NHS Shared Business Services

Mike Gapes Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely. Many members of the public will be faintly amused to hear Labour Members say how important it is that we move to electronic health records. The NHS IT project was an absolute catastrophe, costing billions of pounds. The intention was right but the delivery was wrong, and that is what we are trying to sort out.

[Mike Gapes (Ilford South) (Lab/Co-op)]

I understand that large numbers of patients in north-east London were affected by this failure of the service. How many of my constituents were affected, how many of them were cancer patients, and how many would have been subjected therefore to an inordinate delay in receiving referrals for treatment? Can the Secretary of State give that itemised breakdown to all Members of Parliament who will have constituents affected by this?

[Mr Hunt]

I am very happy to write to hon. Members in the areas affected with any extra information that we are able to provide. However, I reassure the hon. Gentleman that to date we have not been able to identify any patient in any part of the country who has come to harm as a result of what happened.

Mental Health and NHS Performance

Mike Gapes Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is right on both counts. We need to look carefully at where the tier system is not working, and that should be part of our work on the Green Paper that the Prime Minister announced this morning. It is unacceptable for people to be told that they are not sick enough to get the care they urgently need. All the things we have announced and intend to announce to improve mental health will fail if we do not get the recruitment and training of new staff right. Along with the commitment we are making today to invest more in mental health must come some important strategic workforce planning, which I hope will benefit my hon. Friend’s constituents.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The Secretary of State referred to temporary assistance being given to distressed trusts, but is there not a more fundamental ticking time bomb in the form of the sustainability and transformation plans? I draw his attention to the debate I led on 16 December on the north-east London plan, which envisages a deficit of £578 million by 2021 and says that on a “business as usual” case model, with normal-type reductions and savings, there will still be a £240 million gap. That will mean poorer services. There is no capital provision for the closure of the King George hospital A&E and its re-provisioning at Queen’s hospital. Will he look into this matter urgently? There is going to be a massive crisis in my area unless urgent steps are taken to provide more resources.

[Mr Hunt]

I am happy to look into that issue. I take this opportunity to pay tribute to the staff of both Queen’s and King George hospital, who have not only done very well over the winter but have made great progress in turning around the trust, which, as the hon. Gentleman knows, is in special measures. We are hopeful that it might be able to come out of special measures at some stage this year under its new leadership, but that is obviously a decision for the CQC.

North-east London STP

Mike Gapes Excerpts

Friday 16th December 2016 Commons Chamber

[Mike Gapes (Ilford South) (Lab/Co-op)]

Changes to our national health service are being planned all over the country, which are going to have profound implications for the quality of health, the availability of both primary and secondary services and for the size and location of our hospitals. There has been justified criticism of the secrecy with which this process of producing so-called sustainability and transformation plans has been carried out. The Department of Health has produced a five year forward view and a very large number of plans. I want to focus on the north-east London sustainability and transformation plan draft, which was published on 21 October, and on the eight delivery plans supposedly to implement it.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I want to put on record my personal gratitude to my hon. Friend on behalf of all the residents of Walthamstow, because we know that these plans are not going to be subject to parliamentary scrutiny. The fact that my hon. Friend has secured this debate today might be the only opportunity we have in Parliament to look at something that will fundamentally transform their local healthcare services.

[Mike Gapes]

I am grateful to my hon. Friend, who spends a great deal of time, as I do, campaigning with her local council to improve the NHS locally. Throughout our sub-region of north-east London, we are all concerned about what we are facing.

The King’s Fund reported in November that the speed of development of these plans means that

“patients and the public have been largely absent”

from the process and that NHS England has instructed that freedom of information requests should be “actively rejected”. Locally in north-east London a freedom of information request for the financial and working detail of the STP was rejected in November on the basis that:

“Disclosure would be likely to inhibit the ability of public authority staff…to express themselves openly...and explore extreme options…Deliberation needs to be made in a ‘safe space’ to develop ideas and to reach decisions away from external interference which may occur if there is premature public or media involvement.”

My local council, Redbridge Council, has been concerned that it has not been adequately involved in the process. It has made it clear that it will act in the interests of our local community and that Redbridge will not be signing off or endorsing the STP unless we are satisfied that it is in the interests of Redbridge residents

I understand that the STP programme boards are not required to hold meetings in public, and no agenda or minutes are published. The secrecy surrounding this process has not been helpful in building public trust and has caused suspicion within communities all over the country—I speak particularly from local experience—as to the intentions of the proposals.  In many respects what could be a reasonable response in the circumstances to the crisis we face in terms of future funding, the ageing population and other challenges to the NHS, is being undermined because of process issues. The NHS needs to learn from these experiences about how better to engage with the public and key stakeholders, including elected local representatives.

We are fortunate in Redbridge and north-east London because there are good working relationships within the NHS and local government, and there is already a model of collaborative working.  However, the problem with the STP is that it brings a top-down process into this situation and potentially undermines the joint-working that has been voluntarily established over recent years.

Redbridge along with neighbouring authorities will be strongly arguing that the developing STP governance structures should not stifle or negatively impact the local work that is happening. Redbridge and its partners in Barking and Dagenham and in Havering have over a number of years been developing cross-borough, collaborative approaches on the integration of health and social care. Redbridge is arguing that STP governance needs to ensure that this subsidiarity to the local level is taken as a model for the future, and is not undermined by the STP approach. We need to ensure democratic accountability if we are to get public buy-in, and we do not have that at present. Public engagement needs to be enhanced and improved.

The north-east London October STP draft is subtitled “transformation underpinned by system thinking and local action”. It says, however, that

“the system partners may not be able to work together collaboratively to deliver the plans.”

Today we have seen news about the reality we face in our NHS: large numbers of hospitals with dangerously high bed-occupancy levels and little or no flexibility. The CQC’s chief executive recently talked about hospitals being dangerously full. On 26 November, a leaked memo from NHS England revealed that hospitals were being banned from declaring so-called “black alerts” and told to prepare for the winter crisis by passing on scheduled surgery to private hospitals and discharging thousands of patients to get bed occupancy down from a national average of 89% to 85%. 

