NHS Sustainability and Transformation Plans
Rupa Huq Excerpts(7 years, 8 months ago)
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Mrs Emma Lewell-Buck (South Shields) (Lab)
We have all become accustomed to the Conservative party’s disdain for our NHS since the shambles of the top-down reorganisation that began in 2012. Now we have the stealth introduction of sustainability and transformation plans—secret plans that would bring yet more unjustifiable and drastic reforms to cash-starved hospitals. Instead of being given the funding they so desperately need, hospitals are being asked to make £22 billion of efficiencies to compensate for this Government’s total mismanagement of our NHS. The audacity of making hospitals themselves pay the price for that by threatening them with closure or the reduction of acute services is the final act of treachery in a tragic and deliberate play to decimate our NHS.
South Shields is part of the footprint area of Northumberland, Tyne and Wear, an arbitrarily created boundary. By 2021, the health and social care system in that footprint area is projected to be £960 million short of the funds it needs to balance its books while maintaining the same level of care for patients. Make no mistake: these plans are about cuts. They are nothing to do with transforming our NHS for the better. The NHS has been set an impossible task by the Government; the endgame is to see it in private hands.
The Government have said that the initial STP submissions to NHS England are
“for local use, and there are no plans to publish them centrally”—
a nice touch to put the onus once on to our hospitals again, so that the Government themselves do not have to deal with the flak.
Mrs Lewell-Buck
I would rather not, because a lot of people are waiting to speak.
I was born in South Tyneside hospital. I am the local MP for the area, and I have not seen a single plan—not even the governors at my local hospital have, let alone the people of Shields, whose vital acute and emergency services could be devastated by these changes.
I am told that the timetable for implementing these unseen plans begins this autumn, yet the first we will see of them in my area is at the end of this month—that is, in the autumn. I am extremely alarmed at the lack of accountability and transparency with which the plans are being pushed through. There is simply no time at all for consultation. I make a plea to all NHS leaders not to be complicit but to stand up for their hospitals and the communities that they serve. The Government have no mandate for such a radical reconfiguration of our NHS, one that could involve the closure of accident and emergency and acute services up and down the country.
Last week, the Prime Minister called in NHS leaders to order them to stop any hospital mergers or closures that risk causing local protests. There is already a protest in my constituency.
Liz McInnes (Heywood and Middleton) (Lab)
Before entering the Commons, I worked for 33 years in the NHS and saw and experienced on a daily basis the service that it provides to millions across the UK, from its GPs to its world-leading research and development. With 80% of hospitals in debt, bed-blocking at record highs, an ageing population, waiting times for cancer treatment lengthening, underfunding of social care, mass staff shortages in hospitals and a future where collaboration with the European Union is unclear, we should show our commitment to our NHS in its time of need and give it the funding it deserves so that it can succeed for all patients.
The NHS STPs do not clearly address those issues. As many hon. Members have said, they have been shrouded in secrecy and drawn up behind closed doors. There has been no public consultation, and there is a staggering lack of evidence that they will deliver the reductions and improvements the Government promise. They will be untried and untested, and will come at an unimaginable cost to patients if they are found not to be the right path to pursue.
I am a Greater Manchester MP. When the metro mayor plan was introduced, bold promises of devolving power to the region were made, including in health.
Dr Huq
My hon. Friend mentions local government. Is she aware that, in north-west London, which is one of the few areas not to have had its STP published, the London boroughs of Ealing and of Hammersmith and Fulham have not signed up to the STP? They are refusing to do so because it threatens the closure of both Ealing and Charing Cross hospitals. The mistrust and secrecy is everywhere, including in local government.
Liz McInnes
My hon. Friend highlights the secrecy surrounding STPs and the attempts of local authorities and the devolved regions, including Greater Manchester, to deal with devolved health issues, as they are supposed to do.
The promise to devolve health was front and centre of the Cities and Local Government Devolution Act 2016. Metro mayors would need to be consulted like any other political leader, and the plans jeopardise the autonomy of the metro mayor’s powers. The British Medical Journal states that STPs may risk the post of metro mayor
“becoming a rallying point for opposition to service reconfigurations.”
Not only metro mayors and clear legislation are needed if the STPs are to be effective. Councillors and committees must be at heart of the planning process, and health and wellbeing boards must be an integral part of it. They are the only place where local political, clinical and professional leaders come together. They can be pivotal in driving change, but they seem to have been put on the waiting list for consultation.
As with the disastrous Health and Social Care Act 2012, overseen by the former Prime Minister, and now former MP for Witney, the proposals take us on a journey to another calamitous reorganisation of the NHS. It is now a necessity that the Government abandon the timetabling and scheduling of such a major restructure package. Perhaps now is the time to step down and take stock, like the former Prime Minister. I call on the Government and Secretary of State for Health to go back and reconsider not only the timeframe but the proposals in general, and to have a full and frank public consultation, allowing for transparency and debate at local and national level.
Land Registry
Rupa Huq Excerpts(7 years, 10 months ago)
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Dr Rupa Huq (Ealing Central and Acton) (Lab)
My right hon. Friend mentioned the 2014 consultation, in which only 5% of respondents thought that privatisation was a good idea. My right hon. Friend and I are both London MPs, and the market in London is complicated enough as it is. Anything that will complicate things even further cannot be a good idea. If every professional in the sector is condemning these proposals, surely the Government should listen.
Ealing Hospital
Rupa Huq Excerpts(8 years ago)
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Dr Rupa Huq (Ealing Central and Acton) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend and parliamentary neighbour, the Member for Ealing, Southall (Mr Sharma), on securing this important debate. It was the consolation prize for a petition that had more than 100,000 signatures. Initially, that petition went to the Petitions Committee. The number of signatures demonstrates how the Ealing hospital issue has gone beyond being a little local difficulty. It is now a national scandal.
Mr Stringer, I do not know what it says in your diary for 18 May. For MPs from all parts of the House, it says, “State opening of Parliament”. Despite the legislative programme coming our way, it is usually a joyous occasion. It has pomp and circumstance, and we may get a sighting of Her Majesty the Queen. It is also, however, the day when the Ealing clinical commissioning group will take the decision to shut the door on children’s services at Ealing hospital. For people in Ealing, it will be a sad day.
