North-east London STP

Debate between Mike Gapes and Stella Creasy

Friday 16th December 2016 Commons Chamber

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

Changes to our national health service are being planned all over the country, which are going to have profound implications for the quality of health, the availability of both primary and secondary services and for the size and location of our hospitals. There has been justified criticism of the secrecy with which this process of producing so-called sustainability and transformation plans has been carried out. The Department of Health has produced a five year forward view and a very large number of plans. I want to focus on the north-east London sustainability and transformation plan draft, which was published on 21 October, and on the eight delivery plans supposedly to implement it.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I want to put on record my personal gratitude to my hon. Friend on behalf of all the residents of Walthamstow, because we know that these plans are not going to be subject to parliamentary scrutiny. The fact that my hon. Friend has secured this debate today might be the only opportunity we have in Parliament to look at something that will fundamentally transform their local healthcare services.

[Mike Gapes]

I am grateful to my hon. Friend, who spends a great deal of time, as I do, campaigning with her local council to improve the NHS locally. Throughout our sub-region of north-east London, we are all concerned about what we are facing.

The King’s Fund reported in November that the speed of development of these plans means that

“patients and the public have been largely absent”

from the process and that NHS England has instructed that freedom of information requests should be “actively rejected”. Locally in north-east London a freedom of information request for the financial and working detail of the STP was rejected in November on the basis that:

“Disclosure would be likely to inhibit the ability of public authority staff…to express themselves openly...and explore extreme options…Deliberation needs to be made in a ‘safe space’ to develop ideas and to reach decisions away from external interference which may occur if there is premature public or media involvement.”

My local council, Redbridge Council, has been concerned that it has not been adequately involved in the process. It has made it clear that it will act in the interests of our local community and that Redbridge will not be signing off or endorsing the STP unless we are satisfied that it is in the interests of Redbridge residents

I understand that the STP programme boards are not required to hold meetings in public, and no agenda or minutes are published. The secrecy surrounding this process has not been helpful in building public trust and has caused suspicion within communities all over the country—I speak particularly from local experience—as to the intentions of the proposals.  In many respects what could be a reasonable response in the circumstances to the crisis we face in terms of future funding, the ageing population and other challenges to the NHS, is being undermined because of process issues. The NHS needs to learn from these experiences about how better to engage with the public and key stakeholders, including elected local representatives.

We are fortunate in Redbridge and north-east London because there are good working relationships within the NHS and local government, and there is already a model of collaborative working.  However, the problem with the STP is that it brings a top-down process into this situation and potentially undermines the joint-working that has been voluntarily established over recent years.

Redbridge along with neighbouring authorities will be strongly arguing that the developing STP governance structures should not stifle or negatively impact the local work that is happening. Redbridge and its partners in Barking and Dagenham and in Havering have over a number of years been developing cross-borough, collaborative approaches on the integration of health and social care. Redbridge is arguing that STP governance needs to ensure that this subsidiarity to the local level is taken as a model for the future, and is not undermined by the STP approach. We need to ensure democratic accountability if we are to get public buy-in, and we do not have that at present. Public engagement needs to be enhanced and improved.

The north-east London October STP draft is subtitled “transformation underpinned by system thinking and local action”. It says, however, that

“the system partners may not be able to work together collaboratively to deliver the plans.”

Today we have seen news about the reality we face in our NHS: large numbers of hospitals with dangerously high bed-occupancy levels and little or no flexibility. The CQC’s chief executive recently talked about hospitals being dangerously full. On 26 November, a leaked memo from NHS England revealed that hospitals were being banned from declaring so-called “black alerts” and told to prepare for the winter crisis by passing on scheduled surgery to private hospitals and discharging thousands of patients to get bed occupancy down from a national average of 89% to 85%. 