However, north-east London’s population is massively increasing. The report states that the population of north-east London boroughs will increase by 18% over the next 15 years—equivalent to a new city—and yet there is no plan for an additional hospital to cope with that change. In fact, page 20 of the draft policy states that building an additional hospital is “not practical or realistic.” Indeed, the situation is worse than that. Not only is there no extra hospital, there is the planned closure of the A&E at King George hospital in my constituency. The plan is to stop overnight ambulances sometime next year, with a total closure in 2019. The STP is calling for that not only because it would meet some savings and restructuring requirements, but also because there are unsustainable costs. The previous Health Secretary announced in 2011 that the A&E at King George would close in “around two years”. That has not happened because it was deemed unsafe and because there is insufficient capacity at Queen’s hospital in Romford or at Whipps Cross university hospital in Waltham Forest to cope with the increased demand.

Despite our excellent and hard-working staff, all the hospitals in north-east London are in crisis. With pressure for early discharges, but inadequate social care and community support, we have large-scale bed blocking and delayed discharges. Sick patients then get readmitted because they cannot get GP appointments due to the pressures that exist in that sector. The STP sees out-of-hospital and integrated community care as the way forward. However, Dame Julie Moore, who in 2014 chaired a commission on hospital care for frail elderly people, said:

“As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population… the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing… but this can never be a substitution for hospital care.”

We still need hospitals and acute care. Plans to transform care in the community are good, but that requires a transformation of primary care, which needs resourcing. The STP projects a 30% shortfall in nurses by 2021, and we know that many GPs plan to retire over the next few years. Both are difficult issues.

Problems also exist in the potential financial situation, and one such issue is the estates strategy. The STP delivery plan highlights sites such as Goodmayes hospital, which is a large mental health hospital, and King George hospital as places where land could be sold. Contractual issues and other matters mean that that is probably an optimistic approach.

[Stella Creasy]

My hon. Friend is making an incredibly powerful case about why we must involve the public in some incredibly difficult decisions. We know that the financial situation we are facing is particularly dire. He has just mentioned the sites at Goodmayes, but in addition Whipps Cross has a large private finance initiative debt, where it is paying out a huge amount of money. No wonder the suggestion is being made that we need £578 million to bridge the gap.

[Mike Gapes]

My hon. Friend has given the figure I was about to cite. The STP executive summary states:

“Our total financial challenge in a ‘do nothing’ scenario would be £578m by 2021. Achieving ambitious ‘business as usual’ cost improvements as we have done in the past would still leave us with a funding gap of £336m by 2021.”

Those are eye-watering figures. The claim is made that

“we have identified a range of opportunities and interventions to help reduce the gap significantly”.

However, the £240 million gap between the “business as usual” case model and the actual predicted figure requires a series of other measures, including significant funding from the sustainability and transformation fund, reductions and changes in specialised commissioning, and what is called

“potential support for excess Public Finance Initiative (PFI) costs.”

That covers Whipps Cross hospital, Queen’s hospital, Romford, and, to some extent, King George hospital. “Potential”, what a lovely word. So this is not real and it is not even planned—it is just “potential”.

These plans are based on unrealistic, heroic, Soviet-style assumptions. This is a truly Stakhanovite model of over-estimation of potential, yet the STP still proposes it can transform a deficit of £578 million in 2021 into a potential surplus of £37 million—and improve the services. That will not happen. The plans are also predicated on totally unrealistic assumptions about savings from closing the A&E services at King George hospital, and there is a lack of clarity as to when this will happen and how much we are talking about. I have been told that tens of millions would be invested in the sites at Queen’s and Whipps Cross, but I have been told that at least £75 million is needed to do that, and there is no sign of where this capital is coming from in the Department of Health. So wards are being closed in one hospital and then millions are being invested in rebuilding wards or constructing wards at other hospitals, for no real net gain.

There is also a problem about what process will be involved in this closure at King George hospital. I am conscious that I do not have limitless time, but let me say that my local Redbridge Council is very concerned about this, because King George is supposed to be transformed from an acute hospital into an urgent care centre and so the local community needs to be involved. Redbridge is requesting that it should be involved, and I note that it has recently been agreed that it will be involved on the transformation board. However, Redbridge wants an independent chair of that board, because it is important to involve a person of public trust so that there is no controversy. There needs to be a transparent, open process as we discuss the options for the future of King George hospital, so that we can challenge the business case and take account of the fact that the assumptions on which this model is based are 10 years old. They go back to the misnamed “Fit for the Future” plans of 2006. The population growth that we have had and the growth that is yet to come, the young population that we have in the area and the movement in population means we have to look at these issues with great doubt and concern.

We need to assess the implications of all those issues. As Redbridge says, it wants to know how the reconfiguration to an urgent care centre assists primary care, community health services, adult social care, public health, and public health prevention and education. An opportunity exists in the changes, but we need public engagement in those changes, and we do not have that at the moment.

There will be enormous pressure on my local council because of budget problems, and I am worried about the situation. I am glad that the STP highlights the social care challenge, but it needs to be taken seriously by the Government if we are truly to have an effective health and social care system. The statement in this House yesterday did not offer a solution to my borough. It did not answer the challenge that boroughs such as Redbridge are facing. These boroughs are already ahead of the game in the integration of health and adult social services and are working with neighbours to take up the challenge by being a pilot for the development of an accountable care system.

Yet with all that transformation, Redbridge still faces a huge social care challenge. That is made worse by a triple whammy of public sector funding reductions to local government—my borough has lost 40% of its income since 2010—chronic underfunding of adult social care by the Government and the fact that Redbridge does not get a fair funding level in the first place. There is, potentially, a major problem. We face a shortfall of about £4 million in social care and the 1% extra on council tax raises less than £1 million. The responses that we have heard from the Government in recent days have been inadequate—indeed they have been worse even than the silence from the Chancellor in the autumn statement. They offer no real solutions to the growing crisis that will impact on some of the most vulnerable in our society.

I conclude with this plea: please will the Government look at the situation in north-east London and will the Minister meet me to discuss the fact that this plan is unrealistic, incredible, unachievable and will lead to disaster?