It is not yet a year that I have been a Member of Parliament, but some of the subjects that come up in relation to Ealing hospital seem depressingly familiar, even to me as a newbie. We seem to have this common situation when the Government just will not budge. Their intransigence makes it all seem a bit like groundhog day. I was a Labour candidate for 18 months before I was elected, and the NHS was the No. 1 issue on the doorstep. We were told that we were fearmongering. I remember we had a big march—a demonstration—from Ealing hospital to Ealing common, which is a number of miles on the map. We warned that the A&Es at Hammersmith and Central Middlesex would be closed, and we were told that we were fearmongering. They have both gone now, closed in September 2014. That was euphemistically called “changes”. Everyone had a leaflet through the door talking about “changes” when it meant “closures”.
In the run-up to the election, I did several hustings where I warned that maternity was next for the chop at Ealing hospital. Again we were told that we were scaring people and that it was a scare story, but on the other side of my election that closure sadly came to pass. One of the first things I did as an MP was table an early-day motion about it, which my hon. Friend the Member for Ealing, Southall signed. I think my right hon. Friend the Member for Islington North (Jeremy Corbyn) was the first non-Ealing MP to sign that early-day motion, which asked for the Government to think again and condemned the closure.
As my hon. Friend the Member for Ealing, Southall pointed out, Ealing is a young borough. It needs maternity services. Those services closed at Ealing hospital in June, and paediatrics is next, because we cannot have a children’s ward without maternity services, and maternity is gone. There is a fear that there is a domino effect—that these things consequently happen one after another. It creates a climate of fear and uncertainty among the staff and the patients. Many of the mums who had births in the middle of last year were uncertain as to whether the maternity services would be there. The closures are demoralising and out of step with the needs of the wider west London area.
As an academic by trade, I believe in evidence-based policy, and the evidence is that Ealing borough has a population of 360,000 people and rising. That is as big as a city like Leeds. The borough needs accident and emergency services, maternity and a children’s ward. There was a meeting at Richmond House, which I think my hon. Friends the Members for Ealing, Southall and for Hammersmith (Andy Slaughter) attended, along with the Minister. It was a good meeting on the whole, but the PowerPoint we were shown confirmed that Charing Cross and Ealing will be downgraded to minor hospitals. The House of Commons Library confirmed to me this morning that the population of London as a whole is projected to rise to 10 million, so surely we need more capacity, not less.
The bill for the “Shaping a healthier future” reconfiguration programme keeps rising. I think it is £235 million at present. Some £35 million has been spent on management consultants, such as McKinsey and all those people. It does not look like good value for the taxpayer. We are living in an age where every pound of public money spent has to be justified, and the end result of this programme will be fewer acute beds and fewer hospitals, with A&Es in west London decimated. It is a bad deal all round. There is other evidence of that. I am not someone who likes to trot out loads of statistics, but waiting times are massively up at Northwick Park, which is seven miles away from bits of Acton in my constituency. In the immediate aftermath of the closure, it had the worst recorded A&E waiting times in England for six out of 15 months.
My hon. Friend the Member for Ealing, Southall has alluded to the Independent Healthcare Commission for North West London headed by Michael Mansfield, who is a respected QC and who has expressed concerns about the business case. Forget all the emotional stuff; he is looking at whether it is a good deal for the taxpayer, and he has called the business case “deeply flawed”. I pay tribute to the tireless work of Eve Turner and Oliver New, as well as to my constituents Arthur and Judy Breens, who have formed an organisation—it keeps changing names: it was Save Our Hospitals, then it was Save Ealing Hospital.
The petition, which was batted back by the Petitions Committee, talks about
“a peaceful occupation at the Maternity Wing Area”.
That is how bad things have got. It also states:
“Protests are growing and the anger is reaching boiling point amongst thousands of members of the community.”
These people were not political before this issue came up. It has politicised the chattering classes of Ealing behind their net curtains, not that I am dismissing people with net curtains. They are a completely valid form of internal decoration and I love them dearly. The issue has managed to inflame people who are not usually inflamed and who have never been on a demonstration.
Mr Virendra Sharma
I am sorry to intervene when my hon. Friend is in full flow, but it is important to make the point that the campaign is non-partisan. All the political parties on Ealing Council unanimously support it and more than 100,000 people signed the petition. Many hundreds of people actively went around their areas asking for signatures. It is important to understand that the campaign is not led by any political party.
Dr Huq
My hon. Friend puts it very well. I completely accept his point. The strength of feeling about this issue is palpable. It is a non-partisan thing; they are people who have never been on a protest march before.
Talking of protest marches, a couple of weeks ago I joined the junior doctors on the picket line outside Ealing hospital. Some of those people are in the Public Gallery today. We were last together on that day, so we have been reunited. Quite aside from imposing a contract on junior doctors—a contract is not a contract unless there is offer, acceptance and agreement—there are so many other issues with the junior doctors’ strike that should be raised here, such as the fact that they are patronisingly called junior doctors, as if they are the work experience person who makes the tea. They are very experienced people with years and years of clinical experience. Calling them junior doctors is almost a way of belittling them.
I raised the plight of those highly experienced, yet technically junior, doctors with the Prime Minister at Prime Minister’s questions recently. The Government’s equality impact assessment of the new contract shows that it discriminates disproportionately against women because childcare costs more at the weekend, and if weekend hours are counted as normal hours, women will have to pay. Again, the issue was batted back and just shoed away, which is disappointing because the Government’s own advice tells them about the costs. It feels as though junior doctors are being stretched ever thinner, and if something is stretched ever thinner, it can snap.
I wanted to be brief today because I have spoken many times on Ealing hospital both here and in the main Chamber. This morning I asked the Library staff whether they had a briefing pack on the 1.30 debate on Ealing hospital and they said, “Again? You’re always speaking on this. You had three hours on this subject on 24 March,” for which they did prepare a briefing. One would think that after umpteen debates, I would have said all I have to say on this subject, but the tale gets worse and worse.
I have mentioned before the cases of constituents facing long waits: for example, the Khorsandi and Anand families. The last time I faced the Minister in this Chamber, I mentioned my constituent Bree Robbins’s three-year wait for breast reconstruction. She was disappointed she did not get an answer last time, but maybe we can try again today. People have legitimate concerns.
Like my hon. Friend the Member for Ealing, Southall, for me Ealing hospital is personal. It is where I would have been born, but I was born in 1972 and it did not exist then. However, I remember that hospital going up with so much hope attached to it, and now I see it constantly being downgraded. As my hon. Friend says, the suspicion is that it is on the way out. I have been to the acute medical unit in the basement with my mum; I have been to the hospital as a mum; it is where in September 2014 my father breathed his last. So this hospital is not a hypothetical thing on a spreadsheet; it is something that I and family members use.
