Health and Social Care Bill

Jim Dowd Excerpts

Tuesday 20th March 2012 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I have got out of my sick bed to be here today, because this is a vital debate, and I am grateful for the opportunity to participate in it. I often feel that these debates are a bit like the siege of Stalingrad: we are rolling back the forces of oppression. I content myself, with my cough and sore throat, that at least the red army was victorious on that occasion.

In response to the point that the hon. Member for Banbury (Tony Baldry) and the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, made about the ruling by the Information Commissioner, I think we should reflect on the fact that it was indeed a ruling. It was not advice that he was giving. Mr Christopher Graham has some expertise in this field, and although the detailed reasons have not been published, the arguments that were made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and the co-applicants from the Evening Standard—that it was in the public interest to publish the risk register—were obviously accepted.

If I may, I would like to remind the House of what the Information Commissioner said, which was upheld on appeal. Mr Graham said:

“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms”.

Earlier on, Government Members were shouting “Frit!” at Labour Members. I really did not understand what that meant—I am just a simple working-class lad from Easington—but I now understand that it means “You’re afraid”. However, if the Government have complete confidence in the direction of their reforms, surely it is they who are afraid, because they should have the confidence to publish the document.

[Jim Dowd (Lewisham West and Penge) (Lab)]

It is beyond doubt that the Information Commissioner considered all these matters before reaching his decision. Does my hon. Friend agree that, if the risk assessment had supported the Government’s case, the Government would have got it out like a shot? That they have not done so exposes the fact that they are playing fast and loose with one of the nation’s most treasured institutions, and that they are trying to hide that.

[Grahame M. Morris]

Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.

We know that the Bill will increase the risks to the national health service. Indeed, the chief executive of the NHS, Sir David Nicholson, told the Health Select Committee, of which I am a member:

“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”—

that is, the Nicholson challenge; the £20 billion—

“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”

It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.

Health and Social Care Bill

Jim Dowd Excerpts

Monday 31st January 2011 Commons Chamber

[Jim Dowd (Lewisham West and Penge) (Lab)]

It is a pleasure to follow the hon. Member for Boston and Skegness (Mark Simmonds). Although I do not agree with much of what he said—I certainly do not agree with his rationale for supporting the Bill—he made a few genuine points that, in the calmer atmosphere of a Committee, could be looked at in detail.

I agree with the hon. Gentleman that the difference between the two Front Benches could hardly be starker. This is about the view of what the national health service should be. I am not disappointed for one moment that the view of the Labour party is different from that of the Conservative party and its followers from the Liberal camp. Much has been made of that great event on 5 July 1948, when the national health service came into being. Of course, at the time, it was ferociously opposed by the Conservative party. At the beginning, it was also opposed by large parts, although not all, of the medical profession.

[Nadine Dorries]

rose—

[Jim Dowd]

I will not give way, for one good reason: I might get injury time for it, but others would lose out.

The medical profession has changed its view, as has the Conservative party. The Conservative party has changed its view largely because the NHS and the principles that underpin it resound so clearly with the British people. This has been a difficulty for the Conservative party over the years.

I have seen a few Conservative party reorganisations of the health service. Thirty-five years ago, I was appointed to the Lambeth, Southwark and Lewisham area health authority, which included such hospitals as our local one over the river, St Thomas’s, Guy’s, King’s College and Lewisham. The AHAs were set up as a consequence of the Heath Government’s reforms in the early ’70s. They were abolished, but not before Lord Jenkin suspended the Lambeth, Southwark and Lewisham AHA for refusing to accept the cuts in the budgets that the then Government were trying to inflict.

The Tories reorganised the health service again and brought in district health authorities. I served on Lewisham and North Southwark district health authority for some time, until in 1990 I was thrown off for having the temerity to be a local councillor. I am sure that there are others around the Chamber who suffered similarly. Who engineered that amazing transformation? It was none other than the current Secretary of State for Justice. I think that he just sacked anybody who was not on his Christmas card list, quite frankly, because nothing in that reform of the health service did anything to improve its accountability or performance. It did hand over the health service, more than ever, to central control and direction, which, we are asked to believe, the Conservative party today decries so readily.

