Health Services (North-east London)

Lee Scott Excerpts

Thursday 21st October 2010 Commons Chamber

[Mike Gapes]

It may be a new Labour term, but it is still being used by the current Government, so if the Minister can do something to stop that, I would be grateful.

There was a report back to “stakeholders” in September. I shall come to that in a moment, but let me first give a flavour of the responses that were received as a result of the whole exercise. For instance, the responses from the local authorities have been listed. The London borough of Redbridge sent in a clear response, which was a resolution adopted unanimously by the council that said:

“having taken account of the need to provide a wide range of health services in Redbridge which are able to meet the needs of our growing and diverse population, we express our strong opposition to the Health for North East London ONEL proposals to downgrade services at King George Hospital which would include (a) closure of the Accident and Emergency department (b) the ending of critical care support and acute surgical and medical treatment; (c) the ending of Children’s surgery and (d) the ending of maternity delivery in the Borough”.

That was the unanimous Redbridge position, supported by all parties and councillors among the 63 members of Redbridge council.

Barking and Dagenham council took a similar position, writing in its covering letter that it was “concerned about the proposals”. In particular, it was concerned that Queen’s hospital in Romford, which is the larger of the two hospitals in the Barking, Havering and Redbridge trust, would not be able to cope with the increased pressures, including the increased pressures on A and E, and maternity services. Interestingly, Waltham Forest council, which, in a previous incarnation in 2006, had come out in favour of the Fit for the Future proposals, said in 2010 that it would not comment on the A and E position. However, the council was critical that concerns about mental health had been neglected, saying that alternative services were needed. Waltham Forest council also said that Health for North East London needed to

“spell out what will be involved in reducing the number of A & Es from six to five especially in terms of impact on the remaining A & E departments”,

adding that the proposals were not clear. Newham council said that it was not convinced by the proposals either:

“We also note the significant changes to service provision at King George’s hospital. It will be necessary to closely monitor any resulting impact on our local Newham Hospital… Our expectation is that any increase in activity will be matched by appropriate resource levels.”

That was a conditional position. Tower Hamlets did not want to comment on the proposal either. Among the borough councils—these are representative bodies, the people who represent the community—there was either a clear opposition or at least indifference or ambivalence.

What about other organisations? I have already mentioned the Newham trust. It said something very important in its documents:

“experience with the Gateway Surgical centre supports the model of locating elective care in a separate building but on the same site as acute provision, allowing easier access for staff.”

The whole thrust of the proposals is to separate the two out, whereby the elective and the acute are in different places, yet this has been questioned even by one of the hospitals that could benefit by receiving the transferred patients.

The position adopted by other organisations is also significant. The Ipsos MORI documents make it clear that very strong views were expressed. The essence of my debate is captured by an important sentence, which states:

“The views opposing the reduction… from six to five hospitals providing accident and emergency, critical care and maternity services…came from organisations representing the public (elected local authorities and patient representative groups such as LINks)”.

It continues:

“It should also be noted that some opposition was also expressed from representative groups associated with NHS staff, notably some Local Medical Committees.”

Who, then, is in favour of these proposals? Not a lot of people, it seems. Within the local community in Redbridge, it is very hard to find anybody in favour of the proposals. Perhaps some people in other boroughs might be found, but it is certainly true that in Redbridge it is very hard to find anybody of any authority or any representative political role who is prepared to speak out.

[Mr Lee Scott (Ilford North) (Con)]

Does my constituency neighbour agree that of the people who seem to be in favour of this proposal, none have actually lived in the area? Indeed, if I am not mistaken, some of the doctors involved in it were from Newham.

[Mike Gapes]

The clinical director behind these proposals is Dr Mike Gill, who is based at the Newham General hospital, and the general practitioners involved come from Waltham Forest. I think we can safely draw the conclusion that they have other interests in these matters.

On the proposals to end maternity services, I remind the House that we have had a maternity hospital in Ilford since 1926 and there are presently about 3,000 births a year at King George hospital. The Ipsos MORI summary of the conclusions states:

“On maternity services specifically, there were detailed submissions that made specific comments”,

some of which are cited. It notes that the Royal College of Obstetricians and Gynaecologists—a not insignificant organisation—had

“changed its view of maternity service provision”

and cites the royal college as saying:

“The trend towards a rising birth rate in this area over the next decade cannot be ignored, which will have a direct bearing on the capacity of a large unit at Queen’s Hospital.”

It made the following recommendation:

“Both units (King George V Hospital and Queen’s Hospital Romford) should be developed and sustained as fully-fledged maternity units.”

Those, it said, should be accompanied by “midwife-led units”. That was directly contrary to the position taken by Heather O’Meara and the outer north-east London organisation.