Recently, 11 north-west London Labour MPs, led by my hon. Friend the Member for Harrow West (Mr Thomas), signed a letter calling for the National Audit Office to investigate. There is a question of economics. We want the Minister to think again, consider the business case and halt the closure programme. The case simply does not add up.
As I said, I remember the hospital going up and I remember, as will my hon. Friend the Member for Ealing, Southall, several schools in the Borough of Ealing that were closed in the ’80s when rolls were falling. The place in Greenford—I cannot remember its name—where they send school governors on training courses is a disused school, but now schools in Greenford are having to be opened. The Priory Centre in Acton was a community centre in a disused school. Now it has been razed to the ground and a brand-new primary school built, because numbers are going up. The short-sightedness flies in the face of the evidence and ignores the fact that populations are rising.
I do not have any hospitals in my constituency, although I had several on the edges: Central Middlesex, where the A&E has gone, Hammersmith hospital, where the A&E has gone, and Charing Cross, in the constituency of my hon. Friend the Member for Hammersmith (Andy Slaughter), which is going to be downgraded. Although I do not have hospitals in my constituency, all those ones that were there on the edges are disappearing before our eyes, so I urge the Minister, who I know is a reasonable person and a London MP, to think again.
Andy Slaughter (Hammersmith) (Lab)
It is a pleasure to be here this afternoon under your chairmanship, Mr Stringer. Although the debate is difficult, it is a great pleasure to follow my two neighbours from the London Borough of Ealing, and I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate today. As the MP for Ealing hospital, no one has done more than he has to champion the cause of that hospital over the four years that it has been under threat. As we see from the petition that generated this debate—not the first petition of this size—he is admirably and clearly reflecting the view of the vast majority of people not only in Ealing borough but across west London.
Apart from their choice of Member of Parliament, the constituency of my hon. Friend the Member for Ealing Central and Acton (Dr Huq) may be one of the most unlucky in the country. To lose one A&E department may be considered unfortunate; to lose four must be an all-time record. Following the closures of Central Middlesex and Hammersmith and the downgrading of Ealing and Charing Cross to non-type 1 status, her constituents will be in a very difficult position, as will all our constituents.
I am here today for two reasons. I am not an Ealing MP, but I want to support my colleagues and I want to say—I think the Minister will accept this—that the proposals for Ealing hospital are inextricably linked, under the “Shaping a healthier future” programme, to the future of the eight other major hospitals in west and north-west London, four of which, as we have seen, will undergo substantial change and either closure or downgrading of services, or at least movement of services elsewhere.
As my hon. Friend the Member for Ealing Central and Acton said, we have debated this subject many times. I do not think that is surprising. I make no apology for that, given the importance of the issue. In the recent debate in March, which was an across-London debate, “Shaping a healthier future” was raised several times. One of the matters on which I and others pressed the Minister was when we would see the next developments. I was grateful when the Minister said that Members would have the next important document—the draft of the implementation business case—as soon as possible.
Since that debate we have also managed to fix a date, 25 May, for the 11 MPs to meet the health service management across north-west London. Unfortunately, I have been told by my clinical commissioning group that the document will not be available for the meeting, although it will be available later in the summer. The sooner we can see that document and have an update on what the proposals are for Ealing and the other hospitals, the better. I say that because this will be familiar not only to Members here, but to the many people in the Public Gallery. The difficulty we have had over the past four years is a lack of information.
We began with the bombshell proposals in the summer of 2012, which effectively proposed the closure of Ealing and Charing Cross hospitals, leaving just a primary care facility on the site. There was a modification when the final proposals were brought forward in February 2013. Those proposals—which most of us regarded as a fig leaf, albeit a very expensive fig leaf—were for the demolition and disposal of a substantial portion of the site, but with the building of new facilities, primarily for primary care and some other treatment, while still using the majority of emergency and acute services on the site. Since then, nothing. Indeed, we have been waiting a couple of years for the business case. In the place of factual information, rumours tend to spread. As was mentioned previously, nothing has changed.
As for Ealing hospital, the very strong rumour is that, given the poor financial condition of the NHS and the scepticism of the Treasury about the programme, it is likely that the service cuts and reconfigurations will go ahead, but also that the existing buildings will be retained. Those buildings were not designed for the purposes for which they will now be used and will not receive the funding to modernise them that was at least the mitigation in the previous proposals. The sooner we know one way or the other on that, the sooner we can have a proper discussion about it. The news that Imperial will have a £50 million deficit this year—I think the situation for north-west London hospitals is even worse—suggests that the financial imperative is continuing to drive this
Although the health service itself may have been quiet—certainly in what it has told Members and the public—my constituents and those of my hon. Friends have not been quiet over the past few years. As I say, the petition that generated this debate is not the first petition of more than 100,000 signatures that has been lodged. I hope that more attention is paid to this one than has been paid to previous ones. I pay tribute to the thousands of people who have not only signed petitions but been active in the campaign, which is going into its fifth year. The uncertainty is not helping anyone.
The public, the organised campaigns and the local authorities have acted responsibly. The local authorities commissioned the Mansfield report, a serious document that was not taken seriously enough by the NHS. The level of demoralisation is extremely high, and is combined with issues relating to the junior doctors’ dispute. Places such as the Imperial College school of medicine are centres of excellence for training junior doctors. I have spoken many times to the staff there and their morale is very low. All staff morale is very low because people do not know where they are going to be working or what job they will have. They do not know whether the facilities they are working in will survive, or whether they are going to be run down in the meantime. Consequently, we have a substantial overreliance on agency staff. That is not a good template for the NHS.
I appreciate the fact that there are financial difficulties throughout the country and that the situation in west and north-west London is not unique. Nevertheless, I do not think that any other areas have had to put up with this reorganisation—or whatever we want to call it—for as long as we have.
Dr Huq
When my hon. Friend made the point about the loss of four A&E departments, he reminded me of the saying, “Once is unfortunate, twice is a coincidence, but three times is beginning to look like a habit.” I do not believe that any saying even goes up to four. Does he agree that it is unprecedented to lose four A&E departments?
