Acquired Brain Injury

Siobhain McDonagh Excerpts

Thursday 6th February 2020 Westminster Hall

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

I thank the all-party parliamentary group on acquired brain injury for its continued determination to ensure that the issue is given the time and attention it deserves; I particularly thank my hon. Friend the Member for Rhondda (Chris Bryant), who has campaigned admirably. Politicians’ stock is low at the moment, but anyone who heard his contribution, with its passion, hard work, determination and sincerity, would feel a lot better about what we do.

As the right hon. Member for South Holland and The Deepings (Sir John Hayes) said, one person is admitted to hospital in the UK every 90 seconds as a result of brain injury, so it is imperative that the recommendations in the APPG’s report, “Time for Change”, are implemented without delay. I fully support the excellent report and endorse all its recommendations.

As hon. Members may know, I have a long-standing association with the brain injury charity Headway, mainly through its chief executive, Peter McCabe, who has been my friend and colleague in Mitcham for more years than I care to say. His charity does incredible work across the UK to support individuals and families affected by brain injury. The help provided by Headway is seen as a lifeline to those who receive it, whether through its helpline—inquiries to which have more than doubled in the past decade; through the provision of free, award-winning publications to help people understand and adapt to life after brain injury; or through grants distributed via its emergency fund.

Many hon. Members will also testify to the exceptional work done by Headway groups and branches in their own constituencies. The APPG report rightly calls for a national review of neurorehabilitation to ensure that service provision is adequate and consistent throughout the UK. This report must not confine itself to acute care settings. Headway groups and branches are under severe financial pressure as a result of cuts to local authority budgets. The fact that they continue to provide such vital support, through rehabilitative therapies and social interaction programmes, is a testament to their determination to support this vulnerable community.

Let us be clear: the pressure under which Headway groups operate must be eased, and they must be afforded the funding they need to continue to support people who may otherwise be cut adrift from society. “Time for Change” also calls for improvement to how the criminal justice system meets the needs of brain injury survivors. In a previous debate on acquired brain injury, I highlighted Headway’s brain injury identity card, which helps to identify brain injury survivors when they come into contact with the criminal justice system. To date, more than 7,000 such cards have been distributed to vulnerable adults in the UK.

The ID card is part of Headway’s Justice Project, which is helping to increase understanding of brain injury within the criminal justice system. That includes the provision of training to the police, liaison and diversion services, the Crown Prosecution Service, the Public Prosecution Service in Northern Ireland and other agencies. As highlighted in the report, this work is vital and charities such as Headway must be supported in delivering the training required.

I have also previously spoken of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in the acute stage of care following a brain injury. Since it was established, the fund has distributed more than £400,000 to almost 2,000 families with limited income or savings. About 82% of those grants are spent on travel, accommodation or parking at hospitals when no alternative transport is available—an issue I would like to focus on.

In December, the Government announced a new approach, giving access to free hospital car parking for thousands of NHS patients and visitors. I congratulate the Government on that announcement, which stated:

“From April, all 206 hospital trusts in England will be expected to provide free car parking to groups that may be frequent hospital visitors, or those disproportionately impacted by daily or hourly charges for parking”.

Each year, thousands of patients admitted with ABI will have sustained severe brain injuries, putting them at the greatest risk of a fatal outcome. If they survive, they face many weeks or months in acute care and rehabilitation. The development of major trauma centres and specialist brain injury units results in improved outcomes for patients. However, the emergence of such centres has meant patients being treated many miles from the family home, resulting in families facing financial hardship to be by the bedside of their loved ones.

If the patient is the main breadwinner or self-employed, the financial stress placed on the family can force them into impossible choices. The families of patients who have sustained potentially fatal acquired brain injuries will be desperate to be by the bedside of their loved ones at such a critical time, often for periods of several weeks or months. I am sure everyone agrees that they should be classified as “frequent hospital visitors” who are

“disproportionately impacted by daily or hourly charges for parking”.

Will the Minister confirm that that will be the case? It is vital that we receive confirmation today that it will, so that that vulnerable group receive the support they so clearly deserve.

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[Caroline Dinenage]

Yes, I am very happy to commit to doing that.

Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.

The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.

My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.

The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.

For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.

These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.

The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.

It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.

The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.

Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.

The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.

[Siobhain McDonagh]

I thank the Minister for giving way on this important issue. There are many terrible stories of people spending their life savings in an effort to keep being able to visit children and partners. Could the Minister specifically say, or could we have a response in writing to this effect, that that includes the families of people with acquired brain injury? I have been seeking some clarification from the Department, but all the responses have so far been obscure.

[Caroline Dinenage]

I will certainly seek to get that in writing for the hon. Lady.

My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.

NHS Funding Bill

Siobhain McDonagh Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Jonathan Ashworth]

We lost the general election, but that does not give Tory Members a free pass on the state of the NHS. We have seen an increase in trolley waits in hospitals in December of 65%, and trolley waits in the past year, on this Secretary of State’s watch, have risen to 847,000—the highest number of trolley waits in hospital corridors on record.

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

Is my hon. Friend aware that twice in the past fortnight St George’s Hospital in Tooting has been on OPEL—Operational Pressures Escalation Level—alert in A&E? It has been one level below having to close its doors to all emergencies because the hospital was so full. Such a closure would have a devastating impact on south-west London.

[Jonathan Ashworth]

My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.

--- Later in debate ---

[Jonathan Ashworth]

The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.

As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.

The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.

In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.

This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.

We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.

Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.

[Siobhain McDonagh]

Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.

--- Later in debate ---

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

I am really grateful for the opportunity to participate in this debate, because it has particular relevance to my constituency. My mum came from Ireland to London in 1948 to train in the first generation of NHS nurses. She spent her whole working life as a state-enrolled nurse in large, long-stay mental health hospitals. She loved her patients. She loved the NHS. She loved her country, which gave her the opportunity to work and raise her family. The same cannot be said for her views on Mrs Margaret Thatcher, who she blamed for making her redundant in the early 1980s, when my sister Margaret and I were still at university.

