St Helier and St George’s Hospitals

Paul Scully Excerpts

Tuesday 19th February 2019 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

Let me start by putting on the record my respect and admiration for every single doctor, nurse, clinician and staff member at both St Helier and St George’s hospitals for their outstanding service and dedication to the health and welfare of my constituents. These remarkable individuals go above and beyond, despite facing extraordinarily testing circumstances—nine years of austerity have left our treasured NHS desperately short of staff, services and supplies.

For my constituents, however, the biggest threat to our local hospitals is far closer to home. It is in the wild west of south-west London’s NHS, which is once again pursuing desperate attempts to close all acute services, including the major A&E unit and the consultant-led maternity units at St Helier hospital. The impact that that would have on St George’s hospital, would, I believe, be devastating.

This evening I want to outline the reality behind the latest threat to St Helier, branded “Improving Healthcare Together 2020-2030”. I want to challenge every foundation on which that programme has been built, and I want to appeal to the Minister to step in before we see the decomposition of health services that are vital to my constituents. However, I want to start with some history.

For nearly two decades, the NHS in south-west London has pursued several irresponsible attempts to close the acute health services at St Helier hospital, on the border of my constituency, and move them to leafy, wealthy Belmont in Sutton. Under different titles and brands, and in the guise of countless NHS-funded marketing consultants, the proposal is on repeat, and an estimated £50 million has been wasted on almost identical consultations and programmes. Each one starts afresh, portraying to the public a neutral outlook when it is being decided where acute health services should be placed in south-west London.

The Minister may remember that, back in 2015, secret proposals to close St Helier and build a new super-hospital in Sutton were overheard by a BBC reporter on a train, which brought those plans to an embarrassing end. Fast-forward to 2017 and the programme was repeated, this time entitled “Epsom and St Helier 2020-2030”, and once again professing to assess the pros and cons of where to base acute health services. The public support expressed by chief executive Daniel Elkeles, the man running the programme, for moving the services to Sutton somewhat clouded the neutrality of the process.

[Paul Scully (Sutton and Cheam) (Con)]

Does the hon. Lady not agree that the proposal that immediately preceded this was to close facilities at St Helier and move them to St George’s in Tooting, which was universally unpopular? The proposal that is now on the table, on which I certainly hope there will be a public consultation, refers to one of three sites, and includes a reference to locating a new facility at St Helier hospital.

[Siobhain McDonagh]

My recollection of that particular consultation was that that was really the scorched earth strategy of deciding that St Helier and Epsom were going to close and St George’s would take the strain. I thank God that that never happened, because we could be in an extraordinarily difficult position had it ever happened.

I might sound cynical when I talk about the NHS and its bias against my constituency and against services being at St Helier Hospital, but I have been here several times before. A freedom of information request revealed that those running the programme only distributed consultation documents to targeted areas around their preferred site and to just a handful of roads in my constituency. But my constituents care passionately about their local health services and will not be ignored, and 6,000 local residents responded to the programme by calling for St Helier to retain all its services on its current site.

[Siobhain McDonagh]

I agree with the hon. Gentleman, but it is about not just distance travelled but who is travelling that distance: do they have access to a car, or do they have public transport? The NHS constitution requires that equalities legislation is taken into account, particularly looking at disadvantaged people who are in poor health and how they access services, because they access services differently.

As I said, my constituents care passionately about local health services, and when they responded to the consultation 6,000 of them sent in cards explaining how they felt and saying that they wanted St Helier to retain all its services on its current site. Can you imagine the anger when I found out that their responses had been discounted by the programme? Why? Because they were not on the official documentation—the same documentation that had been disseminated in those targeted letterboxes far away from my constituency.

To the public, the trust portrayed a neutral stance whereby a suitable site across south-west London would be selected for their acute services. To the stakeholders in Belmont, it confessed its desire to move the services to their wealthy area, and to mine, it pretended that the consultation would genuinely seek the views of the public. But as my mum always says, much gets more. I would like to put on record that while I fundamentally disagree with the desire to take services away from my constituents, I do recognise Mr Elkeles’ hard work and dedication in leading St Helier Hospital.

