Brain Tumours

Rupa Huq Excerpts

Monday 18th April 2016 Westminster Hall

[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

Thursday 24th March 2016 Westminster Hall

[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.

[Dr Huq]

rose—

[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—

[Bob Blackman (Harrow East) (Con)]

Will the hon. Lady give way?

[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]

There is a target of 95% of patients being seen within four hours. Immediately following the closure, at that hospital the proportion was 53%. We should not just brush that away.

[Bob Blackman]

Will the hon. Lady give way?

[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.

[James Berry (Kingston and Surbiton) (Con)]

rose—

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

rose—

[Dr Huq]

Who is first? I give way to my hon. Friend; there are two of her.

[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.

[Dr Huq]

I thought interventions were not allowed to be lengthy.

[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?

[Dr Huq]

The hon. Gentleman makes an interesting point, and I would include community pharmacies among those community services. There is a lot of worry among pharmacists in my constituency.

[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.

[Dr Huq]

I completely agree with the right hon. Gentleman.

[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.

--- Later in 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.

[Dr Huq]

Will the hon. Gentleman give way?

[Bob Blackman]

I will give way briefly to the hon. Lady, who made a very long oration.

[Dr Huq]

The hon. Gentleman will know that the most recent Care Quality Commission report on Northwick Park hospital says that it requires improvement. Several shortcomings were found. Does he appreciate why Northwick Park strikes fear into the hearts of many of my constituents?

[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.

--- Later in debate ---

[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.

[Dr Huq]

I understand that the block grant that pharmacists receive for things such as driving around delivering medicines is being cut by 6%.

[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.

--- Later in debate ---

[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.

[Dr Huq]

Will the Minister give way?

[Heidi Alexander]

Will the Minister give way?

--- Later in debate ---

[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.

[Dr Huq]

Will the Minister give way?

[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—

[Jane Ellison]

Can Hansard record that that is not true?

[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

Tuesday 22nd March 2016 Commons Chamber

[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

Tuesday 9th February 2016 Commons Chamber

[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

Monday 30th November 2015 Westminster Hall

[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

Friday 6th November 2015 Commons Chamber

[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

Friday 30th October 2015 Commons Chamber

[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]

rose—

[Philip Davies]

I will let the hon. Lady have another go.

[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—

--- Later in debate ---

[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.

--- Later in debate ---

[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.

[Mr Nuttall]

Will the hon. Lady give way?

[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.

[Mr Nuttall]

It has supported Labour.

[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.

Junior Doctors’ Contracts

Rupa Huq Excerpts

Wednesday 28th October 2015 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My constituent Dr Amy Di Marco, specialist registrar in general surgery, says that the term “junior doctors” is pretty misleading. She says

“in fact it applies to all those who are not GPs or Consultants and therefore includes many doctors who, like me, are nearing 40 (or over), with several years of experience and with responsibilities for patients as well as their own families.”

These are not work experience kids making the tea; they are serious professionals. They are highly qualified individuals who need commensurate remuneration and conditions that recognise that fact. In the areas of general practice, nuclear medicine, chemical pathology, emergency medicine, psychiatry, learning disabilities— the list goes on—we have a recruitment and retention crisis in any case, so these changes to contracts are not going to make the situation any better and risk exacerbating it. Junior doctors face the removal of the obligation on hospital trusts to safeguard the hours worked and the hiking up of plain time from 60 to 90 hours a week.

On 5 November there will be the ballot to strike. The BMA states that this is not a decision taken lightly. Indeed, being forced to work at weekends tending to patients on the brink of death after staying up all night cannot be good for anyone. There are also serious concerns that this proposal would disadvantage those on maternity pay or sick leave, employees working reduced hours or those doing research, yet this work pays dividends for the future and pioneering research on incurable diseases might save the NHS. All those people would be disadvantaged because their safeguards are being removed at a stroke.

This summer, we all saw the “#I’m in work, Jeremy” campaign on the promise for a seven-day NHS. It is happening already. I know this; I was born in Queen Charlotte’s hospital on a Sunday in 1972. Bolstered weekend care is obviously a good thing, but not if it means already stretched personnel being spread even more thinly, and not if it is unilaterally steamrollered through without adequate staffing and resources.

My constituent, Dr William Stern, neurology registrar— he has been in the Public Gallery since 4 o’clock—told me that he was not optimistic because of

“the current funding crisis…increasing deficits in most hospitals…targets being missed”

and junior doctors “threatening to strike”—something he does not want to do. I urge the Government to think again and end this stalemate. I urge all MPs to back the motion.