Junior Doctors Contracts

Mike Gapes Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Part of the hallmark of this Government’s approach to the NHS has to be honesty about where we have too many avoidable deaths, and where there is the weekend effect for people admitted to hospital at the weekends. We have a big responsibility in that regard. The reason why we discharge that responsibility is that we believe in the NHS. We want the NHS to be the safest, highest-quality system in the world. Just as this Government have pioneered reforms that have dramatically improved the quality of state education, so too we need equal reforms in the NHS. That is why it is absolutely right to say that we have to focus on these things and debate them in this House. We should not automatically say that there is someone who must be blamed when we are dealing with these difficult situations. Unfortunately, one of the things that has led to feelings running high in this dispute has been the sense of blame being tossed around, when what the Government want to do is try to solve the problem.

[Mike Gapes (Ilford South) (Lab/Co-op)]

May I tell the Secretary of State about my admission to hospital in the early hours of a Saturday morning? I spent five and a half weeks in intensive care. I had many conversations with doctors during the time I was in St Mary’s hospital, Paddington. I ask him to look at the circumstances of those doctors today, as they do work weekends. We do have a weekend NHS. It is not true to say that the lives of people like me who are admitted at the weekend are not saved, because it is the doctors who make it possible for us to survive. Will he stop talking down the medical profession and start defending the doctors?

[Mr Hunt]

With respect, that precisely encapsulates the problem. The hon. Gentleman has interpreted the fact that I want to do something about excess mortality rates, which mean that a person admitted at the weekend has an 11% to 15% higher chance of death than if they were admitted in the week—that is proven in a very comprehensive study—as an attack on the medical profession. Nothing could be further from the truth. It was actually the medical profession—the royal colleges and Professor Sir Bruce Keogh—that first pointed out this problem of the weekend effect. We are simply doing something about it.

NHS in London

Mike Gapes Excerpts

Thursday 24th March 2016 Westminster Hall

[Wes Streeting]

I am grateful to the Chair of the Public Accounts Committee for giving us that insight, which gives me even greater cause for concern about our local situation in Redbridge. The overall gap in funding for the NHS should be a concern to the whole country.

In my borough in particular, I am concerned by a report produced for NHS England by McKinsey & Company in, I believe, July 2014. The report has just been released by NHS England following a freedom of information request, and it identifies a Barking, Havering and Redbridge system gap of £128 million for commissioners and £260 million for providers. I am concerned by several things. One is that one way in which McKinsey identified that the BHR system will be able to address that gap is through acute reconfiguration of King George hospital, where the accident and emergency department is threatened with closure. I am deeply disappointed that, at a recent meeting of the Ilford North Conservatives attended by the hon. Member for Richmond Park (Zac Goldsmith) for his London mayoral campaign, the Conservatives once again stood up and said, “People should not worry about the accident and emergency department, because we always say it’s going to close and it never does.” The only reason why the accident and emergency department at King George hospital is still there is not because of a positive decision to keep it but because the NHS trust and the local health economy are in such a mess that it would not be clinically safe to close it at this time; the accident and emergency department is still very much at risk.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The national health service bureaucracy has been trying to close the A&E at King George hospital since 2006. We are coming up to the 10th anniversary of the misnamed “Fit for the Future” document. My hon. Friend’s predecessor, Lee Scott, and I fought a vigorous campaign to stop the closure at the time, and the closure decision was deemed to be clinically unsound. Now, the Trust Development Authority is in charge, and the A&E cannot be closed because the trust is not out of special measures. My hon. Friend has mentioned the trust’s chief executive, Matthew Hopkins, who was hoping to get out of special measures by the end of the year, but that has not happened. We are still in a period of great uncertainty.

[Wes Streeting]

I agree with my hon. Friend and I welcome him back to Parliament this week after his break. [Interruption.] I know that he has gone to extraordinary lengths to test the resilience of the NHS in London and that he will talk about that shortly. We look forward to it.

In all seriousness, the A&E department is still at risk and many of my constituents worry that it is the financial drivers that are pressing ahead with the closure, rather than the clinical drivers. As my hon. Friend has said, given the length of time since the original case for closure was prepared and since the decision to close was made, it is not unreasonable to ask the Minister to commit to reopening that closure decision and to look at the issue with a fresh pair of eyes, testing whether the evidence base is still there, testing the assumptions that were made when the original closure proposal was put forward and giving people the assurance that it is clinical factors and the healthcare of our residents, rather than financial factors, that are driving this process.

The final thing I will draw upon from the McKinsey report is about meeting the financial pressure within the BHR system. McKinsey observes that to fully close the gap will require further stretch productivity achievement beyond the levels agreed locally, as well as additional private finance initiative support and the closure of the gap to the CCG allocation. The £140 million-odd deficit in 2013-14 was only reached after a £16 million PFI subsidy, and the deficit as a percentage of income is far larger even than it was for Barts at that time.

It is not unreasonable, as part of the wider changes in Redbridge and the work being led by the accountable care organisation, to expect the Government to provide further support in relation to our PFI debt. Many challenges face the local health economy in Redbridge and that debt is like an albatross around our necks. If the Government were to invest now in alleviating that pressure, we may get better outcomes in the long term. I hope that that is an issue the Minister will address when she responds to the debate.

--- Later in debate ---

[Meg Hillier]

I am sure the Minister will do that, but I am happy to share anything I receive from her. I am sure she will not be writing me secret letters, and even if she told me that she was I would ignore her, so I hope she provides information that is fully public.

There is a real concern about health workers being unable to afford to buy homes. When a group of local MPs met officials from the Barts trust after one of the trust’s more recent crises—it was around the time of, or just before, the general election—we asked them about the release of land for health workers. We got the distinct impression that those running the trust at the time—we have had new management in since—did not think that it was their responsibility to provide housing; the process was just about disposing of the land to fill the black hole in the trust’s budget. However, we know that health workers cannot afford to live in London and work locally; that is often true of doctors on good salaries, let alone anyone on a lower salary. There will be a real crisis if we cannot recruit health workers, and I will touch on that issue in a moment.

