Health Services (North-West London)

Karen Buck Excerpts

Tuesday 15th October 2013 Westminster Hall

[Ms Karen Buck (Westminster North) (Lab)]

I am grateful for the opportunity to raise some issues in this short debate, and I welcome the Minister to her role. It is good to have a London colleague here to respond to the debate, which deals with my serious concerns about the management of the delivery of health services in north-west London.

I asked for the debate with considerable sadness. I have been involved with health care delivery in north-west London for decades, on the community health council, when it existed, and as a member of the health authority for the same area; and for many years I enjoyed positive relationships with hospital management and primary care trusts, so it is of concern to me that I shall be describing a diversion away from such good relationships and communications, and the serious implications of that.

The debate is not about individuals, although I have concerns arising from the communication of some individuals’ views about health care delivery in recent months. The problem is structural, and it is not fixable just by improvements in the exchange of e-mails. It goes to the heart of trust and clarity in the way health care is provided. I am not alone in my concerns—I know other elected officials feel the same; but this is not just about politicians having our noses put out of joint when communications are not handled effectively. It is about some fundamental questions that have arisen, to do with how care is and will be provided to my constituents, and residents of the London borough of Westminster, where St Mary’s hospital is situated.

Because the challenges are so great in north-west London, as they are, indeed, in many parts of the health service, it is even more incumbent on those who deliver and manage health care to ensure that communications are clear, that there is a shared strategic approach to planning, and that there are common assumptions. As the Minister knows, the backdrop to the issue is important changes in the provision of hospital care and the “Shaping a healthier future” strategy for north-west London. That, of course, proposes the closure of several accident and emergency units in north-west London.

Fortunately, from my point of view—because it something about which we all care very much—A and E will not be closed at St Mary’s hospital in Westminster. It is good to see my hon. Friends the Members for Hammersmith (Mr Slaughter) and for Ealing North (Stephen Pound) here for the debate; I know that my colleagues have concerns about how emergency services will be provided in their areas when A and E units close.

[Mr Andy Slaughter (Hammersmith) (Lab)]

My hon. Friend shares my pain. Four out of nine accident and emergency units are designated for closure, and two of those are in my constituency; but the point that she is making is that every MP in north-west London shares the pain, because there is simply no capacity in the system to cope with such a decline in emergency services. The sooner the Government and the NHS realise that, the better.

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[Ms Buck]

I agree with my hon. Friend. Of course, the proposed closures and the “Shaping a healthier future” strategy are themselves set against a financial context that puts extreme pressure on delivery. North-west London hospital services must accommodate a £125 million reduction in service between 2011 and 2015. At the same time—and this is pertinent to the core of my comments—local authorities have imposed dramatic cuts in their social care budgets. That is particularly germane to the issue, because the work of local authority care services relates to prevention and hospital discharge arrangements, and needs to be integrated with those areas, so that the highly pressured hospital service can work effectively.

Of course, another factor is the impact of the top-down NHS reorganisation that we were told would never happen, and the £3 billion that it cost, which has taken valuable resources and a great deal of energy away from the planned delivery of services. The slow death of the primary care trusts and the slow emergence of clinical commissioning groups during a time of massive changes has been part of the problem.

Colleagues such as my hon. Friend have legitimate concerns about the effect of the proposed A and E closures on their communities. St Mary’s hospital was not scheduled to lose its A and E unit, and we were pleased about that. I and others were briefed about ambitious plans for the development of a new, improved emergency care service, to be built at St Mary’s hospital. During the discussions and briefings there was no suggestion that there would be any specific consequential changes in the pattern of hospital services at St Mary’s. Therefore, when, at the invitation of my hon. Friend, I attended the independent review panel called to consider the A and E closures in other parts of west London, I was somewhat taken aback to be asked by the chairman how I felt about the closure of up to 200 beds at St Mary’s, and the movement away of most or all elective surgery, as part of the consequential changes resulting from “Shaping a healthier future”.

I immediately contacted the chief executive of the Imperial college health care trust, to ask whether that was accurate, what the implications were, and why I and others had not been told. That was not because I am automatically totally opposed to consequential changes in service delivery. We must be grown up about such things, and it is right that hospitals evolve and change. Things should not be, and never have been, set in stone. Good clinical reasons and financial necessity may drive change. However—and this is my theme today—to make that change work there must be clarity and partnership, and everyone must understand what is being proposed and how decisions are to be taken.

