Rupa Huq
Main Page: Rupa Huq (Labour - Ealing Central and Acton)Department Debates - View all Rupa Huq's debates with the Department of Health and Social Care
(8 years, 8 months ago)
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Dr Rupa Huq (Ealing Central and Acton) (Lab)
I beg to move,
That this House has considered the NHS in London.
I thank the Backbench Business Committee for granting this debate, and I thank the London Members from three different parties who supported my application.
Our consideration today of the NHS in London is timely because there are reorganisations—or reconfigurations, as they are called—going on all over the city. I will address on the situation in north-west London in particular. In Ealing, the NHS was the main issue in the election campaign, and it continues to be a preoccupation, as I can see in my inbox and postbag. I shall talk today about matters such as the junior doctors contract negotiations we hear so much about; A&E closures; changes in maternity and paediatrics, which affect us in Ealing; community pharmacies and some of the other allied services, such as optical services; and staff morale. I have several specific cases from my surgery, including those of whistleblowers. I have a constituent who was sacked and has been effectively blacklisted from NHS employment ever since exposing bribe taking at Ealing hospital. I have raised her case three times on the Floor of the House, but nothing practical seems to be forthcoming for her.
There have been two important reports relating to the health service in north-west London. Most recently, the Independent Healthcare Commission for North West London, chaired by Michael Mansfield QC, was set up in response to the NHS’s “Shaping a Healthier Future” programme to reshape hospital and out-of-hospital health and care services in north-west London. The proposals in “Shaping a Healthier Future” are euphemistically called changes, but they are actually cuts—we know what they really are—and they include nearly halving the number of hospitals in our local area with a proper 24-hour A&E service. There were nine, but that is going down to five.
The London Borough of Ealing is around the same size as cities such as Leeds, but it will have no properly functioning A&E services at a hospital. The nearest four hospitals to my constituency—Central Middlesex, Hammersmith, Ealing and Charing Cross—are set to be downgraded to minor hospitals with no A&E. Instead, there will be urgent care centres.
Ruth Cadbury (Brentford and Isleworth) (Lab)
I congratulate my hon. Friend on securing this debate. She is obviously concerned about the loss of services in her constituency, as are other colleagues about theirs. Is it not true that many people, including my constituents, are concerned about the pressure on the remaining hospitals, such as West Middlesex University hospital, when all the surrounding hospital services are closing? There is no guarantee that the remaining hospitals will have either the capital or the revenue funding they will need to cope with the inevitable increase in demand when services such as those at my hon. Friend’s hospital close.
Mr Andrew Turner (in the Chair)
Order. Before we continue, let me say that Members must abbreviate interventions.
Dr Huq
My hon. Friend makes an excellent point that I believe deserved to be made at length. She anticipates a point I will come on to about the business case and the capacity problem. There is a problem with the way these things are organised. The north-west London area does not include West Middlesex hospital, which she mentioned, but that is more proximate to some parts of my constituency than Northwick Park hospital, to which my constituents are being diverted even though it is miles away. That just shows that people do not think in terms of these boundaries.
Dawn Butler (Brent Central) (Lab)
I congratulate my hon. Friend on securing this debate. My local A&E at Central Middlesex hospital, which was classified as good, was closed, and now the people from the poorest part of my constituency have to travel to the A&E at Northwick Park hospital, which was ill equipped and ill prepared for the closure of the Central Middlesex services and is often rated below par.
Dr Huq
My hon. Friend puts it very well. Ealing has also been hit by the closure. I have no hospitals within my constituency boundary, but Central Middlesex was one of the nearest. It was performing well and had had lots of investment—it was a brand new shiny thing. I used to be a hospital radio DJ there in the ’80s. We were not allowed to play certain songs, including “My Way” by Frank Sinatra, because it is too much about the end for terminally ill people to listen to. Anyway, the hospital is now completely different from what it was like in the ’80s. It is tragic that the A&E there is being downgraded in favour of Northwick Park.
I saw the Minister’s brow furrow when I mentioned the boundaries. The hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), is in south-west London. Perhaps we can think more creatively about crossing boundaries, because an ambulance will not usually take someone there even if it is nearer than Northwick Park. That was the point I was trying to make.
Tom Brake (Carshalton and Wallington) (LD)
On the subject of thinking imaginatively, does the hon. Lady agree that it is important the Government recognise that if more joint working is to take place between, for example, the Epsom and St Helier University Hospitals Trust and the Royal Marsden NHS Foundation Trust—a proposal that I understand is being considered—capital funding might be needed to facilitate the process?
