Princess Royal University Hospital

Robert Neill Excerpts

Wednesday 25th March 2015 Westminster Hall

[Jim Dowd]

I was talking about the fabled meeting in July 2012—two and a half years ago. When the Secretary of State and the trust special administrator said that the answers to the problems of the then South London Healthcare NHS Trust did not lie within its own boundaries, I knew that what they had in mind was effectively the evisceration of Lewisham hospital. For reasons that have eluded me for decades and more—I used to be on the health authority of Lambeth, Southwark and Lewisham, and the district health authority for Lewisham and north Southwark—various elements of NHS London have always had Lewisham hospital in their sights. There was once a plan for there to be only four accident and emergency and general hospitals in south-east London: St Thomas’, King’s, PRUH and Queen Elizabeth; there was no room for Lewisham. I do not know why the various NHS powers think Lewisham is such an encumbrance. The service it provides to its residents and the pressure it relieves from the other hospitals around south-east London are proof positive of its value.

The morning of 5 March dawned—I was quite delighted about that, because it was my birthday. At 9.25 am, I received an e-mail from Monitor, explaining that,

“Monitor is opening an investigation at King’s College Hospital NHS Foundation Trust to find a lasting solution to long-standing problems at the Princess Royal University Hospital…The regulator is concerned that some patients are waiting too long for A&E treatment”—

nothing unusual there. Not one of the hospitals in south-east London—not St Thomas’, over the river, not PRUH, not Queen Elizabeth, not Lewisham, not King’s—is currently meeting the 95% targets for seeing attendances at A and E, so that is not surprising. The e-mail went on to say,

“and routine operations…the trust is predicting a deficit of more than £40m this financial year. This deterioration in its operational and financial performance follows the unexpected costs of making urgent improvements to the quality of care at the PRUH.”

Well, Princess Royal was taken over by King’s College hospital as a consequence of the trust special administrator’s recommendations, and that is the problem it has run into.

When the trust special administrator was appointed, the Secretary of State said in a statement to the House:

“The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS.”—[Official Report, 29 October 2012; Vol. 552, c. 3WS.]

The difference between the £1 million a week then and the predicted £40 million a year at PRUH alone now clearly demonstrates that the trust’s special administration process did not address the right problems. Clearly, the problem was predominantly at Princess Royal.

Queen Elizabeth is now part of a very successful partnership with University hospital Lewisham, and it is doing quite well. It is not without difficulties, but that is the case for any organisations that come together under difficult circumstances. However, it is making progress in clinical and financial affairs, and is well on the way to building a solid and reliable NHS entity in our part of south-east London. That demonstrates that the entire TSA process was substantially illegal, because as we know, the High Court—and subsequently the Court of Appeal—found the trust special administrator’s recommendation with regard to Lewisham hospital, and the current Secretary of State’s stubborn refusal to accept anything other than those proposals, to be illegal. The Secretary of State did not have the powers he assumed he had and could not reorganise in the way that was suggested. He even had the hubris to try and test it at the Court of Appeal, which found similarly that that was the case. Thankfully, sense prevailed at that stage and he left it there, deciding not to waste any more taxpayers’ money by going to the Supreme Court.

However, the Government introduced an amendment to the Bill that became the Care Act 2014, giving them the power that they thought they originally had to do whatever they liked by appointing a trust special administrator. This is where we come to the key worry about the future of Princess Royal and King’s. It is not just about the services that are provided there, which are critically important to all the constituents of Members here today, but about the fear that Monitor, using the powers that the Government put into that Act, will try to engineer another back-door reorganisation involving Lewisham hospital. As I say, that was originally declared illegal, but Lewisham could be dragged into it by other means, so the Government can achieve what they originally meant to achieve and were stopped from so doing.

[Robert Neill (Bromley and Chislehurst) (Con)]

I understand the hon. Gentleman’s point. Do I gather that his principal concern is the impact on Lewisham, and not the fact that Monitor is looking at accepted issues at the Princess Royal and King’s? From his point of view, it is the Lewisham dimension, rather than what it is necessary to do at the Princess Royal. Am I right in that?

[Jim Dowd]

I broadly agree with the hon. Gentleman’s point. Clearly, financial management is an important part of running the NHS. Everybody knows that, whether it is in our part of south-east London or more broadly.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I say now to colleagues who understandably are concerned about local health services and have rightly raised concerns on behalf of their constituents that if I cannot cover some of their questions in the next 12 minutes, I will undertake to write to them in the remaining days of this Parliament, or to ask someone else to write to them, so that we can try to give them some reassurance.

I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and the hon. Member for Lewisham East (Heidi Alexander) on raising her concerns. Taking my cue from what was said previously, I start by paying tribute to all those working in London’s NHS—in those hon. Members’ constituencies, in mine and right across London—for their dedication and commitment to providing first-class services to those in their care at a time when we know that the system is, in places, under pressure.