NHS England is keen to lay the blame for the financial crisis in acute trusts at the door of agency staff costs. The Secretary of State announced a cap on the pay rate in October, but the National Audit Office found that that is not the underlying problem. We also touched on the matter in a Public Accounts Committee hearing. It is the volume of agency working, rather than the rate paid, that is the bigger problem—the vacancy rate, requiring backfilling with agency workers, rather than the amount that they are paid. No doubt there is an problem there and the NHS should begin—I hope that it is beginning—to use its purchasing power to tackle that, but the foundation staffing model for hospitals, which is designed to fit the budget allocated by the Department, often has too few staff to deliver the required health outcomes. The NAO has uncovered the fact that 61% of temporary staffing requests in 2014-15 were to cover vacancies, not emergency cover.

[Mike Gapes]

Is my hon. Friend aware that the NHS employers and London NHS partnership have this week sent out information stating that nursing vacancies in London are running at 17%, which is 10,000 nurses? The NHS and local trusts are going all over the world to recruit, but the Home Office is bringing in a requirement for people to earn £35,000 before letting them in. Does not that contradict what the NHS is trying to do?

[Meg Hillier]

My hon. Friend anticipates what I was going to say—or perhaps it is just that we are all dealing with the same problems. Will the Minister outline what conversations her Department and NHS England have been having with the Home Office about the issue? We have seen many changes in the immigration rules, and they affect what happens. We should be recruiting and training British citizens and enabling them to earn a living, although I have no problem with other people working in the NHS. When we have problems with recruitment, of course it is right to look overseas, and many of our hospitals are well staffed by people from all round the world; but if those people cannot meet the threshold, they will not be allowed in, and that will cause a problem. I know that it is also causing concern to NHS England. No doubt the Minister is being lobbied; perhaps she can advise us. The cost to hospital trusts of the agency staff who fill in the gaps—they could be full-time workers from overseas or from the UK—has risen from £2.2 billion in 2009-10 to £3.3 billion in 2014-15.

I do not have much time to discuss GPs, but we know that that is a big issue, given the demand on the health service at primary care level in particular. On national figures, recruitment of new GPs is slow and early retirement is a looming crisis. If the Minister has not been alerted to that problem, I hope she will look into it. It is not a new phenomenon, but it is getting worse. Between 2005 and 2014 the proportion of GPs aged between 55 and 64 who left approximately doubled. In addition, there is an increasing proportion of unfilled training places—the figure was 12% in 2014-15—and an increasing number of younger GPs are leaving because the job is becoming untenable, with 12-hour days typical. Many GPs just do not want to do that. We need good access and support in primary care to make it work.

The Public Accounts Committee has recently looked at another issue that is worth highlighting, which is the management and supply of NHS clinical staff. We would acknowledge, although our report is not yet out, that in an organisation the size of the national health service, getting things exactly right will always be complex. The figures and the available data about who is needed, together with the problems that I have mentioned to do with GPs and recruitment of hospital and other health workers, could have been predicted. That is something on which I want the Minister to respond: surely, if there is a prediction, there is a need to be able to react quickly, so that training places are available and people are encouraged to take them up. That way, we would ensure that there were enough health workers.

To return to the issue of housing, it is at crisis point in my constituency. Someone on quite a good income cannot afford to buy or to rent in the private sector and will not have a hope of getting social housing, so we have a vast turnover of people. Young people come and live like students, but when they want a home of their own, a spare bedroom for a child, or just a lifestyle that they think befits their status and age, they move out. We have a crisis across the board, but particularly for the NHS. I hope that the Minister will answer some of my questions about how housing can become a key concern for her Department as well as the Department for Communities and Local Government, which delivers housing. My worry is that if the Minister and her colleagues do not lobby hard, the problem will be forgotten in the overall housing crisis and will become a major crisis for public health and health and wellbeing in London.

[Mike Gapes (Ilford South) (Lab/Co-op)]

I am particularly pleased that you are in the Chair today, Ms Buck, because I am going to refer to St. Mary’s hospital and the Imperial College Healthcare NHS trust, which saved my life. You know it very well. This is my first speech or question in the House—apart from my earlier interventions —since November. My neighbour, the hon. Member for Ilford North (Wes Streeting) referred to my extended break. It was not voluntary or by choice.

I had been at a concert at the Royal Albert Hall—in fact, Jools Holland saved my life, because if I had not gone to the concert I would not have had friends with me during the events of that November evening. I was rushed by ambulance initially to Chelsea and Westminster hospital, where I collapsed. They scanned me and decided that I had such a serious ruptured thoracic aneurysm that they had to transfer me by ambulance to St Mary’s hospital in Paddington. I came to in the ambulance and I have a vivid memory of going down the ramp out of the ambulance into A&E at St Mary’s, where about 10 people were waiting. They ran me in the trolley straight into the operating theatre, where the consultant said, “I hope you don’t mind. We have injected you with the anaesthetic, but do you mind if we cut the shirt off your back, because we have got to start straight away? The anaesthetic will take a moment to work.” Then I heard a female voice saying, “I know this is hurting, but I’m sorry, I’ve got to do this.” Then I was unconscious.

I had a total of eight weeks in St Mary’s hospital, with five and a half weeks in the intensive care unit, for nearly three of which I was in an induced coma. I had a series of operations on my heart and a tracheostomy, which is an interesting experience whereby a tube is permanently inserted—or it seems as it if is permanent; fortunately it is not there any more. I had other operations while I was there, as well, so I am a bit bionic. I have not yet flown anywhere, and I am waiting to see what will happen to the metal detectors at the airport, because I have some stents that might cause some complications.

I was at the hospital this morning and they were pleased with my progress, so I am able to be back here in Parliament. I want to say thank you to all the staff —the consultants, the senior and junior doctors, the cleaners, the people who gave me my food, all the nursing staff, and the physiotherapists. They initially got me walking with a Zimmer frame, with oxygen cylinders first at 100% and eventually at 28%; they managed to get me to walk up some stairs, so I could be sent home. I pay tribute to them because it is a bit of a miracle that I am here today—I have been told that by at least two consultants. Most people who go into hospital with what happened to me do not come out, so every day from now on is a bonus.

