(9 years, 8 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
John Cryer (Leyton and Wanstead) (Lab)
I wish to thank Mr Speaker for granting this debate on the closure of Wanstead hospital in Redbridge in north-east London in my constituency.
Wanstead hospital has not existed as a full general hospital since it closed in 1986. It is where my hon. Friend the Member for Ilford South (Mike Gapes) was born 62 years ago—it is his birthday today, so I wanted to mention it. Hon. Members will have noticed all the bunting hung outside to celebrate that event, and he is happy for me to point it out. What remains of Wanstead hospital are two intermediate care wards called Heronwood and Galleon. The care is usually provided to elderly people who have perhaps been ill or in hospital and are not well enough to go home, and they need intermediate care before they can return to their homes.
This issue affects not only the London borough of Redbridge but three London boroughs: Redbridge, Barking and Dagenham, and Havering. It stretches from the boundary of Redbridge in the west to the boundary between Havering and Essex in the east—a huge swathe of north-east London. The plan is to take the three boroughs, cut all the intermediate care beds—there are currently 104—and reduce them to 40 beds located at King George hospital in Ilford. Apart from anything else, that is six miles from Wanstead so it is a long way for people in my constituency, many of whom are elderly, to travel. The facility in Dagenham at Grays Court is being closed, and the biggest facility is Wanstead hospital, which has 48 intermediate care beds over the two wards. We have already lost 35 beds in St George’s hospital—not to be confused with King George hospital—which is in Hornchurch in Havering and is an old RAF hospital. Those beds were lost last year and the plan is now to concentrate all the intermediate care beds in one place in Ilford at King George hospital.
The ongoing consultation has been produced and launched by an obscure and unaccountable group led by chief officer Conor Burke and the chairman, Dr Mehta. This group is not a clinical commissioning group; it has an overall strategic planning role above the CCG. Conor Burke and Dr Mehta are accountable to a small board that is made up of representatives of the three CCGs from those boroughs—hardly a shining example of democratic accountability.
It is basically a deeply flawed consultation. I was told by Conor Burke and Dr Mehta on 13 June that they might possibly be engaging in a consultation that would lead eventually to the closure of what remains of Wanstead hospital and those two wards. They did not volunteer that information; they said that there might possibly be a consultation only because I asked what the future held for Wanstead hospital. They said not that it was closing at that point, but that there might be a consultation. I asked three times for an assurance—which I received—that I would be informed as soon as the decision to consult on the future of Wanstead and the other facilities was made. I was not told about that decision. I found out about it only on 18 July when I received a letter with a consultation document stating that the consultation was already under way. If they treat elected representatives like that, God knows how they treat members of the public. It calls their track record into question.
The consultation document has not been made widely available, and I receive e-mail after e-mail saying that it is difficult to get hold of it or access it online. It is not in the libraries, GP surgeries or community centres—at least not the ones that I or anybody I know frequent. The document sets out a series of options, and then states, “This is the option we want.” It is clearly pushing respondents in a particular direction. That is not a clear, fair or neutral consultation. They are saying, “We’ll set out a few options for you, but this is the one we want, and if you respond, we want you to support this option.” That is clearly what the consultation document says, as anyone will see, if they can actually get hold of it. Only a couple of hours ago, I received an e-mail from a constituent I know quite well who told me about her difficulty—she is an articulate, intelligent person—getting hold of the consultation document and then responding online.
Another great difficulty, and a point that has met with another rebuff, was the request to extend the consultation deadline. The consultation started in July and will end on 1 October, but there has been call after call to extend it until 31 October, because most of the current consultation period falls in the holidays and most people do not know it is happening. I have met scores of people in Wanstead and elsewhere, even people who have used the facilities, who do not know the consultation is up and running. One of the richest ironies of the process is that the newly elected health scrutiny committee on Redbridge council—all people elected on 22 May—clearly requested an extension to 31 October, but so far the health tsars in north-east London have said it is not necessary.
