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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I say now to colleagues who understandably are concerned about local health services and have rightly raised concerns on behalf of their constituents that if I cannot cover some of their questions in the next 12 minutes, I will undertake to write to them in the remaining days of this Parliament, or to ask someone else to write to them, so that we can try to give them some reassurance.
I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and the hon. Member for Lewisham East (Heidi Alexander) on raising her concerns. Taking my cue from what was said previously, I start by paying tribute to all those working in London’s NHS—in those hon. Members’ constituencies, in mine and right across London—for their dedication and commitment to providing first-class services to those in their care at a time when we know that the system is, in places, under pressure.
As we have heard, after consulting with the trust, its commissioners and the London strategic health authority, the then Secretary of State instituted the special administration process at South London Healthcare NHS Trust in July 2012. He was guided in making that very difficult decision on the basis of the clinical interests of local patients, with advice from the NHS medical director, Sir Bruce Keogh. The decision was also based on the fact that there was no clear option for restoring the trust’s finances while maintaining the quality of services to patients. It was clear at the time that doing nothing was not an option. Not resolving the issues at the trust would have carried a high degree of risk. It would have meant that the trust would not meet the London-wide clinical quality standards and that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit.
The trust special administrator looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but no one was able to come forward with a proposal that would solve the problem within the existing footprint of the trust. Indeed, there were no proposals that would not have involved neighbouring health care economies.
The long-standing clinical, operational and financial problems at South London Healthcare NHS Trust led the trust special administrator to recommend that Princess Royal university hospital be acquired by King’s College Hospital NHS Foundation Trust. The associated hospital sites in Bromley—Beckenham Beacon and Orpington hospital—were part of that transaction. I must say for the record that the transaction agreement was signed by all parties and no information was withheld from any organisation.
At the time, South London Healthcare NHS Trust was the most financially challenged in the country, with a deficit of £65 million per annum. Repeated local attempts to resolve the financial crisis at the trust had failed. Millions of pounds were spent on paying for debt rather than improving patient care for the local community in south-east London. The trust special administrator was clear that long-standing problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. That is why, after careful consideration, the Secretary of State accepted his recommendations, including that the PRUH be transferred to King’s.
The new expanded trust is one of London’s largest and busiest teaching hospitals and plays a key role in the education and training of the next generation of medical, nursing and dental students. King’s has acknowledged that it has been facing a number of pressures that have had a bearing on its performance. The challenge of integrating and transforming the performance of the PRUH, combined with a significant increase in emergency in-patient activity, has, as the hon. Member for Lewisham West and Penge described, adversely affected the trust’s operational and financial performance. A key aim of the trust’s five-year strategy is to restore its traditional high levels of performance, in particular by returning to achieving its emergency department and referral to treatment waiting time targets.
Monitor has concerns that some patients are waiting too long for A and E treatment and routine operations and that the trust is predicting a deficit of more than £40 million in this financial year. The regulator is undertaking its investigation to find a lasting solution to long-standing problems at the PRUH. Monitor is concerned that the trust’s operational and financial performance issues post the acquisition of the PRUH have not improved in line with expectations. In particular, some long-standing financial and operational performance issues at the hospital have continued post acquisition.
Robert Neill
May I say this on behalf of my hon. Friend the Member for Orpington (Joseph Johnson), the Minister of State, Cabinet Office, who cannot be at the debate? He and I would want to put on the record the fact that there have been areas of improvement at the Princess Royal and at Orpington, particularly in terms of patient experience scores, which have picked up considerably. On the point that my hon. Friend the Minister just mentioned, we are especially concerned at the prospect that has been raised that the full financial picture may not become available to King’s until after the acquisition. It is very clear—I hope that the Minister can assure us on this—that the Monitor investigation is intended once and for all to get to the bottom of, the root of, the financial difficulties that this trust suffers. May I also say that I welcome the appointment of the noble Lord Kerslake as chairman of the King’s trust? He will bring considerable credibility and rigour to that process.
