NHS in London

Mike Gapes Excerpts

Thursday 24th March 2016 Westminster Hall

[Wes Streeting]

I am grateful to the Chair of the Public Accounts Committee for giving us that insight, which gives me even greater cause for concern about our local situation in Redbridge. The overall gap in funding for the NHS should be a concern to the whole country.

In my borough in particular, I am concerned by a report produced for NHS England by McKinsey & Company in, I believe, July 2014. The report has just been released by NHS England following a freedom of information request, and it identifies a Barking, Havering and Redbridge system gap of £128 million for commissioners and £260 million for providers. I am concerned by several things. One is that one way in which McKinsey identified that the BHR system will be able to address that gap is through acute reconfiguration of King George hospital, where the accident and emergency department is threatened with closure. I am deeply disappointed that, at a recent meeting of the Ilford North Conservatives attended by the hon. Member for Richmond Park (Zac Goldsmith) for his London mayoral campaign, the Conservatives once again stood up and said, “People should not worry about the accident and emergency department, because we always say it’s going to close and it never does.” The only reason why the accident and emergency department at King George hospital is still there is not because of a positive decision to keep it but because the NHS trust and the local health economy are in such a mess that it would not be clinically safe to close it at this time; the accident and emergency department is still very much at risk.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The national health service bureaucracy has been trying to close the A&E at King George hospital since 2006. We are coming up to the 10th anniversary of the misnamed “Fit for the Future” document. My hon. Friend’s predecessor, Lee Scott, and I fought a vigorous campaign to stop the closure at the time, and the closure decision was deemed to be clinically unsound. Now, the Trust Development Authority is in charge, and the A&E cannot be closed because the trust is not out of special measures. My hon. Friend has mentioned the trust’s chief executive, Matthew Hopkins, who was hoping to get out of special measures by the end of the year, but that has not happened. We are still in a period of great uncertainty.

[Wes Streeting]

I agree with my hon. Friend and I welcome him back to Parliament this week after his break. [Interruption.] I know that he has gone to extraordinary lengths to test the resilience of the NHS in London and that he will talk about that shortly. We look forward to it.

In all seriousness, the A&E department is still at risk and many of my constituents worry that it is the financial drivers that are pressing ahead with the closure, rather than the clinical drivers. As my hon. Friend has said, given the length of time since the original case for closure was prepared and since the decision to close was made, it is not unreasonable to ask the Minister to commit to reopening that closure decision and to look at the issue with a fresh pair of eyes, testing whether the evidence base is still there, testing the assumptions that were made when the original closure proposal was put forward and giving people the assurance that it is clinical factors and the healthcare of our residents, rather than financial factors, that are driving this process.

The final thing I will draw upon from the McKinsey report is about meeting the financial pressure within the BHR system. McKinsey observes that to fully close the gap will require further stretch productivity achievement beyond the levels agreed locally, as well as additional private finance initiative support and the closure of the gap to the CCG allocation. The £140 million-odd deficit in 2013-14 was only reached after a £16 million PFI subsidy, and the deficit as a percentage of income is far larger even than it was for Barts at that time.

It is not unreasonable, as part of the wider changes in Redbridge and the work being led by the accountable care organisation, to expect the Government to provide further support in relation to our PFI debt. Many challenges face the local health economy in Redbridge and that debt is like an albatross around our necks. If the Government were to invest now in alleviating that pressure, we may get better outcomes in the long term. I hope that that is an issue the Minister will address when she responds to the debate.

--- Later in debate ---

[Meg Hillier]

I am sure the Minister will do that, but I am happy to share anything I receive from her. I am sure she will not be writing me secret letters, and even if she told me that she was I would ignore her, so I hope she provides information that is fully public.

There is a real concern about health workers being unable to afford to buy homes. When a group of local MPs met officials from the Barts trust after one of the trust’s more recent crises—it was around the time of, or just before, the general election—we asked them about the release of land for health workers. We got the distinct impression that those running the trust at the time—we have had new management in since—did not think that it was their responsibility to provide housing; the process was just about disposing of the land to fill the black hole in the trust’s budget. However, we know that health workers cannot afford to live in London and work locally; that is often true of doctors on good salaries, let alone anyone on a lower salary. There will be a real crisis if we cannot recruit health workers, and I will touch on that issue in a moment.

NHS England is keen to lay the blame for the financial crisis in acute trusts at the door of agency staff costs. The Secretary of State announced a cap on the pay rate in October, but the National Audit Office found that that is not the underlying problem. We also touched on the matter in a Public Accounts Committee hearing. It is the volume of agency working, rather than the rate paid, that is the bigger problem—the vacancy rate, requiring backfilling with agency workers, rather than the amount that they are paid. No doubt there is an problem there and the NHS should begin—I hope that it is beginning—to use its purchasing power to tackle that, but the foundation staffing model for hospitals, which is designed to fit the budget allocated by the Department, often has too few staff to deliver the required health outcomes. The NAO has uncovered the fact that 61% of temporary staffing requests in 2014-15 were to cover vacancies, not emergency cover.

