Accident and Emergency Departments

Joan Ruddock Excerpts

Thursday 7th February 2013 Commons Chamber

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

On a point of order, Mr Deputy Speaker. In his statement on 31 January, the Secretary of State for Health said that he had asked Professor Sir Bruce Keogh, the NHS medical director, to review the recommendations of the trust special administrator to replace Lewisham’s accident and emergency department with an urgent care centre. The Secretary of State then said of Sir Bruce Keogh:

“He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.”—[Official Report, 31 January 2013; Vol. 557, c. 1075.]

The serious implication of that was that lives were currently being lost. We now know that nowhere in his report to the Secretary of State did Sir Bruce mention the saving of 100 lives per annum. The Secretary of State has been made aware of the disputed facts, and I therefore wonder whether you, Mr Deputy Speaker, have had any indication that he will return to the House to explain his statement of 31 January.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I have had no such request to come to the Chamber, as the right hon. Lady would expect. She has, however, put her point of order on the record and I am sure that people will have taken note of it.

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

I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this debate and on the fine speech he made to open it. My hon. Friend the Member for Lewisham East (Heidi Alexander) is in Committee and is unable to join us at the moment, but I know she will agree with all the remarks I am about to make.

Reconfigurations should be on the basis of clinical grounds and patient safety. That is not so in Lewisham. I should not be part of today’s debate, because the A and E at Lewisham hospital should not have been threatened. The only reason it is threatened is that the trust special administrator, acting under the unsustainable providers regime, was sent into the neighbouring South London Healthcare NHS Trust. I do not believe that the trust special administrator had the powers to take in Lewisham hospital, as part of the proposed solution to the failure of that trust; indeed, my local authority is giving consideration today to mounting a legal challenge.

I have come here today to ask the Minister again to explain Government policy, and to act as a warning to others. Lewisham Healthcare NHS Trust is solvent, highly regarded and meets all its clinical standards. The A and E is used by more than 115,000 people every year, yet the TSA proposes to close the A and E, downgrade maternity and sell off two thirds of the land to support a separate, failing trust. My colleagues and I argued that this was a back-door reconfiguration. In response to my urgent question of 8 January, the Secretary of State acknowledged just that. He said that the four tests for reconfiguration would have to apply to the Lewisham proposals. He said:

“the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.”—[Official Report, 8 January 2013; Vol. 556, c. 169.]

I can tell the House that not a single test is met in the case of Lewisham. The newly accredited GP commissioning group—created through the Government’s flagship policy, of course—is totally opposed to these recommendations, and its chair has said that she is considering her position.

The engagement process was a farce. The public questionnaire did not mention the closure of the accident and emergency department at Lewisham and the consultation document did not mention the selling off of the land. Some 25,000 people joined a protest march just a week ago, and 53,800 have signed the local petition. For “increased choice” read “massive loss of local services”. But it is the third test—the clinical evidence base—on which I wish to concentrate.

It is now clear that the Secretary of State had real concerns about these recommendations and thus he sought cover from Sir Bruce Keogh, the NHS medical director. We now have access to Sir Bruce’s advice. He said:

“The TSA must ensure there is no risk to patients by inadvertent under provision at hospitals receiving displaced Lewisham activity.”

On the proposed urgent care centre at Lewisham, he said:

“Consideration should be given to…direct admission…facilities”.

He also recommended the

“addition of senior Emergency Medicine doctors”

as a further safeguard.

Lewisham’s A and E is one of the few such departments consistently meeting its four-hour standard. The buildings were recently refurbished, at a cost of £12 million. Lewisham’s is one of the better performing intensive care units in the whole of England. It has twice-daily consultant ward rounds and access to diagnostics on Saturdays and Sundays. None the less, the Secretary of State has decided to remove the ICU, to remove consultant cover and to displace about 30,000 seriously ill patients—those who are likely to be admitted to the A and E —and take them by ambulance to another hospital. He is creating a smaller, less effective A and E, but there is no capacity at any other A and E in south-east London. Ambulances are often directed away from hospitals like King’s to come to Lewisham. Recently, a 76-year-old waited 18 hours in the A and E at the Queen Elizabeth hospital in Woolwich. The Secretary of State is just saying that he will throw £37 million at it to expand the facilities elsewhere, once he has closed down the Lewisham A and E.

All that ignores the fact that patients arrive at Lewisham hospital on foot, by private car and by bus, and of course the ambulance service is under enormous strain; people being treated in ambulances are parked up at A and E units all over London. Yet we are told that south-east London should have only four or four and a half A and E departments, not five, in order to improve clinical care.

I do not dispute the case that has been made on cardiac and stroke services, but it is not obvious that it applies in respect of other kinds of illnesses and problems. Asked to explain things, the Secretary of State said:

“That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes.”—[Official Report, 31 January 2013; Vol. 557, c. 1081.]

Dr John O’Donohue, a consultant physician at Lewisham, responded to those points in a letter to Sir Bruce Keogh. He said that there have been

“no maternal mortalities in the past 7 years. This is despite the fact that high-risk pregnancies form the majority of our maternity workload.”

He also made the point that

“UHL is in fact one of the highest performing Trusts nationally for the management of hip fractures.”

He went on to say:

“Guidance on…meningitis emphasise the speed of administration of definitive treatment and not the size of the hospital”.

He concluded:

“There is…no basis in clinical evidence for the assertion made by the Secretary of State.”

But the Secretary of State went even further, asserting that Sir Bruce

“believes that overall these proposals, as amended, could save up to 100 lives every year”.—[Official Report, 31 January 2013; Vol. 557, c. 1075.]

We now know that no such reference was made in Sir Bruce Keogh’s review. I have spoken entirely about the adult A and E facility, but there is of course also a very fine children’s A and E unit at Lewisham, which has been much neglected in these considerations.

Lewisham now faces a reconfiguration that it is not said to be a reconfiguration. It now faces having an A and E unit that is not a proper A and E, and a maternity service that no woman giving birth to her first child will be able to go to. Will the Minister explain to me today how that is improved clinical care? How is it improved patient choice? It is an absolute disgrace, it is completely unjustified and we will all fight it to the very last.

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[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

[Dame Joan Ruddock]

rose—

[Gavin Barwell]

I am afraid I cannot take any more interventions.

The hon. Member for Lewisham West and Penge was wrong to state that that has only started to happen under this Government. In my part of London in the past things have gone wrong in neighbouring boroughs and Croydon PCT has had to help them out. In the past two years Croydon PCT has got into trouble and neighbouring boroughs have helped us out. That does not mean that what is happening is right. I am not making a judgment on it. I am just saying that it is not fair to suggest that the present situation is a wholly new departure.

Hon. Members have made powerful arguments for their local hospitals, but there is a balance to be struck between convenience of locality and ensuring sufficient acute cover. I completely understand the point made by the hon. Member for Mitcham and Morden (Siobhain McDonagh) in relation to St Helier, but as a Croydon MP I have to say that there must a solution that gets us to the recommended minimum level of consultant cover in our hospital, and I will continue to fight for that.