Hospital Services (South London)

Debate between Simon Hughes and Joan Ruddock

Tuesday 22nd January 2013 Westminster Hall

[Dame Joan Ruddock]

My right hon. Friend the Member for Leigh (Andy Burnham), who was Secretary of State when the Health Act 2009 was passed, has made it clear that there was never any intention to use the legislation to address major reconfigurations. The legislation was meant to address a financial problem in a specific trust and not to encompass other trusts. Does the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) agree that we need to consider the NHS London-wide? That is where we must find solutions to the financial problems of one trust, quite differently from this particular case. The trust special administrator clearly could not find a solution by considering just the South London Healthcare NHS Trust, but we cannot have the inappropriate procedure that has now been adopted.

[Simon Hughes]

The right hon. Lady, who is my neighbour, raises an important issue. With the help of the Library, I have carefully examined the whole debate on the passage of the legislation, and that issue was not addressed. If she looks back at the debates and the notes on the National Health Service Act 2006, they are silent on whether a trust special administrator could or could not make recommendations that go beyond a trust. That may not have been in the mind of her colleague, the right hon. Member for Leigh (Andy Burnham), who is a former Secretary of State, but he did not say that on the parliamentary record, although I stand to be corrected. It seems to be an open question.

The current Secretary of State told us that he has had legal advice and that he will take further legal advice, but whether or not the legal advice is that the trust special administrator can go beyond the boundaries of the area affected, there is a stronger argument for the Secretary of State not following the trust special administrator’s recommendation—and that argument starts from the legacy of the last general election in terms of the parties in government and the coalition agreement on how to deal with closures of A and E, and not doing so from the top downwards.

Secondly, the Government have set up the four tests, to which the hon. Member for Lewisham East referred and which have not been met. The Secretary of State has been handed this matter on a plate; it is not of his doing and I am sure it is the last thing he would have wished for. The announcement that the trust was going into special administration was made by his predecessor, and the current Secretary of State has been given a report by someone he did not appoint but with whom he now has to work. He has no choice. He has to deal with it, but he made it clear in his answer to the urgent question from the right hon. Member for Lewisham, Deptford that the four tests, which both he and the Prime Minister have cited, must be met.

The first test—that the proposals must be supported by GP commissioners—fails before we even get to the other three. I have no reason to believe that a single GP commissioner in Lewisham is supportive—GPs elsewhere in London might be found but they implicitly do not comment—the whole idea of the proposal seems to be that if we are handing NHS decisions from the top to the doctors, we must do things that the doctors agree are the right decisions. So the proposal falls at that first hurdle.

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[Simon Hughes]

I do not dispute that. I am not as close to the process as the hon. Gentleman. I did not follow those issues as closely, because the process did not directly affect my borough, although it directly affected his. I have taken advice from someone who has been involved over the years at Lewisham hospital and in NHS management, and the history of financial poor management in the South London Healthcare NHS Trust stretches back over 10 years. The advice I have received is that poor management should have been gripped seven or eight years ago, but the problems escalated. We are in our present position because of a legacy of poor decisions made over effectively a decade. Things might have been rescued by the Government at the beginning of this Parliament, but they clearly were not and we are left in our present position.

I have a few comments, and I do not want to take time from other colleagues who have a direct interest. I responded to the consultation to make clear the interests of my constituents. The Secretary of State invited those of us with an interest to see him, and we are grateful for that invitation, which we used, I hope, to put our case effectively. The right hon. and learned Member for Camberwell and Peckham and I, and those MPs whose constituents use King’s, have written to the Secretary of State further to that meeting to make clear our concerns about the impact on King’s of any closure of Lewisham A and E, irrespective of the change in maternity services.

There is an alternative approach, which I commend to the Secretary of State. I hope he understands the benefit of going down the alternative route, rather than following the trust special administrator’s recommendations. The alternative, which we explored at our meeting and which I do not believe was adequately answered by the trust special administrator or his colleagues, is that five of the six recommendations—excluding recommendation 5 on the site configuration—leave open the option of amalgamating NHS management between Lewisham and Greenwich. NHS management could then be allowed to work out the best configuration of services across the two boroughs in consultation with, and with the confidence of, the local authorities in question, which now have direct responsibility through health and wellbeing boards under the Health and Social Care Act 2012, and in conjunction with GPs to seek GP commissioning endorsement and support. I hope there would be much more public support than for the present proposal, as is understandable.

I hope that the Secretary of State will find that to be an appropriate solution. It may have a small financial disadvantage over the present proposals but, as the hon. Member for Lewisham East said in her speech and as she and her colleagues from Lewisham have made clear in their letters to the Secretary of State, the TSA’s figures show a financial gap of only £1.7 million from a break-even position if recommendation 5 were not to be followed, compared with a financial gap of £75.6 million if the recommendations were followed. There are knock-on effects, but we seem to be talking about a sufficiently small amount of money, with little risk of any other financially adverse impact, and if people are motivated to reach a conclusion quickly, that must be a much more satisfactory way of proceeding and much more in line with the four tests set out.