However, north-east London’s population is massively increasing. The report states that the population of north-east London boroughs will increase by 18% over the next 15 years—equivalent to a new city—and yet there is no plan for an additional hospital to cope with that change. In fact, page 20 of the draft policy states that building an additional hospital is “not practical or realistic.” Indeed, the situation is worse than that. Not only is there no extra hospital, there is the planned closure of the A&E at King George hospital in my constituency. The plan is to stop overnight ambulances sometime next year, with a total closure in 2019. The STP is calling for that not only because it would meet some savings and restructuring requirements, but also because there are unsustainable costs. The previous Health Secretary announced in 2011 that the A&E at King George would close in “around two years”. That has not happened because it was deemed unsafe and because there is insufficient capacity at Queen’s hospital in Romford or at Whipps Cross university hospital in Waltham Forest to cope with the increased demand.

Despite our excellent and hard-working staff, all the hospitals in north-east London are in crisis. With pressure for early discharges, but inadequate social care and community support, we have large-scale bed blocking and delayed discharges. Sick patients then get readmitted because they cannot get GP appointments due to the pressures that exist in that sector. The STP sees out-of-hospital and integrated community care as the way forward. However, Dame Julie Moore, who in 2014 chaired a commission on hospital care for frail elderly people, said:

“As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population… the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing… but this can never be a substitution for hospital care.”

We still need hospitals and acute care. Plans to transform care in the community are good, but that requires a transformation of primary care, which needs resourcing. The STP projects a 30% shortfall in nurses by 2021, and we know that many GPs plan to retire over the next few years. Both are difficult issues.

Problems also exist in the potential financial situation, and one such issue is the estates strategy. The STP delivery plan highlights sites such as Goodmayes hospital, which is a large mental health hospital, and King George hospital as places where land could be sold. Contractual issues and other matters mean that that is probably an optimistic approach.

[Stella Creasy]

My hon. Friend is making an incredibly powerful case about why we must involve the public in some incredibly difficult decisions. We know that the financial situation we are facing is particularly dire. He has just mentioned the sites at Goodmayes, but in addition Whipps Cross has a large private finance initiative debt, where it is paying out a huge amount of money. No wonder the suggestion is being made that we need £578 million to bridge the gap.

[Mike Gapes]

My hon. Friend has given the figure I was about to cite. The STP executive summary states:

“Our total financial challenge in a ‘do nothing’ scenario would be £578m by 2021. Achieving ambitious ‘business as usual’ cost improvements as we have done in the past would still leave us with a funding gap of £336m by 2021.”

Those are eye-watering figures. The claim is made that

“we have identified a range of opportunities and interventions to help reduce the gap significantly”.

However, the £240 million gap between the “business as usual” case model and the actual predicted figure requires a series of other measures, including significant funding from the sustainability and transformation fund, reductions and changes in specialised commissioning, and what is called

“potential support for excess Public Finance Initiative (PFI) costs.”

That covers Whipps Cross hospital, Queen’s hospital, Romford, and, to some extent, King George hospital. “Potential”, what a lovely word. So this is not real and it is not even planned—it is just “potential”.

These plans are based on unrealistic, heroic, Soviet-style assumptions. This is a truly Stakhanovite model of over-estimation of potential, yet the STP still proposes it can transform a deficit of £578 million in 2021 into a potential surplus of £37 million—and improve the services. That will not happen. The plans are also predicated on totally unrealistic assumptions about savings from closing the A&E services at King George hospital, and there is a lack of clarity as to when this will happen and how much we are talking about. I have been told that tens of millions would be invested in the sites at Queen’s and Whipps Cross, but I have been told that at least £75 million is needed to do that, and there is no sign of where this capital is coming from in the Department of Health. So wards are being closed in one hospital and then millions are being invested in rebuilding wards or constructing wards at other hospitals, for no real net gain.

