Accident and Emergency Departments

Siobhain McDonagh Excerpts

Thursday 7th February 2013 Commons Chamber

[David Morris (Morecambe and Lunesdale) (Con)]

Thank you for calling me, Mr Deputy Speaker. My constituents will be paying close attention to this debate.

For some weeks the press in my constituency has been awash with allegations about both maternity and accident and emergency services at our local NHS trust. What concerns me is not that the services will change, but the scare stories surrounding all this. I have received a letter from Jackie Daniels, the chief executive of the trust, confirming that it will not shut the A and E department at Royal Lancaster Infirmary. She wrote:

“‘The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster.

We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”

So the chief executive of the trust has said that not only has she no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.

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

May I urge the hon. Gentleman to be careful about this? Most Labour Members face closures of A and E departments that serve twice that number of people.

[David Morris]

I shall come to that in my speech.

A concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E department is likely to close. The campaign involves press briefings, an online petition, a Facebook group, and even people walking around the centre of Morecambe with clipboards inviting people to join it. I want the e-petition to be removed from Directgov, and I have written to the Cabinet Secretary asking him to intervene. We cannot allow a dishonest campaign to be fought on Directgov e-petition platforms. If the A and E department is not under threat, it must be concluded that people are being frightened for the purpose of political advantage, which, in my view, is morally wrong.

Perhaps it is time to admit the truth: the trust is getting better under the present Government. A new and better management was introduced by the former Secretary of State. Only a few weeks ago, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) opened a new minor injuries unit in my constituency. A new health centre in Heysham, costing £20 million, was opened last year, and four new wards have just opened at Lancaster hospital. I pay tribute to my hon. Friend—for he is my hon. Friend outside the Chamber—the Member for Barrow and Furness (John Woodcock) for ensuring that maternity services in Barrow remained secure.

All that was paid for by a 2.8% increase in funding for the NHS under the present Government. This debate is part of a national campaign to scare people into believing that the NHS will be deconstructed.

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

I join this debate as another Member whose A and E is targeted for closure. My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.

Last summer, the bad news came that it would be my local hospital, St Helier, that would lose its A and E, maternity, intensive care unit, children’s unit, renal unit and 390 in-patient beds. To be honest, it has all been a bit of a shambles. NHS South West London was due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed. Then, in September, it proudly press released that a decision was imminent and that the public consultation would start on 1 October. One doctor was quoted as being

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

The decision was put off. I would love to say that it was because of what local residents had to say, but actually it was because of a scathing national clinical advisory team report on the plans, which mocked BSBV’s claim that an astonishing 60% of emergency patients would use primary care instead of A and E, saying:

“The Assumption that 60%...can be managed by clinicians from primary care demands…local analysis. Elsewhere in the UK a consistent finding is…far lower, usually…15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

What really put a block on the plans was the sudden collapse of another nearby hospital. Epsom hospital has long had financial troubles. In the 1990s, they were so bad that it was forced to merge with the more financially viable St Helier to form the Epsom and St Helier University Hospitals NHS Trust. The merger was never ideal, as Epsom has more in common with other Surrey hospitals than with St Helier. In 2011, it was finally decided that the Epsom and St Helier should de-merge and that Epsom should merge with a hospital in Surrey—Ashford and St Peter’s hospital.

All was going well until last year, when it was revealed that Epsom’s debts were far worse than originally thought. The merger deal with Ashford and St Peter’s collapsed, and Epsom was left out in the cold. This made Surrey panic about what BSBV was planning. After all, if St Helier lost its A and E and Epsom collapsed, there might be no hospital between Tooting and Guildford—so BSBV was put on hold again. In retrospect, that only made matters worse. Instead of closing one A and E out of four hospitals, the local NHS has just decided to close two out of five. That will be catastrophic.

We all know that Epsom, with its MP in the Cabinet and its wealthy population who can afford a judicial review, will put up a big fight, so the consequences for south-west London will be disastrous. There are parallels with what happened in Lewisham. Patients will suffer because of the financial problems of a hospital miles away. We thought things were bleak before; they are even bleaker now. With St Helier singled out for service closures even before this latest development, it is going to be even more difficult for our community than ever before. The argument remains the same, and my local community will not stop arguing. Closing services at St Helier is a false economy, as 200,000 people will have further to go in an emergency.

If things were bad enough even before Epsom’s problems were thrown into the mix, we will now find that an A and E will close, even though A and E visits are due to go up 20% in the next five years, and a maternity unit will close, with thousands of patients giving birth further from home, even though birth rates will go up 10%. Even when just St Helier was under threat, the National Clinical Advisory Team said:

“Successful implementation…depends on a multitude of supporting improvements”

and these

“are not well defined in the proposals.”

It concluded:

“The reconfigurations are based on an optimistic view of capacity”.

Next Monday, I will host a meeting for my local constituents to try to update them about what is going on. Obviously, the fight goes on.

The NHS admits it must save £370 million in my part of London alone. The UK Statistics Authority has made it clear that the Prime Minister has broken his electoral pledge to increase health spending. Demand for A and E is up, and the birth rate is up; but instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. If St Helier goes the way of Lewisham or worse, and loses its A and E and countless other services, my constituents will know why. My constituents are very angry: they know this will not work, and they want to hear from the Minister today that it will be stopped.

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[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I greatly enjoyed the speech of the hon. Member for Ealing Central and Acton (Angie Bray) and share many of her sentiments, but I hope she will forgive me for saying that her contribution lacked a sense of regional and national context. Despite the pretence of a national review, to which my hon. Friend the Member for Ealing, Southall (Mr Sharma) alluded, closing substantial numbers of A and E units is clearly now Government policy. Professor Matthew Cooke has been advising the Department of Health on A and E issues—he did so last year, at least. He has spoken to NHS North West London, supporting its plans to close four of our nine A and E departments, and he was reported in the Daily Mail as saying that those plans were in line with national Government policy.

At the 2010 general election, the Conservative party manifesto promised to stop the closure of A and E departments. Indeed, I think the Prime Minister insisted there would be a moratorium to stop further A and E closures. If I remember rightly, during the election campaign the Prime Minister visited Chase Farm A and E department in London and Queen Mary’s A and E department in Sidcup, promising to stop their closure.

[Siobhain McDonagh]

And Kingston, too.

[Mr Thomas]

Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.

My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.

We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.

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[Mr Charles Walker (Broxbourne) (Con)]

rose—

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.