Dr Huq
Yes, I certainly do. I do not know the St Helier hospital well, but I believe it is renowned as a teaching hospital. The business plans must account for such things; there is often too much short-termism.
The implementation of the closures listed is well under way. The A&E departments at Central Middlesex and Hammersmith shut their doors in September 2014, despite assurances from the Conservative party during the 2010 general election campaign that that would not happen. The closures have negatively affected waiting times at Northwick Park hospital in Harrow. That hospital is a considerable distance away from a lot of my constituents; as the crow flies, it is pretty far from East Acton to Harrow. I do not like to churn out loads of statistics, but Northwick Park does have the dubious distinction of the worst A&E waiting times on record in England—
Dr Huq
May I just finish this sentence? The partial sentence might not make as much sense as if I am allowed to complete it. In six out of the 15 weeks that immediately followed the closure, Northwick Park had the worst record in the country. There were anecdotal stories of ambulances backing up at that hospital.
Bob Blackman
I congratulate the hon. Lady on securing this debate, but we must get to the facts of the matter, particularly when we refer to specific hospitals, their standards of performance and what they are achieving. It is true that before the opening of the new A&E at Northwick Park hospital, it had the worst record in London and one of the worst in the country, but since the new A&E opened in November 2014, it has had the best record in London and one of the best in the country.
Dr Huq
I have already given way to the hon. Gentleman once. I want to finish because a lot of Members want to speak, so I shall crack on for the moment. We should not just brush these things under the carpet and say that they did not happen.
The Independent Healthcare Commission for North West London was set up because of the public distrust of the “Shaping a Healthier Future” programme, known among locals as “Shafting a Healthier Future” because it does not do what it says on the tin. One reason why it was further discredited by the Mansfield commission is that it was based on demographic forecasts from 2012 that massively underestimated the population in north-west London, which has increased at a much faster rate than was foreseen. Perhaps the Minister can clarify this, but there has been no clear indication that the programme has been adjusted to take account of those demographic changes.
Reforms have to make sense economically as well as clinically. Last week, we heard in the Budget about the continuing drive to control expenditure, but this ill-advised reorganisation seems to have been given a blank cheque. The Mansfield report states:
“There is no completed, up-to-date business plan in place that sets out the case for delivering the Shaping a Healthier Future…programme”.
There is nothing that demonstrates that the programme is affordable or deliverable, so serious question marks remain regarding its value for money. We are told that we are living in a time when every pound of taxpayers’ money spent has to be justified. Initially, the programme was supposed to deliver £1 billion of savings and cost £235 million, but the costs are ballooning. So far, there has been £1.3 billion of capital investment. Lots of that money has gone to external consultants such as McKinsey and on people’s jollies to America to see how it works there—quite a scary idea. The independent commission concluded that the likely return on the investment is insufficient, based on the strength of the existing evidence.
On the subject of finance, The Independent reported last year that London North West Healthcare NHS Trust warned its staff to limit their use of stationery and stamps, as it is aiming for a £88.3 million deficit this year, and it might miss even that target. Some 95% of NHS acute trusts, which run hospitals, were in deficit in the second quarter of this financial year. The hospital sector is heading for an overall £2.2 billion deficit this year. My hon. Friend the Member for Lewisham East (Heidi Alexander) has warned that the £3.8 billion of extra funding for the NHS next year that was promised in the spending review is going to get lost in the black hole that has emerged in NHS finances; it will be swallowed up in all that debt.
I am a new MP, but since my election I have seen the maternity unit at Ealing hospital join the list of closed departments. That was one of the “Shaping a Healthier Future” recommendations.
Tulip Siddiq
I congratulate my hon. Friend on securing this debate. I apologise, because I have to run off in half an hour for an appointment at the Royal Free hospital’s maternity unit. The birth rate is the highest since the 1970s, yet maternity wards in London have been closing left, right and centre. Elizabeth Duff from the National Childbirth Trust has pointed out how disruptive that is to women’s pregnancy and labour. Will my hon. Friend share her experience of the closure of the maternity unit in her constituency?
Dr Huq
I thank my hon. Friend for that excellent intervention, which is very pertinent to where she is going after this debate. As a mother who has been through these services, I know that it is massively disrupting if the goalposts are suddenly moved, causing people to travel for longer to get to their appointments. The closure of Ealing hospital’s maternity unit was called a consolidation. It was meant to be part of the centralisation of services, but it has had really adverse effects.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Obviously, I will respond to the debate at the end. The hon. Lady is making a wide-ranging speech, but when she talks about adverse consequences, particularly in the context of maternity services, I urge her to give examples and to be careful about her language. We do not want to alarm people—particularly those who are accessing healthcare in her area—for the sake of a rhetorical device. Particularly on Ealing’s maternity unit, where there is now 24-hour consultant coverage, I urge her to be cautious in expressing herself.
