Health Care (London)

Karen Buck Excerpts

Wednesday 8th January 2014 Westminster Hall

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

I am grateful for the opportunity to speak on the subject of the NHS in London and delighted that so many colleagues from the four corners of London want to say something about the health service in their areas. I want to sketch out, with some specific reference to local issues, the momentous changes that are happening within London’s health care and the extent to which the Government have made necessary changes far more difficult to achieve than should have been the case. I fear the results.

When I applied for this debate before Christmas, I did not know that I would spend a large part of the next two weeks experiencing the health care system with a close relative, who was admitted to hospital on Christmas day. We went through the whole process of ringing 111, of paramedics, of the ambulance, of A and E and of spending two weeks in St Mary’s hospital. I can confidently say two things on the basis of that experience.

First, I have seen, and my relative has experienced, nothing but kind and efficient health care at St Mary’s and within the health care system in general. It is true that, over the years, there have been instances of the health care system falling far short of the standards that we expect, but it is also true that most health care professionals and auxiliaries are doing a stunningly good job for the people of London and the rest of England.

There is kindness and the effective delivery of health care everywhere we look in our health service. We must be careful not to succumb to the tendency—I see this too often from Government Members—to talk down the health service’s achievements. It is completely right that Sir Mike Richards of the Care Quality Commission said in his comments on the first wave of inspections that

“there are some very good hospitals in this country, and it is possible, within the NHS, to receive good, excellent, even outstanding care.”

Secondly, from my observations this past fortnight, I can say that the health service is under extraordinary pressure. One would expect not to have the level of staffing for the two-week period of Christmas and new year that one might have outside the holiday period, but it has been alarming to note instances of health care auxiliaries being two thirds below planned staffing levels and nursing being down by one third. Incidentally, I was also shocked to discover when talking to health care assistants that they sometimes work an 11-hour day for a £90 day rate, which is not the London living wage—it is the minimum wage. How can we expect people to provide the intensity and quality of care that we want when we do not pay them even the living wage? That causes me great concern.

Pulling back to the wider picture, as our experiences have demonstrated, the health service is under extraordinary pressure, particularly in the emergency service. Some of that is unsurprising in London, because the capital has the fastest-growing population and has had the fastest rise in the over-65 population of any region in the country. It also has the highest demands on mental health care services and an overwhelming concentration of rarer and more difficult conditions, including tuberculosis, which places particular pressures on London.

Unsurprisingly, those facts are showing themselves in A and E attendance and waiting times. Just before Christmas, the London assembly found that more than half of London’s A and E departments failed to meet their waiting time targets for more than half of last year. Across the capital, Londoners had to wait for more than four hours on 202,000 separate occasions. A and E attendance has soared in London since 2010 and is up by 47% at St George’s hospital in Tooting, 46% at St Bartholomew’s hospital, 33% at West Middlesex university hospital and 35% at Hillingdon hospital. For my own Imperial College Healthcare NHS Trust, even a relatively modest increase of 19% equates to an extra 44,812 people seen last year compared with 2010. Cancelled operations were running at a 12-year high even before the winter, owing to pressure on hospital beds. One London hospital, Barts, topped the national list with 649 elective operations cancelled in the first half of last year.

Vacancy rates are a particular concern in London. Regionally, 11% of nursing posts are vacant, compared with a national average of 6%. At some London trusts, the rate is more than 20%. The regional total represents more than 6,000 vacant nursing posts in London. The Royal College of Nursing, which kindly briefed me for this debate, says:

“Our worry is that the hard work of some trusts in protecting posts is being undermined by a lack of available, suitably qualified nurses to take vacant positions, raising obvious questions about whether training is being commissioned at the level needed.”