[Mike Gapes]

Is my hon. Friend aware that the NHS employers and London NHS partnership have this week sent out information stating that nursing vacancies in London are running at 17%, which is 10,000 nurses? The NHS and local trusts are going all over the world to recruit, but the Home Office is bringing in a requirement for people to earn £35,000 before letting them in. Does not that contradict what the NHS is trying to do?

[Meg Hillier]

My hon. Friend anticipates what I was going to say—or perhaps it is just that we are all dealing with the same problems. Will the Minister outline what conversations her Department and NHS England have been having with the Home Office about the issue? We have seen many changes in the immigration rules, and they affect what happens. We should be recruiting and training British citizens and enabling them to earn a living, although I have no problem with other people working in the NHS. When we have problems with recruitment, of course it is right to look overseas, and many of our hospitals are well staffed by people from all round the world; but if those people cannot meet the threshold, they will not be allowed in, and that will cause a problem. I know that it is also causing concern to NHS England. No doubt the Minister is being lobbied; perhaps she can advise us. The cost to hospital trusts of the agency staff who fill in the gaps—they could be full-time workers from overseas or from the UK—has risen from £2.2 billion in 2009-10 to £3.3 billion in 2014-15.

I do not have much time to discuss GPs, but we know that that is a big issue, given the demand on the health service at primary care level in particular. On national figures, recruitment of new GPs is slow and early retirement is a looming crisis. If the Minister has not been alerted to that problem, I hope she will look into it. It is not a new phenomenon, but it is getting worse. Between 2005 and 2014 the proportion of GPs aged between 55 and 64 who left approximately doubled. In addition, there is an increasing proportion of unfilled training places—the figure was 12% in 2014-15—and an increasing number of younger GPs are leaving because the job is becoming untenable, with 12-hour days typical. Many GPs just do not want to do that. We need good access and support in primary care to make it work.

The Public Accounts Committee has recently looked at another issue that is worth highlighting, which is the management and supply of NHS clinical staff. We would acknowledge, although our report is not yet out, that in an organisation the size of the national health service, getting things exactly right will always be complex. The figures and the available data about who is needed, together with the problems that I have mentioned to do with GPs and recruitment of hospital and other health workers, could have been predicted. That is something on which I want the Minister to respond: surely, if there is a prediction, there is a need to be able to react quickly, so that training places are available and people are encouraged to take them up. That way, we would ensure that there were enough health workers.

To return to the issue of housing, it is at crisis point in my constituency. Someone on quite a good income cannot afford to buy or to rent in the private sector and will not have a hope of getting social housing, so we have a vast turnover of people. Young people come and live like students, but when they want a home of their own, a spare bedroom for a child, or just a lifestyle that they think befits their status and age, they move out. We have a crisis across the board, but particularly for the NHS. I hope that the Minister will answer some of my questions about how housing can become a key concern for her Department as well as the Department for Communities and Local Government, which delivers housing. My worry is that if the Minister and her colleagues do not lobby hard, the problem will be forgotten in the overall housing crisis and will become a major crisis for public health and health and wellbeing in London.

[Mike Gapes (Ilford South) (Lab/Co-op)]

I am particularly pleased that you are in the Chair today, Ms Buck, because I am going to refer to St. Mary’s hospital and the Imperial College Healthcare NHS trust, which saved my life. You know it very well. This is my first speech or question in the House—apart from my earlier interventions —since November. My neighbour, the hon. Member for Ilford North (Wes Streeting) referred to my extended break. It was not voluntary or by choice.

I had been at a concert at the Royal Albert Hall—in fact, Jools Holland saved my life, because if I had not gone to the concert I would not have had friends with me during the events of that November evening. I was rushed by ambulance initially to Chelsea and Westminster hospital, where I collapsed. They scanned me and decided that I had such a serious ruptured thoracic aneurysm that they had to transfer me by ambulance to St Mary’s hospital in Paddington. I came to in the ambulance and I have a vivid memory of going down the ramp out of the ambulance into A&E at St Mary’s, where about 10 people were waiting. They ran me in the trolley straight into the operating theatre, where the consultant said, “I hope you don’t mind. We have injected you with the anaesthetic, but do you mind if we cut the shirt off your back, because we have got to start straight away? The anaesthetic will take a moment to work.” Then I heard a female voice saying, “I know this is hurting, but I’m sorry, I’ve got to do this.” Then I was unconscious.