The plan put forward by the senior health managers was to create two teams. The community treatment team, which provides care in people’s own homes—I have nothing against that, but I think we need the intermediate care beds as well—is not available after 10 pm, and the intensive rehabilitation team stops at 8 pm. It is promised that the CTT will respond to any call within two hours, but if someone needs help at 3 o’clock in the morning, when both teams are off duty, they will need to call the out-of-hours service or the emergency services, which I think is inadequate for a lot of people in need of intermediate care.
Both teams are up and running and seem to have done a good job. The reaction from the public who have received their care has been very positive—I cannot dispute that. However, we now see a proposal to introduce massive changes to intermediate care across a huge swathe of north-east London, including three of the biggest London boroughs—Havering is the second-biggest and Redbridge is one of the biggest—based on very little evidence. There have been intermediate care beds at King George for only a year, and the beds lost at St George’s in Hornchurch were cut only last year, in 2013, yet we now face a huge cut in bed numbers and their concentration in a facility that has been run for only a year, with two relatively new community-based teams, both based at King George hospital. The system is just not tried and tested. In my view and that of most of the people I represent—in my experience—we are not in a position to say the system will work, yet those beds will be lost, and once beds are lost, they are rarely got back.
The health tsars tell me that the beds are not being used. I dispute that. For one thing, last winter, which was very mild, 75 out of the 104 intermediate care beds were used. That is a relatively low number, but, as I say, it was a mild winter. If this or next winter is very cold and harsh and intermediate care beds are needed, we will only have 40 located at King George, rather than what we used to have, which was three far more accessible facilities across the three boroughs. I am being told stories off the record—nobody has gone on the record—by NHS staff and constituents that people are being turned away from Wanstead hospital and sent to King George in Ilford in order, I can only imagine, to massage the figures. I am also told by doctors and nurses who work for the health service that it is quite difficult to get into Wanstead hospital. Again, that will bring down the bed occupancy figures, adding grist to the mill of the senior health managers who are keen on getting bed occupancy down, so that they have a perfect justification for closing Grays Court and Wanstead hospitals and putting 40 beds in the King George hospital.
The Minister will be acutely aware, I imagine, of the difficulties experienced by local hospitals, by which I mean general hospitals. Queen’s hospital in Romford has faced enormous difficulties, as I am sure she will be aware. Capacity at Queen’s was forced down because the Care Quality Commission felt that the hospital was not capable of dealing with the relevant number of people—particularly in maternity, but in other areas, too. Whipps Cross hospital in my constituency has also had significant problems, receiving a series of very critical reports from the CQC.
King George hospital, where the intermediate beds are planned to be located, has been under threat of closure for years. It is only because of the stalwart efforts of my hon. Friend the Member for Ilford South and others in campaigning to keep the hospital open that it is still there. It could close at some point in the future. Against that background, with all those problems in the acute trusts across north-east London, it seems to me that taking out all the intermediate care beds with huge cuts and putting in 40 beds in Ilford at the King George is, at best, a foolhardy decision.
Let me make one more point about the consultation—the lack of accountability. The whole process, in my view, has been deeply flawed. Perhaps the greatest talking point among my constituents is the pig-headed refusal to extend the deadline to the consultation until the end of October, which seems a fairly modest sort of request. The demand for it was overwhelming and the scrutiny committee elected on 22 May called for the extension, yet the senior health managers in north-east London seem absolutely determined to refuse that relatively modest request.
Why are these senior managers so unwilling to respond to public opinion? It is because they do not have to respond to public opinion. The two people responsible for this exercise were not elected. I am not saying that there was a glorious era when everybody running the NHS was elected—such an era never existed—but these two people were certainly not elected and they are not particularly accountable. If they are at all, it is to a fairly obscure board, indirectly appointed. That has resulted in a process that provides a pretty disgraceful example of sweeping aside the wishes of local people, local councillors and locally elected representatives, and saying, “We know best. If only all these daft people would leave us alone and let us get on with it, we can make all the decisions and run the health service efficiently.”
I do not say this as a party political point, but I do not think the national health service was set up for the convenience of well paid senior managers whose wages are paid by the taxpayers I represent. The NHS was set up by Nye Bevan after the second world war in order to provide care for everybody. In future, we should move to a position whereby the people who use the NHS and run it at the sharp end should be far more involved in decisions about how to provide care that will always be free at the point of need. There has to be a change. This exercise has brought home to me just how unaccountable so many senior NHS managers are. If they are unaccountable, they will not care what the people who use the facilities for which they are responsible think. Their lack of accountability has to change in the long term.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Thank you very much, Mr Deputy Speaker—Madam Deputy Speaker, I apologise.