Given that pressure, it is beyond dispute that there is a need to carry on changing how health care is delivered, which we all accept and have accepted for many years. The broad principles mapped out by Lord Darzi in 2007, which were not new, proposed a greater concentration of high-level surgical services to save lives and better community and primary services to reduce unnecessary admissions and enable speedy hospital discharge. Both the demand side of the equation, which is driven by an ageing population and the challenge of chronic conditions, and the delivery side, which utilises the opportunities of new drugs and surgical techniques, push us to the same conclusion. There is clear agreement in principle that we need to carry on with the changes.

The central thrust of my argument, which will be echoed by colleagues, is that managing change of that scale requires that essential preconditions are met. Those preconditions are, however, not being met at the moment, and in some cases the means of delivering them are going into reverse. First—all are important, but this is the first—there must be public confidence in the process, and that confidence is so catastrophically lacking.

Labour colleagues who are facing the closure or downgrading of their A and Es will know what their own communities are telling them, which is that closing A and E units in the midst of an A and E crisis is utterly perverse and should not happen until and unless trusted alternatives are in place. In that context, clause 118 of the Care Bill confirms everyone’s worst fears, because, having failed to win public confidence in London and other parts of the country, Ministers want to give powers to special administrators to override local opposition.

--- Later in debate ---

[Mrs Anne Main (in the Chair)]

Order. Before I call Ms Buck, I ask that interventions be brief. There will be time to make contributions later. This is a well attended debate and many Members have asked to speak.

[Ms Buck]

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) is completely correct. Lewisham hospital brilliantly exemplifies the argument.

Secondly, there must be effective partnership working between hospitals, primary care providers and local authorities in the delivery of services. It was the failure even to inform partners that elective surgery had already moved from St Mary’s hospital to Charing Cross hospital that prompted my debate some weeks ago, to which the Minister replied, and which subsequently prompted an apology for the breakdown in communication. That was not only a matter of leaving someone off an e-mail circulation list, but a complete unwillingness to collaborate even within the national health service, let alone with outside bodies such as the local council, which is responsible for social care delivery.

Furthermore, those three boroughs—Kensington, Westminster and Hammersmith—are part of a pilot scheme to demonstrate integration, yet what happened in the relationship between the Imperial College trust and those local authorities could not have been further from integration—it was like something written for a comedy sketch.

Even worse, fundamental confusion remains about how north-west London hospitals are to be configured with Hammersmith—my hon. Friend the Member for Hammersmith (Mr Slaughter) is in his place and I am sure will comment—which has a different spin on its hospital provision from Westminster, even though they are joined in a tri-borough arrangement. Even after the Secretary of State has blessed the restructuring of west London hospitals, just weeks before Imperial concludes its outline business case, we cannot even have a clear agreement on the status of Charing Cross hospital or, by extension, of St Mary’s. That goes to the very heart of whether we can have confidence in the new structure of the national health service.

Thirdly, everyone needs to keep focused on the key issues, and that takes me to the devastating impact of the Government’s ill-considered reforms on the strategic management of London’s health service. The service should be focused like a laser on delivering the vision set out by Lord Darzi, but instead it has been fragmented, diverted and injected with rules on competition when integration should be the key objective.

The King’s Fund report of only some months ago, “Leading health care in London”, stated that the recent NHS reorganisation and the abolition of strategic health authorities and primary care trusts have resulted in an “absence” of health care system leadership in London. The report states:

“The NHS reforms have created a much larger number of organisations in London and their purposes are not always well aligned; the risks of incoherence and inconsistency are high…Reorganising the NHS in London in such a fundamental way has made a challenging situation much more difficult”.

That is so significant that the country’s top emergency doctor has said that the current A and E crisis could have been averted two years ago had the Government heeded warnings of a looming collapse in casualty ward staffing.

The president of the College of Emergency Medicine has said that Ministers and health chiefs were “tied in knots” by the challenges of implementing the coalition’s health reforms from 2011 onwards, leading them to ignore the first warnings from the college of imminent crisis—that the NHS was failing to recruit enough A and E doctors. Therefore, London, which possibly has the most complex challenges and the greatest need for integrated strategic leadership, actually has the least such leadership. Had leading health care managers and professionals been able to concentrate on dealing with such tasks, we might have had some opportunity to build public confidence, carry people with us and make the changes. In fact, the exact reverse has happened.

