Hospital Services (West London)

Mark Field Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

I congratulate the hon. Member for Hammersmith (Mr Slaughter) on getting this important debate, which affects all of us who are central and west London MPs. I am sure that he regrets the necessity of the debate. Our constituencies have a number of hospitals in common and, over some time, he and I have discussed health matters that affect them. New commissioning boards, run by local GPs, will come into play from next April. The Westminster board will share its management with Hammersmith and Fulham, Kensington and Chelsea, and Hounslow, and it is currently considering how the hospital configuration in west London should work. It is the soon-to-be-defunct primary care trusts, however, that will formally make the final decision.

As recently as 25 June, the North West London Joint Committee of Primary Care Trusts considered the business case for closing four A and E departments in the north-west London region. The plans are out for consultation until 6 October, and the results will, I think, be presented to the PCTs in advance of final consideration next January. As the hon. Member for Hammersmith pointed out, it is recommended that four departments in west London be closed, including those at the Hammersmith and Charing Cross hospitals in his constituency. The plan is that people can easily be steered away from A and E and towards their local health centres and GP services. There are of course a couple of fall-back options, both of which involve closing Hammersmith, though. One also involves closing Charing Cross, and the other affects the Chelsea and Westminster hospital, which, although outside my constituency—in that of my hon. Friend the Member for Chelsea and Fulham (Greg Hands)—serves a considerable number of my constituents. The joint committee seems to favour the closure of both Hammersmith and Charing Cross A and Es.

I agree with the hon. Member for Hammersmith that there is little doubt that if Charing Cross’s A and E is closed, we will see the end of a hospital there, because it would, I suspect, be only a matter of time before the majority of the Fulham Palace road site was disposed of commercially. I have two major hospitals in my constituency, one of which, Barts, serving the eastern part of my patch from over in the City of London, is not affected by any of the considerations. The other is St Mary’s, Paddington which, ironically, is probably more important to the constituents of my neighbour, the hon. Member for Westminster North (Ms Buck), than to mine, although a significant number of my constituents in the Hyde park area and Marylebone use it as their local hospital.

The Department of Health has been mindful of the fact that hospitals in the centre of London, which serve large working populations as well as residential ones, give the NHS more bang for the buck. I have often observed that my constituency has been well served over the past decade and a half by new walk-in centres and the like. The joint committee might have been tempted to realise one of its most valuable assets on the St Mary’s site, which is, like Charing Cross, a prime piece of central London real estate. From the recommendations, it seems that that temptation has been resisted, and I am glad about that, but, like the hon. Member for Hammersmith, I am not going to take anything for granted until the whole process is over. There is, inevitably, a sense that there is an element of a zero-sum game here but, like the hon. Gentleman, I do not recognise that we should necessarily be in this place, for reasons I will set out.

My constituency next-door-neighbour, the hon. Member for Westminster North, and I would have vigorously fought any plans to close St Mary’s, because the hospital has a proud historical importance and is incredibly well served by public transport, which makes it a key local service for countless central London residents. Let us not forget, in this week of all weeks, the seventh anniversary of the terrible 7/7 bombings in London. One of the bombings was on the Edgware road, and St Mary’s, Paddington had pride of place as one of the sites that played an important part in ensuring that lives were saved. I have a great deal of sympathy, therefore, with the hon. Member for Hammersmith, as he faces two closures on his doorstep. If the closures went through, they would not, perhaps, cause me the same amount of political grief, but they would affect my constituents, many of whom receive hospital treatment from some of the institutions earmarked for closure. There would also be the ongoing effect of the substantial burden of increased pressure on the area’s existing hospitals.

I accept the clinical wisdom of trying to steer traffic away from A and Es as far as possible, but before we press ahead with closures, particularly in this part of west London, we must ensure that the alternative services are truly in place and that we are not operating on some naive hope that the pressure on A and Es will miraculously dissipate once four west London departments are removed. Until there has been a proper assessment of out-of-hours care, I question the wisdom of closing as many as four busy A and Es in this area of the capital. The plan is misguided because the population is transient, with huge numbers of non-residents spending time in central London as workers, visitors and tourists. The pressures on central London are very different from those in other parts of the UK. I can understand that the Minister does not want to hear all sorts of special pleading from different parts of the country, but I think that he will recognise that in my unusual constituency I have 70,000 UK nationals, but 920,000 people working there every day of the working week. That is an extreme example, but it is fair to say that around Ealing Broadway and Heathrow airport there are also huge clusters of people who work but do not live in the area, and that should play some part in the thought process about the closures.

