Covid-19

Siobhain McDonagh Excerpts

Tuesday 12th January 2021 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I had arranged a speech about schoolchildren’s access to the internet, but as I was sitting here waiting to speak, I decided that I wanted to say to the House, to the Minister and to you, Mr Deputy Speaker, that I have become increasingly alarmed at comments from Ministers, and comments in the papers and the rest of the media in the past few days, driving the message that people are not following the rules. This has been in order to make people feel bad about themselves. However, when I look at the places in London that I know have the highest rates of coronavirus, I see a straight line to poverty. I suggest to the Minister that if we actually want to drive down rates further, we have to give more support to people to self-isolate if they are contacted by Test and Trace and told that they have been near somebody who has got coronavirus. If we want to encourage carers and support workers to take up lateral flow tests, we have to give them the support to do it. Who wants to know that they have got the virus if they cannot afford to take the time off work? If the choice is feeding three children by going to work or ignoring those uncomfortable symptoms, I suspect I know the decision that most of us would make.

The boroughs in London that have the highest rates are those with the worst housing, where there is a family in every room, where they share a bathroom with people they do not know. What do we do for those people to ensure that they are in a position to self-isolate? I understand that in New York the way they drove rates down was by providing people who did not have it with the money, the hotel room, the food—they even offered to walk their dogs!—to encourage them to self-isolate.

Rather than the siren calls against people who are doing their best, what we need to do as a Government and as a society is say to people, “Go and get the test. We will help you to have your time off work. We will help you to treat your symptoms, because we want to put an end to the virus.” No help to them means increasing rates for all of us.

--- Later in debate ---

[Jo Churchill]

I thank my hon. Friend, and I would say a couple of things. Of course I will take that away and mention it to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi). I would also reiterate the Minister for Health’s comment to my hon. Friend during his opening speech that if at first we do not succeed, we will try, try and try again. It is really important that people feel secure, and that it is not just one hit. If someone has missed their appointment—there may be valid reasons why people cannot get there—we will keep trying over and over again to ensure that as many people can receive the vaccination in as swift a time as possible, because ultimately that is how we will be safe.

Many people mentioned how brilliant pharmacists and their teams have been. We are starting to roll out the vaccine to community pharmacists through the pharmacy network over the course of this week, and building up next week. Many people also mentioned supply. This is a process of driving more and more capacity into the system to make sure that as we build a system—from the mass vaccination sites, in one of which the mum of my hon. Friend the Member for Hazel Grove is working, cascading down through our communities and into more rural sites—those in care homes can get vaccinated without having to leave their care home. This is about making sure we are using GPs and pharmacists across our network, and mobilising the armed forces, who, as we heard in this place earlier today, have been absolutely at the forefront of making sure we get kit such as PPE to the right place, and have been out there helping with testing and helping with the vaccine roll-out. This has been a national effort and a team effort.

[Siobhain McDonagh]

Could the Minister comment on the supply of something fundamental: oxygen? I wrote to the Secretary of State on Saturday about supplies of oxygen to Epsom and St Helier trust, which had a specific problem, but it is not solely Epsom and St Helier—in London, a number of intensive care units are under great pressure and are worried about running out of oxygen.

[Jo Churchill]

I refer the hon. Lady to the in-depth answer on exactly that point that my right hon. Friend the Secretary of State gave during Health and Social Care questions this morning, when he said that there is no national shortage of oxygen in the system. He explicitly outlined the challenges and what is being done to mitigate them.

Pharmacists are being brought online, as are many other parts of our system, including all the staff working hard behind the scenes to keep vital services going and to keep people safe. I reiterate that all front-facing health and social care staff in category 2 can access vaccines, including all dentists and their teams; I think nurses and optometrists were the other professions mentioned during the course of the debate.

We are entering a critical period in our fight against this virus. As my hon. Friend the Member for Milton Keynes North (Ben Everitt) said, there are challenging days ahead—we are not there yet. We are dealing with a new, more transmissible variant of this virus that risks overwhelming our NHS, so we had to put in place these tough but vital rules to slow the spread of the virus. I know how hard these rules have been, not only for those we are asking to follow them but for most of us—it goes to our very core. We did not come into politics to stop people doing things.

Independent Reconfiguration Panel

Siobhain McDonagh Excerpts

Thursday 19th November 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I have lost count of the number of times that I have spoken in this House about the future of St Helier Hospital. Time and again, the hospital has been hurled head first into turbulence, with countless consultations coated in fancy branding repeatedly asking my constituents whether they want their hospital to keep its A&E, critical care and maternity services. The latest plan—almost laughably named “Improving Healthcare Together” proposes to downgrade both Epsom Hospital and St Helier Hospital, moving all acute services south to leafy, wealthy Belmont. The purpose of this debate is to look at whether the Independent Reconfiguration Panel was actually independent when it came to a decision not to look into these proposals.