Andy Slaughter
Yes, I do. I anticipate that we are unlikely to get much by way of an answer from the Minister today, although I will be delighted if she does have some news to impart. I hope she will take the debate in the spirit it has been conducted, because there is genuine anxiety. What we are asking for and what will help is transparency. It may be that we do not like what we hear any more than we liked what we heard three or four years ago, but it is getting beyond a joke now.
We talk a lot about hundreds of millions of pounds of money and about people’s love for institutions such as hospitals, but if we are pragmatic about it, at the end of the day the important thing is whether individuals receive a good standard of care. By coincidence, this morning I spent half an hour on the phone to a constituent whose husband’s life was saved two years ago when he had a serious aneurism. They were told by the professor who operated on him that had they taken a few moments longer to reach Charing Cross hospital, which they live very close to, that would have been the end.
The rider to that is that last week the same gentleman was rushed to Charing Cross hospital again with a recurrence of that issue. He spent seven hours there before being transferred to St Mary’s in Paddington, where he again received very good treatment. I hear again and again that the system is beginning to break down and people are not necessarily taken to the right place at the right time or, when they do get there, they are not seen quickly enough. That is not a criticism of the staff, who are working extremely hard against the odds and are highly professional.
We are very lucky to have such world-class hospitals in west London. We do not take that for granted, but I have given just one example of the kind of story I could probably repeat every week. I worry about the future of the health service for my constituents and those of my colleagues if we do not get to grips with the situation quickly. We are drifting in a way that means that the excellent and superb levels of healthcare we have become used to over the years are no longer likely to be maintained.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Of course, Mr Stringer. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Ealing, Southall (Mr Sharma), a fellow London MP, on securing this debate on an issue that is of concern to him, to his constituents, as we can see from the attendance in the Public Gallery, and, of course, to colleagues in neighbouring constituencies, who also contributed to the debate—not for the first time.
Before I address the issues raised, I would like to echo the words of others and pay tribute to those who work in our national health service. Despite the debates that we have in this place about reconfigurations and the like, all of us are united in praise of the dedication of those working on the frontline to provide first-class services to all in their care.
There is of course considerable ongoing interest in the changes in north-west London proposed under the “Shaping a healthier future” reconfiguration programme. It is worth stressing that those are not just changes to acute hospitals, but planned changes to the whole of that health economy. The aim has been to look at how it can best provide in the future for the local population.
Of course I acknowledge the concern expressed among local people and in particular by the Save Ealing Hospital Community Action Group. The hon. Member for Ealing, Southall will know that I responded in January to a petition by the action group, and I will respond in writing in due course to the latest petition that he has presented. But I want to make it clear that proposals and change on so large a scale as that taking place in north-west London are inevitably controversial. Major change is inevitably controversial, but we have always stressed, as did the shadow Front-Bench spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), that the reconfiguration of services is a matter for the local NHS. That is best organised and shaped by those who know the communities best, and with local clinicians right at its heart, rather than being dictated from Whitehall.
Let me deal with the Mansfield Commission report. On Thursday 14 January, the North West London Clinical Board considered the report of the Independent Healthcare Commission for North West London, and the view of the clinicians on the board—local doctors and health workers—is that the current programme, which was designed by doctors and based on significant clinical data, evidence and experience, continues to offer the best outcomes, experience and equality of access to NHS services for all our patients. That is a direct quote from what they said. Having read the Mansfield report, I am not surprised that that was the conclusion of local health leaders. I take issue with a number of things said about that report, not least about its independence, but I want to use some of the time that I have this afternoon to deal with some of the substance of the concerns raised about services for people in Ealing. Some of the language used was very strong, and I want to try to set a few minds at rest by talking about some of the new services.
Before moving on to specifics about Ealing, though, let me deal with the implementation of the programme itself. The hon. Member for Hammersmith (Andy Slaughter), perfectly reasonably, exposed the case why it is important that people have certainty and transparency. Some colleagues referred to the meeting that I chaired last summer to try to reboot this process after the general election—with a degree of success, in terms of the contacts between Members. But on the proposals for capital works for both Ealing and Charing Cross hospitals, I have been assured that local health and social care partners are working together to produce a sustainability and transformation plan by the end of June 2016, and it is anticipated that details for those two sites will be included in that.
I have been honest enough before to say that I share hon. Members’ frustrations about delay. I quite understand why they want more certainty and I fully expect NHS England and the “Shaping a healthier future” programme to keep me abreast of developments as we move towards the summer. I want to hear if there are any problems with hitting that timetable, because Members have a right to expect to get that information, so that they can respond to it, so please rest assured that I will continue to ask those questions.
The hon. Member for Hammersmith also talked about morale, and it is vital that we put on the record some of the ways in which good progress is already being made as part of the “Shaping a healthier future” programme. As I have said, better healthcare is not just about the acute sector, important though that is. For example, good progress has been made in developing primary and community services, and there are examples showing patients benefitting. GP practices across north-west London now offer more than 1 million people in the area extended opening hours on weekdays, from 8 until 8, and weekend access. That is vital for families’ peace of mind, as has been mentioned. GPs in Ealing now provide 19 new services, including anticoagulation services, electrocardiograms and some mental health services. Many more community services are now in place across all eight boroughs, so more patients can be seen closer to home.
Those are just some of the reasons why I do not recognise the description of the plans given by the hon. Member for Ealing, Southall. He used expressions such as “risking lives” and that is not what local doctors want to do or what the plans are about.
Jane Ellison
I am sorry; I will not, because the hon. Lady made a long speech and I must respond to it.
At the heart of the plans is the fact that local clinicians want to provide more and better services, although delivered differently, it is true, from the way they may sometimes have been delivered in the past. That brings me to the focus on Ealing hospital. Of course I recognise the concerns associated with such significant changes as are proposed, and I take the point entirely that uncertainty, both for Members of Parliament and members of the general public, gives rise to concerns.
Ealing hospital will be redesigned as a 21st century facility for the local community. The hospital will have a local A&E and a 24-hour GP-led urgent care centre, with access to 24-hour specialist care, as well as a range of specialist services designed with the needs of the community in mind, such as a diabetes centre of excellence. The hospital will be a centre of excellence for other areas of care, such as elderly patients, those with long-term conditions and the most vulnerable members of the community, by integrating primary and secondary care with community and social care. It is common ground between all parties that that is how we will help to keep people healthier in the future. So good news for patients is already beginning, in the changes.