Dawn Butler
On my hon. Friend’s behalf, I thank the Minister for that intervention. The Government’s language over the past few months, saying that we do not have a seven-day NHS, has been alarming and destabilising for a number of people, who have failed to attend services. Perhaps the Minister should take her own medicine.
Dr Huq
My hon. Friend puts it excellently. I have some figures that illustrate the adverse consequences. Ealing mums were promised access to 24/7 consultant cover—168 hours per week—for a better, safer service. That has not materialised. Eight months after the closure, the only hospital to come close to that figure is West Middlesex, in the constituency of my hon. Friend the Member for Brentford and Isleworth—it is not even in north-west London. St Mary’s has fallen short at 98 hours. Queen Charlotte’s—the hospital where I was born, although it was somewhere else in those days—offers 116 hours; Chelsea and Westminster, 115 hours; Northwick Park, 108 hours; and Hillingdon, 112 hours. They all missed. There has been nothing concrete. Only on a wing and a prayer will they reach that nirvana any time soon. So much for a better service.
Paediatrics is next for the chop. On 30 June, there will be no children’s wing at Ealing hospital. I have a lot of figures, but people are often numbed by statistics, and other Members want to speak. According to the Office for National Statistics’ 2014 population estimates, Ealing is a very young borough—23.5% of the population is under the age of 18—so we need a children’s wing.
It is worrying. People can be treated quickly and effectively for accident and emergency cases at Ealing hospital at the moment, but the consequence of the changes will be that ambulances will have to take people to Hillingdon and other places miles away. It is unclear who is going to fund that. A lot of those who are admitted to the children’s wing are not taken in an ambulance; they come under their own steam. Will a nurse or a doctor accompany everyone who uses patient transport service, to ensure child safety? There are a lot of question marks.
Jake Berry (Rossendale and Darwen) (Con)
The hon. Lady is familiar with Kingston from having worked there. She knows that it is an excellent hospital with excellent community healthcare service provided by Your Healthcare. She is talking about additional funding for hospitals and acute trusts. Does she agree that, although the Government have provided £10 billion of additional funding for the NHS, it is important that money is not taken out of community services to prop up acute services, because community services are meant to keep people out of hospital?
Tom Brake
I wanted to make that point, too. It looks like up to one in four community pharmacies in my borough—a total of 11 pharmacies—are going to close. That is a bizarre policy, given that the Government have rightly been pressing Members of Parliament to encourage our constituents to go to community pharmacies. Now they propose to close a large number of them.
Clive Efford (Eltham) (Lab)
On the issue of community services, to which the hon. Member for Kingston and Surbiton (James Berry) referred, my local clinical commissioning group is facing a 20% cut in its funding. It has to make savings of £20 million—a fifth of its income—so services that are meant to prevent people from going into tertiary healthcare are being depleted. The Minister said that we should not alarm people, but how do we hold the Government to account if not by bringing these issues to this House for debate?
Dr Huq
I completely agree with my hon. Friend. We are trying to have a serious debate, but we are pooh-poohed at every turn. When my hon. Friend the Member for Hammersmith (Andy Slaughter) asked a question about the Mansfield report, he was told that he was living in a bygone age. I cannot recall the exact remark, but it was something like, “You’re an old soldier fighting a war that’s concluded.” Dismissing people in that way does not inspire confidence.
Andy Slaughter (Hammersmith) (Lab)
I always do what I am told by my hon. Friend—the dismissive comment was that the Mansfield report was commissioned by five Labour councils. I have actually had a slightly more considered response, but it was still dismissive. It was a very serious independent report, and I am sure my hon. Friend will agree that the Minister should take it a bit more seriously.
Dr Huq
My hon. Friend puts it very well. People’s concerns are serious and should not simply be dismissed.
I also agree with my hon. Friend the Member for Eltham (Clive Efford) that the community pharmacy network is a vital component of our country’s health and care system. Suddenly, the Government seem to be imposing arbitrary cuts in a high-value, easily accessed, community-based facility, which relies on private investment as well—pharmacists are small businesspeople. Hiten Patel of the Mattock Lane pharmacy opened my eyes when I spent a bit of time shadowing him there. I saw how the burden on the NHS and GPs is reduced by people having such pharmacies at the end of their street. For most people, they are much nearer than a hospital or even a GP service.