First, the Imperial trust referred me back to the “Shaping a healthier future” proposals, and to a slide pack that was shown to me and the hon. Member for Cities of London and Westminster (Mark Field) in the spring. That set out very broad headings for how services at the three hospitals in the Imperial group—Hammersmith, Charing Cross and St Mary’s—would develop. There was nothing in it that would have led me to conclude that St Mary’s would lose the bulk—or all—of its elective surgery.

I checked with Westminster council, to see whether I was missing the blindingly obvious. I am grateful to the excellent health strategy officer at the council, who has been a model of clarity in explaining how things worked. He told me, with, I believe, the full agreement of local authority members, that the authority—a statutory partner, which there is a requirement to consult about major changes in hospital services—

“did not receive any indication that there would be significant consequential changes to elective surgery at St Mary’s Hospital as a result of Shaping a Healthier Future. Furthermore, Westminster City Council has not been informed of any proposals to re-locate much or all elective surgery currently performed at St Mary’s Hospital to Charing Cross and any developments in this area would be submitted to both the Cabinet Member and Chairman of Health Scrutiny to investigate.”

He said the authority would consider the assumption by the chief executive of the Imperial hospital group

“that these proposals were in the Decision Making Business Case to be incorrect”,

and continued:

“At Imperial College Healthcare NHS Trust’s Board meetings on 24th July and 25th September, we were informed that Imperial were considering their options.”

Indeed, the chief executive of Imperial verbally, when I met him, and in writing indicated that no decisions had been taken and that the timetable for such decisions was for conclusion in the New Year. On 23 August, he wrote:

“I can assure you we are very much in the modelling and evaluation stages of any changes so are yet to consider whether we should propose moving any clinical services between our sites”—

note the use of “any”. That letter was widely circulated, so clarification could have come from other members of the local health service family, but no such clarification was received—to coin a phrase.

Meanwhile, a quick look at Hammersmith council’s website showed me that it was promising its community a reinvigorated Charing Cross hospital, but on a basis that did not appear to have been explained by Imperial to anyone in Westminster. Hammersmith announced in September:

“News that elective surgery is now on the list of possible future services would further boost the amount of expertise at the site, meaning patients in the local community benefit from the care it gives, and giving it greater status as a teaching hospital.”

[Mr Slaughter]

My hon. Friend is making a good case for the second of our concerns, which is not the closures themselves, but the chaotic, shambolic and amateur way in which they are being carried out. In the past six months, I have been told that Charing Cross hospital will close and be a clinic, a local hospital, a specialist social care hospital—whatever that is—or an elective surgery hospital. The person who told me most of those things, the chief executive of Imperial, has just left, suddenly, after only two years in the job. That is typical of the utter chaos in the hollowed-out NHS in north-west London and, no doubt, elsewhere.

[Ms Buck]

I totally endorse my hon. Friend’s words.

To return to my point about how Hammersmith council is presenting its achievements in winning services for Charing Cross that no one in Westminster or at St Mary’s hospital knows about, Hammersmith continued:

“Charing Cross will also become a specialist centre for community services which means that the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel. It will mean local people will be better supported to live independently at home”.

It was good of Imperial to share that vision with Hammersmith and around Charing Cross, but it is a great shame that it chose not to share a single word with Westminster city council.

Reinforcing my hon. Friend’s point about chaos, however, I am not sure that even that is the true picture, because when I showed the press releases on Charing Cross from Hammersmith council to the chief executive of Imperial in September, I was told that it was spin on Hammersmith’s part and that what was proposed was only a 23-hour ambulatory care model, with no new beds at all. It is hard to square that with Hammersmith council’s vision and harder still to know what is true.

I do not begrudge Hammersmith residents their hospital—quite the reverse—but I am concerned about any sense of deals being done to secure their future, at the expense of local residents in Westminster and, critically, without so much as an opportunity for Westminster council even to consider the matter or to think about support services or the community care dimension, which Hammersmith so rightly talks about as important in a local hospital context and which can be applied to Westminster. If Hammersmith council can proudly claim that its new hospital means that

“the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel”,

surely that cannot mean that older and chronically ill Westminster residents, who also need regular visits to hospital, should have further to travel—with no debate and no chance to put in place social care support or travel arrangements.