[Dame Joan Ruddock]

I wanted to give the right hon. Gentleman those figures, so I am glad he has put them on the record, because they are significant. Furthermore, there is real willingness in Lewisham, from the hospital, the GPs, the consultants and all the staff, to work for some kind of merger or co-operation with Woolwich that would reduce costs. Everyone is willing and happy to explore that, but in the right circumstances, in the right time frame and with appropriate consultation, which is what has been missing from the process.

[Simon Hughes]

I have no reason to disbelieve what the right hon. Lady says, but even more important is returning the decision to the people in the health service who are now meant to be leading it—the GP commissioners and others. That is what all of us, in different ways, believe needs to be done. She made an argument for the issue being London-wide, and that of course is the context, but the practicalities of travel and transport, whether buses, cabs, cars and trains, are such that south-east London works as a segment for health service use in a way that does not really cross over into other parts of London, other than to King’s. The only knock-on bits are the small amount of crossover to the London hospitals for specialist reasons, and some to King’s because it is so near—technically, it is south-east London, but it is in Lambeth.

Secondly, the precedent would be a bad one to set for those parts of the NHS that have been financially well managed, compared with parts that have been badly managed. Lewisham has been relatively well managed, being very nearly in balance. We rely on trusts to do their job locally and on people to manage local trusts, so we have to support those who do that job well and responsibly.

My last point is probably the most important. I have been to Lewisham A and E and visited patients there privately. It and the maternity services have developed a reputation for good clinical care of all who attend it. That was not the case some years ago, but it has been worked on, and not only physically. It has become a university teaching hospital, as well as being a local general hospital, and it has good community links—the point made by the right hon. Member for Lewisham, Deptford in her intervention. It has also built up a good reputation for integrating acute care, hospital-centred care, with community provision.

The Secretary of State could take the clinically easy decision to follow the trust administrator’s recommendation, saying, “This is what has been recommended, therefore I am following what I have been told”, but I hope that he realises the greater benefits to the local community and to the wider health economy and service of south-east London, as well as to the Government if they are seen to be listening to the people and to the GPs more than to the trust special administrator. I understand why the trust special administrator takes a hard line, because he is a health economist and his interest is finance. The Health Secretary, however, has a different job, which is to be responsible for the NHS in England, and that means making responsible decisions to secure a good NHS in all parts of south London and elsewhere.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Simon Hughes and Joan Ruddock

Wednesday 2nd November 2011 Commons Chamber

[Simon Hughes]

That would be inappropriate, and I hope that it would not happen. There should be safeguards.

I want to be constructive about how we might deal with the matter. First, when there is a helpline, as there is already, there should be monitoring not just in theory by the Government. Just as we have lay visitors at police stations and so on, there should be a facility for Members of Parliament and others—perhaps a representative group, such as the Select Committee that my right hon. Friend the Member for Berwick-upon-Tweed chairs—to be able to take part in seeing how the telephone helpline works. There will always be a telephone line, and I am not against that as an option, but it should be monitored by Parliament and Members of Parliament, as well as by the Government.

Secondly, I would be much more comfortable if somewhere was available in each region, rather than having to go through a national central location. If there was someone with the capability of knowing local circumstances, that would be hugely preferable. I hope that the Minister will be positive in his response to our concerns, and I hope that we will be given some encouragement that they will be not just listened to, but responded to at the first opportunity.

[Joan Ruddock (Lewisham, Deptford) (Lab)]

I apologise, Mr Deputy Speaker, for the fact that I will have to leave the Chamber soon after I have spoken. I am taking part in the Royal Society’s parliamentary pairing scheme.

I want to support some of the amendments tabled by Labour Front Benchers, and by the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) and my hon. Friend the. Member for Makerfield (Yvonne Fovargue). I am here solely because of constituents who have written to me, and it is their words and their concerns that I wish to bring to the Chamber today. My hon. Friend made an important and informative speech, but I will make a much simpler speech, about my constituents and my relationship with them.

I have been contacted not by the 20,000 names on my database of people for whom we have been providing help, but by the people who help them—those who look to family proceedings and the care of children, and who care for those with mental health problems, and the whole range of welfare associations and advice centres. Those workers know from their experience the limits of their own abilities to assist my constituents and, like me, know the limits of my abilities to assist my constituents. It is they who are aware of how much difficulty people will face if the Bill is enacted.