My mum had a phrase: “Much gets more”—those who have get more, and those who have little get least. We know that the life expectancy of more well-off people is getting longer, with longer periods of good health. We know that the life expectancy of poorer people is going down—in the 21st century!—and the period that they live in ill health is getting longer. We also know that those who are well off have better GP services. We know that poorer people access the NHS in different ways, often via A&E, so one would have thought that the moneys for acute services would be allocated to the poorest areas.

That brings me back to my mum’s phrase “Much gets more”, because in my constituency, my local NHS trust is still consulting on a plan that moves the A&E, the maternity unit, paediatric services and in-house surgery from St Helier Hospital to Belmont. To those who have more, more will be given. So what is the answer? The answer appears to be, from the trust’s deprivation research, to be partial with the truth.

The Minister will know that our constituencies are broken down into areas called lower layer super output areas, which are ranked by levels of deprivation, so that those relocating health services can consider the impact that their decision will have on the most deprived communities. The latest consultation in my area acknowledges that requirement and has even produced a deprivation impact analysis. The title is promising, but the contents are utterly bewildering.

The statistical reality is that, of the 51 most deprived lower layer super output areas in the catchment area, just one is nearer to the site in Belmont that the NHS wants. Meanwhile, 42 out of 51 are nearer to St Helier Hospital, which affects my constituency. Does the Minister agree that acute hospital services should be based where they are most needed and that deprived communities must not be negatively and disproportionately impacted? If so, now that I have put the flawed evidence on record, does he agree that the consultation should review the deprivation analysis before proceeding further? What is more, the consultation assumes that my constituents will travel to the new site, regardless of where it is, but they will not. These plans will put severe pressure on St George’s and Croydon University Hospital, both of which are regarded as having too many people arrive at them right now.

Let me make this clear: I am providing concrete examples of missing and flawed evidence in the consultation analysis, and yet that same analysis has been used to determine Belmont as the preferred site for capital funding. Will the Minister meet me urgently to discuss these proposals? I appeal to him to step in before another penny of taxpayers’ money is spent on this bogus consultation. I hope that my mum’s phrase “Much gets more” is not true of the NHS in south-west London, but Breda was normally right about everything.

--- Later in debate ---

[Edward Argar]

Because the cash set out in the Bill is the money that the NHS is going to be getting as a floor.

The shadow Minister rightly raised the issue of mental health. My right hon. Friend the Secretary of State was rightly clear that spending on mental health provision will increase the fastest under the proposals in the Bill, with spending on children’s mental health increasing the fastest of all. I am sure the Opposition will welcome that.

My right hon. Friend the Member for South West Surrey (Jeremy Hunt) rightly highlighted the quantum of spending and how that compares to other countries around Europe and, indeed, in the OECD. I pay tribute to him, because a lot of what we are talking about today is based on the foundations that he built when he did such a fantastic job as Secretary of State.

The hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) rightly alluded to the Bill’s impact on Barnett consequentials and spending in Scotland. As the hon. Lady will know, the Barnett consequentials will apply. My hon. Friend highlighted the fact that not only the NHS in England but the NHS in Scotland faces challenges that we must all step up to meet.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) highlighted the need for us to focus not just on inputs but on outcomes and what we achieve with the money that we invest. That is exactly what the Secretary of State is determined to do.

The hon. Member for Nottingham South (Lilian Greenwood), a fellow east midlands Member, highlighted the need for capital investment in her local hospitals in Nottingham. I am happy to meet her to discuss that further, if that would be helpful to her.

Let me turn to maiden speeches. My hon. Friend the Member for Darlington (Peter Gibson) made an excellent maiden speech. As Members have said, his predecessor Jenny Chapman was respected and well liked in the House. I suspect that, given his speech, he will achieve exactly the same distinction. He spoke forcefully and powerfully on behalf of his constituents. I am sure that they will find him a doughty local campaigner in their interest.

My hon. Friend the Member for Ashfield (Lee Anderson) paid tribute to his predecessor, Gloria De Piero, who was my shadow when I was a Justice Minister. He was right to pay tribute to her, because she was a fantastic colleague to have in this House. None the less, he achieved a fantastic result. As a fellow east midlands MP, I know his constituency well. It is a fantastic place and his constituents are very lucky to be represented by him. He is a local man standing up for his community. He also spoke movingly of his journey—if I may put it this way—from pit to Parliament, and the power of social mobility, of aspiration and of opportunity. He reminded me of a former colleague of ours and a good friend of mine, Sir Patrick McLoughlin, who made the same journey. He ended up in the Cabinet, so I will be watching my hon. Friend’s inevitable ascent carefully.

The hon. Member for Feltham and Heston (Seema Malhotra) touched on, among other things, Heston health centre. Again, as ever—as in my previous role—I am happy to meet her to discuss that. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), in an eloquent but forceful maiden speech, clearly put this House on notice that he will always speak up for his principles and his beliefs, and, while we may on occasion disagree on policy, I doubt we will disagree on his passion and determination to champion his constituents’ interests.

My hon. Friend the Member for Dover (Mrs Elphicke) also focused on achieving outcomes. She touched on the tragic death of Tallulah-Rai Edwards. I extend my condolences to the family, but may I also say that my hon. Friend the Parliamentary Under-Secretary of State for patient safety will be happy to meet her to discuss that in more detail.

It is always a pleasure to meet the hon. Member for Easington (Grahame Morris) and to hear from him. We have met previously, and he and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), are due to meet again to discuss this matter in a few weeks’ time when we will pick it up further.

Let me turn now to my hon. Friend the Member for Birmingham, Northfield (Gary Sambrook). May I pass on my congratulations to his sister on the birth of Freddie and pay tribute to all staff, as he did, working in our amazing NHS for the work that they do. Many hon. Members paid tribute to them, including the hon. Member for Rhondda (Chris Bryant), and my hon. Friend the Member for Banbury (Victoria Prentis)—I have no doubt that I will be hearing from her about the Horton on many occasions in the future. My hon. Friends the Members for North Dorset (Simon Hoare) and for South Dorset (Richard Drax) made powerful pleas for investment in their community hospitals and in their local health infrastructure. I am a regular visitor to the constituency of my hon. Friend the Member for North Dorset, so I look forward to visiting both colleagues in due course.

