Hospitals: West London

Lord Warner Excerpts

Wednesday 18th October 2017 Lords Chamber

[Lord Warner (CB)]

My Lords, it is good that the noble Lord, Lord Dubs, has given us a chance to traverse the well-trodden paths of the future of north-west London’s hospitals. I want to put his concerns into a wider context. First, let me declare my interest as an elderly resident of Barnes with a personal interest in these hospitals. But I have also dabbled in the issues of London’s hospitals both as a Health Minister and subsequently as the chair of a provider agency established by the former strategic health authority for London which attempted to reshape some of the provider services in London.

Let me start with that latter experience. Reforming London’s health services is rather like battling through the Somme mud. Occasionally after a well-thought-out battle plan you make an advance. This happened with the reform of London’s stroke services where the number of stroke centres was cut from 32 to eight which saved lives and money, and produced better recovery outcomes for patients. This change, however, was a whole-London system change driven by the London SHA which was rather cavalierly abolished by the Secretary of State in the coalition Government. More often, the forces of local public and professional conservatism have thwarted change, as has consistently happened with the various attempts of the noble Lord, Lord Darzi, since 2007 to reshape London’s health services to meet today’s needs rather than those of the 1960s.

All the worthwhile attempts to reform the effectiveness of London’s acute hospital services have required a level and consistency of capital investment which has usually not been forthcoming from any Government. That looks to be the case for the proposals put forward in the five London STP plans. They call for a capital investment plan of about £6 billion over four years. This is probably an underestimate, but in any case, is highly unlikely to be forthcoming, unless the Minister has a surprise up his sleeve. Moreover, it is difficult to see whether these five separate STP plans are consistent with the overall needs of London, especially in relation to the consolidation of specialist services. This is where the loss of the London SHA is very telling. Will the Minister enlighten us on who will knit the five STP plans together in the best interests of Londoners?

Let me now turn to the issue of revenue budgets. According to the STPs themselves, the aggregate London “do nothing” revenue funding gap will be £4.1 billion by the end of 2021. This is without any allowance for any likely, and I have to say sizeable, shortfall in adult social care funding. If London was fairly treated on the basis of its weighted capitation population in 2021, this gap would shrink by about a third. So, can the Minister explain why London is being treated so unfairly in its NHS allocations, given the character and nature of its population? All this assumes that the whole NHS estimated deficit in 2021 will be as low as the NHS has calculated on present assumptions, which is a mere £17 billion.

I say all this because, despite the well-intentioned work that has gone into the STPs, those for London may have no more relevance than the latest Harry Potter story. The truth is that there is no credible funded plan for reshaping London’s health services as a whole. The STPs seem likely to suffer the fate of the noble Lord, Lord Darzi. Instead, what we will actually experience is more likely to be a series of actions aimed at trying to balance the books and patching up the services as best they can. That kind of patch-up approach seems to me—let me assure the noble Lord, Lord Dubs—a much more likely outcome for Charing Cross Hospital which, in any case, under the STP plans, is not due to change before 2021. I would be a bit more relaxed about the NHS’s capacity to reshape Charing Cross Hospital that much before the middle of the next decade.

However, it is crucial that as the London STPs evolve—and they will evolve; they are not going to be set in stone as they stand—they need much greater clarity about the future location of specialist services, not just A&E departments. They should also develop a much better definition of the services to be provided in what is starting to be called a “local hospital”—a term almost designed to raise local anxieties, unless you explain much more clearly than has been done what it means.

The NHS in London also needs to explain better than it has so far why it may well need to reduce its secondary care footprint by selling higher value land and buildings to fund the new community facilities that London so badly needs—and, as the noble Lord, Lord Suri, said, to help to contribute to providing land for affordable housing. So we should not get too excited about demolishing some hospital buildings in London to provide alternative facilities for the NHS and other social goods such as affordable housing, where land is very scarce.

I have to say, in conclusion, that the STPs have made a valiant attempt at coming up with a plan, but that plan lacks coherence across the scale of the whole of London and they do not seem to have done that good a job of taking the public with them.