There is also a problem about what process will be involved in this closure at King George hospital. I am conscious that I do not have limitless time, but let me say that my local Redbridge Council is very concerned about this, because King George is supposed to be transformed from an acute hospital into an urgent care centre and so the local community needs to be involved. Redbridge is requesting that it should be involved, and I note that it has recently been agreed that it will be involved on the transformation board. However, Redbridge wants an independent chair of that board, because it is important to involve a person of public trust so that there is no controversy. There needs to be a transparent, open process as we discuss the options for the future of King George hospital, so that we can challenge the business case and take account of the fact that the assumptions on which this model is based are 10 years old. They go back to the misnamed “Fit for the Future” plans of 2006. The population growth that we have had and the growth that is yet to come, the young population that we have in the area and the movement in population means we have to look at these issues with great doubt and concern.

We need to assess the implications of all those issues. As Redbridge says, it wants to know how the reconfiguration to an urgent care centre assists primary care, community health services, adult social care, public health, and public health prevention and education. An opportunity exists in the changes, but we need public engagement in those changes, and we do not have that at the moment.

There will be enormous pressure on my local council because of budget problems, and I am worried about the situation. I am glad that the STP highlights the social care challenge, but it needs to be taken seriously by the Government if we are truly to have an effective health and social care system. The statement in this House yesterday did not offer a solution to my borough. It did not answer the challenge that boroughs such as Redbridge are facing. These boroughs are already ahead of the game in the integration of health and adult social services and are working with neighbours to take up the challenge by being a pilot for the development of an accountable care system.

Yet with all that transformation, Redbridge still faces a huge social care challenge. That is made worse by a triple whammy of public sector funding reductions to local government—my borough has lost 40% of its income since 2010—chronic underfunding of adult social care by the Government and the fact that Redbridge does not get a fair funding level in the first place. There is, potentially, a major problem. We face a shortfall of about £4 million in social care and the 1% extra on council tax raises less than £1 million. The responses that we have heard from the Government in recent days have been inadequate—indeed they have been worse even than the silence from the Chancellor in the autumn statement. They offer no real solutions to the growing crisis that will impact on some of the most vulnerable in our society.

I conclude with this plea: please will the Government look at the situation in north-east London and will the Minister meet me to discuss the fact that this plan is unrealistic, incredible, unachievable and will lead to disaster?

Budget Resolutions and Economic Situation

Debate between Mike Gapes and Stella Creasy

Friday 22nd March 2013 Commons Chamber

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

At times of economic crisis, historically and all over the world, we have seen people moving towards blaming scapegoats, attacking weaker and poorer communities and trying to damage the interests of those who are not in their own environment. Today the potential for this global economic crisis can be seen in Europe with the rise of neo-Nazi groups in countries such as Hungary and Greece in the EU, and potentially in some other countries. We have to remember that it started in 2008 in the United States with the Lehman Brothers collapse, not with a policy determined and decided by the Labour Government in this country, as some Government Members would have us believe. It was a global, western European, north American economic crisis, with terrible consequences that we are still dealing with today.

In the 1930s, at the time of a similar global economic crisis, bold measures were eventually taken by some countries in an attempt to solve the problems. Unfortunately, it was the rearmament and the second world war that led to more people being in work in some other countries. We face real dangers today, and unless the Government and the politicians—not just in this country, but in the rest of Europe—adopt a different approach, we will see some very nasty developments over the coming years. The Government still claim, I think, that we are all in it together, but from references made by other hon. Members here today, we know how the poorest people in this country are being damaged and scapegoated while millionaires get tax cuts.

I do not have time to talk about all the issues I would like to, but I will say one positive thing about the Chancellor’s Budget. I support the Enough Food for Everyone If campaign and am pleased that we still have, at least on paper—it will be interesting to see if it happens in practice, as my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) mentioned, quite pertinently—the commitment to spend 0.7% of GDP on international development and aid projects. Over the past couple of years we have seen some fudging at the edges, as items previously funded from the Foreign and Commonwealth Office budget have been redefined and rebadged so that they now come out of the aid and development budget. Nevertheless, I take the Government’s commitment at face value and hope that over the next two or three years they will resist the pressures from the far right of their party, and from some newspapers, to cut the budget for helping the poorest people in the world’s poorest countries.