NHS (Contracts and Conditions)

Rupa Huq Excerpts

Monday 14th September 2015 Westminster Hall

[Helen Jones]

No, I need to make some progress.

What, exactly, is the Secretary of State trying to do? If he is trying to bring about a seven-day fully elective service, he needs to say so. As far as I am aware, no major health system in the world has managed to do that. If he is not trying to do that, he needs to tell us clearly—perhaps the Minister will do so when he winds up—which services he thinks should operate at the weekend.

The Secretary of State also needs to recognise that, to have the service he proposes, he needs not only more doctors, consultants and nurses on the wards, but back-up staff. Doctors operate by leading teams. If they do not have the ancillary staff—the people to do the MRI scans, the radiology and the lab tests—they cannot operate properly. We need to hear how the Secretary of State will implement his proposals. Will he recruit more staff, or will he worsen the terms and conditions of staff who are already not well paid, to introduce weekend working?

It might help to improve morale in the NHS if the Secretary of State refrained from attacking staff for not working at weekends, when they do, and actually negotiated with them sensibly. Staff know what is happening at the frontline, and they can best suggest the changes that need to be made.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

We are discussing contracts and conditions. Does my hon. Friend agree that whistleblowing is another issue over which there tends to be silence? The last time there was a full debate on it in this place was 2009. It came up tangentially in 2013, in a debate on accountability and transparency, and it has appeared in statements—I think there was one last July and one earlier this year—but is it not time that we had a full and proper debate?

[Helen Jones]

Whistleblowing in the NHS, as in other areas, is an important issue. It is important to protect staff who blow the whistle to protect their patients, which is their duty. Perhaps my hon. Friend will initiate a debate on that; I am sure we would welcome that.

When the Secretary of State talks about NHS staff and doctors, let us remember that the starting salary for a junior hospital doctor is £22,636. It is not a huge amount when someone has spent years in medical school and works many hours, and often has to deal with seriously ill patients. However, the Secretary of State proposes to change their contracts to take away the extra payments for weekend working, which will effectively mean a huge pay cut. The Scottish Executive will not do that, and that will lead to the ridiculous situation in which two doctors doing exactly the same jobs in different hospitals either side of the border will be on two rates of pay.

As for consultants, I have heard complaints from the Government that Labour raised their pay rates. Yes, we did, and I am proud that we did. I will give the Minister the reason, which was set out very clearly by Frank Dobson, who was formerly my right hon. Friend the Member for Holborn and St. Pancras. In the City there are people who probably messed about for most of their time at school and played noughts and crosses at the back of the class, and who can make millions. Across the road there will be someone who was probably the cleverest kid in their class and has worked for years in training—often someone who is at the cutting edge of medical development. Yes, those people deserve a decent rate of pay for their skills, training and responsibility.

The Government also forget that consultants’ time is allocated in two blocks: direct clinical care and supporting professional activities. Those two together make up the 40-hour week. SPA time is for such things as mentoring, quality improvement and teaching. Some consultants go on to do more teaching and research, perhaps, but they are doing extra work on top of the 40-hour week, which increases their pay. Consultants’ basic pay ranges from £70,249 to £101,451, so the Secretary of State needs to explain how he can tell us that consultants are paid £118,000 a year. How does he calculate that figure, and what is included in it?

If the Government really want more consultant time on the ward, they could look at some of the things that do not need to be done by doctors, but which doctors currently do because of lack of back-up staff. The Government always talk as if non-clinical staff in hospitals are somehow superfluous and an extravagance. That is not correct. Without the right staff, doctors and nurses are forced to take time from clinical care to do some of their jobs. For example, many doctors whom I have spoken to now collect their own data for audit and input it themselves. That is a job that a competent clerk should be doing—not a consultant. I found one hospital where there is one secretary to a group of 25 consultants. Writing letters takes consultants away from clinical care.

I found one place where the IT equipment is so old that it takes six minutes to boot up, and often collapses, with the loss of the data. If the Government really want more doctor time on the wards they should consider those issues as well, and think about the other staff. As an example, if an operating theatre does not have a full complement of staff, there is no one to send out with the patient who is in recovery, and a doctor must go with them. That slows the turnaround time for theatres, and staff are told that their turnaround time is not good enough.

I say again that it takes a team of people to run the NHS, not just doctors. Let us also remember that the NHS depends on many staff who earn very low salaries. As doctors would be the first to say, those people are an essential part of the team. The NHS Pay Review Body could see a case for some adjustments to unsocial hours pay—and I have not met any staff who do not see a case for that; but it noted that both the Department of Health and NHS employers said that the cost of unsocial hours premiums makes the delivery of seven-day services prohibitive. The Minister must tell us whether the Government will try to deliver seven-day services by cutting the pay of staff again. The review body said that that could risk the morale and motivation of staff.