As well as talking about Crawley Hospital, my hon. Friend the Member for Crawley (Henry Smith) highlighted the need for Gatwick airport to be included in the conversations on the coronavirus, and I know that my right hon. Friend the Secretary of State will have heard what he said, and is already factoring that in.

Before concluding, I will touch very briefly on two other contributions: my hon. Friends the Members for Stoke-on-Trent Central (Jo Gideon) and for Stoke-on-Trent North (Jonathan Gullis)—and indeed my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), who was not in his place. They have all highlighted the issue of the private finance initiative. I am happy to meet them to discuss it further.

Let me turn now to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) and the hon. Member for Mitcham and Morden (Siobhain McDonagh). I have to say that my hon. Friend made a very strong case for the benefits that this investment will bring for all those who are served by his local trust. I encourage the hon. Lady to engage with this process and engage with the benefits that this investment will bring.

[Siobhain McDonagh]

Will the Minister give way?

[Edward Argar]

I am afraid that, with one minute to go, I will not give way.

The nation’s health and social care is the people’s priority and it is also our priority. Key to delivering on our long-term plan, and the NHS’s long-term plan, is giving the NHS the investment that it needs. This Bill does exactly that. We are delivering on the people’s priorities and on our pledges to the NHS, and I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Health and Social Care

Siobhain McDonagh Excerpts

Thursday 16th January 2020 Commons Chamber

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

This is my first contribution in the House in this new Parliament, and it is a pleasure to see you in the Chair, Mr Deputy Speaker.

Given that the subject of today’s debate is health and social care, I would like to start by expressing my sincere admiration for the selfless and dedicated staff who have kept our NHS operating this winter under the most testing of circumstances. It has been a period that has pushed A&E waiting times to their worst on record, but despite 10 years of austerity leaving our treasured NHS desperately short of staff, services and supplies, the biggest threat to my constituents is to be found far closer to home. Yes, it is back. From now until April fool’s day, of all days, my constituents are once again being consulted on the future of St Helier Hospital.

Under countless brands and titles, this consultation has been run time and again at a staggering cost of over £50 million. This latest consultation has been triggered thanks to the Government pledge of £500 million to Epsom and St Helier University Hospitals NHS Trust. This time it is branded as “Improving Healthcare Together”, and it builds on the unscrupulous foundation of its predecessors to determine how those funds will be used and where the acute hospitals in south-west London should be based: in St Helier or Belmont.

Of course I welcome any investment in our treasured NHS, but as ever, the devil is in the detail. These latest proposals push for both St Helier and Epsom hospitals to lose their key acute services, moving them south to Belmont. The reality is that St Helier would lose its major A&E, consultant-led maternity, acute medicine, critical care, emergency surgery, in-patient paediatric and children’s beds. That represents 62% of St Helier’s beds, and the move would leave a shell of a hospital that could more accurately be described as a walk-in centre. The consultation assumes that my constituents will travel to the new site regardless of where it is, but they will not. If St Helier is downgraded, my constituents will turn to either St George’s, where the A&E is already in the bottom quartile for space standards, or Croydon University Hospital, where bed occupancy is already at 99%. How can it possibly be a sensible idea to force even more people to rely on such overstretched services? The impact would be devastating.

I have pointed this out time and again to those running the consultation. Meanwhile, they have spent millions of pounds of taxpayers’ money on misleading impact reports with utterly astounding gaps in their analysis. Let us take Pollards Hill in my constituency. It would be considered deprived by comparison with much of Sutton or Epsom, but it was deemed by the consultation to be outside St Helier Hospital’s catchment area. However, the largest GP surgery in Pollards Hill directs 34% of its patients to the hospital. That matters, because areas that rely on St Helier were not even considered in the analysis, so how can the potential impact of moving acute services from the hospital be adequately assessed? I have pointed out such gaps, but they have not been rectified, and the health and deprivation figures in my constituency have been disguised by including the neighbouring constituency of Wimbledon and calculating the deprivation for Merton as a borough. This is not a political tool; it is a hospital, and it should be based where it is needed.

The situation gets even more unbelievable, because the deficient evidence was then assessed in behind-closed-doors workshops, with all those attending forced to sign a non-disclosure agreement before being allowed in. That brings us to the present day, with the latest consultation launched last week. The flawed analysis has been used to decide on Belmont as the preferred site for acute services in south-west London, and that preference is clearly stated on the consultation document itself. How can that possibly be acceptable?

Maybe I should just be grateful that these documents were actually delivered to all households this time around, rather than to the preferred target areas like last time. It is time for some accountability and for the Government to step in before St Helier Hospital’s future is thrown into jeopardy. I challenge every foundation that this programme has been built upon, and I appeal to Ministers to step in before another penny of taxpayers’ money is wasted on this bogus consultation. It is time for the madness to end. Leave these vital services where they are most needed: at Saint Helier hospital on its current site.

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 29th October 2019 Commons Chamber

[Mr Speaker]

Not just a champion but doughty!

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

This plan could see two A&Es reduced to one and two maternity units reduced to one. Have the Government taken into account the need for extra capital funding for both St George’s and Croydon university trust should St Helier place this new hospital on the Sutton Hospital site?

[Edward Argar]

The hon. Lady will know that the plans that will be brought forward will be clinically led and delivered and constructed by the trust itself, so I would encourage her to engage with the trust and with neighbouring trusts, but surely she would welcome this significant investment by the Government in her health infrastructure.

Health Infrastructure Plan

Siobhain McDonagh Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

As he said, my hon. Friend showed some dexterity in asking that question, but I am happy to reassure him. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is looking at this matter, and I am sure that she will be happy to discuss it with him further.

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

I would always welcome more money for our NHS, but as always the devil is in the detail. The “Shaping a healthier future” programme proposed the closure of four A&Es in north-west London, at a cost of £76 million, but just six months ago the Health Secretary stood at that Dispatch Box to declare the scheme scrapped. The author of that scheme, Daniel Elkeles, is now the chief executive at St Helier, where he is plotting to use these latest funds to reduce two A&Es to one—away from those most in need—which would place intolerable pressure on nearby St George’s. Does the Minister not see a pattern here?

