Accident and Emergency Departments

Virendra Sharma Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I beg to move,

That this House has considered the matter of the closure of accident and emergency departments.

On behalf of all my Back-Bench colleagues who wanted time to be allocated for this important debate, may I put on record my thanks to you, Mr Deputy Speaker, and to the Backbench Business Committee for today’s scheduled parliamentary time? The closure of accident and emergency departments is a national issue and one that has profound impacts on the current and future provision of health care across the country. Concerns about the A and E closures and accompanying hospital reconfigurations have been voiced by members of all political parties including Back Benchers and Front Benchers on both sides of the House, so it is crucial that we have this debate.

Weighty decisions are being made about A and E closures across the country by NHS bureaucrats, under the guise of localism and clinically led decision making, without the democratic accountability that is vital for decisions of such importance. In order to bring these decisions to the Secretary of State for Health, local council scrutiny panels have to refer such decisions to the independent reconfiguration panel, which then reports its findings to the Secretary of State. Why are primary care trusts in their dying days making such critical decisions and not clinical commissioning groups? It is vital to have democratic accountability for these decisions and, although it is not sufficient, this debate will shine some much-needed light on these huge decisions that will have profound impacts on all our constituents. I am pleased that the Government have belatedly announced a national review of A and E services, but I am horrified that the review is planning to report by March this year. This is being done in an obscene rush, and it cannot be the considered review that we need.

There are proposed and actual A and E closures in my constituency and in those of other hon. Members. It is clear that this is an NHS-wide change that will affect every constituency in the land. The NHS needs to change and be fit for purpose in the 21st century, and I am not saying that there must be no change. Clearly, we have to provide health care in changed ways, but I am concerned about the pace of change, the impacts on the poorest and the financial drivers of the changes. The financial drivers are clear. The Nicholson challenge means that the NHS is seeking to cut spending by £20 billion by 2014-15.

[Margaret Hodge (Barking) (Lab)]

Does my hon. Friend agree that the care of patients must be at the heart of any changes in the NHS, and not finance? In my part of London, there is a proposal to close the A and E at King George hospital, but it would be madness to do so at a time when Queen’s hospital in Romford has far too many A and E patients and when a Care Quality Commission report has just condemned the quality of care for people who visit that A and E unit.

[Mr Sharma]

I thank my right hon. Friend for putting that case so strongly. I do not think anyone—inside or outside the House—would fail to agree with that suggestion.

In North West London NHS, the proposal translates into a £1 billion cut to budgets over the same time scale. The medical director of North West London NHS said that it would

“literally run out of money”

unless the closures proceeded. The scale of change driven by this financial pressure is unacceptable. It is targeting the poorest and most vulnerable, and it is unfair on the hospitals that have been financially solvent. That last point was graphically illustrated last week at Lewisham hospital, whose A and E was unjustly proposed for closure because of a neighbouring trust’s financial insolvency. That brought tens of thousands of incensed protesters on to the streets.

Sadly, this is happening in Ealing, too, whose hospital is faced with losing its A and E department, yet it is financially viable and has been for many years. It is being sacrificed on account of financial problems in other neighbouring hospital trusts. This threat of closure in Ealing exists even after the Prime Minister assured me, in a response to my question, that there was no such threat.

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

Although this is a debate about the closure of A and E departments across the country, does my hon. Friend accept that it seems particularly unfair that London, with nine accident and emergency departments apparently set for closure, is being hit so hard in losing vital NHS services?

[Mr Sharma]

I agree with my hon. Friend, and I shall definitely cover that point later in my speech.

As in Lewisham, the people of Ealing took to the streets in huge numbers last autumn in protest at the proposals from North West London NHS whereby if the preferred option A is chosen on 19 February, it would mean the closure of four A and E departments in west London: in Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals. The campaign to save our hospitals has been broad and deep, bringing together MPs and councillors of all political parties, and organisations and individuals from all segments of society.

[Martin Horwood (Cheltenham) (LD)]

I am concerned about the future of the emergency department at Cheltenham general hospital. It is not exactly in the same situation as London, but it lies in reasonably close proximity to the Gloucestershire Royal hospital down the road in Gloucester. The consultants and trust management in Gloucestershire tell me that their problem is not financial but the number of consultant posts and more junior medical posts that they can fill, and that there is a national shortage in emergency medicine. Is that a factor in the hon. Gentleman’s constituency, too?