The document quoted the Royal College of Midwives as saying that the proposal for King George V Hospital and Queen’s raised concerns about

“the ability to deliver the configuration of services in such a way as to not result in a high volume of births at Queen’s Hospital.”

It also said that there were

“challenges in relation to…capital investment and workforce planning…in achieving the recommendations.”

The team of midwives from Barking, Havering and Redbridge University Hospitals NHS Trust, who work at the two hospitals, said:

“Geographically, there will be no obstetric unit in Redbridge to serve the women of this area. Residents of Barking will need to travel further for obstetric led care… Although women will have greater choice for low risk birth there will only be one option for hospital birth in three boroughs.”

I could produce more quotations. There are so many in the document. But what has been the outcome? A meeting was organised on 30 September, of which neither the hon. Member for Ilford North nor I was given notice. I only received the information about it because one of my local councillors managed to get hold of the slide presentation. It was advertised as a “stakeholder discussion event”, and was held not at West Ham football ground but at the Holiday Inn, Newbury Park, in the constituency of my constituency neighbour, the hon. Member for Ilford North.

The “stakeholder discussion event” document is very interesting. Anyone reading it might assume that the recommendation was done and dusted. It contain presentations by Heather O’Meara, who is now the chief executive of all the outer north-east London primary care trusts; by Helen Brown, who works for NHS London; and by leading figures in the process. They spoke of “proposals”.

There has been a consultation, which has revealed serious concern among professional organisations in the area, and strong opposition from the local authorities. It might be assumed by anyone believing that consultation and public involvement really matter that something would have changed. On Friday morning, my neighbour and I had a meeting with Heather O’Meara, who described the outcome of the consultation as “some caveats”. She also said that the stakeholder discussion event had been based on clinical working groups where the ideas had been tested, and that there had been consultation with GPs and a huge number of public events. I had not noticed those huge events. Perhaps they happened in big places.

[Mr Scott]

Is it not fascinating that neither of the two local Members of Parliament most closely affected by the proposals was informed about the events and consultation that were allegedly happening, or was invited to take part? Is that not slightly strange? It might give us a complex: we might imagine that they did not want us there.

[Mike Gapes]

Why on earth could that be? I do not know.

On Friday morning, we discovered that the stakeholder discussion document and other proposals would be put before a meeting on 15 December of the joint committee of primary care trusts for outer north-east London. We asked questions. We asked what the process is before then. We asked whether there will be a role for the health overview and scrutiny committees of the local councils—we were told that there would not be. We asked what would happen to the role of the London region NHS and we were told that the meeting on 15 December will make the decision. So we asked who is to be consulted about these proposals before that meeting. That is when the statements that have been made and the positions of the Minister were quoted to us; what we were told is in line with the guidance from the Government since the election.

The Minister wrote to me on 12 October about a complaint I had received from a constituent. He stated:

“In May, the Secretary of State for Health announced a review of all service change proposals. He has outlined new, strengthened criteria that he expects decisions on NHS service changes to meet…proposals must have support from GP commissioners; arrangements for public and patient engagement, including local authorities, must be further strengthened; there must be greater clarity about the clinical evidence base underpinning proposals; and proposals must take into account the need to develop and support patient choice.”

Let us leave aside the last two of those. We have been given a clear view from our local authorities about the original proposals and we have been given a clear view of the public attitude to those proposals. What we have now been given is a slight tweaking of the consultation document. Three or four minor modifications have been made to the proposals and, as a result, those involved now intend to go ahead with the essence of the original proposals.

To confirm what I am saying, I wish to quote from a document produced by Helen Brown as part of the stakeholder consultation. On page 48 of the stakeholder presentation, under the title “Activity and capacity”, is a table describing the

“Proposed shift of activity to hospital sites”.

The figure for the row headed “Non-elective”, which relates to people admitted to the accident and emergency department for King George hospital, is minus 25,937 or minus 100%. That hospital’s figure for “A&E” is minus 59,565, or 100%, and its figure for births is minus 2,910, or minus 100%. Its elective activity is increasing, with some 18,000 being transferred from the Queen’s hospital, so that is a partial shift. Originally this was to be limited, but now some facilities are being moved in. However, the essence of the proposals—to get rid of the A and E department, the children’s surgery and births at the King George hospital site—remains.

So what does this mean? It means that the consultation that has been engaged in at great cost—the public stakeholder engagement—is a sham, a charade and a waste of money. The people behind the proposals, who tried and failed in 2006, and who tried in 2009 only to have this dragged out for longer, are now absolutely determined. This is a juggernaut being driven by unelected people in the NHS bureaucracy. They are disregarding the views of the local community and disregarding the Members of Parliament and the local councillors, and they are not going to be stopped because as far as they are concerned they are right.