Recently we have had a few soundbites from the Government, but no clear mechanism showing how they will set out to do what they say they will do. They have pledged an £8 billion increase in NHS funding by 2020. Even taking them at their word—and some of us are rather sceptical—that is the bare minimum to keep existing services going. [Interruption.] If the Minister’s Parliamentary Private Secretary, the hon. Member for Winchester (Steve Brine), will stop chuntering from behind the Minister, I will wind up my remarks. [Interruption.] PPSs, as I told someone once before, are meant to be seen, not heard.

The Minister needs to make it clear what services the Government will run and what staffing arrangements they will put in place. They can put more doctors on the ward, but that will be useless without the back-up staff. It is not surprising that one surgeon in the #iminworkJeremy campaign posted a picture of himself mopping out his operating theatre at the end of the day. That was very good of him, but is it the best use of a consultant surgeon’s time? Above all, the Secretary of State and his Ministers need to stop attacking the people who work in the NHS, and to try to work with them in a climate of mutual respect. It is not hospital doctors, GPs, nurses, lab technicians or cleaners who have caused staff shortages in the NHS; it is the Government. Those staff members did not introduce the disastrous Health and Social Care Act 2012. They are not the people requiring huge cuts in our hospitals and other services. Unless the Government are prepared to recruit more nurses, doctors and ancillary staff, more and more pressure will be put on existing staff, who will suffer burnout. It will be a downward spiral.

When I worked in teaching, a wise old head teacher said to me, “People say that the first thing you have to do in a school is ensure that the children are happy; but no—the first thing you should do is ensure the staff are happy. If the staff are happy the children will be well taught.” That is something that can be applied in many areas. I tell the Minister honestly that he needs to take note of the anger among staff that generated the petition, take it on board, stop denigrating them, and deal with them properly and sensibly, to achieve what the Government have set out to achieve.

--- Later in debate ---

[Helen Whately]

I believe that the Secretary of State has done a good job of driving the NHS in the right direction, and I know that a large proportion of the workforce have been very supportive of him.

We are all in this room because we value the NHS, but we must not be complacent. We have to recognise when it lets people down. It is intolerable that if someone has the misfortune to get ill and be admitted to hospital at the weekend, they may be more likely to die. I am not going to repeat the statistics on that, because my hon. Friend the Member for Totnes (Dr Wollaston) helpfully updated us, and I suspect that my figures are not as recent as hers. She made a strong case, as have others, for why the NHS needs to have proper seven-day care, which must include the support services mentioned by the hon. Member for Warrington North.

The Royal College of Surgeons strongly supports seven-day care. It has said that one reason why outcomes are worse at weekends is that patients are less likely to be seen by the right mix of junior and senior staff; that such patients experience reduced access to diagnostics; and that earlier senior consultant involvement is crucial. Research from the NHS National Health Research Institute shows that 3.6 more specialists attend acutely ill patients on Wednesdays than on Sundays. More senior doctors need to be available at weekends—not just on call, as many consultants are at the moment, but present in hospitals.

The changes should not be about getting doctors to work intolerable hours, and that is not what is being proposed. As has been mentioned, only a small proportion of consultants exercise their opt-out. One could argue that the changes to the workforce, and to the consultant contract in particular, are about bringing the contract into line with what is actually happening. Looking at the terms of the workforce gives us an opportunity to ensure that there is an appropriate package for doctors in A&E, where there are large numbers of vacancies. That is the case in hospitals in and around my constituency in Kent, which is an area with a high proportion of out-of-hours work. It also gives us an opportunity to ensure that clinicians are recognised and rewarded for taking on management and leadership responsibilities. We really need clinicians to step up and take on those responsibilities. It gives us an opportunity to make sure that consultants are treated as professionals who take responsibility for their patients, their team and the whole service that they provide.

The NHS faces an incredibly tough time over the next five years. It faces rising demand for its services and rising expectations, and even with an extra £8 billion on its way, things will have to change. Senior doctors, along with senior nurses and other health professionals, will have to lead those changes. When I worked in hospitals grappling with the challenges of transformation, ideas came from everyone: junior doctors, senior doctors and patients. When it comes down to it, consultants, matrons and senior staff have to lead from the front and make things happen. They often face opposition from colleagues, so they need to be courageous and put in extra hours.