Hiten Patel and his staff help people to make lifestyle choices. They provide a range of services and information to promote health, wellbeing and self-care. They are a useful check on prescribing errors and are dedicated and trusted people. We have such pharmacies all over the country, and they form obvious back-up and support at a time of crisis for GP recruitment and retention. We should value those people, not make life more and more difficult for them.
Last Sunday, I collected my elderly mum’s meds from Harbs pharmacy in South Ealing Road. That pharmacist is open out of hours. I recall that one year he was open even on 25 December—I did not go past this year, but he was probably open then as well. That releases the Ealing Park surgery practice next door for more acute and specialist care, but the Government seem to do short-termism. The long-term impact of eroding the network will have a disastrous effect.
Another troubleshooting service that is located at the heart of the community and has hidden value is opticians. They, too, have a valuable role of social contact, with networks and support mechanisms, and they can contribute to signposting and safeguarding the vulnerable. As the right hon. Member for Carshalton and Wallington (Tom Brake) pointed out in connection with community pharmacists, opticians can also catch things early.
I visited the Hynes opticians in Northfield Avenue, where staff are worried about the continuity of their supply chain. Joint strategic needs assessments enable clinical commissioning groups and local authorities to work in tandem, and the Ealing Council assessment mentions effective eye services and sight loss, but the NHS Ealing CCG does not use the JSNA in its commissioning decisions. Will there be some guidance from the Minister about how to integrate CCGs and local authorities better?
I could go into mental health services, which are chronically underfunded and a huge cause for concern. The Prime Minister made a speech about them last month, but I would like to see more action. Labour has a shadow mental health services Minister. The chief executive of Central and North West London Foundation Trust, Claire Murdoch, has claimed in an interview that mental health can be an “easy target” at times of belt tightening, saying that
“during recessions mental health tends to be hit first and hardest and recover most slowly…There is an absolute anxiety that people are depressed and really are suffering as a result of some of the economic reforms. What we don’t know yet is the extent to which some of the welfare reforms are driving people to real, serious illness.”
I have the sense of morale taking a nosedive locally. My constituent Michael Mars, who is now retired but was a senior consultant at Great Ormond Street hospital, said:
“The essential problem is the feeling of impotence experienced by those at the coal face
because of an
“overwhelming management culture where clinical knowledge and experience is secondary to management.”
Such words echo, because we hear them from a lot of other public service professions such as teachers and the police. They all say that they are doing all the paperwork and are not allowed to do what they are supposed to do. Michael Mars talked about survival in the culture of management and worries that we might be in danger of forgetting what clinical consultants are appointed to do.
At the other end of the career scale are junior doctors, on whom there was a debate in this Chamber on Monday. I have had numerous representations from constituents who are junior doctors. The latest NHS staff survey showed that the percentage of junior doctors suffering from work-related stress has gone from 20% in 2010 to 34% in 2015.
Tulip Siddiq
As my hon. Friend is aware, junior doctors are poised to withdraw emergency cover for 48 hours in April. Does she agree that the Health Secretary’s comments, such as those about the British Medical Association being
“brilliantly clever at winding everyone up on social media”,
show his total disregard for medical professionals who are quite capable of knowing a bad deal when they see it?
Dr Huq
My hon. Friend makes an excellent point. The Health Secretary is the one who is winding everyone up. It cannot be advisable to make staff feel undervalued and overworked. The health service cannot run on good will alone, nor can pharmacists and other such professions. The imposition of a new contract that is overwhelmingly opposed by the vast majority of junior doctors is part of a pattern. The majority of NHS staff have faced pay freezes or real-terms cuts in recent years. The Government should accept that they cannot keep asking everyone to do more and more for less and less.
With such a vast topic, there is never time to cover everything. As I said, I did not want to make this speech a blizzard of statistics, so I will briefly highlight one constituent’s case, then I will make some concluding remarks. Bree Robbins, from Ealing Common, actually ended up not coming to my surgery because she was in too much pain to make it in person, so we took up her case on the phone. Her issue is access to breast reconstruction surgery, and there is a question for the Minister here. My constituent was diagnosed with breast cancer in 2013. She underwent a mastectomy and then suffered an infection, which meant that the reconstruction was delayed. Eventually, she underwent partial reconstruction in January at Charing Cross hospital. She now needs that to be completed, but she is experiencing continued delays, even though she is in pain.