I went in on a Friday night, in the early hours of Saturday morning—a weekend. We must not let anyone say we do not have a seven-days-a-week NHS. I have seen it. I have been cared for seven days a week, looked after and fed seven days a week, for two months. I have had the most excellent treatment. I have seen the 8 o’clock in the morning shift come on and then the 8 o’clock at night shift—12-hour shifts. I have seen the turnaround. Whether I was in the intensive care unit, the Charles Pannett ward or the Zachary Cope ward, I have seen the dedication and commitment of the staff. They come from all over the world. The nurses who treated me included a man called Riad, a Palestinian from Jordan, who was fascinated to know that I had been in Amman with the Foreign Affairs Committee four days before I went into hospital. There were nurses from Malaysia, the Philippines, Ireland, Ilford and many other places around the world.

The fact is that we in London depend on a pool of staff who have come to our city from all over the world to help us, to save us and to keep us well. We must never forget that. It is why the Home Office needs to understand that London’s success as a global city depends on the workers in London being healthy. As Anne Rainsberry told us in the meeting with London Labour MPs the other day, 20% of the people treated in London do not live in London. London serves the whole community. The vascular facilities at St Mary’s take patients from all over. I was told that even if I had had the heart problem in Ilford, I might still have been transferred to St Mary’s. The unit has patients from Southend, Newport in south Wales and even from Gibraltar.

That indicates to me that we have to retain the staffing levels and level of expertise in our specialist hospitals and in our specialist departments within London hospitals. That is not possible, as my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) pointed out, if people cannot afford to live in London and if most newly trained nurses seek jobs elsewhere within two or three years. It is not because they do not enjoy their work, but because they cannot afford or are fed up with two or three hours of travel every day.

We have to deal with the problem, and it requires the new Mayor of London, all our local authorities and the Government to look at it seriously. It also requires the Home Office, after the European referendum, to think again about the absurd position where we will cut off our nose to spite our face by making it impossible in a shortage period to recruit people to certain occupations because of the £35,000 threshold.

[Paul Scully]

The hon. Gentleman is making an incredibly powerful speech and I am grateful to hear about his personal experience. On the shortage of nurses, while it is preferable to train people domestically, does the hon. Gentleman agree that where we cannot fill those places, the shortage occupation list—it is devised by the Migration Advisory Committee, which has placed nurses on the list—goes some way to mitigating the £35,000 criteria?

[Mike Gapes]

The interesting thing is that NHS nurses were not originally on that shortage list. There had to be a lobbying campaign to get them put in because of the stupidity of the people in the Home Office who drew up the list. The fact is that the £35,000 figure will present a problem. Obviously, it will not present a problem in recruiting doctors from abroad, but it is a significant problem in recruiting nurses and other people at lower wage levels. We need to raise that issue, because it will be damaging in the long term.

Of course we need to train more nurses, but to do so the Government need a consistent policy. It takes several years to train a nurse. It is not something that can be switched on and switched off. The other issue is retention. Large numbers of nurses leave our NHS and go and work in other countries. Just as we take nurses from other countries, so British nurses go abroad. There is no reason why that should not be the case; it is a global health economy and the reality is that if we do not pay the lower paid staff in the NHS what they need, we will not recruit sufficient numbers of people to do those jobs.

[Wes Streeting]

In the context of the recruitment and retention challenges for NHS staff, does my hon. Friend share my concern and that of a number of Members from all parts of the House on the plans to charge nurses, midwives and students of allied health subjects full tuition fees and to remove the NHS bursary? Those things will be deeply damaging to recruitment of the very staff that we need to bring into the NHS.

[Mike Gapes]

Absolutely, I do agree. That is why I signed my hon. Friend’s early-day motion today. I am about to put it in so that my name is added, now that I am back.

In conclusion, it is a great pleasure and a bit of a coincidence that this debate was here today, but I could not miss the opportunity to say thank you to those people who saved my life.

Male Suicide and International Men’s Day

Mike Gapes Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I will.

[Mike Gapes (in the Chair)]

Order. I say to hon. Members: please can we conduct this debate in a civil manner, without it degenerating into an argument of that kind? I ask all Members, please, can we get back to the subject of the debate?

Mr Walker wanted to intervene.

[Mr Robin Walker]

I did; thank you, Mr Gapes. My hon. Friend has never been afraid to put his head above the parapet. We may not all agree with every point that he makes, but he is raising important issues about family breakdown and suicide. Does he agree that reforms to create equal parental leave are important in fostering men’s role in the family? It is vital that the Government continue to pursue such initiatives as the family test to ensure that we take every opportunity to avoid the causes of family breakdown, which is a great problem for men as well as women.

Cardiac Screening: Young People

Mike Gapes Excerpts

Tuesday 27th October 2015 Commons Chamber

[Mims Davies]

I absolutely agree. The UK National Screening Committee has refused to make a comprehensive offer of heart screening for young people in the UK, which I think is a scandal.

[Mike Gapes (Ilford South) (Lab/Co-op)]

I lost my own daughter three and a half years ago from sudden unexplained heart failure. I am a supporter of CRY, and I appeal to the Government to listen to what is being said in this debate. Many young people between 14 and 35 die suddenly from an unexplained cause, and that is a personal tragedy for the families and friends of those young people. I came to this debate unsure of whether I would be able to intervene, and it is a great grief and something that is with me all the time. I wish that people would take this issue more seriously.

[Mims Davies]

I thank the hon. Gentleman for such an eloquent and kind intervention. I am sorry for his loss. We think of all the children in this debate.

How can it be right to wait for tragedy to strike before taking action? That is truly unacceptable. I urge the Minister tonight to review the policy and to reverse it. As with many other preventable illnesses, screening needs to be part of the standard healthcare provided to our young people. Screening has more than just general benefits: it helps to prevent future diseases. Heart UK estimates that if 50% of people with the potential genetic condition known as familial hypercholesterolaemia or FH—a naturally occurring high cholesterol condition—were diagnosed and then treated, the NHS could save £1.7 million per year on treatment. Truly comprehensive heart screening is a good measure for now and a perfect insurance policy for the future.