I want to touch on some of the points made by my hon. Friend the Member for Walthamstow (Stella Creasy) in what I thought was an absolutely fantastic contribution. She highlighted the problems that are coming out of the Department for Work and Pensions employment service in her constituency. I, too, am a north-east London MP. Some of my constituents have come to me with interesting information in recent weeks. I understand that the DWP staff in north-east London who deal with my constituents have now been told to refer to them no longer as “clients” but as “claimants.” There is apparently an instruction to that effect. That clearly changes people’s attitude. The approach is no longer about customer service; it is about dealing with supplicants who are asking for help.

[Stella Creasy]

My hon. Friend might be interested to know that one of the people mentioned in the leaked e-mail about the conduct in my jobcentre is a regional manager who also covers his part of the borough of Redbridge, which might explain why the issue of sanctions and targets is emerging. I would also like to take this opportunity to apologise to you, Mr Deputy Speaker, for not explaining in my earlier contribution that, owing to a previous commitment, I will unfortunately be unable to stay for the wind-ups, but the Minister can be assured that, even if Members are not here in person, we will all be listening very closely to what he has to say.

[Mike Gapes]

I am grateful to my hon. Friend for her intervention, which also gives me the opportunity to speak for another minute.

I have been pursuing a number of cases on behalf of my constituents in recent months, and for several weeks now we have received no written responses to any representations we have made to the DWP. The reason was not clear. We received telephone calls, but nothing in writing. We have begun to receive some responses by e-mail, but they are late and do not contain much detail. I do not know whether that is a policy position, because under the previous management of the Department’s services in my area I used to receive detailed written responses to the representations I made in respect of individual cases. The responses are no longer so detailed and they are delayed. I wonder whether that is because of the pressure on staff because of the cuts within the Department, or whether it is because of an attitude that says, “We don’t want MPs to have the information because then they can make effective representations about the inadequacies and failures of the Department.”

I also want to highlight what is happening with levels of unemployment. At a superficial level, because more people are in work the Government are claiming that everything seems to be fine. We have the paradoxical situation in which real living standards and real wages are falling, yet despite the double-dip recession and the flatlining economy more people are in work. However, if we dig into the statistics for the Ilford South constituency this week, we see that between February 2012 and February 2013, although the number of young people unemployed and registered for the claimant count is down, the number over 12 months of people out of work has gone up by 44%. The number of over-25s who have been claiming for more than two years in my constituency has gone up from 140 to 420—a 200% increase in one year. It seems to me that the organisations being used by the Department are concentrating on getting people into low-paid jobs quickly but not on those who might have mental health or alcohol problems, poor work records or a lack of confidence. The difficult cases are there, and they will add up in the future. That is really worrying.

Finance (No. 3) Bill

Debate between Mike Gapes and Stella Creasy

Tuesday 3rd May 2011 Commons Chamber

[Stella Creasy]

It is a pleasure to follow my hon. Friend the Member for Scunthorpe (Nic Dakin) and his eloquent description of the problems facing us as a country. I rise to speak to clause 72 and amendment 9 because this debate is about the bank levy and whether it is being applied in the right way and to the correct extent.

I support the amendment, because it seeks to address the challenges of any new legislation and answer the question of how we as a Parliament ensure that the legislation that we pass is effective at doing what we want it to do. The amendment would meet the challenge of asking whether bankers pay their fair share of the cost of dealing with the global financial crisis, just as we as taxpayers have paid more than our fair share, some might say, in trying to support them. That goes to the heart of today’s debate about clause 72 and what the Bill will do for the financial future of this country, so I support the amendment because it highlights the need to address the adequacy of the bank levy.