I want to say a little about two slightly more parochial issues, because this is not the only health proposal that has caused my constituents alarm. One is the Royal Brompton hospital, which the hon. Member for Hammersmith mentioned. The hospital is just outside my constituency, in that of my hon. Friend the Member for Chelsea and Fulham, but it serves a lot of my constituents. I have received many e-mails and other correspondence imploring me to fight the decision to close the specialist children’s heart surgery unit at the hospital, as I am sure have other central London MPs. I buy into much of the thinking on the issue of specialist care, not just by this Government but also from before 2010. In my view, it is better to concentrate specialist services in fewer and larger centres, rather than to hold on to a widespread but perhaps more mediocre service. I know that it is easy to make that case in a constituency such as mine, where services are in parts of London that are only 10 miles apart, and I appreciate that in more rural parts of the UK we are talking about distances of many dozens of miles, but I have great sympathy with the concerns that some of my constituents have highlighted. They are particularly worried that the review of the Royal Brompton has failed to consider what a difference having child and adult cardiac services in the same centre makes to the quality of care.

My constituents will point out that the Royal Brompton is one of only two hospitals in the country where four surgeons already handle well over 500 congenital cardiac cases a year, meeting, therefore, the standards expected by professionals and the review panel’s criteria. It is the only centre in the country to have undertaken more than 1,000 interventions in a year for such diseases, and the service has consistently been rated as excellent by the Care Quality Commission, the review team and, of course, Ministers. The campaigners fear that the decision to close children’s heart services will threaten the viability of the entire trust in the Royal Brompton area. The hospital hosts the country’s largest service for children with cystic fibrosis, which requires intensive paediatric care, and also anaesthesia teams to support the respiratory team with some of the most complex cases. I hope that the Minister will continue to listen to some of the concerns.

Finally, the other parochial issue, which the hon. Member for Hammersmith also raised, relates to Imperial College Healthcare, which has an important part to play on the St Mary’s, Paddington site. If the changes go ahead, the hospital looks set, rightly, to become ever more important in that part of London. I wish to touch on the recent negative press coverage, and give Imperial the right to reply, as it were. Following the deaths of some 25 patients, my local authority, Westminster city council, has expressed concern about Imperial’s poor record keeping, and the loss of a large amount of referrals data.

I received this week a missive from Mark Davies, Imperial’s chief executive, explaining that in January the trust took the rare step of taking a temporary break from reporting its performance in meeting the 18-week waiting time target for referral to treatment, and waiting times for both cancer and diagnostics. He contends that the break was necessary to establish new and robust systems for recording and reporting patient data. Reviews of that period have found that there is no evidence of the trust missing any cancer diagnoses, and the measure was a short-term one, allowing for new configuration. The trust’s view is that the negative press coverage rather overstates the case.

The matter we are debating affects us all as Members of Parliament. We understand that it will inevitably be a partisan, party political issue to an extent, but we all hold close to our hearts the area of London that we represent, and I hope that as far as possible we will work together to get the best deal for west and north-west London as a whole.

[Several hon. Members]

rose—

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[Mr Burns]

First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays. We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.

[Mark Field]

Will the Minister give way?

[Mr Burns]

I only have one minute left; I hope that my hon. Friend will forgive me.

Trauma services have also been centralised, with a major trauma centre sited at St Mary’s and the two heart attack centres at Harefield and Hammersmith, which will continue to provide service.

Let me remind hon. Members of the process after the consultation is completed. As the hon. Member for Hammersmith rightly said, after the consultation has concluded, the responses have been considered and a decision taken, if the local authority overview and scrutiny committees do not agree and do not think the proposition is in the best interests of the local community, they have the right to communicate with my right hon. Friend the Secretary of State to request that he refer it to the independent reconfiguration panel. If my right hon. Friend does so, the panel will independently consider the proposals and advise him whether it believes that they are right for north-west London, and he can then take a decision accordingly. There is full consultation, full involvement and a mechanism to allow the matter to be pursued further after the consultation has concluded.