I had a total of eight weeks in St Mary’s hospital, with five and a half weeks in the intensive care unit, for nearly three of which I was in an induced coma. I had a series of operations on my heart and a tracheostomy, which is an interesting experience whereby a tube is permanently inserted—or it seems as it if is permanent; fortunately it is not there any more. I had other operations while I was there, as well, so I am a bit bionic. I have not yet flown anywhere, and I am waiting to see what will happen to the metal detectors at the airport, because I have some stents that might cause some complications.

I was at the hospital this morning and they were pleased with my progress, so I am able to be back here in Parliament. I want to say thank you to all the staff —the consultants, the senior and junior doctors, the cleaners, the people who gave me my food, all the nursing staff, and the physiotherapists. They initially got me walking with a Zimmer frame, with oxygen cylinders first at 100% and eventually at 28%; they managed to get me to walk up some stairs, so I could be sent home. I pay tribute to them because it is a bit of a miracle that I am here today—I have been told that by at least two consultants. Most people who go into hospital with what happened to me do not come out, so every day from now on is a bonus.

I went in on a Friday night, in the early hours of Saturday morning—a weekend. We must not let anyone say we do not have a seven-days-a-week NHS. I have seen it. I have been cared for seven days a week, looked after and fed seven days a week, for two months. I have had the most excellent treatment. I have seen the 8 o’clock in the morning shift come on and then the 8 o’clock at night shift—12-hour shifts. I have seen the turnaround. Whether I was in the intensive care unit, the Charles Pannett ward or the Zachary Cope ward, I have seen the dedication and commitment of the staff. They come from all over the world. The nurses who treated me included a man called Riad, a Palestinian from Jordan, who was fascinated to know that I had been in Amman with the Foreign Affairs Committee four days before I went into hospital. There were nurses from Malaysia, the Philippines, Ireland, Ilford and many other places around the world.

The fact is that we in London depend on a pool of staff who have come to our city from all over the world to help us, to save us and to keep us well. We must never forget that. It is why the Home Office needs to understand that London’s success as a global city depends on the workers in London being healthy. As Anne Rainsberry told us in the meeting with London Labour MPs the other day, 20% of the people treated in London do not live in London. London serves the whole community. The vascular facilities at St Mary’s take patients from all over. I was told that even if I had had the heart problem in Ilford, I might still have been transferred to St Mary’s. The unit has patients from Southend, Newport in south Wales and even from Gibraltar.

That indicates to me that we have to retain the staffing levels and level of expertise in our specialist hospitals and in our specialist departments within London hospitals. That is not possible, as my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) pointed out, if people cannot afford to live in London and if most newly trained nurses seek jobs elsewhere within two or three years. It is not because they do not enjoy their work, but because they cannot afford or are fed up with two or three hours of travel every day.

We have to deal with the problem, and it requires the new Mayor of London, all our local authorities and the Government to look at it seriously. It also requires the Home Office, after the European referendum, to think again about the absurd position where we will cut off our nose to spite our face by making it impossible in a shortage period to recruit people to certain occupations because of the £35,000 threshold.

[Paul Scully]

The hon. Gentleman is making an incredibly powerful speech and I am grateful to hear about his personal experience. On the shortage of nurses, while it is preferable to train people domestically, does the hon. Gentleman agree that where we cannot fill those places, the shortage occupation list—it is devised by the Migration Advisory Committee, which has placed nurses on the list—goes some way to mitigating the £35,000 criteria?

[Mike Gapes]

The interesting thing is that NHS nurses were not originally on that shortage list. There had to be a lobbying campaign to get them put in because of the stupidity of the people in the Home Office who drew up the list. The fact is that the £35,000 figure will present a problem. Obviously, it will not present a problem in recruiting doctors from abroad, but it is a significant problem in recruiting nurses and other people at lower wage levels. We need to raise that issue, because it will be damaging in the long term.

Of course we need to train more nurses, but to do so the Government need a consistent policy. It takes several years to train a nurse. It is not something that can be switched on and switched off. The other issue is retention. Large numbers of nurses leave our NHS and go and work in other countries. Just as we take nurses from other countries, so British nurses go abroad. There is no reason why that should not be the case; it is a global health economy and the reality is that if we do not pay the lower paid staff in the NHS what they need, we will not recruit sufficient numbers of people to do those jobs.

[Wes Streeting]

In the context of the recruitment and retention challenges for NHS staff, does my hon. Friend share my concern and that of a number of Members from all parts of the House on the plans to charge nurses, midwives and students of allied health subjects full tuition fees and to remove the NHS bursary? Those things will be deeply damaging to recruitment of the very staff that we need to bring into the NHS.

[Mike Gapes]

Absolutely, I do agree. That is why I signed my hon. Friend’s early-day motion today. I am about to put it in so that my name is added, now that I am back.

In conclusion, it is a great pleasure and a bit of a coincidence that this debate was here today, but I could not miss the opportunity to say thank you to those people who saved my life.