The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) spoke about the telephone gateway. Recently I tried to use uSwitch. I rang it because I accepted the Government’s message to switch my energy company. I had all the papers in line as I sat at a desk with a landline. I called up and had a discussion, but when I was asked for my S number, I asked where I was likely to find that in the papers that I had already described. The person at the other end was unable to tell me. That should have been a simple process for a middle-class educated person.

We make e-mail addresses and phone numbers available to constituents, so why, in my constituency and those of the right hon. Gentleman and so many other right hon. and hon. Members, do constituents come to see us in person? The majority of my constituents do not come in person, but the 20, 30 or 40 people at every constituency surgery do not feel able to deal with their problems over the telephone. Although I have extremely experienced and competent caseworkers, with the best will in the world they often have to say to those who call up, “I’m sorry, but I can’t get to the bottom of your problem unless you bring me the paperwork, and I see you face to face.”

[Simon Hughes]

I want to endorse one point, and to amplify it. I gave an example of someone from abroad, but in my experience, even people who were born and brought up here and have spent all their life here often need two, three or four visits before we can sort out what the issues are and get them on their way. It is not one-off bits of advice that they need.

[Joan Ruddock]

The right hon. Gentleman is absolutely right. This is key to the service that we provide as Members of Parliament. I know that Government Members have argued that we should not provide these services for our constituents, but I believe that we should, and I want to continue to do so.

Sometimes a vulnerable, sick and disabled person who has been wrongly deprived of sickness or disability benefits comes to me. I can say, “This should happen,” “That should happen,” “Yes, there ought to be a review,” or, “There ought to be an appeal.” However, I cannot assemble the evidence with that person. I do not have people with many hours to spend on each individual case who can put together the paperwork and the arguments and do the research. At the end of the day, that expert job is done by an advice person in an agency, who will refer the person to a solicitor, who will provide them with legal aid—or we might refer them directly. That service is absolutely vital, and if the person does not have it, they are totally denied justice.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Simon Hughes and Joan Ruddock

Monday 31st October 2011 Commons Chamber

[Simon Hughes]

I will speak briefly on amendment 145, which the Minister has addressed and on which I asked him a quick question. If I may, I will amplify that point.

My point is not about the important matter of domestic violence, which my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) has spoken about and on which there is continuing concern across the House, but about the families of those who are rightfully admitted to this country as refugees or beneficiaries of humanitarian protection. Many Members, including me and my neighbour the right hon. Member for Lewisham, Deptford (Joan Ruddock), encounter such cases routinely in their constituency surgeries. This is not an irregular occurrence in our work.

Somebody who is granted the ability to stay in this country as a refugee because of race, religion, nationality, membership of a social group or their political opinion, or somebody who is given humanitarian protection because they are at risk for some other reason, might have applied for their family members to come with them as dependants or their family members might have made separate, parallel applications. In such cases, their family members can be dealt with in the same way.

However, we all know that when people come here as refugees, they do not often do so in an orderly way as a family. It might be that one family member comes here from one country and other family members from another. For example, when Sierra Leone had its civil war, people fled from it with some ending up in Gambia and others elsewhere. It might be that one family member comes at one time while another is left in a refugee camp. It might be that other family members had disappeared when the application was made. It might be impossible for the mother, the wife or the daughter to make an application at the same time. It is those cases that I am concerned about.

I accept that often there are straightforward applications that do not have complications, but sometimes there are significant complications and we need to ensure that people are not disadvantaged because they cannot match the state in argument.

[Joan Ruddock]

The right hon. Gentleman is indeed my neighbour and we share such cases. Perhaps I can help him by giving an example. I am dealing with a woman at the moment who has advanced cancer. She has children and has the right to be here, and she is trying to get her husband to join her. She tried to make the application alone, but got it all wrong and the state said no. She does not need me giving her a bit of advice, but proper legal assistance to make her case speedily and accurately. She would not get that under the future arrangements.

[Simon Hughes]

The right hon. Lady gives a good example. It is often people with difficult personal circumstances who have such problems. They might be here and unwell or dying. They might be literally on their own in this country. All the evidence shows that if we want people who come here as refugees or for humanitarian protection to integrate, the best way to achieve that is for their family to be here to give them support; often that is intergenerational support.

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[Simon Hughes]

It might or might not surprise the hon. Lady to hear that I was not at the Conservative party conference. I can mischievously go one step further and say that I was on an official visit to India at the time, so if she will forgive me, I cannot comment on the conference because I did not even see it. I understand where she is coming from. Such sensitive issues are often capable of being misrepresented by our constituents and by public opinion at the tabloid end of the press. However, if my family had undergone such trauma, I would want the support of the country in which I had sought refuge.