[Edward Argar]

I always think it a little unfair in this House to name or attack individuals where they do not have the ability to answer back. The Government have made it clear that the announcement today and yesterday is about putting more money into our NHS, which will improve services for the hon. Lady’s constituents and for those across the capital and indeed the country.

Acquired Brain Injury

Siobhain McDonagh Excerpts

Thursday 9th May 2019 Commons Chamber

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

I praise the remarkable work of the APPG on acquired brain injury for its dedication to this issue and for securing this particularly important debate. Research from Headway, the brain injury association, shows that every 90 seconds someone in the UK is admitted to hospital with an acquired brain injury-related diagnosis. That is approximately 350,000 people a year. If this debate lasts for an hour and a half, another 60 people will have been struck by brain injury while we are in the Chamber. The majority of those people will need at least some form of short-term support or long-term rehabilitation to help them rebuild their lives, re-learn lost skills and regain a degree of independence.

Excellent work is done in the charity sector to support people with acquired brain injury. I am sure that many colleagues across the House will want to join me in congratulating Headway on reaching its 40th anniversary this year. I am proud to say that the charity is based in my constituency and led by my friend and colleague, Peter McCabe, as chief executive. For four decades, it has been supporting brain injury survivors and their families and carers, to ensure that lives saved by significant advances in neurosurgery are lives worth living.

When a brain injury strikes, it is usually without warning. Put simply, it can happen to anyone, at any time. The support provided by Headway starts from the moment brain injury strikes and continues for as long as it is needed. With the introduction of major trauma centres, the chances are that a patient with a significant brain injury will be quickly transferred to a unit that is better equipped to provide specialist emergency care. That can be many miles from the family home. I am sure we can all agree that, if a loved one were involved in an accident or suddenly became seriously ill, we would want to be at their bedside, but for some people—particularly in low-income families—that can be a challenge if the patient is transferred to a unit many miles away.

That is why I would like to raise the importance of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in a coma. To date, the charity has distributed more than £369,294 to 1,783 families across the UK. In addition, families can receive emotional and practical support to help them to cope with the overwhelming situation and to make sense of what is happening. They can also rely on the charity’s nurse-led helpline, which has seen an increase in demand of 131% over the last 10 years.

Given that there will be many people watching the debate who are working on this issue, I would like to raise the Headway brain injury identity card, which is endorsed by numerous agencies in the criminal justice system, including the Police Federation and the National Police Chiefs’ Council. The House has previously discussed the high prevalence of brain injury among the offender population. This new initiative from Headway is helping the police to identify brain injury survivors at the earliest opportunity, to ensure that they receive appropriate support.

We should all be proud of our national health service, particularly when it comes to emergency and acute care, but a life worth saving has to be a life worth living. Many of my hon. Friends here today will be aware of the excellent work being done by Headway groups and branches in their constituencies. Whether through rehabilitative therapies to improve speech and language skills or facilitate a return to work or education, or social interaction to prevent isolation, the work being done in our local communities by these groups and branches can be a lifeline to families affected by brain injury, helping people to rebuild their lives and become less dependent on costly state support.

[Dr Julian Lewis (New Forest East) (Con)]

May I add briefly to that catalogue of virtues the fact that Headway has been reaching out to parliamentarians like ourselves? The reason I am here for this debate is that Jo Hillier of Southampton Headway got in touch with me and asked me to be here. That is why I am learning so much more about this condition than I would otherwise have had the possibility of knowing.

[Siobhain McDonagh]

That is my experience as well. Had Peter McCabe not called me, I might not be here, and I would know so much less about the volume of people who experience brain injury and the sort of problems they and their families and carers have.

We are very grateful for Headway’s intervention. However, Headway cannot do this alone. Local charities are under incredible pressure. Funding cuts are causing harm to the lives of some of society’s most vulnerable people, who are being cut out of society due to a lack of access to vital support services. For many people, Headway provides a route back to independent living, further education or employment. The reality is that, aside from Headway, most people—particularly those who cannot afford private healthcare—will receive insufficient support or rehabilitation after leaving hospital. Unless action is taken to enable people to access the vital support needed to ensure that these services survive, more and more people will be cut out of society and taxpayers will be left footing the bill for the longer-term care of those without the means to care for themselves. Considering that another four people will have been struck by brain injury during my speech, there simply is no time to delay.

St Helier and St George’s Hospitals

Siobhain McDonagh Excerpts

Tuesday 19th February 2019 Commons Chamber

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

Let me start by putting on the record my respect and admiration for every single doctor, nurse, clinician and staff member at both St Helier and St George’s hospitals for their outstanding service and dedication to the health and welfare of my constituents. These remarkable individuals go above and beyond, despite facing extraordinarily testing circumstances—nine years of austerity have left our treasured NHS desperately short of staff, services and supplies.

For my constituents, however, the biggest threat to our local hospitals is far closer to home. It is in the wild west of south-west London’s NHS, which is once again pursuing desperate attempts to close all acute services, including the major A&E unit and the consultant-led maternity units at St Helier hospital. The impact that that would have on St George’s hospital, would, I believe, be devastating.

This evening I want to outline the reality behind the latest threat to St Helier, branded “Improving Healthcare Together 2020-2030”. I want to challenge every foundation on which that programme has been built, and I want to appeal to the Minister to step in before we see the decomposition of health services that are vital to my constituents. However, I want to start with some history.

For nearly two decades, the NHS in south-west London has pursued several irresponsible attempts to close the acute health services at St Helier hospital, on the border of my constituency, and move them to leafy, wealthy Belmont in Sutton. Under different titles and brands, and in the guise of countless NHS-funded marketing consultants, the proposal is on repeat, and an estimated £50 million has been wasted on almost identical consultations and programmes. Each one starts afresh, portraying to the public a neutral outlook when it is being decided where acute health services should be placed in south-west London.

The Minister may remember that, back in 2015, secret proposals to close St Helier and build a new super-hospital in Sutton were overheard by a BBC reporter on a train, which brought those plans to an embarrassing end. Fast-forward to 2017 and the programme was repeated, this time entitled “Epsom and St Helier 2020-2030”, and once again professing to assess the pros and cons of where to base acute health services. The public support expressed by chief executive Daniel Elkeles, the man running the programme, for moving the services to Sutton somewhat clouded the neutrality of the process.

