NHS in London

Dawn Butler Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

My hon. Friend makes an excellent point that I believe deserved to be made at length. She anticipates a point I will come on to about the business case and the capacity problem. There is a problem with the way these things are organised. The north-west London area does not include West Middlesex hospital, which she mentioned, but that is more proximate to some parts of my constituency than Northwick Park hospital, to which my constituents are being diverted even though it is miles away. That just shows that people do not think in terms of these boundaries.

[Dawn Butler (Brent Central) (Lab)]

I congratulate my hon. Friend on securing this debate. My local A&E at Central Middlesex hospital, which was classified as good, was closed, and now the people from the poorest part of my constituency have to travel to the A&E at Northwick Park hospital, which was ill equipped and ill prepared for the closure of the Central Middlesex services and is often rated below par.

[Dr Huq]

My hon. Friend puts it very well. Ealing has also been hit by the closure. I have no hospitals within my constituency boundary, but Central Middlesex was one of the nearest. It was performing well and had had lots of investment—it was a brand new shiny thing. I used to be a hospital radio DJ there in the ’80s. We were not allowed to play certain songs, including “My Way” by Frank Sinatra, because it is too much about the end for terminally ill people to listen to. Anyway, the hospital is now completely different from what it was like in the ’80s. It is tragic that the A&E there is being downgraded in favour of Northwick Park.

I saw the Minister’s brow furrow when I mentioned the boundaries. The hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), is in south-west London. Perhaps we can think more creatively about crossing boundaries, because an ambulance will not usually take someone there even if it is nearer than Northwick Park. That was the point I was trying to make.

--- Later in debate ---

[Dr Huq]

I thought interventions were not allowed to be lengthy.

[Dawn Butler]

On my hon. Friend’s behalf, I thank the Minister for that intervention. The Government’s language over the past few months, saying that we do not have a seven-day NHS, has been alarming and destabilising for a number of people, who have failed to attend services. Perhaps the Minister should take her own medicine.

[Dr Huq]

My hon. Friend puts it excellently. I have some figures that illustrate the adverse consequences. Ealing mums were promised access to 24/7 consultant cover—168 hours per week—for a better, safer service. That has not materialised. Eight months after the closure, the only hospital to come close to that figure is West Middlesex, in the constituency of my hon. Friend the Member for Brentford and Isleworth—it is not even in north-west London. St Mary’s has fallen short at 98 hours. Queen Charlotte’s—the hospital where I was born, although it was somewhere else in those days—offers 116 hours; Chelsea and Westminster, 115 hours; Northwick Park, 108 hours; and Hillingdon, 112 hours. They all missed. There has been nothing concrete. Only on a wing and a prayer will they reach that nirvana any time soon. So much for a better service.

Paediatrics is next for the chop. On 30 June, there will be no children’s wing at Ealing hospital. I have a lot of figures, but people are often numbed by statistics, and other Members want to speak. According to the Office for National Statistics’ 2014 population estimates, Ealing is a very young borough—23.5% of the population is under the age of 18—so we need a children’s wing.

It is worrying. People can be treated quickly and effectively for accident and emergency cases at Ealing hospital at the moment, but the consequence of the changes will be that ambulances will have to take people to Hillingdon and other places miles away. It is unclear who is going to fund that. A lot of those who are admitted to the children’s wing are not taken in an ambulance; they come under their own steam. Will a nurse or a doctor accompany everyone who uses patient transport service, to ensure child safety? There are a lot of question marks.

--- Later in debate ---

[Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Turner, and to be called early in the debate. I thank the Backbench Business Committee for giving us this long and generous slot on the last day before the recess. Given that it is the last day, there is a good turnout from London Labour Members, and one or two London Conservative Members. Indeed, we had the whole of the Liberal Democrat representation for London, but he has gone now.

I particularly thank my neighbour and hon. Friend the hon. Member for Ealing Central and Acton (Dr Huq) for introducing this debate in a comprehensive manner, which permits me to make my contribution shorter than it otherwise would have been, because I am going to deal with some of the same issues. I preface my remarks by saying that London Members deal with a great many health service issues—on the whole successfully—through their clinical commissioning groups, hospital trusts and the other myriad health service bodies that the Government inflicted on us in the last top-down reorganisation.

We have heard about primary care, mental health and community pharmacies. The reason why we—particularly the 11 Labour MPs for north and west London—keep returning again and again to the issue of acute hospitals and the “Shaping a Healthier Future” programme is not only that it is such a major reorganisation of services but that it has become very politicised. Of course, all these issues are political—money spent on the health service is always political—but we feel that we are either not being given information or being given the wrong information.