The response from Imperial College Healthcare NHS Trust explained that the delay was due to an increase in urgent cancer cases in the plastic and reconstruction department. That is highly unsatisfactory for my constituent and prompts the question, what are the Government doing to ensure that those awaiting breast reconstruction surgery will undergo it in a timely manner, without having to face delays of three years, as my constituents do?
Ealing has an expanding population. Today, the House of Commons Library confirmed that, paradoxically, the number and percentage of the population aged under 18 and aged over 65 are increasing. Those are the two demographics that need NHS services most. The young and old populations seem to be getting bigger—I feel that I am “the squeezed middle”, to coin a phrase, as I am a mother and a daughter who has to run off to NHS services for offspring and parents.
No one doubts the need for comprehensive weekend care and for efficiencies to be made, but too often such plans amount to cutting corners. We heard in the Budget statement about the need for devolution, but the centralisation that we have discussed today is at odds with that. Pharmacists in my constituency fear that, ultimately, they will be merged with GP surgeries—or co-located or whatever it is called—contrary to popular need. People like to have such services at the end of their street.
Cuts are being targeted at the most deprived communities. There is a lot of distrust about the public consultation, “Shaping a Healthier Future”, because it was so flawed. We have mentioned the escalating costs, and the changes are not good value for taxpayers; they are a waste of precious public resources and involve no business plan.
I have not gone into the Government’s long-standing ambition to integrate NHS health services with council-run care services for the elderly. Ealing is not one of the pilot boroughs, so I will leave that subject to my colleagues. Nor are we a pilot borough for the health devolution deal, announced at the end of last year by Simon Stevens, but I will end with his words at the launch. He said:
“In London’s NHS, we’ve got some of the best health services anywhere on the planet, but also some of the most pressurised. London is the world’s most dynamic and diverse city—why shouldn’t it be the healthiest?”
I am sure that both Opposition and Government Members agree, and I am interested to hear other contributions to the debate.
Bob Blackman
I am going back not 10 years but to 2009 when a report was produced under the previous Labour Administration that would have decimated us in north-west London in terms of A&E. The incoming Health Secretary froze that and said, “No, we’re not going to implement this. We want a clinically led review of what provision should be provided.” In certain instances, it is clear that some of those areas have been led in that way. I am going to talk about Northwick Park hospital because through better investment and better provision it has been transformed and it treats people better.
Bob Blackman
I will give way briefly to the hon. Lady, who made a very long oration.
Bob Blackman
I will come on to a CQC report on the Royal National Orthopaedic hospital in my constituency in a minute. The reality is we can pick and choose from CQC reports, but I want to ensure that the brilliant doctors, nurses and support staff who work in Northwick Park hospital are recognised for the work they do and not the fear, uncertainty and doubt created by Opposition Members about the performance of an outstanding hospital.
I will move on to the Royal National Orthopaedic hospital in my constituency. The Minister knows about this subject extremely well. The reality is shown in the most recent CQC report, which I will quote directly. It said that the hospital has
“Outstanding clinical outcomes for patients”
in premises that were—and are—
“not fit for purpose—it does not provide an adequate environment to care and treat patients.”
I could not have put it better myself. The reality is that, over the past 30 years, under Governments of all persuasions, we have heard promises to rebuild the Royal National Orthopaedic hospital. The medical and support staff there do a brilliant job; if I took you to that hospital, Mr Turner, you would see for yourself. They are treating patients in Nissen huts created during the second world war. It is an absolute disgrace that staff have to operate in such dreadful facilities. They do brilliant work to rehabilitate patients who come in crippled and leave much better able to live a decent-quality life.
That is why I am concerned about national health service bureaucracy. Previous Governments have committed to funding. The Chancellor stood up at the Dispatch Box during the emergency Budget in June 2010 and agreed and confirmed funding to rebuild the hospital. None the less, we still drag on. It is nothing to do with the Government; it is NHS bureaucracy. I will not go through all the details of everything we and the board have had to do to get to the point where the hospital can be rebuilt.
We have a plan. The hospital will be completely rebuilt. We will have a private hospital alongside the NHS hospital, so that consultants and medical staff will not have to leave the site to do their excellent work. We will sell off part of the land for much-needed housing. Instead of selling it off as a job lot, we will sell it off in tranches to ensure that we get the best value for money, and then the money can be reinvested in the national health service, in the hospital itself.