[Paul Scully (Sutton and Cheam) (Con)]

Does the hon. Lady not agree that the proposal that immediately preceded this was to close facilities at St Helier and move them to St George’s in Tooting, which was universally unpopular? The proposal that is now on the table, on which I certainly hope there will be a public consultation, refers to one of three sites, and includes a reference to locating a new facility at St Helier hospital.

[Siobhain McDonagh]

My recollection of that particular consultation was that that was really the scorched earth strategy of deciding that St Helier and Epsom were going to close and St George’s would take the strain. I thank God that that never happened, because we could be in an extraordinarily difficult position had it ever happened.

I might sound cynical when I talk about the NHS and its bias against my constituency and against services being at St Helier Hospital, but I have been here several times before. A freedom of information request revealed that those running the programme only distributed consultation documents to targeted areas around their preferred site and to just a handful of roads in my constituency. But my constituents care passionately about their local health services and will not be ignored, and 6,000 local residents responded to the programme by calling for St Helier to retain all its services on its current site.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way. I sought her permission to intervene beforehand because I am always very interested in health issues, and I am here to support her as well. Centralising the health service means that the ill and the vulnerable and pregnant women are expected to travel for miles to get medical assistance. That is totally absurd. Surely the health of the patient must always be put first and foremost.

[Siobhain McDonagh]

I agree with the hon. Gentleman, but it is about not just distance travelled but who is travelling that distance: do they have access to a car, or do they have public transport? The NHS constitution requires that equalities legislation is taken into account, particularly looking at disadvantaged people who are in poor health and how they access services, because they access services differently.

As I said, my constituents care passionately about local health services, and when they responded to the consultation 6,000 of them sent in cards explaining how they felt and saying that they wanted St Helier to retain all its services on its current site. Can you imagine the anger when I found out that their responses had been discounted by the programme? Why? Because they were not on the official documentation—the same documentation that had been disseminated in those targeted letterboxes far away from my constituency.

To the public, the trust portrayed a neutral stance whereby a suitable site across south-west London would be selected for their acute services. To the stakeholders in Belmont, it confessed its desire to move the services to their wealthy area, and to mine, it pretended that the consultation would genuinely seek the views of the public. But as my mum always says, much gets more. I would like to put on record that while I fundamentally disagree with the desire to take services away from my constituents, I do recognise Mr Elkeles’ hard work and dedication in leading St Helier Hospital.

We now fast-forward to the present day and the latest brand, “Improving Healthcare Together 2020-2030”, a programme built upon the unstable and unscrupulous foundation of its predecessors and that once again considers the pros and cons of moving St Helier Hospital’s acute services 7 miles west to Epsom or south to leafy Belmont in Sutton. The programme was launched last summer—they always choose the summer—undertaking an initial public engagement that is expected to transition to a public consultation this coming summer. But just 837 people responded to the public engagement, and that is including hundreds of NHS staff and 169 comments on Twitter or Facebook. That is an utterly abysmal response considering the £2.2 million of taxpayers’ money squandered on the programme already. Does the Minister agree that this is a complete misuse of taxpayer funds at a time when our NHS is under such overwhelming pressure?

This is about more than just the future of St Helier Hospital. My constituents tell me that if St Helier Hospital were to lose its acute services, they would turn not to Epsom or Sutton but east to Croydon University Hospital or north to St George’s. That is a completely terrifying prospect. Before Christmas, my constituent, Marian, was left queueing outside St George’s Hospital with her left leg badly infected, because the A&E was full. And that was the calm before the storm, with St George’s A&E facing its busiest ever week just a fortnight ago. We all remember the winter crisis last year, but the first full week of February this year was 16% higher than last year’s equivalent, with a simply staggering 600-plus visits every single day. This is a hospital that already relies on St Helier as its safety valve. The maternity unit at St George’s had to close temporarily in 2014 and 2015, directing women who were already in labour to St Helier Hospital.

That is why a letter sent in November from the chair of the St George’s trust to those running the programme is completely astonishing. In the letter, the chair expresses her concern that

“there is no formal requirement to take account of the impact on other providers”

when deciding where to relocate acute health services across south-west London. It is hard to put into words just how dangerous that disregard is. I should like to pause briefly to thank the chief executive of St George’s Hospital, Jacqueline Totterdell, for her hard work and tenacity in steering one of London’s largest hospitals at a time of such difficulty.

St George’s is a hospital already under immense pressure. The plumbing, ventilation and drainage facilities are at breaking point, leading to a bid for £34 million of emergency capital from the Treasury. Does the Minister agree that a recent outflow of sewage in the hospital A&E is a clear sign that such emergency funding is justified and, more importantly, urgent? How busy does she think the same A&E would be if the local NHS were to get its way and move St Helier’s major A&E to wealthy, leafy Belmont? Will she step in today and require any proposal to reconfigure health services to wholeheartedly take into account the impact that such a decision would have on all other nearby health providers?

Merton Council recognises the devastating impact that these proposals could have, and I would like to put on record my thanks to leader of Merton Council, Stephen Alambritis, the cabinet member for social care, Councillor Tobin Byers, and the director of community and housing, Ms Hannah Doody, for their unflinching support. It is so disappointing that those at Sutton Council can stand so idly by.

By law, when deciding where acute services should be based across a catchment area of this size, it is fundamental that the level of deprivation and local health needs are accurately understood and thoroughly assessed. So I read from cover to cover the deprivation and equality analysis produced by a range of external consultancy services as part of their £1.5 million programme fee. At a time when the NHS is so strapped for cash, it is extraordinary that my local NHS seems to have carte blanche to employ so many consultants on such extraordinary rates. But even I was absolutely astounded by the monumental gaps in the analysis that these consultants have delivered.

In the pieces of analysis on deprivation and equality, areas that rely on St Helier Hospital are either absent from the documents or actively described as falling outside the catchment area. Take Pollards Hill in my constituency, an area that would be considered deprived in comparison with much of Sutton or Epsom. Wide Way Medical Centre is the largest GP surgery there, and it directs 34% of its patients to St Helier Hospital, but Pollards Hill is deemed to be outside St Helier’s catchment area. Why does this matter? Because if areas that rely on St Helier Hospital are not even considered in the analysis, how can the potential impact of moving acute services from the hospital be adequately assessed? Pollard’s Hill is not alone. The report does not mention Lavender Fields despite almost a fifth of Colliers Wood surgery patients and Mitcham family practice patients being directed or referred to St Helier from the ward.