The panel is a little known but hugely important body that provides checks and balances to the plans of one of the most powerful institutions in our country: the NHS. The NHS employs as many people as the red army, and some would argue that it is built around the same command and control principles—that is, decisions are made and everyone is expected to row in behind them. Communities are hugely affected by proposed NHS changes. As such, their representatives in local government have the power to consider whether they agree with a hospital reorganisation. If they do not, they can refer it to the Secretary of State, who has the power to refer it to an independent panel of experts.

In the case of the “Improving Healthcare Together” programme, my argument is not that the chair of the panel, Professor Sir Norman Williams, is not a man with a hugely important and successful medical career who has brought benefits to thousands, or that he has not made a huge contribution to the NHS. My argument is simply that he could not be regarded as independent, and that through his involvement as a member of the board of St George’s Hospital—which will be profoundly affected by these changes—he should have recused himself. We know that in public life not only do we have to do the right thing; we have to be seen to do the right thing. I will argue that Sir Norman could not be regarded as independent because his connection is far from “tangential”.

Let me turn first to the plans themselves. The programme proposes to turn St Helier Hospital into a glorified walk-in centre, removing its A&E, maternity services, children’s beds and critical care. Some 62% of beds would be lost from the area where health is poorest and life expectancy shortest. The programme’s own analysis unsurprisingly reveals the indisputable link between deprivation and the need for acute services, but ignores the fact that 42 of the 51 deprived areas in the catchment are nearest to St Helier. It is a slap in the face for expectant mums in my community.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that although moving beds to a nearby hospital may make sense on paper, to ask expectant mothers to add a lump of time to their journey makes no sense, and that community-led care is essential and should be kept in the community?

[Siobhain McDonagh]

I agree with the hon. Member.

In the plan, it is assumed that mothers in my area want home births. That is a discriminatory assumption that is completely against their right to choose. It takes maternity services away from the mothers who are most likely to deliver a low-weight baby and mothers who are less likely to want a home birth. It also breaks up the continuity of care, with pre and post-natal services being delivered at one hospital and the birth at another.

The programme ignores the intrinsic link between old age and life expectancy in pointing to the higher number of elderly people in Belmont when deciding where need is greatest. The sobering reality is that Mitcham has a far lower life expectancy than Belmont—nine years lower, in fact. There are more elderly residents in Belmont because, quite simply, its residents live longer. To experts, it is yet another example of the Tudor Hart law, or the inverse care law as it is also known: the understanding in health academia that the areas in greatest health receive the most health investment. Or as my mum, herself a nurse, would say, “Much gets more.”

The reality is that the Minister and his Department are being asked to commit £500 million of scarce NHS resources to move acute services to one of the richest and healthiest areas in London, at the expense of one of the most deprived. Surely the Minister can see that that is wrong, if not from a health perspective, then from a financial one. The plans require 22% more capital than the option of rebuilding where health needs are greatest. Improving St Helier would have a higher return on investment, posing far less risk with a significantly lower capital requirement. Our economy is being decimated by the virus. Can the Minister not see that this proposal goes completely against Treasury guidance and value for money?

This was a devastating decision before the pandemic, but have we learned nothing from coronavirus? How can it possibly make sense for south-west London to come out with fewer acute beds and fewer intensive care units than before? Surely the decision to place the only intensive care unit on the same site as a cancer hub now has to be questioned. I do not dispute the extraordinary work of the Royal Marsden or challenge whether it requires an intensive care unit, but these plans were formed long before the pandemic was known about and have to be reassessed in the light of it.

The programme’s own impact assessment in January warned that any unplanned event such as a pandemic could challenge the resilience of the proposed reconfiguration. It described this situation as “unlikely” and yet, astonishingly, just five pages of analysis have been produced on the pandemic’s impact on the plans. It is the wild west, where everything proceeds full steam ahead, no matter the evidence presented—evidence that cannot be dismissed.

We now know that people from black and ethnic groups are most likely to be diagnosed with coronavirus, more likely to require admission to an intensive care unit once in hospital, and up to twice as likely to die than those from white British backgrounds. We know that black women are five times more likely to die in childbirth than white women, and more likely to require neonatal or specialist care baby units. We also know that 64 of the 66 areas with the highest proportion of BAME residents are nearest to St Helier, and that half of those are in the bottom two quintiles of deprivation, increasing their likely reliance on acute services.