Jane Ellison
Yes, it has.
I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this debate on issues that are clearly of great importance to him and his constituents. Before I try to address some of the issues he has raised—I have listened carefully to what he has said, and if there are issues to which I cannot respond now, I will certainly take them up with NHS London—I would like to put on the record my thanks to all those who work in the NHS, not only in his constituency but right across the service, for their dedication to providing first-class services to his and all our constituents.
As the hon. Gentleman is aware and as he described in his speech, Wanstead hospital closed in 1986 so the services that are the subject of this debate are provided from the Heronwood and Galleon unit on the site of the former hospital. As he said, it houses 48 rehabilitation beds in two wards, and it is one of three community rehabilitation units providing intermediate care for people in the three boroughs of Barking and Dagenham, Redbridge and Havering. The two other units are located at Grays Court in Dagenham and the Foxglove ward at King George hospital. The proposal put forward by the clinical commissioning groups for the three boroughs is to centralise these services at King George hospital, and that is the subject we are addressing this evening.
As the hon. Gentleman described, the three local CCGs outlined five possible options for the future of intermediate care services in the document issued on 9 July. I understand what he says about the preferred option steering people, but we would also probably be critical if local health leaders did not tell us what their preferred option was. I suspect we would want them at least to tell us what their thinking was in order to guide the public and be transparent. The proposals are currently the subject of a full 12-week public consultation. I understand that he has recently met Redbridge CCG and has expressed his concern, as he has done again tonight in the House, about the current length of the consultation, asking for an extension. That is being considered by the CCGs and I have asked that they respond to him as soon as possible after this debate, having given that further consideration and heard the strength of his feeling on the subject.
On support for the proposals, I know that in June, as partners on the local integrated care coalition, the three local authorities all agreed the content of the intermediate care pre-consultation business case. That includes the case for service change and the proposal for the local CCGs to go to public consultation. Subsequently, the three local CCG governing bodies all agreed to go to consultation and to consult on the preferred option, which we have described. I also understand that the Havering health and wellbeing board is very supportive of the proposals, urging the CCGs to get on with the proposed changes more quickly. Discussions are to be held next week with the health and wellbeing boards for Redbridge and Barking and Dagenham.
The head of nursing at the Partnership of East London Co-operatives has described the proposals in positive terms, and a number of positive comments have been made about the innovative ideas on home care, which the hon. Gentleman has been fair to describe as positive and good for his constituents. I know that in Redbridge the CCG is continuing to engage with community groups, some of which he has alluded to, in order to explain the proposals in more detail, and that is quite right. I was concerned when he said that members of the public locally are not clear about what is happening and do not feel that they are in the know, because these processes should always have at their heart the desire to convey what is being proposed to the public in order that they can comment meaningfully on them.
Under the preferred option, the overall number of rehabilitation beds provided would reduce from 104 to 40, with the capacity to increase to 61 should the need arise. On the face of it, that does sound like a very significant reduction, and I can understand why the hon. Gentleman and other local people may be concerned when they hear those figures. Local people needing intermediate care have generally been cared for in beds at community rehabilitation units, which means that the number of intermediate care beds across his area is relatively high compared with many other areas. However, I am advised—he made mention of this in his speech—that many of those beds are not being used because there is insufficient demand. The latest bed figures for August show that 49 intermediate care beds—47% of the total capacity—were unused across the area for that month. I note that he disputes those figures, and he makes a fair point about the waxing and waning of demand across the year. I would certainly hope that the local clinicians and managers who put these plans together would take into account those shifts in demand across the year.
The CCGs have also heard from the public that people want to be cared for and supported in their own homes wherever possible. That is a consistent message we get from the public across a range of health services. Keeping people at home helps them to stay independent for longer, and they recover just as well, and in some cases better and more quickly, at home. That is why the CCGs are developing a model of care where people are cared for and supported in their own homes, not in hospital. That model has been developed by clinicians, with, properly, input from patients and carers. However, patients who need a community bed will still be able to get one. The CCGs believe that concentrating all the rehabilitation beds on one site is the best way to develop high-quality care for the hon. Gentleman’s constituents and other patients who need to stay in a rehab unit.