One would think that, if someone came up with a plan like that, the NHS bureaucracy would be leaping to say, “Yes, let’s get on with it.” Instead, we have had report after report, and business case after business case. I will not, as I did once in the Chamber, describe the 11 stages of the business case that a hospital must go through to get approval for finance. More money is spent on management consultants producing reports than on hospital consultants delivering health services.
Paul Scully
The hon. Lady makes some interesting points. There have been changes and closures in Sutton. The stroke service was one, and it made sense to provide immediate treatment at St George’s although it was further away, because those first few hours are crucial. Several smaller hospitals also closed over many years. However, I return to the changes and closures of A&E and maternity services to concentrate them at St George’s. Although it is only a few miles away, in rush hour traffic it takes those without the ambulance service’s blues and twos a long time to get to St George’s. If politicians were concerned, I would have thought they would do a more effective job than just trying to get tens of thousands of signatures on a petition aimed at the primary care trust. It took so long that the petition was still being presented two and a half years after PCTs were abolished in favour of CCGs. Effectively it was a data-harvesting exercise to extract a whole lot of email addresses that could be used in a political campaign and as a political football. The NHS is inherently political, but sometimes we must take the party politics out of it and focus on healthcare and what we have to do to best treat patients in a local area.
As I was saying, the St Helier building is fast becoming not fit for purpose, with 43% of the space having been deemed functionally unsuitable. That is no way to provide 21st century healthcare. The hospital predates the NHS by some time. The huge white building on a hill was used by German fighters to line up as they were coming to London on their bombing raids.
I look forward to plans being produced, using any capital funding we can attract from the Government in a cost effective way, so that it is not too onerous for the Treasury, to make use of all the component parts of the Epsom, St Helier and Sutton hospital sites. Businesses, the Royal Marsden hospital and the Institute of Cancer Research are sited there and the NHS is planning an exciting project—a London cancer hub—to attract even more world-class research. The Institute of Cancer Research and the Royal Marsden have a world-class reputation and it would be fantastic to expand it, but the Royal Marsden needs acute facilities to support treatment there. If we can use that huge space for healthcare for the borough as well specialist healthcare, that would be brilliant.
The “Save St Helier” campaign is great in theory, but there are some holes in the plans and there may be unintended consequences resulting in the opposite of what we want. With the “Better Services Better Value” campaign, the fact that St Helier sits between Kingston hospital, St George’s hospital, Croydon University hospital and Epsom hospital means it is always at threat because of the way the catchment area is designed. The trust is acutely aware of that. We want St Helier to be meshed into the London cancer hub with an integrated approach.
We have heard that the NHS can be somewhat bureaucratic. A few years back, I was at a hospital that closed—Queen Mary’s hospital for children. It was eventually sold for a secondary school and housing in Sutton, but it took two years and £1 million in legal fees for two public bodies, the local authority and the NHS to agree terms. The lawyers got the money and children were not educated there for another two years at a time when there was a shortage of school places. Cutting through that bureaucracy and making sure we get the healthcare we want without having to go through the 11 tiers to which my hon. Friend the Member for Harrow East (Bob Blackman) referred would be fantastic.
We have heard a little about the difficulties of getting GP appointments and how infrastructure in London does not always keep up with planning and the need for housing. Sutton is no different. Worcester Park is one of the densest wards on the border with Kingston and has two vets but no GPs. I am not sure what that tells us about Worcester Park, but there is certainly a lack of planning somewhere.
I live in Carshalton and the one Liberal Democrat MP who was here is my MP. There is a health centre and it is a good example of how we might roll things up across Sutton and other areas. Two practices have come together in a purpose-built building with a shared practice, so it is slightly easier to get an appointment, although it may be not with one’s named doctor, but with one of their colleagues. People can wait to see their named doctor, or they can get a reasonably quick appointment if it is an emergency; they can have blood tests, antenatal care and vaccinations. I recently had a rabies vaccination there—for a trip to Burma, not because of the prospect of facing hostile Opposition Members. The range of facilities helps to keep people away from A&E.
I have visited several pharmacies in my local area. They are concerned about closures, but the Minister has talked about putting in extra funding and integrating the pharmacy service as an alternative first port of call.
Paul Scully
My understanding is that that may vary from pharmacy to pharmacy. It is important that, however the block grant is carved up, we can offer the range of services in any area. I was at a pharmacy last week that had a needle exchange programme, but another just round the corner does not offer that. It is important to have a range of services in a given area.