We now fast-forward to the present day and the latest brand, “Improving Healthcare Together 2020-2030”, a programme built upon the unstable and unscrupulous foundation of its predecessors and that once again considers the pros and cons of moving St Helier Hospital’s acute services 7 miles west to Epsom or south to leafy Belmont in Sutton. The programme was launched last summer—they always choose the summer—undertaking an initial public engagement that is expected to transition to a public consultation this coming summer. But just 837 people responded to the public engagement, and that is including hundreds of NHS staff and 169 comments on Twitter or Facebook. That is an utterly abysmal response considering the £2.2 million of taxpayers’ money squandered on the programme already. Does the Minister agree that this is a complete misuse of taxpayer funds at a time when our NHS is under such overwhelming pressure?

This is about more than just the future of St Helier Hospital. My constituents tell me that if St Helier Hospital were to lose its acute services, they would turn not to Epsom or Sutton but east to Croydon University Hospital or north to St George’s. That is a completely terrifying prospect. Before Christmas, my constituent, Marian, was left queueing outside St George’s Hospital with her left leg badly infected, because the A&E was full. And that was the calm before the storm, with St George’s A&E facing its busiest ever week just a fortnight ago. We all remember the winter crisis last year, but the first full week of February this year was 16% higher than last year’s equivalent, with a simply staggering 600-plus visits every single day. This is a hospital that already relies on St Helier as its safety valve. The maternity unit at St George’s had to close temporarily in 2014 and 2015, directing women who were already in labour to St Helier Hospital.

That is why a letter sent in November from the chair of the St George’s trust to those running the programme is completely astonishing. In the letter, the chair expresses her concern that

“there is no formal requirement to take account of the impact on other providers”

when deciding where to relocate acute health services across south-west London. It is hard to put into words just how dangerous that disregard is. I should like to pause briefly to thank the chief executive of St George’s Hospital, Jacqueline Totterdell, for her hard work and tenacity in steering one of London’s largest hospitals at a time of such difficulty.

St George’s is a hospital already under immense pressure. The plumbing, ventilation and drainage facilities are at breaking point, leading to a bid for £34 million of emergency capital from the Treasury. Does the Minister agree that a recent outflow of sewage in the hospital A&E is a clear sign that such emergency funding is justified and, more importantly, urgent? How busy does she think the same A&E would be if the local NHS were to get its way and move St Helier’s major A&E to wealthy, leafy Belmont? Will she step in today and require any proposal to reconfigure health services to wholeheartedly take into account the impact that such a decision would have on all other nearby health providers?

Merton Council recognises the devastating impact that these proposals could have, and I would like to put on record my thanks to leader of Merton Council, Stephen Alambritis, the cabinet member for social care, Councillor Tobin Byers, and the director of community and housing, Ms Hannah Doody, for their unflinching support. It is so disappointing that those at Sutton Council can stand so idly by.

By law, when deciding where acute services should be based across a catchment area of this size, it is fundamental that the level of deprivation and local health needs are accurately understood and thoroughly assessed. So I read from cover to cover the deprivation and equality analysis produced by a range of external consultancy services as part of their £1.5 million programme fee. At a time when the NHS is so strapped for cash, it is extraordinary that my local NHS seems to have carte blanche to employ so many consultants on such extraordinary rates. But even I was absolutely astounded by the monumental gaps in the analysis that these consultants have delivered.

In the pieces of analysis on deprivation and equality, areas that rely on St Helier Hospital are either absent from the documents or actively described as falling outside the catchment area. Take Pollards Hill in my constituency, an area that would be considered deprived in comparison with much of Sutton or Epsom. Wide Way Medical Centre is the largest GP surgery there, and it directs 34% of its patients to St Helier Hospital, but Pollards Hill is deemed to be outside St Helier’s catchment area. Why does this matter? Because if areas that rely on St Helier Hospital are not even considered in the analysis, how can the potential impact of moving acute services from the hospital be adequately assessed? Pollard’s Hill is not alone. The report does not mention Lavender Fields despite almost a fifth of Colliers Wood surgery patients and Mitcham family practice patients being directed or referred to St Helier from the ward.