Jane Ellison
I thank my hon. Friend for that intervention. I will say more about Monitor’s role, but it is very much in line with what he said and I hope to give him the assurance that he seeks.
Monitor has been working with King’s, local clinical commissioning groups, the NHS Trust Development Authority and NHS England since the acquisition and has worked more closely with the trust recently to get a better picture of the challenges that it faces. However, Monitor has decided to take the new, formal action because King’s has not been able to tackle its challenges on its own. Monitor considers that continuing to work with the trust through more intensive and formal engagement will help to drive the necessary changes.
I want at this point to highlight the fact that, following a formal investigation into a suspected licence breach at a foundation trust, Monitor does not have the power to direct non-foundation trusts, nor does it have the power to direct neighbouring foundation trusts unless they themselves are in breach of their licence. The range of actions available to the regulator range from informal action—for example, requesting further information—to formal enforcement action, including the imposition of additional licence conditions.
Where appropriate, Monitor seeks to encourage the whole health economy to work together to reach a locally owned, consensual solution, which is very much in line with the NHS “Five Year Forward View”. Monitor has said that it recognises that King’s has been working hard, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has said, to improve the quality of care provided at the PRUH. However, through its close work with the trust, Monitor has discovered that achieving the necessary financial and operational turnaround at the PRUH will be a greater challenge than was initially anticipated. Therefore, the regulator has decided to open a formal investigation as part of the regulatory process, which will enable it to use its legal powers to underpin the changes that the trust needs to make. The investigation will help Monitor to decide what resources and support King’s needs to enable it to deal with its financial problems and reduce waiting times for patients. Monitor will announce in due course the outcome of the investigation and whether it will take any further action. There is no statutory time scale for the investigation, because it depends on the scale of the issues encountered. I am sure that all hon. Members would want those issues to be looked at thoroughly.
Bob Stewart
May I just confirm that that means that Lewisham hospital will not be touched by Monitor? Lewisham hospital was a successful hospital before the last investigation, and it appears to be a successful hospital now. If it ain’t broke, don’t fix it.
Jane Ellison
I have just made clear for the record what Monitor’s powers are and are not. I hope that that gives Members on both sides of the Chamber greater clarity than they had when we started. Monitor is in the process of concluding its investigation. It will announce in due course the outcome and whether it will take any further action. Key findings and any next steps will be announced by means of a press notice. Colleagues from Monitor are here in the House, and I would like to put them on notice that I expect—I am sure that they also expect this—Monitor to engage fully with local Members. Clearly, we are entering a more tricky period from that point of view, but on the other side of the election I expect there to be full engagement with local Members, particularly as the solution lies, as I think it will in other health economies that are challenged, in the whole local health economy coming together to understand how to work through the problems. That is laid out in NHS England’s “Five Year Forward View”.
Heidi Alexander
The Minister talks about further support that may be available to King’s and the PRUH when Monitor has concluded its investigation. Will she give some examples of the form that that support may take?
Jane Ellison
If it is acceptable to the hon. Lady, I will write to her to provide some clarity on that. It might be helpful, for example, for Monitor to give examples from other investigations of the sorts of things that it undertook and the changes that it requested through the formal process. I will write to her with some examples to give her a sense of that. I have sought to give a degree of reassurance to Members, and I hope that I have managed to do so.
Jim Dowd
I detect that the Minister has almost concluded her remarks, and I will not have the opportunity to intervene once she has sat down. I am grateful for what she has said, and I will look at the Official Report most carefully. I would be grateful to be copied in on any information that is sent to other Members.
I would like to make another point, out of courtesy, as much as anything else. The hon. Member for Bromley and Chislehurst welcomed the appointment of the new chair of King’s trust, Lord Kerslake. May I put on record a huge vote of gratitude to Sir George Alberti, who is standing down as the chair of the trust, for the service that he has given to King’s and the health service more generally?
Jane Ellison
That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.
I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.
Mr Clive Betts (in the Chair)
Order. For the last time this Parliament, the sitting stands adjourned.
Question put and agreed to.