I shall briefly add a last few facts, and I pay tribute to the Immigration Law Practitioners Association, which provides a good support system for all who deal with this sort of work. First, 61% to 66% of refusals are overturned on appeal. The evidence, therefore, is that people win such cases not occasionally, but regularly, even if they need to come through the system on appeal.

Secondly, the situations of the applicants often seriously compound their difficulties in making the application or pursuing an appeal. Family members could be in hiding, or they could be in a country where they have no lawful status. They too might have faced or fled persecution. The remnants of the family might be isolated, in hiding or shunned. As the hon. Member for Bridgend (Mrs Moon) said, they could be in dire financial straits. For such people, making phone calls, let alone international ones, would be impossible. The chances of a person in Shatila refugee camp, for example, having the cash or ability to make international phone calls to establish their rights to join their family in the UK are minimal. Camps are not geared to dealing with individual international applications for family reunion—they are just not an appropriate context for that.

Evidential demands could be substantial and protracted. People might need witness statements from other relatives, who could be in this country or another one, which might not be the one where the applicant is. Family members often have to be traced and communication is sometimes slow. The right hon. Member for Lewisham, Deptford made the point that submitting the application correctly so that it gets through the system is not easy.

However good the immigration judge is, a litigant in person in those circumstances, who might have poor English and who might be only a recent arrival, and who might be worried and traumatised by their history, might not be in a good position to make an effective case in front of the court. In any event, the judge cannot, by definition, see the other family member, because they will not be here. The judge cannot hear evidence from them or others from whom he may need to hear.

I hope the Minister understands. Those are real cases, and I hope I can appeal to the sympathy and understanding of colleagues in the Department. If somebody can come here as a refugee or on humanitarian grounds, the logic must be that their immediate family should be able to come with them. That is the expectation of the international agreements that we have signed, which the Government should understand.

[Joan Ruddock]

The right hon. Gentleman makes an utterly compelling case—I agree with it totally and I wish to vote for the amendment, so I trust that he will press it to a Division.

[Simon Hughes]

In one sense, the right hon. Lady makes an absolutely reasonable proposition. I am determined that we will win this argument, but I will wait to see what the Minister—[Interruption.]

Local Government Funding

Debate between Simon Hughes and Joan Ruddock

Monday 6th December 2010 Commons Chamber

[Simon Hughes]

I say clearly to the right hon. Lady that, as I have indicated, I have argued publicly and privately that it would be better for the spending reduction to be spread more evenly. I have been into the Department to make that case. A parliamentary committee of Liberal Democrats from both Houses has collectively made that case, and it includes people who have been leaders of local councils. I understand and share the view that it would clearly be easier for local government to manage a gradual reduction than sudden and bigger reductions in the first two years, a small reduction in the third year and then an intermediate reduction. There is no disagreement on this issue between the right hon. Lady and me, and there is not much disagreement between councils of all colours around the country, which are making that point to the Government. I hope that the Government and Ministers in the Department for Communities and Local Government have been able to make some progress on that point, given that they obviously have to start with an announcement made by the Chancellor which reduces their flexibility—we will doubtless hear when the settlements are made.

[Joan Ruddock]

I do not know where the hon. Gentleman’s local authority lies in the indices of multiple deprivation, but mine is the 39th most deprived in the country. I say to him that there is a need for him to advise the Government on how to create fairness between boroughs such as ours and the Prime Minister’s local authority, which has been cited and is in the 5% least deprived areas in the whole country.

[Simon Hughes]

The right hon. Lady would expect me to be sympathetic to that point and I have acted in the past few weeks on that very issue. I have been in to see Ministers; I went to see the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Hazel Grove (Andrew Stunell), and civil servants to discuss exactly that issue. I believe that it would be wrong if all the funding currently given to councils, including the working neighbourhoods fund, which was a top-up in order to assist deprived communities, was not taken into account as the starting point for the calculation for the next grant. I have also argued that it would be inappropriate for there to be a greater decrease in percentile terms for authorities such as hers and mine, which have significant deprivation, than for smaller authorities, just because we happen to have had a larger amount of public money before. I have been given reassurance that an upper and lower percentage reduction will be common across all local government—a band above and below which the reduction cannot happen—and that there is a likely inclusion of at least some, although I hope all, of the other funding, not just the core formula grant.

I understand the point that the right hon. Lady makes, and she would expect me to go into bat for deprived communities, because I represent a borough that has a higher deprivation index than the next-door borough of Lewisham—I believe that is the case. Relative deprivation is not a competition we are proud of, but this is something we have to deal with. Of course one of the things that we have to do is try to get a fair settlement that reflects the needs of and deprivation in all the local authorities in that settlement. Again, I can tell her that I have been doing the job that she, my constituents and my local authority, although it is run by Labour, would expect me to do, just as I would have done when my local authority was run by my colleagues.