I urgently brought the gaps in the analysis to the attention of those operating the programme and Jane Cummings, the NHS’s chief nursing officer. I was pleased that everyone agreed that such significant analysis shortfalls would be addressed and rectified.

[Paul Scully]

The hon. Lady is being generous in giving way. Does she agree that Colliers Wood is pretty much smack-bang next to St George’s and that the proposal on which last year’s public engagement was based was that 85% of current patients would still be treated in their current hospital, whether St Helier, the proposed Sutton site or Epsom?

[Siobhain McDonagh]

There is no reason why the hon. Gentleman should know this, so I am not trying to be tricky, but Colliers Wood surgery is the title of a split-site GP surgery. One site is on Lavender Avenue off Western Road—the hon. Gentleman probably knows Western Road from driving up and down it a lot—in the heart of one of the most deprived areas in my constituency, and many people there go to St Helier hospital. The idea that we could remove an A&E and a maternity unit and keep what is left is complete nonsense, because all the blood and testing facilities and all the talented doctors and nurses simply would not stay there. Chase Farm Hospital, which is in the constituency of my right hon. Friend the Member for Enfield North (Joan Ryan), is a wonderful example of such a situation, and Members may want to have a look at it.

I pointed out that areas in my constituency and large surgeries had not been included in the analysis, and I was promised that they would be. However, months have passed, and the process has proceeded unscathed, with no indication of when such significant gaps will be remedied.

The icing on the cake came in December when three behind-closed-doors workshops based on the deficient evidence were run by the programme. They were designed

“to inform the Governing Bodies decision making process about how the community and professionals ranked each of the three potential sites for acute hospital services”.

Let me be clear: hand-picked professionals and members of the public used incomplete evidence to rank Sutton as the preferred site for acute services. The Minister will not be surprised to hear that more participants in the workshops were from Sutton than from Merton or Epsom. How can a fair, balanced and rounded opinion be accrued from workshops based on flawed evidence and disputable criteria and with an unrepresentative group of people? For the findings to be used in any capacity in the decision-making process would be completely unacceptable.

Of course, I understand that figures and analysis can always be skewed in one direction or another. Someone wanting to disguise the 76.5-year life expectancy of men in Mitcham West in my constituency could include the 84.4-year average in Wimbledon Park and classify the figures by the borough of Merton as a whole. They could count cancer rates, stroke rates, mortality rates by borough rather than by ward or lower super output area. They could ignore deprived parts of the catchment area and proceed full steam ahead with the programme.

When will the gaps in the analysis be completed? When will taxpayers’ money stop being splurged on flawed and biased consultations? When will the madness end? Here is the reality: there are over twice as many people with bad or very bad health within a mile of St Helier than there are living within a mile of the Sutton site, and almost four times the number within a mile of Epsom. Around St Helier, the local population is significantly larger, with considerably more dependent children and more elderly people. Furthermore, the population local to St Helier is far more reliant on public transport, with residents statistically less likely to have access to a car.

Despite all that, when I secured—I can hardly believe it myself—£267 million from the Department of Health and the Treasury under both the Labour Government and the coalition Government to rebuild St Helier Hospital, guess what happened? The local NHS sent the money back. Can the Minister confirm whether the hospital will again receive its funding this time round?

It is time for some accountability and for the Government to step in before even more money is wasted and the future of both St Helier and St George’s is thrown into jeopardy. Leave these vital services where they are most needed: at St Helier Hospital, on its current site.

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this incredibly important debate on the future of St Helier and St George’s hospitals. I thank her for her continuing interest in healthcare services in south-west London over many years. She has been a passionate, highly motivated and extremely effective advocate for the interests of her constituents, and I am sure many of the points she has raised today will be heard beyond these four walls.

The hon. Lady is rightly concerned about the future of services at St Helier Hospital, which is run by Epsom and St Helier University Hospitals NHS Trust, and particularly about the future of its A&E service. She is right that the organisation of acute services in south-west London appears to have been discussed for a number of years. In the interest of time, I will not set out the timescales and all the things that have occurred over that period, as she has already articulated it well.