Barking, Havering and Redbridge University Hospitals NHS Trust

Mike Gapes Excerpts

Wednesday 15th July 2015 Westminster Hall

[Mike Gapes (Ilford South) (Lab/Co-op)]

I beg to move,

That this House has considered the future of Barking, Havering and Redbridge University Hospitals NHS Trust.

I begin by declaring an interest: I was a patient at Queen’s hospital in January. My operation was cancelled at two hours’ notice, but despite that hiccup I was given excellent treatment a couple of weeks later. I want to place on the record the fact that despite being in a very busy department, the staff were working very well and had excellent morale, as far as I could see during my groggy recovery from my operation.

The Barking, Havering and Redbridge University Hospitals NHS Trust was established in the 1990s. It brings together two acute general hospitals—King George hospital in Ilford in my constituency and Queen’s hospital in Romford, which was a new-build private finance initiative hospital to replace the old church hospital.

Since 2006, there have been many pressures for reorganisation of services in north-east London. There was a misnamed project called “Fit for the Future”, which was scrapped because it was clinically unsound. Since then, there have been proposals that would have meant downgrading services at some hospitals, particularly King George hospital. To cut a long story short, an independent reconfiguration panel looked at the proposals, and eventually, in 2011, the then Secretary of State for Health, Andrew Lansley, gave the go-ahead to close the maternity and accident and emergency services at King George hospital in around two years. The maternity services were reconfigured in early 2013, but A&E is still at King George hospital.

The trust is very big. There are 750,000 people in its catchment and it covers three London boroughs—Barking and Dagenham, Redbridge, and Havering. Havering has an elderly population overall, but Barking and Dagenham and Redbridge have some very young people. There is a churning population, with lots of migrants, from both elsewhere in the UK and many other parts of the world. GP services and primary care services have been poor and inadequate for many years. There have always been pressures on the hospitals and trusts in north-east London. Those pressures have led to accumulated deficits and concerns about the quality of service.

In October 2013, the Care Quality Commission carried out an inspection of the services at the Barking, Havering and Redbridge trust. It concluded that the trust should be put into special measures. The press release put out on December 18 said:

“The NHS Trust Development Authority…today confirmed that Barking, Havering and Redbridge…will be placed into special measures. The move follows the CQC Chief Inspector of Hospital’s report…which concludes that while there have been signs of sustained improvements in some areas, the leadership of the Trust needs support to tackle the scale of the problems it faces. While aware of many of the issues raised by CQC around patient safety and patient care, attempts to address these issues have had insufficient impact.”

As a result, the trust was put into special measures and all the management were got rid of. It took a while to fill the various posts, but an interim chief executive was brought in and other posts were changed. I have been impressed with the chief executive, Matthew Hopkins. He and the team around him are doing their best to improve services in the area. However, fundamental, difficult problems remain.

The CQC’s 2013 report, which led to the involvement of the NHS Trust Development Authority, highlighted a number of areas of concern, and follow-up work was carried out. One underlying issue was the financial crisis, which remains at the trust. A new finance director, Jeff Buggle, was appointed in July last year, although he did not take up his job until December. The press release at the time he was appointed said that the trust had a £38 million deficit, with expenditure of somewhere around £400 million or more in 2013-14. I understand that the target for the deficit this year was £29 million, but that has not been met; the deficit remains at about the level it was a year ago. That is not surprising; the Health Service Journal from June 26 this year has an interesting statement from Richard Douglas, the former director general for finance at the Department of Health. He said that trusts placed in special measures

“tend to exit the regime with a financial position that had deteriorated”.

The reason is that there is so much pressure to improve services that the expenditure must continue.

It is a bit like the situation in Greece: we have an underlying deficit, a temporary troika, or body, comes in to sort out the problems and the trust is put into special measures. Fortunately, we do not have a far-left, far-right coalition running the hospitals. Nevertheless, we face fundamental difficulties.

The special measures, which were called for, have led to a number of changes. I wish to draw attention to the further inspection that the CQC carried out in March, the results of which were published only at the beginning of July. To the disappointment of the new leadership of the trust, the CQC says that BHRT must remain, for the next few months at least, in special measures. The CQC’s latest report says that although improvements have been made in a number of services, many are still rated as requiring improvement. Professor Sir Mike Richards concluded that significant improvement was still required, and therefore there will be a further inspection before the end of the year to see whether other changes have been introduced since that assessment was made in March.

Clearly I do not have time, even in an hour-long debate, to go through the voluminous reports—the general one and the one on each of the hospitals in the trust—but I will refer to some of the main points. I hope the Under-Secretary of State for Health can reassure me on some issues in his response.

First, I want to make it clear that anything I say here is not a criticism of the staff in my local hospitals. They face enormous pressures; we have a trust that faces huge demand and there are huge pressures on it. I will just give some figures. There are just over 1,000 beds in the two hospitals, of which 80 are maternity beds, 32 are critical care beds, and 972 are general and acute beds. There are 73,000 in-patient admissions, 592,000 out-patient attendances and 245,000 emergency department attendances each year. That figure of 245,000 is divided into 97,000 attendances at King George hospital in Ilford, which Andrew Lansley said in 2011 should be closed within about two years, with the rest—nearly 150,000 attendances —at Queen’s hospital in Romford.

Average bed occupancy in the hospitals is consistently around 93%, 94% or 95%. There is almost no flexibility, and my own experience in January of having an operation cancelled at short notice is sadly repeated from time to time. We had a mild winter and yet operations were being cancelled in January. The same pressures will come each year in this area in outer north-east London, which has a young population and rapid population growth.

I will refer to some of the issues affecting the hospitals. I begin by quoting Mike Richards again:

“Despite considerable attention the trust is failing to meet waiting time targets in the emergency department. Outpatients and diagnostics can’t cope with demand and the children’s services do not meet local need.

I am particularly concerned at the large backlog of investigations into serious incidents, which suggests that safety has not been given the priority it requires and lessons are not being learnt as they should.