Jane Ellison
I do not accept how the hon. Lady characterises that. Clearly, there is an interaction between action now and action in the next few years—that is part of how we plan for the future—but, as I said, I will respond to some of the more detailed points in writing. I know that she has examined the matter in some detail in the Public Accounts Committee, with civil servants, Simon Stevens and some of my parliamentary colleagues.
The NHS needs to work beyond the boundaries of individual organisations and sectors. All Members in all parts of the House agree about the need, for example, for health and social care to be further integrated. That process began under the better care fund, but the fact that we need more of it was in all parties’ manifestos. Together with the additional investment that has been made available, the plans are intended to ensure better health for local people, transform the quality of care delivery and, crucially, ensure the sustainable financial position to which a number of Members referred.
That approach represents a step change in strategic planning at the local level, moving away from the year-to-year cycle. However, there is no one-size-fits-all template. London will be covered by a total of five footprint areas, which are geographic areas in which people and organisations will work together to create a clear overall vision and plan for their own area. As Members have eloquently illustrated in their contributions, one sometimes finds different parts of a local system in tension with each other, so it is vital that we sit down and understand how the pathway can become seamless for the individual. We will learn a lot from some of the vanguards in devolution areas such as Greater Manchester.
The NHS’s financial position is undoubtedly challenging. No one would dispute that, least of all me, but it is important to recognise that despite the difficult decisions the Government have had to take, we have chosen to prioritise funding for the NHS. That is why we have committed an additional £10 billion over the lifetime of the Parliament, starting with £2 billion this year. Simon Stevens has been clear that he asked for an amount of money and that is what he got. He also asked for a certain weighting in the spending review settlement, with front-loaded money to drive transformation, and the money has been set up with that structure.
I am a London MP, too, so I do not want the debate to be confrontational. I share many of the concerns that have been raised today. Everyone acknowledges that in London the health system in general is under pressure, for many unique reasons, but I gently point out to the shadow Secretary of State that while she listed many challenges, and many other Members did the same, she did not list that many solutions. At the general election, the Labour party did not pledge to give the NHS the shortfall it had identified in its funding. That is significant, and I need to put it on the record.
Jane Ellison
We have had the time, during a three-hour debate, to make inquiries, so I will perhaps give the hon. Gentleman an update afterwards.
There have been a lot of references to the interaction with Members. Members of any party may feel they are knocking their heads against a brick wall, but sometimes, to be fair, information cannot be shared for good reasons. There may be commercial confidentiality, or things may be at a particular stage where information cannot be shared. However, I am quite clear that all plans for the local populations that Members represent must be shared with the best level of detail possible, at the most opportune moment. I am always happy to hear from London Members if they feel that that is not happening.
Reconfiguration is about modernising the delivery of care and facilities. I recognise that proposals for those changes sometimes arouse concern. There has been a particular focus on “Shaping a Healthier Future” in this debate, but under that programme, many more community services are now in place across all eight boroughs, so more patients can be seen closer to home. Eleven new primary care hubs are now open. Improved access to GP services has meant an additional 32,000 appointments in Ealing since August 2015, while weekend appointments are now offered to more than 1 million patients across north-west London. Rapid access services in each borough are helping to keep patients with long-term conditions out of hospital where possible, which has already prevented 2,700 hospital admissions in Brent alone.
Jane Ellison
I will not, if the hon. Lady will forgive me, because I think she is going to have a moment to speak at the end, if I can allow it. She gave a half-hour opening speech, which is a little longer than I have to respond, so I will press on.
The Mansfield commission report, which I have read, has been referenced. The costs stated in that independent health commission report are not from the NHS and are not recognised by the NHS. In terms of the response, the unanimous conclusion of the north-west London clinical board was that the commission’s report offered no substantive clinical evidence or credible alternative to consider that would lead to better outcomes for patients than the plan the NHS has put in place. That plan enjoys an extraordinary level of clinical support, and it is important to say that that unanimous clinical support has been sustained. The financial impact of significant delay and challenge cannot be dismissed, and I know Members are aware of that.
Members have rightly focused on primary care. We all know the important role that primary care in London will play in helping us to meet the significant challenges we face. There are still a large number of single-handed GP practices in London. A significant number of GPs are approaching retirement age, and in some London boroughs, patient list turnover is as high as 37% in a year. The Government have made a number of important commitments on improving primary care. In June 2015, the Secretary of State set out details of a new deal for general practice. In London, the transformation of primary care is being planned and implemented with the support of local resources and a pan-London transformation team. More than £40 million has been invested in primary care transformation in the capital this year.