Finally, we need community and social care and other support services that minimise unnecessary admissions, especially for chronic conditions, and facilitate early discharge. Again, we can all agree on the principle. There are some excellent specific examples of integrated practice and of people working hard to deliver it, but there are also some harsh truths of individual experiences and the funding of social care.

The reality is illustrated in letters from my constituents in response to the moving of elective surgery from St Mary’s. One letter states:

“When I had my mastectomy I was sent to Charing Cross Hosp. After the operation I went home by bus and underground holding my drainage…bottle…from my operated breast. In the same way I travelled after my cardiac arrest on my second lumpectomy due to anaphylactic shock!”

That is only one hazard of putting patients with no family far from where they live. A second letter states:

“They took my City of Westminster Taxi card from me and so I have to pay for taxis to take me to St Marys Hospital and…Charing Cross. I pay £6.50 there and the same coming home (£26 one way to Charing Cross). I cannot walk far”—

—she is unable to use public transport—

“as I get out of breath. I am 84 this year”,

diabetic and

“have had one breast removed with cancer.”

Another constituent told me:

“I have lost my…home help”—

due to the cuts in social care—

“If I’m ill, I wait for it to go away.”

London as a whole faces a £1.14 billion shortfall in social care funding as a consequence of the pressures on adult social care and of the extra costs likely to arise because of the cap—in principle, that is a good thing, but obviously revenue is necessary to fund social care costs. That situation is London-wide and has been set out clearly in a London Councils report. My local authority also set the situation out clearly in a report to the health and wellbeing board, which states:

“As a result of reductions in local government funding Adult Social Care…has to deliver substantial savings in 2013/14”—

£4.4 million in Hammersmith and Fulham, £2.1 million in Kensington and Chelsea, and £2.9 million in Westminster. The report continues:

“These are very large savings; the cumulative effects are much bigger than any other savings programme delivered in the local authorities in the past.”

That is on top of £8 million in cuts to the adult social care budget already coming into effect since 2011. The report states:

“Amongst big reductions to back office and support functions, the savings programmes also include reductions in the use of packages and placements, the greatest area of spend for ASC.”

Rather sweetly, it adds:

“Some of the savings projects may be difficult to deliver or may take longer than anticipated.”

It continues:

“Funding growth for packages and placements arises mainly in the Learning Disabilities, Mental Health and the Young Disabled care groups where client numbers are growing, but also in Older People, as people live longer and are supported in the community.”

There is an important point. There is an integration care fund, which is shifting money from the NHS into social care, but, as Westminster council’s report on the pressures on social care funding states, that funding will mainly be used for purposes that include:

“To sustain services, otherwise at risk from savings plans”.

We are in an extraordinary position. There is a transformation fund designed to put in place the services that would allow us to make changes in hospital care, with which in principle we agree—we would argue in some specific cases—but that funding is simply going to fill the gaps caused by the cuts in social care, which are the result of cuts to local authority budgets. In London, as we know, there has been a 25% cut in local authority funding, with a further 10% cut as a result of the Chancellor’s autumn statement. Much of that new money is simply sustaining services that would otherwise be at risk from savings.

[Heidi Alexander (Lewisham East) (Lab)]

Is my hon. Friend aware of the estimate made by London Councils for the future? Between 2016 and 2020, we might see adult social care departments facing budget pressures of £1.1 billion, owing to rising demand and some of the changes proposed by the Government. Does she agree that the future looks extremely bleak?

[Ms Buck]

I agree totally. A thoughtful and planned process throughout London that would allow us to build up community and primary services, reduce unnecessary A and E admissions, speed up unnecessary discharges and concentrate some of our specialist services in fewer sites is sensible, but the means to realise it have been pulled out because of the pressures on social care funding. Furthermore, the strategic leadership that would allow us to make changes has been undermined by a completely unnecessary, £3-billion, top-down reorganisation that we were promised would not happen.