Things get worse. Four weeks after my meeting with the chief executive of Imperial, all my follow-up questions about what that means, whether decisions have been made or what services will be located where still remain unanswered. That is no doubt partly a consequence of the unexpected departure of the chief executive, who has been replaced in what is clearly a holding operation, in a manner that does not indicate a smooth and planned transition.

[Stephen Pound (Ealing North) (Lab)]

Is my hon. Friend aware that one of the justifications for the closure of the A and E department mooted for Ealing hospital is that it will be possible for ill Ealonians to glide effortlessly through the gentle traffic of west London and rock up at St Mary’s in Praed street for their essential treatment? Will she enlighten us as to whether she feels that the closure, or proposed closure, of some of the St Mary’s beds should have been put to the good people of Ealing?

[Ms Buck]

I absolutely agree with my hon. Friend. It is surely impossible to make decisions about one hospital after discussion with only one local authority—with its statutory responsibilities on consultation and delivery of services—and simply fail to talk about them to anyone else. I am afraid that that prompts so many questions about whether Imperial and, possibly, the north-west London clinical commissioning groups have buckled under the political pressure in Hammersmith— I understand that, political pressure is a reality—and have simply failed to recognise that they have responsibilities elsewhere in north-west London.

Things get even worse, I am afraid. I then had a letter from a north-west London CCG to say that the “Shaping a healthier future” programme did not include the St Mary’s site as one of those that would undertake routine planned elective surgery, but that that work was modelled to transfer to the Central Middlesex hospital, which was designated as one of the elective centres in north-west London—the first that any of us had heard about the Central Middlesex being part of the equation, and a fact not mentioned by Imperial. The letter went on to say:

“As the Trust are still undertaking this work and have not reached any conclusions they are yet to consider whether it should propose changing the location of any clinical services between their sites and therefore are not yet in the position to ask the relevant OSCs”—

overview and scrutiny committees—

“about consultation on this”.

Note again, the use of “any”.

Since then, however, further questions have emerged, including the suggestion that almost all elective specialties have already moved. So far from being the subject of future consultation and decision making, they have already moved, without any formal consultation on anything with Westminster council since 2011. That implies that no one actually knows where Westminster residents are being treated—an absence of grip that I find worrying.

Westminster council was therefore prompted to write to Imperial at the end of last week to say:

“We are at a loss to understand the presentation made to the Westminster Adults, Health and Community Protection Committee on September 25th”

when it was told that

“options as to what elective work could be located at Charing Cross Hospital were being investigated.

Westminster were informed by the North West London Commissioning Support Unit that Imperial were on course to develop a first view of the Outline Business Case…for the private meeting of Imperial’s September Trust Board. It was planned that this will take place alongside a discussion on the emerging clinical strategy. Following feedback from the Board, the complete OBC would be finalised to go back to the Board in the autumn for approval—Imperial are required to obtain NHS Trust Development Authority sign-off by Christmas and the OBC needs to be fully aligned as part of the FT application. Westminster are still of the view that the Outline Business Cases for the Alternative Proposals to Ealing and Charing Cross Hospitals (which did not include the transfer of Elective from St Mary’s) are yet to be agreed and are not confirmed.”

That is of substantive importance, and not only as an illustration of a monumental communications breakdown, precisely because health care is supposed to be moving in the direction of greater integration between primary, community and local authority-provided social care. How can such a model exist when a local authority, and, for that matter, some GPs, do not even seem to know where their patients are being operated upon?

Will the Minister ensure that Westminster council and the local CCGs, together with the Westminster MPs, get an accurate status report immediately, including what service changes have taken place over the past two years and without any going to formal consultation? What action can she take to ensure that the whole process of statutory consultation is not undermined by hospitals such as Imperial not even telling councils such as Westminster that substantial service changes have taken place, and that there is clarity on what decisions will be taken when, including in the context of the foundation trust application?