I also pose a wider question about how the clause will work to ensure that all those who have benefited and, indeed, continue to benefit from the financial crisis that this country has endured pay their fair share in helping the economy out of recession and back into growth, not least because I am deeply concerned, as many Members know, about this Government’s policy of reducing the national debt by increasing private household debt, and about what that might mean for many of our constituents.

I spoke at length on Second Reading last week about the impact of that policy on families throughout the country, and I do not propose to repeat the measures that I put forward, but, on the adequacy of the bank levy, the clause makes an omission that I hope the amendment will address. High-cost lenders are benefiting disproportionately from the impact of the Budget on our people, and from the fact that mainstream lenders are not lending because of banks paying out more in bonuses than they do to the people of this country, who need that money. Indeed, perhaps the omission calls for a new clause to deal with that issue and, therefore, to make sure that that money benefits our economy.

The industry has certainly benefited greatly from this Government and from the events of the last year alone. Of the £216 billion of unsecured lending in this country, £8.5 billion comes from that market, which has increased by £1 billion in the past year, and £8.5 billion is the same amount of money that it would cost to repair all the schools in England—a cause dear to many Opposition Members. It is also the entire budget of the Department for International Development; we are talking about a substantial amount. The market is growing not least because of the lack of regulation—the lack of Government action to deal with the high-cost credit industry—and the amendment could deal with that omission.

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

My hon. Friend refers to schools, and she knows from her constituency and borough how the coalition parties’ drastic, ruthless and unplanned cuts to Building Schools for the Future have caused great grief to her constituents, yet she says that they could have been compensated for by the measures to which she has just referred—

National Insurance Contributions Bill

Debate between Mike Gapes and Stella Creasy

Thursday 13th January 2011 Commons Chamber

[Mike Gapes]

Allegedly, we are all in this together. If so, why is it that those of us in east London, along with people in the 21 authorities in the Thames Gateway, which include authorities in Kent, where there is not a single Labour Member of Parliament—they are only Conservatives—and those in Essex, are excluded from the package that we are discussing? We heard earlier today about the Maoist chaos of the Government’s regional policy. That is not the responsibility of the Treasury; it is the responsibility of its close allies and partners, and the Business Secretary. However, as we are all in this together, presumably the Treasury is also involved up to its neck.

We have also heard that, apparently, the Government are refocusing regional policy. Well, that regional policy refocus includes, in today’s measures, discrimination against poor people in poor communities. My right hon. Friend the Member for Delyn (Mr Hanson) spoke from the Front Bench about a number of boroughs and constituencies that have high unemployment—higher than the national average—and where, at the moment, there are also high levels of public sector employment. Those areas will take a disproportionate hit because of the measures announced in the comprehensive spending review and the Government’s policy to reduce, for ideological reasons, the size of the public sector so drastically and quickly.

So, we are not all in this together: some of us are in it much deeper than others. I suppose that we are a bit like the residents of Brisbane, Australia. When the tsunami or flood comes in, we hope that it will meet a certain ceiling point before going back down, and that the next day it will go no higher. Some people have a little footbridge or step to get them above the water, but others are pushed down below it. People in the small business sector in my community—in Ilford and Redbridge, which is a Conservative-Liberal Democrat borough—will not benefit from these measures. When it comes to benefits, we are not in this together with those in Tatton or elsewhere. We will lose out.

Other Members represent poorer communities than mine, but I have wards in my constituency with very high unemployment. I also have a very diverse community. One of the interesting features of excluding London from the proposals is that it is not only discriminatory geographically; it could also be discriminatory ethnically. That needs to be taken into consideration, given the way in which the measures disproportionately affect different communities in different parts of the country.

I do not want to delay the House for long. I spoke on Second Reading in November. I hoped at that time that the Government would come forward with some changes to their proposals. I hoped that they would listen to the logic, but they did not. We have already had Committee stage and Report brings us to today.