My neighbour, the hon. Member for Ilford North, will doubtless wish to comment on the fact that on Friday morning we got into the essence of the issue, when we heard the argument that clinicians know best. In which case, what is the point of pretending that a public consultation is being carried out? What happens if the consultation comes up with a conclusion that these people do not like? I recall the old quote of Bertolt Brecht, “The electorate has made the wrong decision, so change the electorate.” Joseph Stalin’s 1936 constitution was adopted and the result was announced the day before the referendum was held in the Soviet Union. Are we moving that way with certain people in the professions believing that they know best, disregarding the wishes of the community?

King George hospital is not perfect. We have a lot of problems, but we also have a lot of problems with the other hospital in the trust, Queen’s hospital. The two together have a big ongoing deficit that they have had for five years and, despite promises to get rid of it, they have not done so. There is a real difficulty and I believe that an element of this is financially driven. As I pointed out in 2009, getting rid of the A and E at Newham general hospital would save £28 million a year, whereas getting rid of the A and E at King George hospital—according to the figures provided by those behind the proposals, not mine—would save only £19 million. Nevertheless, the decision has been made to go ahead with getting rid of the A and E at King George.

We are facing a very important time. We need a decision that is in the interests of the people, not in the interests of the people who run the bureaucracy of the national health service. There are strong arguments, but I want to finish with a quotation of the Prime Minister. In answer to a question yesterday from my hon. Friend the Member for Ealing, Southall (Mr Sharma), the Prime Minister said:

“The whole point of the reform of the NHS is to put power in the hands of patients and doctors, so decisions about hospitals will be made on the basis of what local people want”.—[Official Report, 20 October 2010; Vol. 516, c. 947.]

Interestingly, last Friday morning we asked, “How will the doctors be consulted?” We were told, “We will take soundings,” so we asked, “How do you take soundings? Is there a ballot? Do the GPs vote on whether they agree to the proposals?” We were told, “No, we will take soundings of health practices.” So we asked, “What is a health practice?” My GP is part of a health centre and there are eight or nine GPs. We were told that each practice would have one vote. So a single-handed GP could be equivalent to eight or 10 GPs in a group practice or health centre. That is a very strange way to find something out. It is perhaps like the Hong Kong Legislative Council or the estates in pre-revolutionary France, but if we are talking—as the Prime Minister said—about decisions made on the basis of what local people want, we need to be clearer about who is making those decisions.

I fear that at the meeting on 15 December these proposals will be pushed through regardless, and the running down of the accident and emergency—which is already beginning, with salami-slicing—and of the maternity services will start, so that in future no one will be born in Ilford except in the back of a car or taxi rushing them to the Queen’s hospital in Romford. People who need to go to the local hospital will not have that hospital facility, because they will have to go several miles away.

These matters are so important to my community and my constituents that I hope that I will not have to come back to this House for a fourth time with a debate on the future of my hospital—but if necessary I will do so. I hope that when the Minister responds he will reassure me that this process will not be allowed to be driven in the interests of people who are disregarding the wishes of the local community and their elected representatives.

[Mr Lee Scott (Ilford North) (Con)]

I congratulate my constituency neighbour, the hon. Member for Ilford South (Mike Gapes), on securing the debate. We must both be feeling déjà vu, because we have found ourselves on many previous occasions debating and saying exactly the same things about this issue. However, the situation now is totally different.

I will try not to repeat anything that the hon. Gentleman has said, although the events of last Friday were a little surreal, to say the least. We sat down and were told about all the consultation that had been taking place, which was surprising news to us. I had received an invitation that was posted the day after the meeting had taken place—so my hosts were obviously desperate for me to be there! I realise that they might have been unhappy with me because of my views about Redbridge NHS, but not inviting me to the meeting until after it has happened was, perhaps, a step too far. The hon. Gentleman has compared that to a rigged Afghani election, but I think that is being unkind to rigged Afghani elections; it was far worse than that.

This House has been presented with a petition of about 9,000 signatures from my constituents in Ilford North and another from the hon. Gentleman that brings the total of signatures to about 27,000. Our local paper, the Ilford Recorder, has also presented petitions to Downing street, of a further 16,000 signatures. In my past five and half years as Member of Parliament for Ilford North, not once has anyone e-mailed, phoned, come to my surgery or written to me to say, “We think it would be a wonderful idea to carry out these proposals,” and all these thousands of people are opposed to it.