[Stephen Pound (Ealing North) (Lab)]

I entirely associate myself with the earlier comments about the quality of my hon. Friend’s address so far. She talks about trying to have a logical and sensible planning process. Is she aware that London boroughs such as Ealing, ably led by Councillor Julian Bell, have had to divert intense amounts of resources to oppose something that is the antithesis of good planning? That is an additional double whammy against responsible local authorities, which have to divert scarce resources and face up to a desperately uncertain future.

[Ms Buck]

I totally agree. Local authorities are on the front line of delivering the social care made necessary by some of the planned hospital changes and they are under pressure. The councils have expertise and knowledge and they are, as my hon. Friend says, sensibly involved in planning services, so they are making thoughtful objections when they see that services cannot be delivered as we want. Indeed, they have to divert resources to make the case on behalf of their populations.

In conclusion, London’s NHS continues to save lives and to provide the same quality of care it currently provides. That is a tribute to tens of thousands of men and women on the front line, whether in the NHS or employed directly by local authorities, but it owes absolutely nothing to a Government who have let us down with a change process that we should have been able to work through. They have done that by the way they have treated local authorities and by the way that, through this unnecessary reorganisation, they have diverted attention and resources from the leadership that could ensure that London’s health care is delivered in line with the wishes of Londoners. The Government have let down London’s patients and the men and women who deliver health care to them.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

What an amazing debate! I congratulate the hon. Member for Westminster North (Ms Buck) on securing it; a lot of issues have been covered. Many London colleagues have contributed, made interventions or simply been present to listen to it. As a London MP, I am particularly conscious of the unique challenges facing health care in London, and many of the issues raised apply as much to my constituents as they do to those of colleagues across the House. As hon. Members have said, London is an amazing city with world-leading expertise and services, but it has unique challenges. Whichever party was in government, it would have to respond to those challenges.

I will do my best to respond to some of the points that have been made, but there were such a range of points, and some of them were so specific, that I may need to write to colleagues after the debate. I hope that hon. Members understand that. I will ensure that I follow up those points personally or ask NHS London to do so. Forgive me for having to make that health warning.

I start by echoing the praise from the hon. Member for Westminster North for our NHS staff in London. They work under many interesting and unique pressures, and they respond, for the most part, magnificently. We all realise that no service is above criticism, but our starting point is that we have some amazing people working very hard under difficult circumstances. I am particularly glad that the hon. Lady and her family experienced good care at a crucial time.

The hon. Lady is right to caution that debates about health need to acknowledge, but not to exaggerate, risk. We always teeter on the brink of exaggerating points for political effect, and it is really important that we keep some sense of perspective. Several hon. Members have referred repeatedly to an A and E crisis. I want to put on the record that for the week ending 29 December 2013 last year, the figures for A and E waiting times in London demonstrate that 96% of patients were seen in under four hours in all A and E types, against a standard of 95%. For the third quarter of last year, 95.3% of patients were seen in under four hours in all A and E types.

I am not saying that we do not have problems and challenges, but let us be clear that in many places, the NHS is responding well to those challenges and meeting targets. Work force statistics show that the number of community health service doctors increased by 8.5% from 2010 to 2013. Let us make sure that we keep a sense of perspective on where we are.

Some of the comments during the debate referred to reconfigurations across London. We are quite clear that reconfiguration of front-line health services is a matter for the local NHS, precisely for the reasons that some hon. Members have given. We are trying to make sure that they are led by clinical decisions. That was acknowledged in the opening speech, as was the need for change. The hon. Member for Westminster North made that point.

[Ms Buck]

Will the Minister give way?