On maternity services, some strong language was used in the opening speech about concerns for local mums and their babies. As has been pointed out, maternity services were consolidated in July across north-west London into six maternity units. Women from Ealing now have a choice in maternity services, with 30 antenatal sites across Ealing, including Ealing hospital, and six sites for delivery across north-west London. As a result, there has been a 10% increase in choice of midwifery-led units. I am told that 778 women had their maternity care safely transferred from Ealing to a new maternity unit of their choice with no incidents reported.
What is the benefit to Ealing women from the changes? Before the changes, Ealing hospital was achieving 60 hours of consultant cover—lower than all the neighbouring hospitals. Across north-west London before the transition, the average was 101 hours. North-west London has set out to achieve 123 hours in 2015-16, and it currently has 122 hours of consultant cover. Also, 100 new midwives have been recruited across north-west London as a result of the changes. Antenatal and postnatal care are still available at Ealing hospital, and as I said, the number of community midwives has also increased locally at 30 sites across Ealing. It is clear that a complex service change has been managed safely, with benefits to patients—mothers and their babies. It is telling—Members need not just listen to my words—that Ealing Council’s health and adult social services standing scrutiny meeting on 26 April heard from the Royal College of Midwives. That is not the Government. It endorsed the transition and congratulated the NHS in north-west London on the model of care and the detail in the transition. Again, I do not recognise that service in the words of the hon. Member for Ealing, Southall, although I know that he meant them with due concern for his community.
On paediatric in-patient services, good progress is being made on the implementation of changes. I am informed that that will ensure that children in north-west London will receive consistently high-quality seven-day care, with more paediatric nurses and specialist doctors available. Paediatric in-patient services, which are for children who require emergency treatment or an overnight stay, will move on 30 June from Ealing hospital to five other hospital sites in north-west London. That will significantly expand capacity—more beds, doctors and nurses, seven days a week.
The changes do not mean that all children services are moving from Ealing. Nearly three quarters of existing children’s services will continue on the Ealing hospital site and elsewhere in the borough. Services remaining include routine appointments and treatments that do not require an overnight stay, such as day care unit activity, so most children will be seen in the same place as they are now. Urgent care for minor injuries and out-of-hours GP appointments will also remain at Ealing hospital. The majority of children who are brought to Ealing’s A&E by their family or friends are already treated in the urgent care centre. Services for children with long-term conditions, such as asthma and epilepsy, and child and adolescent mental health services will also remain unchanged.
To reiterate, 75% of existing children’s services will continue to be delivered by the dedicated staff of Ealing hospital, but—this is an important “but”—the sickest children in north-west London will receive better care as a result of the changes. That is what we all care about the most.
It is right that local people have the chance to hear from their parliamentary representatives in such debates, so I welcome the fact that we have had the chance to debate the subject again. I suspect that we will do so again at some point in the future. As the programme moves through its implementation, I encourage those with particular concerns to continue to engage with the local NHS. I thank colleagues for doing so, as they have been, because that is the right way to proceed. I have reiterated to local health leaders the need to share plans in a timely fashion. I only ask of hon. Members that they also share the positive changes that are already visible to people in their communities, as I have illustrated today. I look forward to hearing how the meeting later this month goes—it was referred to earlier—and I will continue to engage positively with colleagues as they handle this important issue, which matters so much, as we can see, to local members of the public.
Brain Tumours
Rupa Huq Excerpts(8 years ago)
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Mrs Maria Miller (Basingstoke) (Con)
It is a great pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Warrington North (Helen Jones) on such an excellent start to the debate. I also pay tribute to my hon. Friend the Member for Castle Point (Rebecca Harris) for her excellent chairmanship of the all-party parliamentary group on brain tumours, and to other hon Members who support her in that work.
My contribution will be succinct. As the hon. Lady pointed out, this is the largest cancer killer of children and adults under the age of 40, yet just 1% of research funding is given to find a cure or new treatments. The hon. Lady said that this felt to her almost like a Catch-22, and I think she is entirely right: a lack of research means that there can be difficulty in having effective professional development, which leads to continued late diagnosis. The fact that 61% of brain tumour patients are being diagnosed in A&E is backed up by information from my local hospital and Dr Lara Alloway, a consultant in palliative care there, who said that brain tumours are
“most frequently diagnosed when people present as an emergency with stroke-like symptoms, headache or confusion. It is less common for people to be diagnosed as an outpatient.”
The lack of early diagnosis was also picked up by my local primary care trust. However, the issue is not just a lack of early diagnosis, but a lack of guidance from NICE. There are just seven pages of guidance on this matter, but more than 30 pages for blood and haematological disorders. The limited evidence base makes it very difficult for doctors and GPs to be able to diagnose in the fashion that the hon. Lady talks about.
It would be difficult to do justice to the number of constituents who have contacted me about this debate. I pay tribute to them all. I pay particular tribute to Olya Elliott, who lost her son, to Sandra Welch, who was diagnosed after a year of seeking help from her GP—that was too late to be cured—and to the gentleman who talked about his daughter, who had died at the age of 44. The list goes on, and it is very difficult to talk about it. I think that the debate today will do a great deal to send a positive message to all those constituents. I pay particular tribute also to Jan Pearson, who came to my surgery on Friday and spoke incredibly movingly about her son Tom, aged 21. He was diagnosed with an inoperable tumour on his brain stem at the age of 18. He was diagnosed because of the tenacity of his mother, who identified the symptoms after five years of insisting to his GP and other medics that he needed help and support. It was really only through her tenacity that he got the brain scan that diagnosed his tumour, but unfortunately it was too late for it to be operable.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
May I draw the right hon. Lady’s attention to my constituent, Caroline Fosbury, mother of Ella? Caroline lost her daughter at the age of 11. She said that it is a three-way cycle between support, awareness and research, and the family have started Ella’s fund to campaign for more research.
Mrs Miller
That positive effect in terms of fundraising is so important. When I speak to my constituents who have lost loved ones, that is often the way they can find most solace. The hon. Lady makes a very good point.
I also pay tribute to those who support my constituents who have gone through such appalling losses, particularly St Michael’s hospice, which cares not only for individuals who are going through the last hours of their lives, but for bereaved relatives and carers.
NHS in London
Rupa Huq Excerpts(8 years, 1 month 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)).