However, the new executive team has made significant improvement ensuring the overall culture of the trust was more open and transparent making it a much more positive place to work.”

The point I am making is that this trust needs support, and it needs that support to continue for a period of time.

The CQC report asked whether services at the trust were safe, effective and caring. The rating for all three was “Requires improvement”. It asked, “Are services at this trust responsive?” The rating was “Inadequate”, which is the red one on the traffic lights. It asked whether services were well led; the rating was “Requires improvement”. That is the overall rating for the trust—“Requires improvement”—and there are particular concerns about urgent and emergency services.

The CQC report covers a range of different services at the two hospitals, but the essence of the report is that there are major difficulties, and I will refer to just a few of them. First, the report says:

“The service planning for children’s services was not responsive to local needs.”

Secondly, it says:

“The trust faces significant capacity pressures which it has tried to address”.

Thirdly, it says:

“Across all core services there was limited evidence of learning from complaints and concerns being applied to service improvement. We identified areas where complaints response was slow leading to backlogs, lack of action planning and absence of thematic analysis.”

Fourthly—and this is very significant—it says, under the heading “Governance, risk management and quality measurement”:

“Amidst many improvements within the trust since our last inspection, governance, risk management and quality measurement is an area of significant concern as little improvement has been made…Previous cost reduction plans had significantly reduced the infrastructure to support governance and safety.”

This is a trust with a deficit of about £37 million or £38 million, and it has to eliminate that deficit. When it comes out of special measures—as it no doubt will, perhaps in a few months or maybe in a year, depending on what the next inspection says—it will still face these financial pressures. One of the reasons why it has had difficulties is that it has already had to subject itself to those pressures.

The CQC report continues:



“There is a heavy reliance on individuals and the use of short term interim staff.”

Recruitment and retention of staff have been major difficulties, and they have added to the cost pressures.

We face a difficult situation. We have a management—a leadership—who are trying to turn the trust round, and they are doing much better than their predecessors. They face enormous pressures, and those difficulties are perpetuated and even made worse by the cuts in social care at local authorities, the fact that we have inadequate GP services and the fact that many people just present themselves at accident and emergency rather than going to a GP. That is because they have been trying to get an appointment with their GP for two weeks, and, in the case of the Loxford polyclinic in my constituency, they have been phoning for hours but cannot get through because there is a problem with the switchboard. The same problems arise in a more intense way while the trust is dealing with this financial crisis.

What is the way forward? I will speak for just a few more minutes, to allow my colleagues the chance to contribute to the debate. The CQC report carries out a “Friends and Family test”, and I find the results for the trust extremely concerning. In the test, there is an assessment of the different departments. The report says:

“NHS Friends and Family test (July 2014)—average score for urgent and emergency care was 20%, which was worse”—

in fact, considerably worse—

“than the national average of 53%.”

The report continued:

“The average Friends and Family score for inpatients was 73, which is the same as the national average…The Friends and Family score for maternity…was 70, which was better than the England average of 62.”

So it is not all bad news.

However, the urgent and emergency care is a significant problem, yet the Government decided in 2011, based on the independent reconfiguration panel and the CQC report, that the A&E department at King George hospital should be closed and all A&E services should be relocated to Queen’s hospital. Queen’s cannot cope as it is. Consistently, the Queen’s A&E has had worse assessments than the King George A&E. Yet the sword of Damocles is still hanging over the A&E at King George, and there is this mass of 245,000 patients who go to the A&E departments at the two hospitals, which they cannot cope with.

Let us suppose that the assessment in December, or whenever it is, leads to the trust coming out of special measures next year. What will that mean? What will the consequence of that be? I will quote the summary of the CQC report on urgent and emergency services. The “Friends and Family test”, which I have just quoted, said those services were

“showing no signs of improvement over the 12 months prior to the inspection. The hospital had not achieved the national four-hour waiting target of 95% of patients seen within this timeframe for more than a year, and usually averaged around 90% of patients seen within this time. Patients often had waits of four hours or more in the department and were waiting for long periods of time to be moved to an appropriate bed once it has been decided they should be admitted.”

This is the key sentence:

“There was no clarity about the future of the department and when, or if, it might close in the future.”

This has been hanging over my local hospital since 2006. We have fought vigorous community campaigns and the issue is still hanging over it. There is no clarity. If, because of improved management, the situation improves later in the year and the trust comes out of special measures, will that mean—I suspect it will—that there will then be moves to close the A&E at King George because the trust is no longer in special measures? There is not the capacity at Queen’s to deal with that. It will take years, considerable cost, and millions of pounds of investment on the Queen’s hospital site before Queen’s hospital is ready to cope with this situation.

Rather than wasting millions of pounds and causing more difficulties for several years, would it not be better if the sword of Damocles was taken away, thereby ending the uncertainty and lack of clarity mentioned in the CQC report? Then we could deal with the problems of recruiting sufficient specialist doctors and having adequate cover at all times, and maybe work out a plan for a relationship between the two acute and emergency departments whereby there would not be a closure, but perhaps a rethink about how services were run.

Clearly, Queen’s cannot cope today. However, it is still the Government’s plan to close King George. I have asked Ministers about this for several years and the answer has never changed. There is still uncertainty. What will the future of King George be? It is time to end the uncertainty, to give a sense of clarity and, as the trust improves, to take away the threat to close the A&E department at King George.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Ilford South (Mike Gapes) for raising what is an important matter not only for his constituents, but for the whole health economy of east London, and for the measured way he presented his case. He has been a watcher of and campaigner on the matters in his constituency for a long time. This matter has been addressed and debated on several occasions in this Chamber, and I know he has raised it in the main Chamber too. The last time he raised it here was in January 2014, just after the trust had been put into special measures by the Care Quality Commission in December 2013.

The distance that has been travelled since then is quite considerable. I was able to see it for myself recently, as my first ministerial visit was to visit the Queen’s hospital site—albeit to hear about the trust as a whole. It was clear from talking to staff, which I was able to do without management being present, that the distance travelled over the past 18 months has been considerable and transformative not only for patient care, but for staff experience of the workplace—the two, as all Members will recognise, are coterminous. The most instructive moment came in the staff discussion, when a nurse explained that, the day before, a petition signed by 3,000 local people, which had not instigated by anyone at the hospital, had been delivered to say how much they valued staff efforts to turn around their hospital and how they felt that it was a different place from the one that had gained a mixed reputation in the many years before the hospital was put into special measures.