I must disagree with the hon. Member for Harrow East (Bob Blackman). My memory goes back a long way. I was part of the campaign against the closure of Charing Cross hospital in the early 1990s. It was successful, obviously, but it was a long and hard-fought campaign, and again, the grounds for closure were entirely spurious. I remember the former Member for Brentford and Isleworth, who was a Health Minister, leading that campaign when she was the head of nursing there.

[Dawn Butler]

I remember leading a campaign in 2006 to save Central Middlesex hospital’s A&E, which was successful. Unfortunately, it then closed when I was not an MP in, I think, 2011.

[Andy Slaughter]

We all bear these scars. I am grateful for all the efforts that Members have made to protect their local health services.

The next time that Charing Cross hospital came up, it was in the context of the 2005 election campaign, when a Conservative candidate, now the right hon. Member for Chelsea and Fulham (Greg Hands), shamelessly said that it was going to close, with no evidence whatever; there were no plans to close it. The candidate running against me in 2010 did exactly the same in relation to the hospital in my constituency. The difference was that immediately after the 2010 election, plans began to be drawn up—we did not see them until 2012—by McKinsey and others. The reference to consultants was well made by the hon. Member for Harrow East, because the spend on consultants on “Shaping a Healthier Future” alone is running at something like £20 million per annum at the moment.

I did not recognise, in what the hon. Gentleman said, what has actually happened. The brief history is as follows. Those plans were presented. They were kept under wraps and took us all by surprise with the dramatic changes they contained—the downgrading of the four A&Es and what was going to happen to Ealing and Charing Cross hospitals. However, that was a long time ago now, in the summer of 2012. The only revision to those published proposals was at the end of the so-called consultation process in February 2013. Apart from references in board papers and other statements, we have not had a formal upgrade to the process since then. That is more than three years ago, yet the proposals affect about 2 million people across the whole of west and north-west London.

I accept that there can be faults on all sides and that in the run-up to elections, people get quite emotional and political about these issues, but that is partly because they matter so much to our constituents. At the 2015 election, at least we were getting emotional and political about something that was actually proposed, rather than something that was invented. Since the election last year, we have attempted—certainly I have, and I think this goes for a number of my colleagues—to engage in the process with Ministers and officials, partly to find out what is going on and partly to try to influence the outcome. The Minister met a group of MPs last summer and said that there would be a great deal of engagement and transparency. I have not given up on that, but it has not happened so far.

The key document in the “Shaping a Healthier Future” programme—the implementation business plan—is still under wraps. We have been asking for it for the best part of three years, formally, informally or through freedom of information requests. Different reasons have been given at different times—“It’s a work in progress,” or “It’s commercially confidential”; all the usual reasons. It becomes a bit ridiculous after a while. I am not sure it is very helpful to the Government or the NHS, because in the end we have to rely on what information we can scrape together.

Of course, the world has changed a lot in those three years. Let me give some examples. The London head of NHS England, Anne Rainsberry, came to brief Labour London Members earlier this week and gave us some quite interesting information. First, “Shaping a Healthier Future” alone will not deal with the financial problems, which have got substantially worse. My trust, Imperial College Healthcare NHS Trust, last reported that it was running a £25 million deficit, but I know that other trusts, including London North West Healthcare Trust, have higher deficits than that.

The position has got markedly worse. I know the Government say there is a clinical basis for “Shaping a Healthier Future”, but it is interesting that there has been a concession that there is a financial basis to it; it is about saving money. Opposition Members would say that it is mainly about saving money, but the Government might say that that is an ancillary purpose. We are now being told that even if “Shaping a Healthier Future” were implemented, it would not save enough money given the deteriorating situation.

The shadow Secretary of State, my hon. Friend the Member for Lewisham East (Heidi Alexander), mentioned the shift from capital to revenue, partly as a bail-out. That may be a crisis move to offset the immediate financial crisis, but it has implications, particularly for a grandiloquent project such as “Shaping a Healthier Future”, which is about a major redesign of hospital sites—particularly the Charing Cross and St Mary’s sites, which are taking the bulk of the money.

We know—the NHS is now being slightly more candid about this—that the Treasury is getting cold feet about the programme, and the date is being pushed back and back. That is good in a way, because originally we were told that Charing Cross was going to be demolished in 2016-17, and now we are talking about 2020 at the earliest. I am delighted by that, because the longer it is pushed back, the less likely it is to happen, but it reflects serious concerns in the Treasury, and possibly in the Department of Health, about where the programme is going.

[Dawn Butler]

My hon. Friend is being generous with his time. Is he concerned, as I am, by the letter from Clare Parker, the senior responsible officer for “Shaping a Healthier Future”? Brent has been trying to get hold of the latest version of the implementation business case. She notes the request, but states:

“Unfortunately this document is in draft form and not currently suitable to be shared.”

Does he wonder, as Brent and I do, when we will be able to have sight of that document?

[Andy Slaughter]

That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.