I have one last thing to say before the Minister’s reply, which I am looking forward to. This letter from Imperial, dated 15 February, made me smile:

“Clearly we need to reassess aspects of our attitude to our health care partners in NW London, including the bodies that are newly established as a result of NHS reform. Stakeholders clearly expect more engagement and visibility from me”—

the chief executive—

“and my team in order that we may win and cement your trust. Equally we are too often perceived as defensive and not good listeners in our approach and we are resolved to address that issue at all levels where we interact with the external world”.

That letter, I am afraid, turned out not to be worth the paper it was written on. In fact, we have had something of a car crash on communications over recent months. This matters not for us—not for our sense of probity or self-importance—but for the delivery of health care to patients. This is a serious and structural problem, and I hope that the Minister will not only respond today, but get a grip on the situation, so that we can learn from the mistakes and make urgent improvements.

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[Ms Buck]

The Minister is kindly referring to my sense of the communication problems. To reinforce the point, I should say that at the heart of this problem is a local authority that is meant to be a statutory partner. It has a duty to be consulted and that has clearly not happened. That is what matters, because it is through that consultation that decisions are made on how a local authority performs its role on supporting care. I want that message to go back to the Secretary of State. It is not a matter of opinion; it is a matter of absolute fact that the local authority has been ignored by Imperial for probably two years.

[Jane Ellison]

I hear that. I believe in the role that local authorities have to play in shaping health outcomes for their residents; as the public health Minister, one of my jobs is to champion their role. Like Members of Parliament, they care so deeply for the health of their local population and are so close to them that they are well placed to shape the future of health care in their area, and we take that seriously. I will take the hon. Lady’s concern back, reflect on it and talk to the Secretary of State about it.

There is a limit on what more I can say on the detail that the hon. Lady has given me. We have a lot to look at and talk to health partners about. I can only assure her that I take it seriously. The role of hon. Members in periods of enormous change such as this is critical, as it is for key local authority partners, too. That message is fully taken on board.

I will use my remaining time to give a little background on the reconfiguration. I know hon. Members will be familiar with it, but it is worth putting on the record. The reconfiguration of NHS services is a matter on which the local NHS is taking the lead, hence the importance of engaging local partners. The hon. Lady has already made reference to the fact that we do not believe that these things can be shaped only in Whitehall. They have to be influenced by enormous local input. I cannot agree with the description of the service as “hollowed out”, which is neither accurate nor fair.

Individual health overview and scrutiny committees, and the joint overview and scrutiny committees, made up of democratically elected members of all the councils concerned, have the power to refer the reconfiguration to the Secretary of State if they believe that the consultation has not been conducted appropriately, or that proposed changes are deemed to be not in the best interests of the local health service. We know that one council has exercised that power.

As the hon. Lady is aware, the proposals were referred to the Secretary of State by Ealing borough council in March this year; the hon. Member for Ealing North referred to that. The Secretary of State has sought and received advice on that referral from the Independent Reconfiguration Panel. I fully understand the importance of the Secretary of State’s decision to the hon. Members present and to others who have been prominent in this debate. The Secretary of State is actively considering the panel’s report and that decision will be made public shortly. Although I have not been pressed on when that might be, it is imminent. I cannot say anything further about the IRP’s report.

The one thing I want to stress is that all the changes are being driven by clinical need and a desire to get better outcomes for patients. They are not driven by a desire to save money. In that regard, I reject the comments made by the hon. Member for Hammersmith. The hon. Lady acknowledged that the driving force behind the reconfigurations is looking at whether we can get better outcomes for all our constituents through greater specialism.

[Ms Buck]

rose—

[Jane Ellison]

If the hon. Lady wants to intervene again, she is welcome.

[Ms Buck]

The Minister is being generous. She refers to decisions made by Ealing council and Hammersmith and Fulham council, but Westminster council was not even told about some of these changes, so it could not exercise its powers on overview and scrutiny in this case. While that is absolutely true, I do not think that anyone is setting out to change these things deliberately. They are, however, doing it without telling anybody.

[Jane Ellison]

As I said, I have heard the hon. Lady’s points. All relevant CCGs and trusts supported the overall shape of the reconfiguration. Local authorities have been key partners in that as well. She has rightly made specific points on some specific aspects that affect her constituents. We will reflect on those points and come back to her.