I will address each of the issues raised by hon. Members in turn, but I want first to set the context and add slightly to the narrative provided by the hon. Member for Ilford South in his recounting of the trust’s history. The key review in the matters that we are discussing was begun in 2009. The review took in the whole of Health for North East London and was conducted under the right hon. Member for Leigh (Andy Burnham), then the Secretary of State for Health and now the shadow Secretary of State. It began reporting just before the 2010 election and required an answer immediately after. The hon. Member for Ilford South will know the report’s conclusion, which is basically what we are still sitting with. It encompassed not only the health economy of north-east London, but the relationship with what is now the Barts Health NHS Trust, encompassing Whipps Cross university hospital, St Bartholomew’s hospital, Newham university hospital and the Royal London hospital.

Several hon. Members have discussed the Government’s intentions regarding reconfiguration, but the report was not led by the Government or Whitehall but was under the sensible regime set up by the previous Labour Government of clinically led reconfiguration panels. The principle behind it was a better organisation of A&E and urgent care in east and north-east London—in particular, being able to provide superior trauma care at fewer sites. That model has wide understanding across the House and is based on international evidence and, increasingly, the experience in the NHS. It has affected my constituency as much as it has others around the country.

I understand why hon. Members who are concerned about a hospital that will lose particular services—although King George hospital will retain a 24-hour urgent care service—will feel aggrieved by that change. When engaging with patients and constituents, however, I ask that we remind everyone that this was a clinically led decision that was set up under the previous Labour Government and that the recommendations were continued by the coalition Government as a result. However, none of that questions the fundamental reason why the hon. Member for Ilford South called for this debate, which was to ask, “How can you continue this reconfiguration when one part of the trust is in crisis?” Crisis is the correct word to use for a hospital that was put into special measures. It was not one of the Keogh trusts that were put into special measures due to adverse mortality; it was one of the first to be put in because of systemic and endemic problems at the trust, many of which the hon. Gentleman highlighted.

The change that has occurred over the past 18 months to two years—I am grateful to the hon. Member for Ilford North (Wes Streeting) for highlighting exactly what has gone on—has been one of culture. Another remark from a nurse with whom I spoke was that, since special measures, her comments about patient care were being noticed by management for the first time. That was the difference that the CQC inspection made. The change in culture has been recognised by local people and the result is much-improved family and friends figures. I do not recognise the figures provided by the right hon. Member for Barking (Margaret Hodge), but the most recent figures are close to the national average. I will receive those figures in a moment, but I believe the overall A&E figure for family and friends was up at 84%. That is not quite where it should be, but the in-patients figure had also risen to nearly the national average. The most recent family and friends figures showed an improvement in results.

Hon. Members recounted figures suggesting that the A&E performance was poor. It is true that the A&E department has failed to hit its required standard for a long time, but the most recent figures are encouraging. Performance for the first quarter of this year was 93.39%—just under the 95% target—compared with the figure for the first quarter of the previous year of 85.62%. That is like for like. Despite the problems encountered across the NHS over last winter, that hospital showed a sustained improvement in the first quarter of this year.

I second the remarks made by several hon. Members about the quality of the new chief executive and the team he has built around him. I have spoken to him, and although he was not going to make predictions, his confidence about going into winter, as well as the place the hospital was in, was significantly different from where he and his team were this time last year.

Let me clarify the A&E figures before I get upbraided. I believe that the figures are that 96% of in-patients would recommend the service to their family and friends, and 1% would not; in A&E, 84% would recommend and 10% not; in maternity, 98% would recommend; in antenatal, 95%; in postnatal wards, 93%; and in postnatal community, 97%. Those figures are roughly around the averages in national FFTs—family and friends tests—which is a significant and marked improvement, showing that local people are responding to the changes made in the hospital and to what needs to happen.

None the less, despite all the improvements, it is true that the A&E is not in a sustainable position to receive the services from King George hospital, either physically—I saw its buildings for myself—or in terms of the new rotas and rosters, although recruiting is now much better managed than in the past. I understand from local commissioners that there is no intention to move these services from the King George to the Queen’s site until the physical and staff changes have been made to the satisfaction of the commissioners and the provider—the trust itself. I understand also from the commissioners that the time limit they have imposed means that that cannot happen even within the next two years, because they need to see a degree of sustainability before they can have the confidence to make the changes.

[Mike Gapes]

Does the Minister accept that, given that the A&E will be closed, whether in two, three or four years’ time, there is a level of uncertainty? The CQC report comments on that. Is it not better for the sword of Damocles to be lifted and for us to go ahead on the basis of having two A&Es that work together?

--- Later in debate ---

[Mike Gapes]

I am pleased to have got some injury time, Mr Davies. I emphasise to the Minister and his officials that the problems in north-east London and in my borough of Redbridge in particular are serious. He referred to the Barking and Havering trust and the Barts trust. Every single resident of Redbridge now has to use a hospital that is in special measures, as Whipps Cross hospital is part of the Barts and Royal London agglomeration and King George hospital is part of the Barking and Havering trust. In that borough people cannot go to a hospital that is not in special measures. Some of the constituents of my hon. Friend the Member for Ilford North (Wes Streeting) go to Whipps Cross rather than to the King George.

The reality is that the situation is a fundamental challenge to a population that is growing rapidly. The Mayor of London has just agreed to invest £55 million to build 2,000 new dwellings in the heart of Ilford. A young, dynamic and largely migrant population is moving to Ilford. That means we have to deal with these problems soon—they must not become long-term issues. I am conscious that the people of north-east London—of Redbridge, Barking, Dagenham and Havering—will expect decisions to be taken in their interests. I and my colleagues will continue to fight for them.

Question put and agreed to.

Resolved,

That this House has considered the future of Barking, Havering and Redbridge University Hospitals NHS Trust.