I urgently brought the gaps in the analysis to the attention of those operating the programme and Jane Cummings, the NHS’s chief nursing officer. I was pleased that everyone agreed that such significant analysis shortfalls would be addressed and rectified.

[Paul Scully]

The hon. Lady is being generous in giving way. Does she agree that Colliers Wood is pretty much smack-bang next to St George’s and that the proposal on which last year’s public engagement was based was that 85% of current patients would still be treated in their current hospital, whether St Helier, the proposed Sutton site or Epsom?

[Siobhain McDonagh]

There is no reason why the hon. Gentleman should know this, so I am not trying to be tricky, but Colliers Wood surgery is the title of a split-site GP surgery. One site is on Lavender Avenue off Western Road—the hon. Gentleman probably knows Western Road from driving up and down it a lot—in the heart of one of the most deprived areas in my constituency, and many people there go to St Helier hospital. The idea that we could remove an A&E and a maternity unit and keep what is left is complete nonsense, because all the blood and testing facilities and all the talented doctors and nurses simply would not stay there. Chase Farm Hospital, which is in the constituency of my right hon. Friend the Member for Enfield North (Joan Ryan), is a wonderful example of such a situation, and Members may want to have a look at it.

I pointed out that areas in my constituency and large surgeries had not been included in the analysis, and I was promised that they would be. However, months have passed, and the process has proceeded unscathed, with no indication of when such significant gaps will be remedied.

The icing on the cake came in December when three behind-closed-doors workshops based on the deficient evidence were run by the programme. They were designed

“to inform the Governing Bodies decision making process about how the community and professionals ranked each of the three potential sites for acute hospital services”.

Let me be clear: hand-picked professionals and members of the public used incomplete evidence to rank Sutton as the preferred site for acute services. The Minister will not be surprised to hear that more participants in the workshops were from Sutton than from Merton or Epsom. How can a fair, balanced and rounded opinion be accrued from workshops based on flawed evidence and disputable criteria and with an unrepresentative group of people? For the findings to be used in any capacity in the decision-making process would be completely unacceptable.

Of course, I understand that figures and analysis can always be skewed in one direction or another. Someone wanting to disguise the 76.5-year life expectancy of men in Mitcham West in my constituency could include the 84.4-year average in Wimbledon Park and classify the figures by the borough of Merton as a whole. They could count cancer rates, stroke rates, mortality rates by borough rather than by ward or lower super output area. They could ignore deprived parts of the catchment area and proceed full steam ahead with the programme.

When will the gaps in the analysis be completed? When will taxpayers’ money stop being splurged on flawed and biased consultations? When will the madness end? Here is the reality: there are over twice as many people with bad or very bad health within a mile of St Helier than there are living within a mile of the Sutton site, and almost four times the number within a mile of Epsom. Around St Helier, the local population is significantly larger, with considerably more dependent children and more elderly people. Furthermore, the population local to St Helier is far more reliant on public transport, with residents statistically less likely to have access to a car.

Despite all that, when I secured—I can hardly believe it myself—£267 million from the Department of Health and the Treasury under both the Labour Government and the coalition Government to rebuild St Helier Hospital, guess what happened? The local NHS sent the money back. Can the Minister confirm whether the hospital will again receive its funding this time round?

It is time for some accountability and for the Government to step in before even more money is wasted and the future of both St Helier and St George’s is thrown into jeopardy. Leave these vital services where they are most needed: at St Helier Hospital, on its current site.

--- Later in debate ---

[Caroline Dinenage]

My hon. Friend makes an excellent point, and that is why it is important that no significant changes are made without consultation so that local people’s views can be taken into consideration. The CCGs will need to consult the public fully before making any decisions about a new hospital or changes to the configuration of acute services, but clearly any form of investment is welcome.

[Siobhain McDonagh]

Lists of NHS capital programmes in London have appeared in various newspapers, with Imperial College Healthcare NHS Trust at the top of those lists—Charing Cross and other hospitals are in that group. St George’s is desperate. Sewage came through the sinks and toilets in its A&E only a few weeks ago. It is not sure whether the electrics are going down, or whether the plumbing, the water and the water systems have caused considerable health problems to patients. Who is getting the money? Is it all going to south London? It would certainly all have to go to south London if there were to be a brand-new hospital anywhere.

[Caroline Dinenage]

The hon. Lady asks an excellent question. The CCGs are working closely with NHS England and NHS Improvement to develop the programme’s capital scheme prior to the next spending review, with a view to NHS England and NHS Improvement presenting the scheme for funding. They expect the public consultation on their proposals not to take place until after the next round of capital bids is concluded, which is likely to be after the autumn. There is a duty to carry out a travel times analysis when developing proposals, and this will be included in the consultation. CCGs also have duties to reduce inequalities. She spoke a lot about the inequalities in her area, and an impact analysis of that has to be done.

I understand that the hon. Lady is also concerned that any potential changes could increase pressure on St George’s hospital, and she is absolutely right to raise that important point. The Department is clear that NHS England and local NHS organisations must think about potential impacts on other services, which is why we are developing a more strongly regional approach in designing NHS services. CCGs must consider the impact on neighbouring hospitals close to the CCG boundary, such as St George’s. Changes to A&E services at any one hospital potentially have an impact on a number of surrounding hospitals, so the three CCGs have to engage with their neighbours throughout this process. In addition, the neighbouring CCG can respond to any public consultation and its response must be taken into account.

On the next steps, the hon. Lady will be aware that the reconfiguration of services is a matter for NHS England and local NHS bodies. Such matters have to be addressed at local level rather than in Whitehall because local organisations understand the needs of their community. No changes to the services people receive can be made without formal public consultation. They must have support from GP commissioners, demonstrate strengthened public and patient engagement, and have a clear clinical evidence base. They must also be consistent with the principle of patient choice. The NHS England test on the future of use of beds requires assurance that the proposed reduction is sustainable in the longer term. The Department is very clear that throughout the service change process local NHS organisations have to engage with the wider public and with the local MP on these issues, so I am sure that she and her constituents will take part in any local engagement as plans move forward.