The GP access fund has accelerated delivery in some areas of London. For example, 700,000 patients in Barking, Havering and Redbridge now have the opportunity to see a GP in the evenings, and 305,000 patients in south-east London have seven-days-a-week access to GPs via new primary care hubs. Some important measures are being invested in and taken forward, but we acknowledge that we need to do more in those areas.
Members have raised a number of concerns about trusts in special measures. I reiterate that those trusts are receiving support to ensure they have in place the strong leadership they need to implement their improvement plans. It was good to hear an expression of support from the hon. Member for Ilford North (Wes Streeting) for local leadership in that regard.
We have touched very little on mental health services in London, which I know is not because Members do not think it is important; we all want to drive towards the parity of esteem that is rightly this Government’s aspiration. In March 2015, the London mental health transformation board was established to support the development and delivery of projects to improve the mental health of Londoners. I do not have time to go into local examples of how that is beginning to make a difference, but they are important and making progress.
I have talked about the integration of health and social care. There are 25 integrated care pioneer sites developing and testing new and different ways of joining up those two important services. In Waltham Forest and east London, services are focused on keeping patients at home, providing care close to home and, if patients are admitted to hospital, getting them home as quickly as possible. In Islington, the local health and social care network is providing a named professional to take responsibility for the co-ordination of the patient’s care plan, with a view to providing the seamless, co-ordinated and proactive care that we want to see particularly for our most vulnerable patients.
In the time left to me, I will try to address one or two particular points raised. I have said that I will look to respond in more detail to points made by the hon. Member for Hackney South and Shoreditch on the McKinsey report and the issues around NHS land. One Member mentioned in an intervention the recruitment of nurses and the position of the MAC.
The hon. Member for Edmonton (Kate Osamor) made important points about the particular needs of our poorest populations. Like many hon. Members, my seat in Battersea has everything, from very wealthy to very poor people and everything in between—that’s London. She talked about the need to invest in prevention. This week, we saw the national diabetes prevention programme launched, which is the first at-scale intervention of its kind in the world. We are also working on important areas, such as a new tobacco plan.
A number of Members touched on the issue of public health budgets when we move to business rates retention. Of course we need to get the balance right, to ensure we continue to bear down on health inequalities. I would be happy to have further discussions, but I reassure Members that we are very conscious of that in the Department of Health and will be doing work to address it. Important points were also made by the hon. Member for Edmonton about North Middlesex hospital. She rightly mentioned that key safety issues are being addressed there by some of the local leaders.
I am glad that my hon. Friend the Member for Harrow East (Bob Blackman), who has had to go to the main Chamber, talked about the transformed performance at Northwick Park hospital. It is right to shine a light where we see such improved performance, and I know that the staff very much appreciate it. It was good to hear from my hon. Friend the Member for Sutton and Cheam that his mother had great service. He also illustrated the sometimes unintended consequences of local healthcare campaigns, which he has seen at close hand.
I want to give an assurance that the Department’s capital settlement meets the needs of the NHS and allows the Department to continue with priority public capital projects and support delivery on the five-year forward view over the coming years. St Helier was mentioned on a number of occasions. In anticipation of all the plans there, further work is going on around their affordability, and that ongoing work is important.
The hon. Member for Brent North (Barry Gardiner) made quite a detailed point that I will, of course, look into. We have the recess to look back at Hansard and pick up some of the many detailed points made in this debate. Many notes were being written behind me, and we will look to come back to Members.
There will be things that I have not quite been able to capture, but I give fellow London Members my reassurance that I am always happy to talk to them. I would rather they talk to me at an early stage if they are concerned about something. We share many of the same challenges, but we also share the same ambition: to have the very best healthcare for our local residents. This Government are determined to invest in the NHS to be able to deliver on that. With that, I leave the hon. Lady a minute to close the debate.
Dr Huq
It is a shame you were not here to take part in what has been a really good debate, Ms Buck, in which all three parties in London have been represented. I think everyone agrees that the stand-out contribution was from my hon. Friend the Member for Ilford South (Mike Gapes)—the bionic Member for Ilford South. The point I was going to make in an intervention—I was worried I would not have time to make it—is this. Everyone recognises the Minister is a thoughtful person and not really a Conservative because—
Dr Huq
She is not a robotic one of those; I think people recognise that she is not a robot. She made the point a few times that we should not use this issue as a political football and we should want the best for everyone. Some of the people I quoted in my speech are not Labour party members. Michael Mars is the chair of Ealing synagogue. He came for a visit this week and pointed out that managerial culture is stifling what the—
Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).