[Mr Sharma]

I disagree with that. The evidence shows that all these decisions are finance-led. It is not to do with the clinicians’ or consultants’ proposals. That may apply in the hon. Gentleman’s constituency, but I can assure him that it is not true of west London.

My hon. Friend the Member for Ealing North (Stephen Pound) will join us later and the hon. Member for Ealing Central and Acton (Angie Bray) will speak later, too. I thank them for their support for our campaign. I would also like to acknowledge the tremendous efforts of my hon. Friend the Member for Hammersmith (Mr Slaughter), who would be in his place here were it not for his Front-Bench duties in the Justice and Security Public Bill Committee. Back in June, when North West London NHS announced its plan to close four of our A and Es, my hon. Friend organised a public meeting, which gave rise to the Hammersmith “Save our Hospitals” campaign. He has been at the forefront of the community campaign in his own constituency and has been instrumental in organising MPs of all parties to come together for this debate. He asked me to mention particularly the threat to Charing Cross hospital, which will lose not merely its A and E but 500 in-patient beds, turning a world-class hospital into a local urgent care centre.

My hon. Friend would have reminded us that this is the second time he has defended Charing Cross from closure. He stands now with his constituents, as he did in the last century during the dark days of John Major’s Government, holding a candle for Charing Cross at its Sunday evening vigils. That light did not go out, and I am sure it will not be allowed to go out now.

Let me now raise some of my specific concerns—as well as welcoming you to the Chair, Mr Deputy Speaker. I have very grave concerns about the way in which the consultation was carried out in north-west London. It was carried out over the Olympic summer months, with an impenetrable document of 80-plus pages and a response document with leading questions that set community against community, doctor against doctor, and hospital against hospital. There were also significant parts of the consultation period when no translated materials were available for many of my constituents who speak various community languages. That was totally unsatisfactory.

Notwithstanding those difficulties, some people in Ealing were able to complete the consultation and overwhelmingly rejected the preferred option that means the closure of Ealing’s A and E, maternity, paediatric and other acute services, and the closure of Central Middlesex, Hammersmith and Charing Cross A and Es. Moreover, a majority of respondents across the whole of north-west London rejected the fundamental premise of the proposed changes—that acute services should be concentrated on fewer sites. I fear that such an inconvenient consultation response will be ignored and ridden roughshod over.

Equally, I fear that the clinical opinion of Ealing’s GPs and hospital consultants who opposed the preferred option will be ignored, despite this being one of the Government’s four tests for such reconfigurations. The clinical concerns are real and should not be brushed over. Let me address some of the key concerns.

First, the scale of change being proposed in north-west London and the associated risks of such large-scale changes is causing great concern. Taking out in one go four of nine A and Es that serve a population of 2 million—set to grow continually over the next 20 years —is a high-risk strategy. Concerns over A and E capacity are growing, as hospitals up and down the country say that their A and Es are full and that they are putting patients on divert to other hospitals. This has happened recently at Northwick Park hospital—one of the hospitals that Ealing patients are meant to be treated at if the four A and Es close. If these proposals go through, yes, there are plans for some increased investment at both Northwick Park and Hillingdon A and Es, but there are well over 40,000 patients a year using Ealing hospital’s A and E alone, in addition to those currently attending Central Middlesex, Charing Cross and Hammersmith—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I think the hon. Member was told that he had a 10-minute limit imposed on him, as applied in the previous debate. Sadly, however, his time is up. If he wants to make a concluding remark, however, I think the House would allow him to do so.

[Mr Deputy Speaker]

We will give the hon. Member two minutes to conclude.

[Mr Sharma]

Thank you very much, Mr Deputy Speaker.

Let me finally say to the Minister that there should be a moratorium on all A and E closures until a proper, considered and full review of A and E services has been carried out, as opposed to the current rushed review. I hope that the Minister will listen.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am extremely grateful to you, Mr Sharma, for your understanding.

From now on, Back-Bench speeches will be limited to eight minutes.

--- Later in debate ---

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

[Mr Sharma]

Is this not the story of every trust, including Ealing and other west London hospitals, where the local consultants and GPs have totally opposed such proposals but the threat of closure still exists?

[Stephen Lloyd]

I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.

--- Later in debate ---

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

[Mr Virendra Sharma]

rose—

[Anna Soubry]

I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.

Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.

[Mr Virendra Sharma]

How disappointed I am that the Minister failed—utterly failed—to address the issue—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sadly, time has defeated us.