Accident and Emergency Departments

Baroness Bray of Coln Excerpts

Thursday 7th February 2013 Commons Chamber

[Angie Bray (Ealing Central and Acton) (Con)]

I am listening carefully to my hon. Friend’s remarks. Does he feel at this stage that he is pushing at an open door or a closed door?

[Nick de Bois]

I am sitting next to my hon. Friend, who shares a great interest in this subject, and I think she has been reading my notes. With a new Secretary of State and with such interest across the country, Chase Farm does not feel as if it is alone any more. There is a momentum and an opportunity to examine new issues, so I hope I am pushing at an open door. On cost and on how we treat patients, we need to be bold and innovative. For example, we should be examining the impact of telehealth care on our acute centres. Such things will drive not just costs, but better health care. Can they have an impact on whether we retain more services at our acute centre in A and E, while more people are being treated in the primary sector?

I think that my constituents look at the Lewisham solution almost with envy. We should be able to at least guarantee to our constituents—[Interruption.] Bear with me here. As a minimum in Enfield, we would like to see 24/7 access to a doctor because the proposal for our urgent care centre is 12 hours. I think people need that comfort. I am not playing politics with Lewisham and I am not saying that the situation there is satisfactory—the hon. Member for Lewisham East (Heidi Alexander) knows well my position on that. However, I am saying how we look at it from Enfield. I hope the Minister will consider innovative ways, looking for providers be they from clinical commissioning groups or with direction from the centre, in which we can offer 24/7 doctor-led care to my constituents after years and years of frustration.

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[Angie Bray (Ealing Central and Acton) (Con)]

I sympathise with the problems described by the hon. Member for Mitcham and Morden (Siobhain McDonagh).

It seems a long time since NHS North West London presented its “Shaping a healthier future” proposals and Members from across west London first came together to debate them. On that occasion, I explained why I opposed the plans, and put on record my fear that they would have a serious and negative impact on my constituents. Downgrading the four nearest A and E departments—at Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals—would be completely disproportionate, and would leave the people of Ealing and Acton slap bang in the middle of an emergency care black hole.

Since that debate, a cross-party coalition—including the hon. Member for Ealing, Southall (Mr Sharma), who opened the debate, and the hon. Member for Hammersmith (Mr Slaughter), who is also present—embarked on fighting the plans. We have organised rallies, marches, petitions and leaflets, and pages and pages of coverage have appeared in the local as well as the national press. I am not a natural marcher, but I did attend the big rally on Ealing Common to oppose the plans, along with other local Conservatives.

We felt that the most constructive use of our time would be to encourage as many people as possible to fill in the consultation document provided by NHS North West London. We offered guidance on how best to navigate the bewildering and unnecessarily lengthy set of questions, and we helped about 600 people to register their views. That was a large contribution in a borough which returned the highest number of responses to the consultation, almost all of which opposed the plans, and it demonstrates the level of worry that exists in Ealing and Acton.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Despite the biased nature of the questionnaire, efforts were made to fill it in, and a few thousand people did so. However, 80,000 people signed petitions which were then studiously ignored. Only the responses to the questionnaire were taken into consideration. Perhaps the hon. Lady would like to comment on that.

[Angie Bray]

I certainly think that a petition of that size cannot be easily ignored. However, as we pointed out when we encouraged people to take part in what was a massive and time-consuming process, I suspect that, technically and legally, the authority is obliged to register only the responses to the consultation.

Beyond what I have described, my role has been to make my objections, and those of my constituents, fully known to and understood by as wide an audience as possible in Government. After doing the rounds of meetings with the previous team at the Department of Health, I held meetings with the new ministerial team and the Health Secretary after last autumn’s reshuffle. I followed that up with a meeting with the Prime Minister, whom I left in no doubt that this issue was of the utmost importance to my constituents.

We all believe that the closure plan must be reviewed. None of us can believe that it is anything other than reckless. We wonder how the A and E departments that are left standing will be able to cope with all the extra pressure that will result from the closure programme. I explained to the Prime Minister in detail why the extra travel time to A and E departments further afield would be unacceptable. He listened carefully, asked a number of detailed questions, and told me that he would certainly discuss the issue this with Health Ministers.

Much of our campaigning has focused on the baffling way in which NHS North West London has chosen to present the proposals as a virtual fait accompli, without adequately explaining quite how they will work in practice. We are told that new “urgent care centres” will cater for everyone’s needs, but we have also learnt that there is a lengthy list of conditions, and that there are a number of possible problems with which they will not actually deal.

[Steve Baker (Wycombe) (Con)]

It is, in a sense, reassuring to hear that my hon. Friend is experiencing exactly the same problems as we are experiencing in Buckinghamshire. It is always made to sound so good, and then it is so awful. I hope that the Minister will be able to explain how things can change, so that instead of standing here complaining on behalf of our constituents we can actually make a difference.

[Angie Bray]

I entirely agree. The issue of trust is so important, but I suspect that we shall have to do a lot of work if we are to build that trust.

What I have just said about urgent care centres will not be at all reassuring for my many constituents who use the local A and Es. We must not forget that Ealing hospital’s A and E sees at least 100,000 people every year. Nobody is suggesting that we do not need to make long-term improvements to our health service and the way services are delivered, but we need better guarantees that the planned changes will provide an acceptable replacement for what we have at present.

It is unreasonable to expect my constituents to support the closure of their local much-cherished A and Es without any certainty that what they are told will be put in place will materialise. In the meantime, there is the practical question that everybody is asking: if the A and Es are closing at four hospitals, what will happen to the queues at the A and Es that are left open?

No one is under the impression that everything is rosy and that the way health care is delivered in north-west London is absolutely perfect. Clearly, in the longer term we will need to encourage more people to sign up to local GPs rather than depending on A and Es for all their health care needs, but that requires time and organisation. We cannot just close the A and E and expect people to cope. Looking forward, we clearly need to make sensible decisions on how we fund health care provision locally, to ensure money is available to meet all the rising costs associated with people living longer, new medicines coming on-stream and new costly treatments, but we have to take people with us as we approach change.

Understandably, people have an emotional attachment to their local hospitals and they need to be persuaded of the case for change. Given that the health reforms are about to put GPs in charge of local health provision, why are we not waiting to see what decisions they think would be appropriate, rather than pushing these decisions through now? The whole approach has been too rushed. Local GPs have hardly been queuing up, in public at least, to support these proposals. The impression my constituents have been left with is that the consultation was little more than an attempt to channel their views towards the preferred option, in what was a box-ticking exercise by NHS North West London.

There are too many questions left unanswered, and too much of the information provided in the consultation was too questionable. For all these reasons, I can only hope that if NHS North West London decides on 19 February to proceed as it currently intends, the Secretary of State will ensure that that is reviewed in its entirety. My constituents are deeply concerned.