The Conservative party, of course, contains members who believe—and who go on foreign broadcasting stations to announce—that the national health service is a 60-year-old mistake. That is what was said by an MEP who was advising Republicans in the United States to oppose the Obama reforms. He was slapped down quite quickly, unsurprisingly. It is the great embarrassment of the Conservative party that it cannot reconcile its atavistic feelings towards the health service and belief in the free market with the feelings of the vast majority of the British people.

In recent years, as my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, waiting times for most specialisms have come down almost to the point where they are no longer a consideration. I will tell the House briefly about the experience I had towards the end of 2009. I suffered chest pains of various kinds. I went to A and E at Lewisham hospital on 28 July. I was referred to the chest pain clinic at the same hospital the following week. I went for an angiogram at King’s College hospital two weeks after that, where the consultant advised me that I needed bypass surgery. I asked how long it would take—I did not mean the operation, obviously, but the wait. He said, “When can you come in?” I could not make the first date that I was offered, so I had to put it back. My experience was repeated millions of times across this country when the Labour party had stewardship of the NHS. It is that relationship that is so critically under attack.

The NHS is about patients—of course it is. Everybody knows that patients come first and that it must be patient-centred. Those things are meaningless clichés. Patient care and patient choice matter, but what matters more is patient trust. Patients must trust that any therapy, drug or treatment that is suggested by their clinicians and medical advisers is what is best for them—not what is cheapest or what has been contracted for. It is that critical, basic relationship in the national health service that is most under threat from this Bill and that Government.

Lewisham Healthcare NHS Trust

Jim Dowd Excerpts

Friday 12th November 2010 Commons Chamber

[Jim Dowd (Lewisham West and Penge) (Lab)]

May I say in passing that I agree totally with the comments of my hon. Friend the Member for Stoke-on-Trent North (Joan Walley)? The private Member’s Bill process in this place is chaotic and we need to overhaul it.

I am grateful to Mr Speaker for giving me the opportunity to raise an important local issue. This is the first time, Mr Deputy Speaker, that I have spoken in the Chamber under your wise and sagacious chairing of our proceedings. I welcome you to the Chair.

I welcome the Minister to his place. We shared a number of experiences—I found them entertaining; I am not sure whether he did—a few years ago on the Health Committee. I suspect that if most members of the Committee had been asked whether they thought he would be occupying his current position, the view might have been that he would not. However, he has got there, and regardless of the Government arrangements, he got there completely on merit. I wish him well in the post that he holds and in his efforts to discharge his duties.

May I point out a mistake on the Order Paper which is entirely of my making? I tabled the title that appears on the Order Paper for the debate, but I have not been keeping up with developments. Lewisham Hospital NHS Trust is now Lewisham Healthcare NHS Trust. It assumed responsibility for primary care functions some 100 days ago and has now expanded to the health care trust. There was supposed to be a celebration yesterday of those first 100 days of responsibility for primary care, but that was cancelled. I am sure there were a number of reasons, but the disruption caused by the events that I am about to describe may well have played a part in that.

University hospital Lewisham has made remarkable progress over the past dozen years or so, the last eight of which have been under the stewardship of the current chair of the trust. For many years previously it was the poor relation in inner south-east London, without the kudos or connections of its much more illustrious neighbouring cathedrals of medicine in the shape of Guy’s, St Thomas’ and King’s College hospitals. In 1990, under the previous Tory Government, it was used as a pawn and a make-weight in the ill-fated attempt to set up the Guy’s and Lewisham self-governing trust. When that ploy failed, it was separated as Guy’s was linked to St Thomas’, and it has prospered ever since as an independent trust.

The notable achievements in recent times and the improvements in services over recent years have included the more than £70 million private finance initiative project at the Riverside block and improved maternity services, including one of the best birthing centres in London and therefore in the country. There have been improvements in paediatrics in the primary care centre. It has achieved some of the lowest hospital acquired infection rates in the country. During a recent stay in King’s College hospital I acquired MRSA, so that has a certain resonance with me. Just 10 days ago, work commenced on the latest stage of building there, which will run through until autumn 2011, including a new urgent care centre, upgraded and refurbished A and E facilities, new and refurbished children’s and adults’ out-patient suites, and a new main entrance and reception.