Clinicians locally believe that that is the safest way to provide care and the best way to provide care of consistent quality. Concentrating the service on one site would enable staff to maintain their practice standards and share expertise more easily. The hon. Gentleman referred to the fact that the CCGs have been trialling two new services—the community treatment team and the intensive rehabilitation service. The community treatment team provides short-term intensive care and support so that people can be cared for in their own home, rather than in hospital. That is something that my constituents, his and other Members’ constituents say all the time: they would much prefer to do that. The intensive rehabilitation service provides support, such as physiotherapy, for people in their own homes and further reduces the need for patients to stay in community beds.
Figures for the last seven months are very encouraging. They show that nearly all patients supported by the community treatment team—90%—do not go on to be admitted to hospital. There are important issues to consider such as knock-on effects and the sustainability of local health services. The intensive rehabilitation service is similarly successful, with 90% of patients able to recover at home without needing to go to hospital.
Before the trial of the new services, patients waited an average of five days to access bed-based care. Since the trial, patients are able to access community beds or the intensive rehabilitation service in less than two days on average. Most people who need the community treatment team are contacted within two hours. We should pay tribute to the innovation that has taken place and to some excellent local service delivery.
I understand that patient satisfaction ratings for both the new services have been consistently high across the three boroughs since the trials began. The results of the latest satisfaction survey, published in June, were taken from patients recently discharged from the community treatment team, and it is good to hear patients being positive about their experience. In Redbridge, patient satisfaction with the service scored an overall average of 9.5 out of 10; 94% of patients and relatives said they would be “extremely likely” to recommend the community treatment team service to family and friends—the new family and friends test is being introduced across the NHS and is a good measure of what people really think of the service—and 100% of community treatment team patients were responded to within two hours.
Most of the patients surveyed felt that they either would have attended A and E or would have been admitted to hospital if that service had not been available, which goes to my point about the sustainability of local acute services. Since the trial started, 7,600 patients have been seen by those two new services, 1,000 from Redbridge. Only 1,300 patients would have been seen in a “beds only” service. Therefore, we can see service change bringing great quality of service to the hon. Gentleman’s constituents and others in the area.
Demand for rehabilitation beds has further reduced during the trial of the new services as more people are being cared for at home. I am advised that, during July, 46 of the available 104 beds were unused, as I have mentioned.
The Government are clear that reconfiguration of front-line health services is a matter that should be led by the local NHS. It is best placed to know the needs of local people and it knows how to deliver them. Putting the patient first is central to that, although it always concerns me when hon. Members bring to the House their worries that consultation and transparency have not been as good as they could be. I note the hon. Gentleman’s points, as will local health leaders, with concern. I know that they have met him on a number of occasions. I am sure that we will meet him again to take up those points, but at the heart of reconfiguration is the all-important issue of putting patients first and delivering a better service for all patients. The NHS in London, as elsewhere, has to constantly evaluate the way in which services can best be tailored to meet the needs of local people and improve standards of patient care.
I recognise that proposals for service change inevitably arouse public concern, and that is why it is important that we get consultation processes as good as they possibly can be. It is absolutely the role of hon. Members to express those concerns, to hold all of us who are involved to account, to engage with local clinical and operations leaders and to test the NHS’s response to those concerns.
I know that the hon. Gentleman has both corresponded and met senior staff from the local NHS, and I have met local health leaders, and I hope the response he received from the chief officer of Redbridge clinical commissioning group has gone at least some way towards addressing his concerns about the proposed reconfiguration of intermediate care services. The consultation on the proposals is open until at least 1 October and, as I said earlier, an extension is being considered. I undertake after this debate to further draw to the attention of local health leaders the strength of feeling the hon. Gentleman has expressed tonight about the need for more time for him and his constituents, but I urge him to participate and to make his constituents’ views known during the course of that consultation, as he has done tonight in the House.
Question put and agreed to.