[Jane Ellison]

Forgive me, but I really will not have a chance to respond to any of the points made if I give way. I will catch up with the hon. Lady afterwards if there are points that she specifically wants to discuss.

All the reconfigurations must focus on delivering modern health care, better patient outcomes and services as close to home as possible, but, most importantly, they must focus on saving lives and improving quality of life. Those service changes are best led by clinicians, with all of us getting involved and engaging with the process, as we must do. That is what we all want for our constituents, and there are different ways to achieve that.

Change is inevitable, as most, but not all, hon. Members have acknowledged. We have debated questions such as the changes to stroke services in London, which many campaigners predicted would have dire and dreadful outcomes. In fact, the opposite has been true, and London clinicians believe that hundreds of our constituents’ lives have been saved by the concentration of excellence in certain centres. We must be realistic about the fact that reconfiguration can bring great health benefits, as long as it meets the important tests set out by the Secretary of State, and is clinically led.

The health service has to respond to growing demand. Much of the debate has focused on the long-term challenges to the health service in London and across the country. The Government are trying to respond to those huge long-term pressures. We are looking at GP opening hours and at access. That could not be a bigger issue in London, which has a highly diverse and highly mobile population in a 24-hour city. People need to be able to access health care at a time that suits their work patterns and lifestyle, and we are pushing for changes to contracts in that area. There will be named GPs for over-75s. We are looking at the integration of social care and public health. We know that there are big challenges around that, but a big project is under way to try to tackle it.

Ring-fenced public health budgets will empower local authorities to do the very thing that many hon. Members have drawn our attention to, which is to look at the needs of local communities and respond to them at the most local level. We do not want to take a “Whitehall knows best” approach; we want to tell local authorities, “We have ring-fenced your local public health budget so that you can look at the needs of your local population and work with health and wellbeing boards and clinical commissioning groups to devise services that help people to live longer and healthier lives without the need to resort to acute services.”

There has not been much recognition of the need for the changes made to public health budgets, but of all the measures raised in the debate, those changes have some of the most exciting potential to tackle the challenges that we face.

I have touched on health and wellbeing boards. The challenge around Newham GPs would be ideal for discussion at a health and wellbeing board, where all the key people are present. It is a big challenge, and one of the first questions I asked as a Health Minister is why we struggled so badly to get GPs in our most deprived areas. There are varying answers to that, but it is a problem across the country.

The health and wellbeing board is exactly the right forum for discussion because the right people are around the table. Tackling health inequality is now built into statute through the Health and Social Care Act 2012, which must be given due attention in all parts of the health service. The Darzi-led London Health Commission will be interesting. I spoke to Lord Darzi about it just before Christmas to improve my understanding of its objectives. As a Minister with responsibility for public health and as a London MP, I will be looking closely at the commission’s outcomes and I will be keen to work with people on that. It is a big opportunity.

To touch on the point raised by my hon. Friend the Member for Cities of London and Westminster (Mark Field), the formula does not currently reflect non-resident population or the homeless, but that is something that the Advisory Committee on Resource Allocation and NHS England continue to consider. I will ensure that I draw my hon. Friend’s concerns to their attention and that those are fed into the ongoing process of looking at formulas.

For the first time, the formulas for CCG patients and public health allocations take into account health inequalities, and they look at GP populations rather than census-based populations. The formulas are also designed to be more locally sensitive. As the hon. Member for Westminster North and I know particularly well, in a city such as London areas that appear to be quite affluent can contain pockets of tremendous deprivation. The new formula allows for that by enabling consideration of sub-areas and the real health inequalities that they suffer. I hope that hon. Members feel some reassurance about that. We keep the matter under close watch.

Several detailed concerns were raised by the hon. Member for Lewisham East (Heidi Alexander) about Lewisham, the south London reconfiguration, maternity services and accommodation. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne) referred to clause 118. I will ensure that I draw his concerns to the attention of the Minister who is leading on that Bill. No doubt that point will be responded to when the Bill is brought before the House. The Court of Appeal overturned the decision to make service change in Lewisham, and we respect that. The Secretary of State has put that on the record.