The challenges facing the health economy in south-west London have been widely understood for a number of years. I recognise and appreciate that potential changes to local health services are often a cause of great worry and that they inspire impassioned debate among those involved. It is time for local partners to work together to find a solution which, as the hon. Lady said, has to be right for the people of south-west London and will secure a sustainable configuration of health services in the future. I thank her again for her continued dedication to these health matters.

--- Later in debate ---

[Siobhain McDonagh]

Will the Minister unequivocally put on the record that any consultation document has to go everywhere or nowhere, and that some consideration must be given to how much things cost? I am amazed that the NHS gets so few people to turn up to events that it spends so much money on.

[Caroline Dinenage]

The hon. Lady makes an excellent point. It always amazes me how few people engage in some of the consultations, which are often discussing huge sums and affect really important day-to-day provision of essential care services in their area. Yes, consultation has to go to the whole area—indeed I have already spoken about how it needs to go beyond the area and look at the impact on other local services and the people who use them. She is absolutely right to say that consultation has to be effective and it has to ask everybody who might be affected by any changes. With that in mind, I thank her again for her continued dedication to her constituents.

Question put and agreed to.

NHS Reorganisation

Siobhain McDonagh Excerpts

Wednesday 12th December 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gapes; I love saying that, particularly to our current Chair. I thank my hon. Friend the Member for Warrington South (Faisal Rashid) for securing this important debate.

I am here today to put on record the wild west of the NHS in south-west London, which will be well known to the Minister. It is a branch of the NHS that has spent the past two decades desperately trying to close the A&E and maternity unit at St Helier hospital on the border of my constituency and move those services to leafy, wealthy Belmont in Sutton. I will describe the geography for any hon. Members unfamiliar with my constituency. St Helier hospital is based in the deprived area of Rose Hill. Further south is the Royal Marsden in the wealthy area of Belmont, and seven miles west is Epsom hospital. The local CCGs are proposing to move all their acute services to just one of those sites.

This is about accountability. Over the past 20 years a staggering £50 million has been wasted on almost identical consultations to reach the obvious conclusion: acute health services must be placed in the area where people are most deprived and most in need, and have the greatest health issues. They must be placed at St Helier hospital’s current site. It does not matter how many brands or names the local NHS gives these proposals or how many marketing consultants are hired. Moving these health services would be catastrophic for my constituents, and catastrophic for south-west London.

What my local NHS fails to consider is this: if St Helier hospital loses acute services, my constituents will not turn to Belmont. The Minister will know Lavender, Cricket Green, Figges Marsh and Mitcham town centre. They will turn north to St George’s or east to Croydon, both hospitals that are already under extraordinary pressure. I told the Prime Minister only today of the case of my constituent who had to queue outside St George’s hospital last Monday because the A&E was simply full. Two weeks ago, St George’s was on black alert. It had no beds. The managers had to cancel all meetings and walk around wards, attempting to get people discharged. Those pressures exist even before the winter bad weather starts and before the flu epidemic that we are anticipating.

I could not possibly have emphasised any more strongly to my local NHS that its statistics and suggestions that people will move from London and parts of my constituency to Belmont are simply not going to happen. In all the years I have been fighting this, nobody in the NHS has ever said anything publicly to support my view, until the week before last. I could not believe it when the chair of St George’s NHS trust wrote a letter that argued:

“There is no formal requirement to take account of the impact”

of its proposals on other providers.

Let me make this clear. Moving acute hospital services from St Helier to Sutton could bring St George’s hospital to the point of collapse, yet those consulting on these proposals were not even taking the inevitable impact on other hospitals into account. Is there a code of guidance on consultation in the NHS? It does not seem that people in south-west London have read it. Take last year, when the same consultation was run, this time by the hospital trust itself, and was called “public engagement”. To the public, the trust portrays a neutral stance and says a suitable site will be selected across south-west London for its services. To the stakeholders in Sutton, it confesses its desire to move the services to their wealthy area. To me, it pretends that the consultation will genuinely seek the views of the public, before it happens to ignore the fact that the consultation receives six times as many negative responses as positive ones.

I was not surprised, given that—this is hard to believe—Epsom and St Helier University Hospitals Trust delivered the consultation document to most parts of Sutton and most parts of Epsom, but not a single street in my constituency; and that is called a consultation. I ask the Minister whether he thinks it is appropriate for an NHS body to run a consultation or an engagement and simply exclude part of the catchment area. Better to deliver no leaflets at all than not to include everybody.

Fast-forward to the latest attempt, where flawed consultation documents are created so that boxes can be ticked and the process can move along more and more quickly. The latest versions argue that Belmont is the deprived area locally, but, staggeringly, the same documents suggest that Pollards Hill is outside the catchment area for the Epsom and St Helier trust—something that will come as news to Wide Way, the largest GP surgery in Pollards Hill, which sends 35% of its patients to St Helier hospital. The trust claims to be neutral about sites, but when I secured £267 million from the Department of Health and the Treasury under both the Labour Government and the coalition Government to rebuild St Helier, guess what happened? The local NHS sent the money back; it did not want to use it.

It seems that every step forward comes up with a new consultation involving closed meetings that unswervingly fails to take account of health inequalities, which I understand is a legal requirement for the NHS. The trust ignores access to the site, public transport and percentage of car ownership, and we make no progress. For me, the last 20 years as the MP for Mitcham and Morden has been like being in the film “Groundhog Day”. Every month there is something, and we can absolutely rely on the fact that every July some bit of the south-west London NHS will want to come up with a consultation to move acute services from St Helier hospital. I simply want to put a stop to it. I want the staff at St Helier to know they have a future, and I want my constituents not to be worried about how they will access an A&E.