The financial management of the trust has been outstanding in recent years. Earlier in the year, as part of the Challenge Trust Board funding scheme, KPMG was asked to review the trust and measure its performance against nine domains: good business strategy, financial viability, well governed, capable board to deliver, good service performance, clinical leadership, local health economy, clinical strategy and performance. On a traffic light rating, they were all well into the green, as a net result of which the Challenge Trust Board awarded Lewisham £4 million to pay off historical cash deficits, and KPMG concluded that the

“Trust has rectified the problems that caused the trust to fall into deficit and has a platform for a medium term sustainable position”.

This organisation has not only done well; it continues to do well. It has set its ambition to become a foundation trust within two or three years. It has demonstrated the benefits of strong executive and non-executive leadership. Why then has the chair not been reappointed, or, to put it in plain language, why has he been sacked? He has been a personal acquaintance of mine, colleague and good friend for more than 30 years, and we have served variously on a number of organisations, including Lewisham borough council and Lewisham and North Southwark district health authority before it was abolished by the previous Conservative Government in 1990.

I raise this matter not at the chair’s request—he is a man of such natural modesty and charm that if it was left to him, I am sure that I would not be allowed to raise it at all—but because I want to express my outrage at the way in which he, and by extension, Lewisham Healthcare NHS Trust and the people of Lewisham have been so badly treated by the travesty of a process that has resulted in his not being reappointed. I also have to raise it because although the Appointments Commission has a complaints procedure, under item 8 on remedial action, it says that what shape such remedial action may take will vary from case to case, but in general one of the principles that will apply is that

“where an appointment has been made, this cannot be overturned.”

So clearly the die has been cast and we will have to live with the consequences.

The chair was appointed in 2002, and he was re-appointed, uncontested, in 2006, with the term ending on 31 October this year, just a few weeks ago. The process to find a new chair was implemented in August, and, under the regulations, he could serve a maximum of only two more years in the post before reaching the 10 prescribed. That was well understood by everybody involved in the health care community in Lewisham, by the chair, and by those who encouraged him to stand. Such is his reputation among the stakeholders, partners and others with knowledge of health care provision in Lewisham that many of them encouraged him to stand for those extra couple of years, including Ann Lloyd, the appointments commissioner for London, and Sir Richard Sykes, the then chair of NHS London, to get Lewisham Healthcare NHS Trust to the verge of foundation trust status.

Everybody understood the process. As the regulations said:

“At the end of an individual’s second term of office the post will automatically be the subject of an open competition. The office holder will be free to apply provided they have served less than 10 years in the same post and will be considered alongside other candidates.”

Everybody knew that to be case. However, such is the support for the current chair of the trust that, to my certain knowledge, many other candidates—including a former Member of Parliament—who would have applied had the competition been completely open, did not do so out of respect for, and trust in, the work that the existing chair of the trust had done. Either knowingly or unknowingly, the Appointments Commission and the strategic health authority have between them served to reduce the pool from which a suitable candidate to chair the trust might be found.

Most people understood that the current chair would serve for another two years, and that during that period a completely open competition would be held, in which all those who had any suitability or intention to become the chair could have stood. By skewing the process, as they have, those organisations have denied the people of Lewisham the opportunity to look at the best possible candidates.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

My hon. Friend is certainly not alone in his concern about such issues. The west midlands regional health authority has decided not to appoint the chairman of the University hospital of North Staffordshire, Mike Brereton. Today, indeed, is Mike’s last day, yet the authority has not given any reasons either to the public or MPs. It has failed to draw up a shortlist for a successor, and I now learn that it has made a temporary appointment for one year. May I put on the record our appreciation of Mike Brereton’s long record of public service in north Staffordshire, and our deep concerns, like that of my hon. Friend in his area, about the west midlands regional health authority’s secret and unaccountable way of going about the process?

[Jim Dowd]

I am grateful to my hon. Friend. Incidentally, I gave way because, if I had not, he might have punched me and I did not want to tempt providence. I accept his point, however. The Appointments Commission will of course be abolished in a couple of years, but unreasonable, undue and improper influence has been exerted over the appointment of people to such positions, and the losers will ultimately be the local communities that they attempt to serve.