Oral Answers to Questions
Rupa Huq Excerpts(8 years, 1 month ago)
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Mr Hunt
Under this Government, staff levels have actually risen: we have 11,000 more doctors and 12,000 more nurses. If the hon. Lady is worried about NHS funding, perhaps she might look in the mirror, because in 2010 her party wanted to cut funding to the NHS—in Wales, it actually did cut it—and in 2015 it wanted £5.5 billion less than the Conservatives. The NHS does not need Labour rhetoric; it needs more doctors and more nurses, which we can have only on the back of the strong economy that only the Conservatives can deliver.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
10. What recent assessment he has made of staff morale in the NHS.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
The Department assesses staff morale in the NHS using engagement scores from the annual NHS staff survey. I am delighted to say that the engagement score currently runs at 3.78 out of 5, which is a rise from the position in 2012, when the survey began, when it was at 3.68.
Dr Huq
On top of the junior doctors debacle, the staff survey shows that midwives are stressed, with 90% of them working extra shifts unnecessarily. I have raised before the case of the radiographer Sharmila Chowdhury, who was sacked for exposing bribes at Ealing hospital, but has yet to get a practical response, other than the words, “Francis review”, which has yet to be implemented. When will the Government get a grip on plummeting morale in the NHS?
Ben Gummer
The hon. Lady asked a number of questions. On the specific issue about this particular member of staff, I know that my right hon. Friend the Secretary of State has met her, and I would be happy to discuss this further. The hon. Lady is wrong about the Francis recommendations, which are being implemented in full. She should look at the balanced results from the staff survey, with more staff saying that their motivation at work is going up, with the number recommending their trust as a place of work and as a place to receive treatment going up, and with the number able to contribute to improvements at work also going up. There are issues in the staff survey that we would like to address—it is unfortunate to see reports of bullying and harassment going up—but we are addressing the problem through the staff partnership forum, which I chair. Overall, however, this is a balanced and positive return from the staff survey.
Oral Answers to Questions
Rupa Huq Excerpts(8 years, 3 months ago)
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Jane Ellison
The hon. Gentleman rightly says that we had a constructive meeting but, as with everything in this area, it is time to move on. There is a grave danger of him appearing to be like one of those soldiers discovered on a Pacific island after the second world war still fighting the old war. Part of the reason for cost escalation in NHS projects is the constant challenge and delay, and “Shaping a Healthier Future” has complete clinical consensus across north-west London. The clinicians say that this
“will save many lives each year”.
It is time to get on with this project.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
The report heavily features Ealing hospital, where the radiographer Sharmila Chowdhury blew the whistle on consultants taking bungs—extra payments. She is now jobless and, as a widow with a mortgage, soon to be homeless. Will the Minister urgently look into her case, because despite a plethora of reports—this one and the Francis review—this Government do not seem to be doing anything for her?
Jane Ellison
I do not think that is fair. In fact, my right hon. Friend the Secretary of State of State has met the clinician in question, and the Francis review recommendations, as we have adopted them, make it quite clear that staff have a right to speak out. Of course we want everyone to speak out on behalf of patient safety.
Sugary Drinks Tax
Rupa Huq Excerpts(8 years, 5 months ago)
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Dr Rupa Huq (Ealing Central and Acton) (Lab)
I am a late contributor to a long debate, so some of what I say will have been touched on, but I hope it is not all déjà vu.
Apparently today is the first day of Sugar Awareness Week, after “black Friday” and “cyber weekend”, or whatever—it is all good to know. According to Mick Armstrong, chair of the British Dental Association:
“Britain is addicted to sugar, and inaction can no longer be justified, either morally or financially.”
The debate, which to some extent reflects Britain’s love affair with sugar, is not the result of an intellectual curiosity, as subjects discussed in this Chamber often are, but arises from a petition. We have heard the figures —150,000 people have signed it—and we see it reflected in the number of people in the Public Gallery today.
One in four children leave primary school clinically obese—the hon. Member for Totnes (Dr Wollaston) said it is one in three—so we have to do something about the ticking health time bomb. The cost to the NHS runs into billions—my hon. Friend the Member for Warrington North (Helen Jones) mentioned £6 billion. Some people argue that the state should not interfere in such things, but it would not be the first time, because it is something that Governments of both complexions have done before, and as a result we have seen a reduction in the number of adult smokers in this country.
The clamour for action on sugary drinks and the arguments in favour of the funds raised going to tackle public health problems have received not inconsiderable public attention, at a time when health budgets are being squeezed. There is also the weight of expert opinion, not only the much mentioned one-time “naked chef” Jamie Oliver, but the Health Committee, chaired by the hon. Member for Totnes, who spoke movingly and powerfully earlier—she was a doctor first and an MP second—the British Medical Association, the British Heart Foundation, Diabetes UK and the British Dental Association. Hitherto, however, all appeals have fallen on deaf ears in the Government. The Royal College of Paediatrics and Child Health conducted a poll that revealed that 53% of the public support a tax measure.
Public Health England, in its sugar reduction action plan, states that the recommended proportion of added sugar in people’s diets should be 5%, but at the moment it is more like 12% for adults in this country. Added sugar accounts for 14.7% of calorie intake for children and 15.6% for teenagers. I am a mum myself and understand pester power and the attraction of sugary drinks. For under-threes, 27% of added sugar intake comes from soft drinks; for 11 to 18-year-olds, the category that I am a mum of, that figure rises to 40%. Furthermore, it is the 11 to 18-year-olds with the least amount of money who are attracted by cheaper alternatives to drinks such as water. Why is it that in any sweet shop water is more expensive than fizzy drinks?
Sugary drinks give a short fix of energy and have no nutritional value, while at the other end of the process the NHS is treating people for preventable illness. We have heard how most children in this country who go under general anaesthetic are doing so for tooth decay. Many hon. Members have also mentioned the figures for type 2 diabetes; 22,000 people in my constituency live with it, and it is responsible for a death every seven seconds in the G20 member states, which is a higher rate than HIV and malaria combined. At a meeting of the all-party group on diabetes, chaired by my right hon. Friend the Member for Leicester East (Keith Vaz), who is no longer in his place, we heard an impassioned speech from “St Jamie”, as one of my constituents called him at the weekend. I believe that in Jamie Oliver’s own restaurants there is a 10p levy on fizzy drinks.
