health

Siobhain McDonagh Excerpts

Tuesday 18th September 2012 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

My local NHS says that it needs to reconfigure services because it has

“to deliver £370 million savings each year...a reduction of around 24% in…costs.”

As a result, it plans, through a programme ironically called “Better Services Better Value”, to close a wide range of services at my constituency’s local hospital, St Helier. Most of the controversy has focused on the closure of our A and E and maternity units, but we also face losing our intensive care unit, neonatal ICU and renal unit, as well as about 50% of St Helier’s 390 in- patient beds.

Since I last raised this subject in the House in July, a number of interesting things have happened. First, the right hon. Member for Sutton and Cheam (Paul Burstow)—whose constituency, like mine, is on the borders of St Helier—lost his job as a Health Minister and launched a withering attack on the plans, describing them as “dangerous and flawed”. As a Minister in the Department for Health, he would know; although I imagine that he wanted to stay and to continue to be collectively responsible for St Heller’s demise.

Then the right hon. Member for Carshalton and Wallington (Tom Brake), whose constituency contains St Helier, decided that he was so upset about the plans that he would take a principled stand by joining the Government as deputy to the man who is responsible for what has happened in the NHS over the past two years. Congratulations are due to him for showing his disapproval so strongly.

Ten days ago, Michelle Baker and Karen Russell, mums from my constituency and part of the Save St Helier campaign, organised a picnic with a purpose outside the hospital. Thousands of local residents joined in, and although it was billed as a fun day, we were deadly serious. The leader of Merton council, Councillor Stephen Alambritis, a former football referee, was cheered as he brandished a red card at the plans, while the medical director of “Better Services Better Value” was booed as he was handed our petition, signed by more than 30,000 people.

In other developments, it is becoming increasingly clear that, behind the scenes, the case for the closure is falling apart. NHS South West London was originally due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed at the last minute. Then, last month, the team proudly issued a press release stating that a decision would be made on 27 September and that

“the aim is for it to go out to public consultation from 1 October”.

Dr Finch said that he was

“excited by the huge potential of the BSBV programme.”

Now even that decision has been put off for at least another month. Perhaps the delay is connected to polls of GPs and patients that showed that a majority were against the closure, but I suspect that that it is mainly due to the publication of the National Clinical Advisory Team’s report on the plans.

NCAT reports represent a key step in any hospital reconfiguration and need to be properly scrutinised, so on 17 July I requested a copy of the report under the Freedom of Information Act. Under FOI rules, I should have received a copy by 14 August, but it was not until a week later that I received one, along with a press release claiming that NCAT had

“given the Better Services Better Value review the green light to move forward”,

and that

“we are very pleased that the NCAT team have agreed that our proposals should be supported”.

However, although the press release gave the impression that everything was running smoothly, that impression was extremely misleading.

The most fundamental criticism of the closure plan is that it is predicated on the assumption that 60%—yes, 60%—of emergency patients can use primary care instead of A and E services. Obviously, it is very much in GPs’ interests for BSBV to succeed. It is led by local GPs, and they clearly have an interest in ensuring that more patients use primary care rather than hospitals, whether or not that is what patients want, because the money follows the patient.

NCAT has looked at the 60% target and, ever so politely, has laughed it off. The report says:

“The assumption that 60% of ED”—

emergency department—

“patients have conditions that can be managed by clinicians from primary care demands detailed… analysis. Elsewhere in the UK a consistent finding is…far lower, usually in the order of 15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

NCAT goes on to say:

“The ED consultants interviewed suggested that the primary care workload in their departments is in the order of 15-20%”

and that

“The estimate of 60% is often derived from coding data...patients who have no x-rays, no specific treatment, no follow up and are not admitted are regarded as ‘minor’ and therefore it is assumed that they could be seen by primary care clinicians. It is recognised throughout the NHS and particularly in emergency care, that such data lack reliability”.

The report also questions the assumptions behind the proposal that St Helier could be saved by becoming South West London’s elective hospital. It is hard to see why any patient would choose to travel so many miles from Croydon, Wandsworth or Kingston to a hospital that had lost so many services, to receive treatment that they could receive at their local hospitals, or why any ambitious staff member would want to work there.

NCAT says:

“The concept of a planned in-patient care or elective hospital serving the whole area was generally supported”

by clinicians. It continues:

“However there was no evidence that this would free enough in-hospital capacity to absorb the additional acute workload for the remaining three hospitals.”

The report adds:

“There was concern that the links between acute medical services and the community were not dependable.”

NCAT admits that, although most experts consider it a bad thing for maternity units to deliver more than 6,000 babies a year, South West London’s three remaining maternity units would have to deliver 6,500 babies each—in addition to the 2,500 babies delivered in midwife units and the 880 delivered at home.

NCAT concludes:

“Successful implementation…depends on a multitude of supporting improvements in primary care, community services and professional practice that are not well defined in the proposals.”

Worse, it admits:

“The reconfigurations are based on an optimistic view of capacity, recruitment, meeting increased demand in primary and community care and the challenges posed by the introduction of new ways of working.”

I could go on and on.

On the basis of such optimism, 200,000 people will have to make longer journeys to hospital in an emergency. An A and E department will close, although the number of A and E visits will rise by 20% in the next five years. Tens of thousands of women will have to worry about how they will give birth at hospitals further from home, and a maternity unit will close, although the number of births will rise by 10%. Thanks to the combination of cuts and GP commissioning, a flawed decision to close St Helier is about to happen. It will not work, and it must be stopped.