To ensure that that happens, and to get the NHS from where it is now to where we want it to be in five years’ time, there has to be a sense that we are all in it together. We cannot have a situation in which doctors blame managers and politicians, while politicians and managers point fingers at doctors. We absolutely have to move on and focus on doing what is best for patients, and what will achieve the best clinical outcomes. We have to build trust among all who are involved in healthcare and work out how we can have, and how we can afford, excellent care seven days a week, day and night. We have to support the healthcare professionals—consultants, nurses, managers and everyone else who is going to make that happen.

[Dr Huq]

Will the hon. Lady give way?

[Helen Whately]

I was just finishing.

[Dr Huq]

I just wanted to ask where the hon. Lady would place management consultants in that. The NHS in north-west London has spent, I think, £13 million this year alone on Saatchi and Saatchi, and various other groups. I just wondered where she would place that in that trajectory. Hopefully, it will be something we can all agree on.

A&E Services

Rupa Huq Excerpts

Wednesday 24th June 2015 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

First, I place on record my condolences to the friends and family of the two people who tragically lost their life at Ealing Broadway station yesterday. I am sure that all Members of the House will join me in that.

Who was it who said,

“I think of the emergency nurse practitioner in Surrey, still in his overalls, telling me that closing A&E means an hour long drive to hospital for some people, and potentially lives lost”?

Does anyone know? It was the right hon. Member for Witney (Mr Cameron) in 2007. In my constituency, that possibility is becoming a reality. Four of our A&E units have either been closed or are closing. Charing Cross hospital has numerous specialisms, but 55% of the site has been earmarked for luxury housing—you couldn’t make it up. Both Hammersmith and Central Middlesex hospitals’ A&Es have already shut their doors, although Central Middlesex’s was a brand-new, well-rated facility. People are being diverted to Northwick Park, over 7 miles away from those two, which the Government’s own Care Quality Commission has rated as a failing hospital.

The Government claim that these units have been saved, but their replacement—urgent care centres—cannot be used for emergencies, are staffed by general practitioners rather than consultants, and do not take ambulances. In short, they are not A&Es. Ealing hospital—my hon. Friend the Member for Hayes and Harlington (John McDonnell) has gone now—loses its maternity services this month. The last projected birth is today, 24 June. People see that as a precursor of things to come, given what is happening to A&E.

Ealing hospital is where I lost my dad in September, so it is a place I know well. I remember the building going up in 1979. My dad was nearly 80 and had been ill for a long time, but we hear of cases such as that of the two-year-old in north London who was taken to what people thought was an A&E, but it had closed down, and he died. These cases are dismissed as anomalies, but they will become more and more frequent, if not the norm.

In my constituency, Mrs Khorsandi lives in the next road to Central Middlesex hospital. In November, after its closure, she had a seizure and was taken to Northwick Park. Her daughter Shappi Khorsandi told me that the hospital discharged her, even though she was not well enough. It was clear that there was no room for her. Her daughter said, “As I don’t drive, she came home in a taxi. She has no recollection of that.” The mother had another fit at her daughter’s house, hit her head on the sink, was taken to hospital again, and had a third seizure in front of the doctors. The daughter told me that they were amazing. Out of nowhere, five people appeared, and they were excellent; however, they had no time to breathe, let alone answer questions. NHS staff are doing the best they can, but they are operating in incredibly uphill circumstances.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Does my hon. Friend agree that while her urban constituency contrasts dramatically with my rural constituency, Government Front-Benchers should recognise the challenging geographical differences between our constituencies? The reason why the University Hospitals of Morecambe Bay NHS Foundation Trust may run a £26.3 million deficit is our challenging rural area.

[Dr Huq]

Yes. My hon. Friend makes an excellent point. Another constituent of mine, Mr Anand, lives near Hammersmith hospital and its now closed A&E. He wrote to me describing what he called “near third-world conditions”, and a queue of 10 ambulances. NHS North West London has had the worst waiting times in the country. We have witnessed cutting corners in a process that adds up to its fragmentation and selling off.

The Tory promise, “No top-down reorganisation of the NHS”, did not come to pass for my constituents. As my hon. Friend the Member for Hammersmith (Andy Slaughter) described, NHS North West London has spent £33 million in two years on consultants. It spent £13.2 million this year alone, including on Saatchi and Saatchi and McKinsey, through its programme “Shaping a healthier future”, which the locals see as trying to justify the closure of hospitals. Do not get me started on the famously airbrushed poster from 2010 that proclaimed, “I’ll cut the deficit, not the NHS”. In west London, that does not ring true. Ealing used to be known for comedy, but what has happened to our NHS locally has gone beyond a joke.