On the one hand we have campaign groups and medical professionals, but on the other hand there is the argument about the nanny state. Many hon. Members have said that the solution is severalfold. The food and drink industries need to act more responsibly—they are the main lobbyists against the sugar tax—instead of arguing that any tax would be passed on to consumers and end up being a tax on the poor. They have also warned of sinister factory inspections and claimed that the tax would be unworkable, but they are acting in their own interests and not with the NHS health bill at heart. In Mexico, as we have discussed, a reduction in sales took place when a tax was introduced. I am almost reminded of that television programme set in the 1950s or ’60s, “Mad Men”, which is about the advertising industry. The advertisers in it say, “It’s not bad for you”, when they know it is.
There are good commercial operators. In my constituency is the UK headquarters of the French dairy company, Danone, which has its “Eat Like a Champ” programme, which 35 children will go through this year. It is unbranded, so no one knows it is a Danone programme, but it introduces healthy eating, diet and so on throughout the London boroughs. The programme has been developed with the British Nutrition Foundation. Such initiatives should be encouraged. The programme is also supported by Diversity—the pop group, not the concept—as its ambassadors. Danone is doing that as part of its corporate social responsibility. The hon. Member for Britvic—the hon. Member for Rugby (Mark Pawsey)—has gone now, but—
Barbara Keeley (Worsley and Eccles South) (Lab)
Says the hon. Member for Danone.
Dr Huq
Yes, sorry. I am a secret lemonade drinker—no, I’m not.
I want to be brief, but we are discussing something important. Voluntary agreements do not seem to be moving fast enough. As everyone has said, we need a range of different approaches, and hiking up sugary drink prices by pennies is part of that. As for the industry’s worry that the cost would have to be passed on to consumers, the industry itself could absorb or partly absorb the cost.
Eleven to 18-year-olds will choose drinks based on price, because they are short on cash, although other factors could come into play—peer pressure, habit, availability and so on. We need to think smartly about things such as advertising bans, which have been mentioned, encouraging physical activity, curbing “buy one, get one free” types of promotions, discounting fruit and veg, and considering portion sizes. In New York the authorities have banned the largest size of soda cups.
I want to ask the Minister what happened to the ban on fried chicken shops at school gates, because I still seem to have them in my constituency. Such a ban was talked about, and it would be good if its implementation could be accelerated. Also, what about minimum unit prices for alcohol? If sugary drink prices go up but alcohol prices are low, there could be some awful, cataclysmic thing going on as a result, possibly—
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Hopefully not at primary schools.
Dr Huq
No, but alcopops and such things have always been popular with young people, because they look harmless, but some of them have a high alcohol content. We have a golden opportunity, because the Government are working on a childhood obesity strategy, and we must not waste that opportunity We must think long-term and heed the BDA chief’s words:
“Public health policy must be guided by evidence, not by personal prejudice or commercial interests.”
So happy Sugar Awareness Week, one and all. I will be interested to hear the summing-up speeches.
Steve McCabe (in the Chair)
We have just over an hour, but I remind Members that we do not have to fill the entire time. I would, however, like enough time to be left for Helen Jones to reply to the debate. I call Philippa Whiteford.
Off-patent Drugs Bill
Rupa Huq Excerpts(8 years, 6 months ago)
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Nick Thomas-Symonds
On the second part of the hon. Lady’s intervention, I entirely agree that it would assist the Alzheimer’s Society. On the first part, I am sure the whole House wishes her best friend a speedy recovery.
Given the time restraints, I will touch on just one benefit that the Bill would have. zoledronic acid, a type of bisphosphonate, was originally used to treat bone fractures in advanced cancer and osteoporosis, but it can also reduce by 28% the risk of breast cancer spreading to the bone in post-menopausal women. If it were routinely available to 34,000 women, it could save 1,000 lives a year, at the cost of about 5p per day per patient. That is precisely the kind of benefit the Bill could bring.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
My hon. Friend talked about cost. Does he agree with my constituent, Elena, of west Ealing, who wrote to me on this subject to say that it would help MS sufferers in particular and that
“it is crucial that affordable treatments are used to their full potential particularly at a time when NHS resources are stretched. The Bill will tackle this issue head on and stand to benefit hundreds of thousands of people in Ealing and beyond.”?
Nick Thomas-Symonds
I agree entirely with my hon. Friend. It is precisely that kind of benefit that the Bill would bring.
Hospital Parking Charges (Exemption for Carers) Bill
Rupa Huq Excerpts(8 years, 6 months ago)
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Philip Davies
My hon. Friend has made a very good point, and I hope that he will expand on it in his own speech. I do not want to steal his thunder.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
Did the hon. Gentleman not hear the compelling cost-benefits analysis presented by my hon. Friend the Member for Burnley (Julie Cooper)? It is the Conservatives who go on about a long-term economic plan. The proposed exemption for the carers who prop up the NHS in so many ways will save the NHS billions upon billions of pounds, so it will be good value in the long term.
Philip Davies
I was prepared to hear lots of arguments in favour of this Bill and some of them I was going to find quite compelling. The idea that this provision is going to save the NHS millions of pounds is an argument I was not prepared for, I must admit, because it is quite clearly a load of old nonsense. If that really is the economic thinking of the Opposition that we can look forward to over the next five years, then Lord help the lot of us, because the Opposition clearly have no economic credibility whatever if that is the case the hon. Lady is making. This clearly incurs a cost—
Dr Huq
The briefing all MPs were sent based on research by Leeds University and Carers UK puts the figure at £119 billion, because these are people who take stress off the NHS. As my hon. Friend the Member for Burnley clearly described in her speech, they are people who change incontinence pads and do the feeding; they keep people out of hospital in the long run. This proposal will cost less than bed-blocking in the NHS. Furthermore, of all the representations all of us on both sides of the House have received, it is only the parking industry that wants to keep things as they are.
Philip Davies
The hon. Lady is approaching this Bill as if nobody at the moment does any caring and if we have this Bill everyone will start caring and save the NHS billions of pounds. The point is the people—
Julian Knight
My hon. Friend makes a good point. During my election campaign in the course of canvassing and door-knocking, we mentioned the hospital parking campaign and the response was mainly positive. Obviously, as soon as people are asked whether they want free hospital parking, they say, “Yes, absolutely”, but the other question was what this means for nurses and doctors and for the bottom line of our local hospital’s finances.
Dr Huq
Is not the point that the Bill does not propose a free-for-all for everyone, but free hospital parking just for those on carer’s allowance, which is a paltry £62 a week? These are not carers who come through an agency and indirectly through the local authority and who add to the mounting social care bill. These people keep the social care bill down. We pay them carer’s allowance, and if all their money goes on parking charges, they will be deterred from coming into hospital to do the job that they do.