Several points were raised about the north-west London reconfiguration. That was debated in this Chamber on 15 October, after which a letter was sent by the local NHS to the hon. Member for Westminster North. If other hon. Members have not seen that letter and would find it helpful to, I am happy to put it in the Library. I note the ongoing concerns expressed by the hon. Member for Hammersmith (Mr Slaughter) about the reconfiguration, and I will relay to the Secretary of State the detailed points that he has made and his desire for a meeting.

Other hon. Members have made comments about the same reconfiguration. For all the criticism of the plans and the analysis, I note that the shadow Minister did not commit his party to changing any of the reconfigurations or to changing NHS funding levels. If I may say so, his speech was long on analysis and short on commitment.

I conclude by saying that the issues raised today are important to all of us as London MPs. There are some big long-term challenges and the Government are trying to respond to them in the best interests of all our constituents.

Changes to Health Services in London

Karen Buck Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.

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

The Secretary of State’s statement has left us even less clear than we were on the implications for hospital services for Westminster residents. Frankly, that is quite an achievement. Planned non-emergency hospital services have already moved away from St Mary’s Paddington to pre-empt the closure programmes that he is now telling us will not happen. That was done on the basis that St Mary’s would become the premier emergency hospital for west London, so where does that leave the provision of additional emergency services? Will that leave my constituents having to travel to Hammersmith, Ealing and Central Middlesex hospitals for their treatment, something the local authority was not even consulted on? Many GPs did not even know where their patients were being treated.

[Mr Hunt]

I hope that I have provided clarity by saying that there will remain an A and E at Ealing and Charing Cross, and that I support what the report says, which is that there should be five major A and E centres, of which St Mary’s Paddington will probably become the most pre-eminent trauma centre in the country. This is a big step for the hon. Lady’s constituents who use St Mary’s, and I think that they will be pleased with what I have said today.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Hospital Services (West London)

Karen Buck Excerpts

Wednesday 11th July 2012 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

rose—

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

rose—

[Mr Slaughter]

I give way to my hon. Friend and will give way to the Minister in a moment.

[Ms Buck]

I am grateful to my hon. Friend. He was with me when we met representatives of north-west London recently and were advised that the number of A and E attendances is rising by about 10% a year. Does he agree that, even for those of us who agree that in an ideal world, we would reduce unnecessary A and E admissions through the provision of quality care in the community, it is wrong to propose the closure of A and E units before we have a demonstrable improvement in the community facilities that would allow for that reduction in unnecessary A and E admissions?

[Mr Slaughter]

Indeed, and I will come on to that when I talk about the process and history of the closure of services.

Oral Answers to Questions

Karen Buck Excerpts

Tuesday 8th March 2011 Commons Chamber

[Mr Lansley]

I can give my hon. Friend the reassurance that in future her local general practices—together in a commissioning consortium—and their other health care professionals, meeting with the health and wellbeing board in the local authority, will be able to bring democratic accountability in order to ensure that they have in her town and surrounding area the necessary services, based on a strategic assessment of need in their area.

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

T9. The NHS in north-west London is facing a £1 billion shortfall in funding over the spending period. Is the Secretary of State surprised, therefore, that yesterday’s NHS Confederation survey of managers found that just 13% of managers thought that supporting GP commissioning was the highest priority, compared with 63% who thought that the cash crisis was the highest priority? Is it not the case that financial pressures are dictating the NHS reform agenda, rather than the other way around?

[Mr Lansley]

I remind the hon. Lady again that next year we are increasing NHS resources in real terms. There will be a 3% increase across England in resources for primary care trusts, and as she will know, PCT managers in London are being brought together into PCT groupings. I do not understand the survey. They have a responsibility both to improve clinical commissioning by supporting their GP groups, which are coming together across London to do this, and to ensure strong financial control.