I shall now turn to the process. Two weeks ago I received a phone call from the Ilford Recorder asking what I thought of these proposals, which, as the hon. Gentleman said, are virtually identical to proposals we have previously seen on various occasions over the past number of years. I said that these proposals could not be proposals because they had not undergone any independent review, which we had clearly said would take place if we became the party of government and which was clearly stated during the last days of the previous Government. Miraculously, by the time the press phoned Redbridge NHS back, they were no longer proposals; they were now just a possibility or an option—although, funnily enough, I did not see too many other options in the document. Like the hon. Gentleman, I found that my copy of the document turned up three weeks after the meeting—which I admit was not held at West Ham United football ground. It turned up in my office late—after the meeting—so I could not possibly have commented on any of its contents as I had not known about them at the time of the meeting.

It seems to me that the previous leader of Redbridge NHS, who is now in a much more exalted position, had decided that, come rain or shine, she wanted to push through the proposals. In the past, both the hon. Gentleman and I as the local Members of Parliament were called in for a meeting or a briefing separately, not together. I should say here that even though we clearly disagree on a number of political matters, it is not possible to put a cigarette paper between us on this matter; we are in total agreement on it. Those at Redbridge NHS have, without any question, tried to change that by briefing us separately. The people briefing us have come from Newham and a practice that is serviced by Waltham Forest, so would obviously not be affected by any changes at King George hospital. They would say what a wonderful idea it was, yet in all the conversations and meetings I have had, not one GP has said that; they have all said that they are concerned about its impact .

If, God forbid, someone were to be involved in an accident or have a heart attack in my constituency, they could die before they got to Queen’s hospital accident and emergency unit. I am not over-dramatising; that would sometimes happen, and that is why there has been such an outcry against this plan from the whole of Redbridge—not from one part of it or from one political party, but from the whole of Redbridge.

I go back to one freezing cold day last year when I, the hon. Member for Ilford South and hundreds of others marched through sleet to protest against proposed closures to the accident and emergency, maternity and other services at King George hospital. We did the same again—admittedly in much more clement weather—this year. The message was loud and clear: the results of this lack of consultation that are going forward to the meetings on 15 December are absolutely null and void and do not meet any of the criteria, because there was no proper consultation.

I and the hon. Member for Ilford South have held meetings in our respective constituencies and invited members from Redbridge NHS. I want to state clearly that in no shape or form were they political meetings, because they were open to the general public and I have no idea of the allegiances of those who attended them. None the less, the message was loud and clear: we need to maintain our accident and emergency and maternity services at King George hospital. They cannot be closed by stealth. They cannot be salami-sliced and closed. They must remain.

I would like to thank my hon. Friends the Members for Hornchurch and Upminster (Angela Watkinson) and for Romford (Andrew Rosindell) for their help and support. Their areas are serviced by Queen’s hospital. People might not think, because that hospital is not under threat, that the proposals would affect my hon. Friends’ areas, but of course it would, because the pressure of 250,000 extra people using Queen’s hospital will have a knock-on effect for their constituents.

I do not intend to detain the House further. However, like the hon. Member for Ilford South, I tell the Minister that this consultation is wrong. If those concerned try to railroad through the suggested closures on December 15, we will resist.

--- Later in debate ---

[Mr Burns]

I agree that we do not need to get into to-ing and fro-ing about what exactly was written. My point was that some of the questions—I am not saying all of them—on some of the petitions were not directly relevant to what was being consulted on. Having said that, it has been recognised that they will be considered as part of the consultation process.

[Mr Scott]

My own petition did not say anything like “Lee Scott’s petition”; it talked purely about the proposals to close A and E and maternity services, and made no reference to anything else. I therefore trust that those 8,000 names will also be taken into account.

[Mr Burns]

I have no doubt that they will, as part of the ongoing consultation and evaluation of responses to the consultation process.

Before 15 December, the London strategic health authority will assess north-east London’s readiness against the four tests that my right hon. Friend the Secretary of State introduced in May this year to ensure more local engagement in the proposed reconfigurations of services throughout the country. In certain previous consultations, there was a long-held view that although lip service was paid to local people and medical practitioners—clinicians and GPs—the views of the local community did not matter because, in effect, a decision had been taken at the launch and things would end up in exactly the same state at the end of the process.

To give greater credence and importance to local views, my right hon. Friend the Secretary of State announced his changes to the criteria that had to be conformed with for reconfigurations to take place, to empower people to take part in the discussions and to ensure that their views would be fully considered before decisions were taken. To achieve that, he has said that reconfigurations and consultation processes that are already in progress will have to be checked against the revised and strengthened criteria to ensure that they have been carried out under the new format. I can assure the hon. Member for Ilford South that that will happen prior to the meeting on 15 December.