Julian Knight
I agree that we must value carers. However, the Bill is very narrow in its focus, whereas a much greater number of people could be covered by the guidelines and the NHS patient, visitor and staff car parking principles. There are opportunities to engage in our localities with our local hospitals and local hospital trusts in order to encourage them to expand existing provision. There is the possibility of working on a case-by-case basis, rather than by means of a rather blunt instrument. I take the hon. Lady’s point, but we should look at hospital car parking charges in the round, not just as they affect carers. [Interruption.] The Bill is about carers. The subject matter, though, is a much greater variety of people who use hospital car parks, including many vulnerable people, as we know.
I suggest that other hon. Members follow what has been done by my right hon. Friend the Member for Harlow (Robert Halfon), the Minister without Portfolio, and my hon. Friend the Member for Wellingborough (Mr Bone) and engage with the local hospital trust, put pressure on the trust and get it to reduce the complexity of charges and to ensure that when it puts charges in place, they reflect the local area. For example, I made a case to my hospital trust that we have three hours’ free parking at council car parks in Solihull, so why do people have to pay £2.75 for just one hour at the local hospital? Why is that not in tune with the local economy and the local environment?
More widely, on the people who are not covered by the Bill, I have mentioned those who may be covered by the NHS patient, visitor and staff car parking principles, but what about people who do not have a car? What about carers who travel by public transport? I was involved in a campaign in Solihull to help save the No. 73 bus service, which was a lifeline to Heartlands hospital. If it had been cancelled, people in Shirley in the west of my constituency would have had to travel by three buses in order to attend hospital appointments. If there is any extra money, surely it would be better for it to be directed at them as they are more likely to be on a lower income and potentially in a more vulnerable position than those driving and using the car park.
In conclusion, I welcome the sentiments of the Bill and I applaud the hon. Member for Burnley for introducing it. We have had a vigorous debate. There is a patchwork of provision and it is up to us as individual Members of Parliament, as well as local councils and bodies such as chambers of commerce, to come together in order to try to get the best possible deal for our area. That, in some instances, may include many more people than are the subject of the Bill.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
I congratulate my hon. Friend the Member for Burnley (Julie Cooper) on her important private Member’s Bill from which, thanks to Conservative Members’ contributions, a somewhat epic debate has ensued. I am pleased to speak in favour of the Bill. I have broken my usual rule of Fridays in Ealing Action and Bedford Park to be here since 9.30 am. The Bill is an important piece of legislation, which we need. I shall be brief.
It is important to point out that we are talking about carers who are in receipt of carer’s allowance of £62.10 a week. To receive this, they have to do at least 35 hours of caring for an older or disabled person, and they are not allowed any extra income above £110 a week. The state is paying these people in recognition of their caring duties, which take a burden off the health service. If all that is going on car parking fees, then it is a false economy. Waiving their car parking fees alone would pay dividends for the future.
I have elderly parents; in fact, I lost my father a year ago.
Dr Huq
I need to do a TV interview that I am late for, so I wish to make progress; I will not be giving way.
My parents have had all sorts of ailments. We lost my dad a year ago last September so I have been in and out of Ealing hospital as a visitor, and I have grumbled that it seems to cost no less than £4 for an in-and-out visit. People on carer’s allowance can be there for days on end, or hours on end, and the cost for them can rack up into the hundreds. This is even more punitive given that they are on £62.10 a week and bear a heavy burden as it is.
For these carers, the stress of parking is at best, the last thing they need, as my hon. Friend the Member for Burnley said, and at worst, on a more generous interpretation, bordering on a slap in the face. They are people who negotiate difficult situations. My own mother has dementia, and people with such conditions can fly off the handle and be quite erratic. If someone is negotiating that, or, say, dealing with someone’s incontinence pads, they do not want to be fumbling about for the correct change, as my hon. Friend so graphically described. This is the least we can do, as a decent society, in recognition of the enormous contribution that carers make. They are almost the social glue of the NHS; it would fall apart without them.
Yesterday in this Chamber we discussed benefit changes and how the safety net is tightening. It is important to consider these parking charges, which are sky-high in any case. In 2008, my hon. Friend the Member for Ealing, Southall (Mr Sharma) said to the local press that they are a stealth tax on the poor. They are already steep, but disproportionately so for carers. We heard research quoted earlier. Leeds University and Carers UK have estimated that £119 billion a year is saved on the adult social care bill through having these unpaid carers who just receive an allowance.
Conservative Members have said that it is fine to exercise discretion. At Ealing hospital, that amounts to a handful of spaces, and there are quite strict criteria. Often, a situation that would result in an unpaid carer taking the person they care for into hospital would arise from sudden things that cannot be predicted, and the four spaces, or whatever, that some London North West Healthcare NHS Trust hospitals reserve as part of their discretionary allocation may be gone.
Members on both sides of the House are lobbied all the time from powerful groups with identical emails that clog up our in-boxes, but this is about people who are the unsung heroes of our system. It should not be those who shout the loudest—the powerful lobby groups—who get their way. According to the figure I got from the House of Commons Library last night, there are 944,000 of these unsung heroes, but I have heard different figures here today. Anyway, on the basis of a cost-benefit analysis, a substantial number of people are saving the NHS money in this way. It is a matter of respect that as a country we should be saying thank you to these carers and we should appreciate their vital contribution. We have the power to change all this today and to deal with the fact that they are being penalised.
We would not want carers to be put off going to hospital because of these charges. That is the logical extension of the 81% rise in NHS West London CCG’s car parking charges. When I lobbied it and said that this is a constant issue in my postbag and my in-box, I was told, “It’s the commercial car parking providers you should take this up with.” Does the House want to be seen to be siding with commercial car parking providers or with carers in our society?
Campaign groups such as Contact a Family, the Alzheimer’s Society and the Multiple Sclerosis Society are all supporting this Bill. Even The Sun, which is not usually a newspaper that supports Labour, is backing the Park the Charges campaign.
Dr Huq
Not in recent times. It has not supported the Labour party in any recent general election. Historically, Rupert Murdoch’s politics are not aligned with ours.
I urge Members in all parts of this House to do the decent thing and support this Bill in the strongest possible terms. I congratulate my hon. Friend the Member for Burnley on leading this extraordinary debate. I suppose I should also congratulate some Conservative Members on the show of stamina to which they have subjected us.