Health Services (North-West London)

Stephen Pound Excerpts

Tuesday 15th October 2013 Westminster Hall

[Ms Buck]

I totally endorse my hon. Friend’s words.

To return to my point about how Hammersmith council is presenting its achievements in winning services for Charing Cross that no one in Westminster or at St Mary’s hospital knows about, Hammersmith continued:

“Charing Cross will also become a specialist centre for community services which means that the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel. It will mean local people will be better supported to live independently at home”.

It was good of Imperial to share that vision with Hammersmith and around Charing Cross, but it is a great shame that it chose not to share a single word with Westminster city council.

Reinforcing my hon. Friend’s point about chaos, however, I am not sure that even that is the true picture, because when I showed the press releases on Charing Cross from Hammersmith council to the chief executive of Imperial in September, I was told that it was spin on Hammersmith’s part and that what was proposed was only a 23-hour ambulatory care model, with no new beds at all. It is hard to square that with Hammersmith council’s vision and harder still to know what is true.

I do not begrudge Hammersmith residents their hospital—quite the reverse—but I am concerned about any sense of deals being done to secure their future, at the expense of local residents in Westminster and, critically, without so much as an opportunity for Westminster council even to consider the matter or to think about support services or the community care dimension, which Hammersmith so rightly talks about as important in a local hospital context and which can be applied to Westminster. If Hammersmith council can proudly claim that its new hospital means that

“the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel”,

surely that cannot mean that older and chronically ill Westminster residents, who also need regular visits to hospital, should have further to travel—with no debate and no chance to put in place social care support or travel arrangements.

Things get worse. Four weeks after my meeting with the chief executive of Imperial, all my follow-up questions about what that means, whether decisions have been made or what services will be located where still remain unanswered. That is no doubt partly a consequence of the unexpected departure of the chief executive, who has been replaced in what is clearly a holding operation, in a manner that does not indicate a smooth and planned transition.

[Stephen Pound (Ealing North) (Lab)]

Is my hon. Friend aware that one of the justifications for the closure of the A and E department mooted for Ealing hospital is that it will be possible for ill Ealonians to glide effortlessly through the gentle traffic of west London and rock up at St Mary’s in Praed street for their essential treatment? Will she enlighten us as to whether she feels that the closure, or proposed closure, of some of the St Mary’s beds should have been put to the good people of Ealing?

[Ms Buck]

I absolutely agree with my hon. Friend. It is surely impossible to make decisions about one hospital after discussion with only one local authority—with its statutory responsibilities on consultation and delivery of services—and simply fail to talk about them to anyone else. I am afraid that that prompts so many questions about whether Imperial and, possibly, the north-west London clinical commissioning groups have buckled under the political pressure in Hammersmith— I understand that, political pressure is a reality—and have simply failed to recognise that they have responsibilities elsewhere in north-west London.

Things get even worse, I am afraid. I then had a letter from a north-west London CCG to say that the “Shaping a healthier future” programme did not include the St Mary’s site as one of those that would undertake routine planned elective surgery, but that that work was modelled to transfer to the Central Middlesex hospital, which was designated as one of the elective centres in north-west London—the first that any of us had heard about the Central Middlesex being part of the equation, and a fact not mentioned by Imperial. The letter went on to say:

“As the Trust are still undertaking this work and have not reached any conclusions they are yet to consider whether it should propose changing the location of any clinical services between their sites and therefore are not yet in the position to ask the relevant OSCs”—

overview and scrutiny committees—

“about consultation on this”.

Note again, the use of “any”.

Since then, however, further questions have emerged, including the suggestion that almost all elective specialties have already moved. So far from being the subject of future consultation and decision making, they have already moved, without any formal consultation on anything with Westminster council since 2011. That implies that no one actually knows where Westminster residents are being treated—an absence of grip that I find worrying.

Westminster council was therefore prompted to write to Imperial at the end of last week to say:

“We are at a loss to understand the presentation made to the Westminster Adults, Health and Community Protection Committee on September 25th”

when it was told that

“options as to what elective work could be located at Charing Cross Hospital were being investigated.

Westminster were informed by the North West London Commissioning Support Unit that Imperial were on course to develop a first view of the Outline Business Case…for the private meeting of Imperial’s September Trust Board. It was planned that this will take place alongside a discussion on the emerging clinical strategy. Following feedback from the Board, the complete OBC would be finalised to go back to the Board in the autumn for approval—Imperial are required to obtain NHS Trust Development Authority sign-off by Christmas and the OBC needs to be fully aligned as part of the FT application. Westminster are still of the view that the Outline Business Cases for the Alternative Proposals to Ealing and Charing Cross Hospitals (which did not include the transfer of Elective from St Mary’s) are yet to be agreed and are not confirmed.”

That is of substantive importance, and not only as an illustration of a monumental communications breakdown, precisely because health care is supposed to be moving in the direction of greater integration between primary, community and local authority-provided social care. How can such a model exist when a local authority, and, for that matter, some GPs, do not even seem to know where their patients are being operated upon?

Will the Minister ensure that Westminster council and the local CCGs, together with the Westminster MPs, get an accurate status report immediately, including what service changes have taken place over the past two years and without any going to formal consultation? What action can she take to ensure that the whole process of statutory consultation is not undermined by hospitals such as Imperial not even telling councils such as Westminster that substantial service changes have taken place, and that there is clarity on what decisions will be taken when, including in the context of the foundation trust application?

I have one last thing to say before the Minister’s reply, which I am looking forward to. This letter from Imperial, dated 15 February, made me smile:

“Clearly we need to reassess aspects of our attitude to our health care partners in NW London, including the bodies that are newly established as a result of NHS reform. Stakeholders clearly expect more engagement and visibility from me”—

the chief executive—

“and my team in order that we may win and cement your trust. Equally we are too often perceived as defensive and not good listeners in our approach and we are resolved to address that issue at all levels where we interact with the external world”.

That letter, I am afraid, turned out not to be worth the paper it was written on. In fact, we have had something of a car crash on communications over recent months. This matters not for us—not for our sense of probity or self-importance—but for the delivery of health care to patients. This is a serious and structural problem, and I hope that the Minister will not only respond today, but get a grip on the situation, so that we can learn from the mistakes and make urgent improvements.