure that has now been adopted.

[Simon Hughes]

The right hon. Lady, who is my neighbour, raises an important issue. With the help of the Library, I have carefully examined the whole debate on the passage of the legislation, and that issue was not addressed. If she looks back at the debates and the notes on the National Health Service Act 2006, they are silent on whether a trust special administrator could or could not make recommendations that go beyond a trust. That may not have been in the mind of her colleague, the right hon. Member for Leigh (Andy Burnham), who is a former Secretary of State, but he did not say that on the parliamentary record, although I stand to be corrected. It seems to be an open question.

The current Secretary of State told us that he has had legal advice and that he will take further legal advice, but whether or not the legal advice is that the trust special administrator can go beyond the boundaries of the area affected, there is a stronger argument for the Secretary of State not following the trust special administrator’s recommendation—and that argument starts from the legacy of the last general election in terms of the parties in government and the coalition agreement on how to deal with closures of A and E, and not doing so from the top downwards.

Secondly, the Government have set up the four tests, to which the hon. Member for Lewisham East referred and which have not been met. The Secretary of State has been handed this matter on a plate; it is not of his doing and I am sure it is the last thing he would have wished for. The announcement that the trust was going into special administration was made by his predecessor, and the current Secretary of State has been given a report by someone he did not appoint but with whom he now has to work. He has no choice. He has to deal with it, but he made it clear in his answer to the urgent question from the right hon. Member for Lewisham, Deptford that the four tests, which both he and the Prime Minister have cited, must be met.

The first test—that the proposals must be supported by GP commissioners—fails before we even get to the other three. I have no reason to believe that a single GP commissioner in Lewisham is supportive—GPs elsewhere in London might be found but they implicitly do not comment—the whole idea of the proposal seems to be that if we are handing NHS decisions from the top to the doctors, we must do things that the doctors agree are the right decisions. So the proposal falls at that first hurdle.

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[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.

[Dame Joan Ruddock]

I wanted to give the right hon. Gentleman those figures, so I am glad he has put them on the record, because they are significant. Furthermore, there is real willingness in Lewisham, from the hospital, the GPs, the consultants and all the staff, to work for some kind of merger or co-operation with Woolwich that would reduce costs. Everyone is willing and happy to explore that, but in the right circumstances, in the right time frame and with appropriate consultation, which is what has been missing from the process.

[Simon Hughes]

I have no reason to disbelieve what the right hon. Lady says, but even more important is returning the decision to the people in the health service who are now meant to be leading it—the GP commissioners and others. That is what all of us, in different ways, believe needs to be done. She made an argument for the issue being London-wide, and that of course is the context, but the practicalities of travel and transport, whether buses, cabs, cars and trains, are such that south-east London works as a segment for health service use in a way that does not really cross over into other parts of London, other than to King’s. The only knock-on bits are the small amount of crossover to the London hospitals for specialist reasons, and some to King’s because it is so near—technically, it is south-east London, but it is in Lambeth.

Secondly, the precedent would be a bad one to set for those parts of the NHS that have been financially well managed, compared with parts that have been badly managed. Lewisham has been relatively well managed, being very nearly in balance. We rely on trusts to do their job locally and on people to manage local trusts, so we have to support those who do that job well and responsibly.

My last point is probably the most important. I have been to Lewisham A and E and visited patients there privately. It and the maternity services have developed a reputation for good clinical care of all who attend it. That was not the case some years ago, but it has been worked on, and not only physically. It has become a university teaching hospital, as well as being a local general hospital, and it has good community links—the point made by the right hon. Member for Lewisham, Deptford in her intervention. It has also built up a good reputation for integrating acute care, hospital-centred care, with community provision.

The Secretary of State could take the clinically easy decision to follow the trust administrator’s recommendation, saying, “This is what has been recommended, therefore I am following what I have been told”, but I hope that he realises the greater benefits to the local community and to the wider health economy and service of south-east London, as well as to the Government if they are seen to be listening to the people and to the GPs more than to the trust special administrator. I understand why the trust special administrator takes a hard line, because he is a health economist and his interest is finance. The Health Secretary, however, has a different job, which is to be responsible for the NHS in England, and that means making responsible decisions to secure a good NHS in all parts of south London and elsewhere.

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[Heidi Alexander]

rose—

[Dame Joan Ruddock]

rose—

[Anna Soubry]

I will give way, but please be brief, because I do not have much time.

[Dame Joan Ruddock]

Will the Minister confirm that the four tests are relevant? Will she also note that the Secretary of State has said, “on or before” 1 February? It would be good to have clarity.

[Anna Soubry]

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