Nursing: Higher Education Investment

Siobhain McDonagh Excerpts

Wednesday 21st November 2018 Westminster Hall

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

Last month my mum celebrated her 95th birthday. Like many Irish nurses of her age, 75 years ago she travelled to London from Ireland to start her career in the very first generation of NHS nurses by qualifying as a state enrolled nurse at Warlingham Park psychiatric hospital. Growing up, I saw at first hand just how vital a dedicated, passionate and happy nurse was for the welfare of the patients. That is why I am incensed when I see the treatment of trainee nurses today. Let us be clear. Nursing students are exceptional. Their courses are complex, their training is tough, and they spend significant amounts of time on clinical placement, working all hours of the day and night. They deserve a tuition and living cost funding model that recognises their extraordinary efforts and the importance of those efforts.

England is now the only country in the UK without some form of bursary for the nursing degree. That has crumbled the number of nursing applications and fostered an environment that is utterly unfair to nursing students and completely unsafe for patients. The Government promised that reforms would provide up to 10,000 additional nursing and health professional training places but, since the loss of the bursary, nursing applications in England are down by a third and falling fast. In fact, the 2018 figure was the lowest since nursing courses were first included in the UCAS system.

Nursing must be made an attractive profession for all groups, and restoring the bursary is a fundamental step to achieving that. Now is not the time to experiment with funding models for nursing students. One in three nurses is due to retire within the decade. Ensuring the long-term recruitment of new nurses must be a Government priority. That, of course, is before we take account of the Brexit impact: 75% of NHS trusts have done nothing to prepare for the UK’s departure from the EU. Meanwhile, there is an alarming trend for nurses and midwives to leave the profession before retirement, citing intolerable working conditions. However, it is not a numerical conundrum. It is a national crisis. A fall in student numbers is simply exacerbating our current recruitment shortage and it is patients who are being put at risk.

Ms H, a student nurse in London, contacted me this morning:

“I’ve felt completely unsafe on many occasions because of short staffing, not just because of my personal protection but more so because of the safety of the patients that I care for”.

Her colleague, Ms Y, found a young patient on an adolescent ward with a ligature tied around her neck. Short staffing meant that there was no one to debrief, and in fact no one even realised that it was a student who found the young patient. Ms H said:

“Most weeks of my final year as a student nurse I have cut out sleeping an average of 2 nights per week. Staying awake for 36 hours is the only way I can afford to train, study, and work to sustain a living.”

And yet her main grievance is not about the present, but the future:

“It just doesn’t feel like there is really light at the end of the tunnel. Instead, we will just enter a longer tunnel of a career completely unsupported by Government.”

The warning signs are loud and clear. The conditions described today are unfit for those who selflessly care for our most vulnerable. The devastating consequences of leaving the system broken would be felt for decades to come.

Budget Resolutions

Siobhain McDonagh Excerpts

Tuesday 30th October 2018 Commons Chamber

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

This was a Budget for

“the strivers, the grafters and the carers who are the backbone of our communities and our economy.”—[Official Report, 29 October 2018; Vol. 648, c. 653.]

Or so we were told—I would like to extend an invitation to the Chancellor to come to my weekly advice surgery and say that to the dozens of families I meet every single week who are trapped in insecure gig economy work, who are being failed by universal credit and who cannot afford to put a private rented sector roof over their head. I will talk about each of those issues in turn.

Let us start with workers’ rights. The Chancellor stated that delivering higher wages for those in work is core to his mission, yet our national living wage is littered with loopholes and used by some of the biggest organisations to cut terms, conditions and take-home pay. Those organisations should be named and shamed—I am referring to the likes of Marks & Spencer, Zizzi, Ginsters, Le Pain Quotidien, Caffè Nero and countless others that have sought legislative loopholes, against the spirit of the law.

Only this morning, I heard from one of the thousands of B&Q staff members being forced to move from nights to days. Just two years ago, one lady lost her annual bonus and her Sunday premium. She works the twilight shift to enable her to care for her two children. If she keeps her job, by the end of the month she will earn £1.50 an hour less than she currently does, but she cannot work the new shift because she cannot care for her children as well. She is not being offered redundancy. I ask those on the Treasury Bench to use their influence to encourage B&Q to offer redundancy to the 441 twilight shift workers who cannot at the moment take the hours that are being offered to them.

The Chancellor talked about protecting employment for lower-paid workers. Does that mean that the Government will follow the lead of British Telecom and the Communication Workers Union by calling for the abolition of exploitative “pay between assignments” contracts that keep agency staff on low pay for years at a time, even though they lack a gap between assignments?

On housing, which is a supposed Government priority, I was expecting a little more than the few lines that we heard yesterday. I welcome the proposed measures and money, but they are simply not of a scale that will make the difference that is so desperately needed. Solving the housing crisis is the politics of “and”: we should lift the housing revenue account cap, for sure, but is it not time to argue that all public sector sites that have been disposed of should be used first for the purposes of social housing, to introduce more punitive action for empty properties and to increase the surcharge for the one in six over-55s who own a second property? What about councils such as Merton that do not have a housing revenue account? In the past year, Merton has had one four-bedroom property to offer, and there are 441 families chasing that one four-bedroom property.

What about the green belt? The Budget states that revised planning reform ensures

“more land in the right places…for housing.”

Do Treasury Ministers agree that we should de-designate the 19,334 hectares of unbuilt green-belt land within a 10-minute walk of London train stations? This supposed green belt includes a car wash, a waste plant, a disused airfield and even a lap dancing club. At no environmental cost, that is enough space for almost 1 million new homes.

Finally, I turn to universal credit. I appreciate that I do not have much time left to speak, but I must ask those on the Treasury Bench for their help with Mr C, who applied for universal credit at the beginning of September. As the result of a routine operation, he had an artery severed, and the likelihood is that his foot will now have to be removed. He lives in one room above a shop, which he shares with his sister, who is in her 50s. Since the beginning of September, we have attempted to get a home visit for him so that he can claim the money he is entitled to. More than eight weeks later, in spite of getting the help of the local jobcentre manager, and in spite of numerous calls and letters to everybody we can think of, that man is still awaiting his appointment. Surely that is absolutely wrong.

This is a Budget with an absence of hope. The era of austerity is said to be coming to an end, but for now it continues to proceed, dragging almost a decade of damage in its wake, affecting people without homes for their children, people trying to claim benefits and people who just want a fair week’s pay for a fair week’s work.