The Thames Gateway Partnership for London, Kent and South Essex recently wrote to Members, urging us to make representations to the Minister—[Interruption.] He might wish to listen to this. It wanted us to write to him to point out the discriminatory nature of the proposals and to urge the Government, even at this stage—I say again, even at this stage—to see what they can do to help the Thames Gateway authorities. The partnership pointed out that there are 3.5 million residents in the Thames Gateway local authorities area and that it believes that in

“excluding London and the South East from the regional freeze on National Insurance contributions the government is failing to take proper account of local economies, particularly the challenges faced by the Thames Gateway growth corridor.”

My right hon. Friend the Member for East Ham (Stephen Timms) has already referred to that.

The Bill is damaging to a potential growth sector of our economy. The Thames Gateway is part of the future of London as a global city. It is vital to the prosperity of our nation, yet this short-sighted, quasi-Maoist Government are operating in such a chaotic way that they cannot see the damaging consequences of what they are proposing. Next year, I hope, they will come seriously to regret what they are doing. I urge all local authorities in the Thames Gateway area to look very closely at the Division lists for today and to register which Members from Essex, Kent and London went through the Lobby in favour of such discrimination against London, Kent and Essex and which Members voted against it. Then, hopefully, those local authorities, councillors and communities will hold those Members to account.

[Dr Creasy]

I want to talk about three things in my comments on the amendment, the first of which is the test set by the Opposition about what this policy is designed to achieve. Secondly, I shall explain why the amendment is needed to ensure that the policy achieves what is intended. Thirdly, I shall say a little about the evidence base for the policy, which was a matter of great concern to me in Committee—and the Bill is still found wanting in that respect. I shall show how the amendment addresses some of those challenges.

The test we set for this policy and, indeed, for this Government, given our concerns about their economic approach, relates to jobs. At the heart of what we do as a Parliament must be the concerns of our constituents, and I know that one of the main concerns of my Walthamstow constituents and those of many other Members is jobs. How are people going to keep a roof over their heads, keep their families fed and ensure that their families stay together? Those concerns relate to the jobs people have and the support we can give to them in their jobs. Job creation is, as my hon. Friend the Member for Edinburgh East (Sheila Gilmore) ably set out, absolutely key to how we judge this policy.

In that context, the symptoms are not good. We know that unemployment is rising and that it has hit 2.5 million—it has been suggested that it is likely to increase further, especially in areas currently excluded from this policy—so job creation is a critical aspect of what the Government can and should be doing. Six people are chasing every vacancy in this country; if there were ever a time when we needed to create more jobs for which people can apply, it is now. We cannot have a jobless recovery; that is not sustainable. Indeed, the cost to the public purse of doing so would be tremendous. It is worth noting that every extra 100,000 people on the unemployment register is half a billion pounds of welfare expenditure that has to be found. There is a great cost to us of not doing something about rising joblessness.

We therefore look at this policy and ask how it will meet the test that the Minister set. In Committee, he said that the purpose of the policy was specifically “the creation of jobs”. It was to

“help the wealth-creation sector in regions currently reliant on the public sector”. ––[Official Report, National Insurance Contributions Public Bill Committee, 2 December 2010; c. 47, Q167.]

That is the second test that we put: does this policy affect not the regions but the people it is designed to help? If we look at the people test, we see that, as currently constructed, the policy does not meet it; it fails on that basis.

Many Members have named areas in which some of the public sector workers most affected by the Government’s cuts are living. My constituency is already among the top 100 in the unemployment league. Our current unemployment rate is 8.5%, and it is rising as we speak. About 24% of people living in Walthamstow work in the public sector. They are losing colleagues, and they are worried about themselves. My surgeries are full of people asking for help after receiving redundancy notices. I ask the Minister what I should tell those people. What will this policy offer them? The task of Government is supposedly to support people and create jobs in the economy. What can I tell those people in Walthamstow who work in the public sector and risk losing their jobs, or have already received redundancy notices?