As we have heard, after consulting with the trust, its commissioners and the London strategic health authority, the then Secretary of State instituted the special administration process at South London Healthcare NHS Trust in July 2012. He was guided in making that very difficult decision on the basis of the clinical interests of local patients, with advice from the NHS medical director, Sir Bruce Keogh. The decision was also based on the fact that there was no clear option for restoring the trust’s finances while maintaining the quality of services to patients. It was clear at the time that doing nothing was not an option. Not resolving the issues at the trust would have carried a high degree of risk. It would have meant that the trust would not meet the London-wide clinical quality standards and that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit.

The trust special administrator looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but no one was able to come forward with a proposal that would solve the problem within the existing footprint of the trust. Indeed, there were no proposals that would not have involved neighbouring health care economies.

The long-standing clinical, operational and financial problems at South London Healthcare NHS Trust led the trust special administrator to recommend that Princess Royal university hospital be acquired by King’s College Hospital NHS Foundation Trust. The associated hospital sites in Bromley—Beckenham Beacon and Orpington hospital—were part of that transaction. I must say for the record that the transaction agreement was signed by all parties and no information was withheld from any organisation.

At the time, South London Healthcare NHS Trust was the most financially challenged in the country, with a deficit of £65 million per annum. Repeated local attempts to resolve the financial crisis at the trust had failed. Millions of pounds were spent on paying for debt rather than improving patient care for the local community in south-east London. The trust special administrator was clear that long-standing problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. That is why, after careful consideration, the Secretary of State accepted his recommendations, including that the PRUH be transferred to King’s.

The new expanded trust is one of London’s largest and busiest teaching hospitals and plays a key role in the education and training of the next generation of medical, nursing and dental students. King’s has acknowledged that it has been facing a number of pressures that have had a bearing on its performance. The challenge of integrating and transforming the performance of the PRUH, combined with a significant increase in emergency in-patient activity, has, as the hon. Member for Lewisham West and Penge described, adversely affected the trust’s operational and financial performance. A key aim of the trust’s five-year strategy is to restore its traditional high levels of performance, in particular by returning to achieving its emergency department and referral to treatment waiting time targets.

Monitor has concerns that some patients are waiting too long for A and E treatment and routine operations and that the trust is predicting a deficit of more than £40 million in this financial year. The regulator is undertaking its investigation to find a lasting solution to long-standing problems at the PRUH. Monitor is concerned that the trust’s operational and financial performance issues post the acquisition of the PRUH have not improved in line with expectations. In particular, some long-standing financial and operational performance issues at the hospital have continued post acquisition.

[Robert Neill]

May I say this on behalf of my hon. Friend the Member for Orpington (Joseph Johnson), the Minister of State, Cabinet Office, who cannot be at the debate? He and I would want to put on the record the fact that there have been areas of improvement at the Princess Royal and at Orpington, particularly in terms of patient experience scores, which have picked up considerably. On the point that my hon. Friend the Minister just mentioned, we are especially concerned at the prospect that has been raised that the full financial picture may not become available to King’s until after the acquisition. It is very clear—I hope that the Minister can assure us on this—that the Monitor investigation is intended once and for all to get to the bottom of, the root of, the financial difficulties that this trust suffers. May I also say that I welcome the appointment of the noble Lord Kerslake as chairman of the King’s trust? He will bring considerable credibility and rigour to that process.

[Jane Ellison]

I thank my hon. Friend for that intervention. I will say more about Monitor’s role, but it is very much in line with what he said and I hope to give him the assurance that he seeks.

Monitor has been working with King’s, local clinical commissioning groups, the NHS Trust Development Authority and NHS England since the acquisition and has worked more closely with the trust recently to get a better picture of the challenges that it faces. However, Monitor has decided to take the new, formal action because King’s has not been able to tackle its challenges on its own. Monitor considers that continuing to work with the trust through more intensive and formal engagement will help to drive the necessary changes.

I want at this point to highlight the fact that, following a formal investigation into a suspected licence breach at a foundation trust, Monitor does not have the power to direct non-foundation trusts, nor does it have the power to direct neighbouring foundation trusts unless they themselves are in breach of their licence. The range of actions available to the regulator range from informal action—for example, requesting further information—to formal enforcement action, including the imposition of additional licence conditions.

Where appropriate, Monitor seeks to encourage the whole health economy to work together to reach a locally owned, consensual solution, which is very much in line with the NHS “Five Year Forward View”. Monitor has said that it recognises that King’s has been working hard, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has said, to improve the quality of care provided at the PRUH. However, through its close work with the trust, Monitor has discovered that achieving the necessary financial and operational turnaround at the PRUH will be a greater challenge than was initially anticipated. Therefore, the regulator has decided to open a formal investigation as part of the regulatory process, which will enable it to use its legal powers to underpin the changes that the trust needs to make. The investigation will help Monitor to decide what resources and support King’s needs to enable it to deal with its financial problems and reduce waiting times for patients. Monitor will announce in due course the outcome of the investigation and whether it will take any further action. There is no statutory time scale for the investigation, because it depends on the scale of the issues encountered. I am sure that all hon. Members would want those issues to be looked at thoroughly.