I recognise readily that there is no automaticity to reappointments, and nobody should expect there to be. That point was equally well understood by all those involved in the process, and I offer no comment on the ability or personal qualities of the chosen successor. I have met her just the once and formed a mildly favourable impression. The only reason why I met her is that my constituency boundary changed at the last election to include parts of the borough of Bromley, and she is chair of Bromley primary care trust. I have no reason to believe that she is complicit in any of the mishandling and misconduct that I believe has taken place.

At best, there has been incompetence and, at worst, improper interference. A couple of weeks ago, Professor Mike Spyer, the interim chair of NHS London, contacted the existing chair of the Lewisham Healthcare NHS trust to inform him that the Appointments Commission would not be reappointing him as he could be appointed for only two years, which was insufficient time to see the organisation through to foundation trust status. That is complete and utter nonsense. That fact was known before NHS London and the London commissioner, among others, encouraged him to stand for re-adoption as the chair of the trust.

The existing chair then received a letter from the Appointments Commission, which explained that the decision not to reappoint him

“was based on the advice of the interview panel and recommendation of the appointments commissioner and represented the overall best ‘skill mix’ for the board.”

That is complete and utter baloney. It is nothing more than an unconvincing collection of cliché and waffle to hide the fact that the board had clearly made up its mind. Why has the board not had the correct skill mix previously, I wonder? Why has it asked the existing chair to stay on until the end of the year? Because of its incompetence, the new chair cannot take up the post because of her position with Bromley PCT until the end of the year. The board has asked the existing chair to stay on for an extra couple of months, but clearly the skill mix on the board during that time will not be optimum, by definition. It speaks volumes about the character, dignity and integrity of the existing chair—and his dedication to Lewisham hospital and to health care in Lewisham—that he has said that he will stay on to facilitate the changeover to the new chair.

I contacted the Appointments Commission as soon as I heard about this outrage. I sent a letter to its chair, and she replied:

“I am sorry that you have concerns about the manner in which this campaign was conducted and hope to reassure you that it was carried out in line with best practice and in accordance with the Code of Practice issued by the Office of the Commissioner for Public Appointments.”

Well, Ms Anne Watts CBE, chair of the Appointments Commission, you have not reassured me at all. Incidentally, the letter plumbs new depths of disingenuousness by telling me that for “reasons of confidentiality” Ms Watts cannot confirm whether the existing chair was a candidate for the post—how very unco-operative. I had to make my own inquiries into the matter. She went on:

“Seven candidates applied, 3 of whom subsequently progressed to the interview stage…An excellent and experienced candidate with a sound background in NHS leadership locally was identified from among those interviewed, and an announcement regarding an appointment will be made in due course.”

Yes, that candidate was appointed—that candidate was the existing chair, but he was not appointed as the chair of the trust, though.

I received a letter from the incoming chair in her capacity as the chair of Bromley PCT. It is dated 5 November, and says:

“Thanks to the generosity of the outgoing chair…I am able to stay in Bromley until 31 December, which gives me time to ensure that appropriate transition measures are in place. However, I shall start my induction in parallel with working my notice at Bromley.”

That is fine. However, that letter is dated 5 November, and I know for a fact that until 10 November—five days after the letter was written—the existing chair in Lewisham had not made the decision to stay on until 31 December. I do not know who is trying to convince whom of what, but I suspect that there has been a degree of duplicity; as I say, I do not expect the successor chair to have been part of that, but there has been.

The whole process has been chronically mishandled. The strategic health authority, London NHS and the Appointments Commission have completely let down the institution of Lewisham hospital and the people of Lewisham by their abject failure to ensure that the best available candidate was appointed to the post. The new chair might well survive a totally open process in future, but because there has not been one, we shall never know.

Clearly, I will need to establish a working relationship with the trust and its executive and non-executive members—previously, that has been very good—and I will need to establish such a relationship with the new chair as we work for the common purpose of promoting the interests of the people of Lewisham. But that has been made extremely difficult by this astonishing catalogue of failure.