In June 2018 the clinical commissioning groups published an issues paper, which outlined the challenges faced by the local healthcare system and the four key local aims: improving the health of the population; delivering care as close to patients’ homes as possible; ensuring high standards of healthcare across all providers; and maintaining the provision of major acute services within their combined geographies. The issues paper set out a provisional shortlist, with three potential options for acute care: locating major acute services at Epsom Hospital and continuing to provide all district services at both Epsom and St Helier hospitals; locating major acute services at St Helier Hospital and continuing to provide all district hospital services at both Epsom and St Helier hospitals; or locating major acute services at Sutton Hospital and continuing to provide all district services at both Epsom and St Helier hospitals.

The CCGs invited comments and suggestions from local stakeholders over a period of three months. The CCGs stressed that the proposals do not involve closing any hospital. At this stage, they say, they do not have a preferred local proposal. I understand they are continuing to work with local partners to further develop the proposals, which will include a full options appraisal, an impact assessment and the development of a pre-consultation business case that will, of course, have to undergo NHS England assurance. I am sure the hon. Lady will make her thoughts known to NHS England.

[Paul Scully]

Does my hon. Friend agree that one thing many people in Sutton and Merton do not have, because St Helier is such an old hospital, is a possible £400 million brand-new facility, which would bring benefits no matter where it is located?

[Caroline Dinenage]

My hon. Friend makes an excellent point, and that is why it is important that no significant changes are made without consultation so that local people’s views can be taken into consideration. The CCGs will need to consult the public fully before making any decisions about a new hospital or changes to the configuration of acute services, but clearly any form of investment is welcome.

[Caroline Dinenage]

The hon. Lady asks an excellent question. The CCGs are working closely with NHS England and NHS Improvement to develop the programme’s capital scheme prior to the next spending review, with a view to NHS England and NHS Improvement presenting the scheme for funding. They expect the public consultation on their proposals not to take place until after the next round of capital bids is concluded, which is likely to be after the autumn. There is a duty to carry out a travel times analysis when developing proposals, and this will be included in the consultation. CCGs also have duties to reduce inequalities. She spoke a lot about the inequalities in her area, and an impact analysis of that has to be done.

I understand that the hon. Lady is also concerned that any potential changes could increase pressure on St George’s hospital, and she is absolutely right to raise that important point. The Department is clear that NHS England and local NHS organisations must think about potential impacts on other services, which is why we are developing a more strongly regional approach in designing NHS services. CCGs must consider the impact on neighbouring hospitals close to the CCG boundary, such as St George’s. Changes to A&E services at any one hospital potentially have an impact on a number of surrounding hospitals, so the three CCGs have to engage with their neighbours throughout this process. In addition, the neighbouring CCG can respond to any public consultation and its response must be taken into account.

On the next steps, the hon. Lady will be aware that the reconfiguration of services is a matter for NHS England and local NHS bodies. Such matters have to be addressed at local level rather than in Whitehall because local organisations understand the needs of their community. No changes to the services people receive can be made without formal public consultation. They must have support from GP commissioners, demonstrate strengthened public and patient engagement, and have a clear clinical evidence base. They must also be consistent with the principle of patient choice. The NHS England test on the future of use of beds requires assurance that the proposed reduction is sustainable in the longer term. The Department is very clear that throughout the service change process local NHS organisations have to engage with the wider public and with the local MP on these issues, so I am sure that she and her constituents will take part in any local engagement as plans move forward.

The challenges facing the health economy in south-west London have been widely understood for a number of years. I recognise and appreciate that potential changes to local health services are often a cause of great worry and that they inspire impassioned debate among those involved. It is time for local partners to work together to find a solution which, as the hon. Lady said, has to be right for the people of south-west London and will secure a sustainable configuration of health services in the future. I thank her again for her continued dedication to these health matters.

[Paul Scully]

The Minister mentioned the fact that the consultation might be done after the spending review. I have written to the Secretary of State asking whether he would consider looking at that again, because the mayoral election is coming up next year and the purdah period will mean that this will, in effect, be delayed for a whole year. Anything more that can be done to bring it forward would be very helpful.

[Caroline Dinenage]

In the nick of time, my hon. Friend makes that point well, and I will definitely make sure that it is passed on.