It is indisputable: these proposals would negatively and disproportionately impact BAME residents, deprived communities and expectant mums in my constituency. It is no wonder that when they were put out to public consultation, tens of thousands of residents voiced their disapproval, with overwhelming opposition to the downgrading of St Helier. It was also clear from the public response that if these plans went ahead, many residents would not travel to inaccessible Belmont, but would head instead to St George’s—a hospital that is already under immense pressure, with an A&E in the bottom quartile for safe standards.

Why does Sir Norman have a conflict of interest? Because this is a reorganisation of a neighbouring trust that will have a profound impact on St George’s. That is a case that the board of St George’s has rightly and successfully fought, very publicly, so much so that in a letter in March this year, the chief executive of St George’s made it clear that support for the plans was contingent on her hospital receiving capital investment for a new emergency floor to take account of the increased number of emergency care patients that it would receive. That is the kind of change that requires the full consideration, scrutiny and involvement of the board and the most senior staff. I can think of a number of words to describe that relationship: conditional, connected and dependent, but certainly not “tangential”.

In July this year, Merton Council saw these plans for what they are and used its power to call them in for review by the Department of Health and Social Care Independent Reconfiguration Panel. By its name and nature, it is an independent panel of health experts who can cast a fresh, impartial eye for the Secretary of State. The chair of the panel is Professor Sir Norman Williams, who until 30 September 2019 was a long-standing board member at St George’s Hospital. Naturally, I presumed that that conflict of interest would be recognised and he would step aside from judging this proposal. Unfortunately, he did not, with his connection to the plans described as “tangential” and

“not relevant to his role in independently formulating a response”.

This evening, I ask the Minister to consider just how tangential that connection is. In April 2016, Sir Norman became a board member at St George’s, and board meeting minutes and papers reveal that the reorganisation was debated time and time again. The papers from one of his first board meetings in June highlighted the requirement for service change and reconfiguration in south-west London. In March 2017, the chair discussed the upcoming board-to-board meeting with Epsom and St Helier, which would provide an opportunity to discuss the development of joint renal services. Fast forward to October, and the board’s attention was on a joint letter signed by the CEO of St George’s about the importance of considering the future of their hospitals with any reconfiguration at St Helier.

The issue came to the board again in December, following Epsom and St Helier’s indication that it needed to change its clinical model. By the following November, the impact of the proposals on St George’s was so clear that the chair of the board, Gillian Norton, wrote to the programme directly on behalf of her board, including Sir Norman:

“Senior staff within St George’s have spent significant amounts of time over the last 3 months engaging with both the programme team and colleagues in other providers to work through the impact on providers of the shortlisted options…The board agreed that I need to write to you now, formally, to set out these concerns…I understand that a key principle of how programme process has been agreed is that there is no formal requirement to take account of the impact on other providers. I find this difficult to understand in any event given we are a health system but particularly so in the context of the SWL Health and Care Partnership and the expectation that we will work collaboratively.”

I found this letter so extraordinary, after fighting this reorganisation for 23 years, that I wrote back to the board and the chair. Naturally, this issue rightly remained high on the board’s agenda. The papers for the board meeting of December 2018 show concerns from St George’s finance and investment committee about the lack of options explored by Epsom and St Helier, and agreement that the trust should feed this back to the programme. By January 2019, the chief executive spelled out to Sir Norman and the board:

“Any changes to the current configuration of services at Epsom and St Helier are likely to impact St George’s, and it is important these are factored into any future proposals.”

She again used her notes at the February board meeting to state:

“While the location of the new facility is yet to be decided, it’s clear that there are significant estate issues at both Trusts that need to be addressed through capital investment.”

Time and again, the programme was brought to Sir Norman and the board’s attention—in April, in May and in June. This would be a landmark decision for St George’s Hospital. It is completely understandable that it had their full attention.

In July 2019, the programme released the impact assessment on St George’s. It is utterly inconceivable that someone as diligent and respected as Sir Norman would not have been aware of this, particularly as senior staff at his trust had helped produce it—a document released just months before he became chair of the Independent Reconfiguration Panel. That Sir Norman was so heavily involved in these proposals is no criticism. He was rightly fulfilling his responsibility as board member of a hospital that would be heavily impacted by these proposals. He declared his role to the other Independent Reconfiguration Panel members, explaining that he had even had recent discussions with senior consultants at Epsom and St Helier through his role as chair of the national clinical improvement programme. All public office holders are subject to the seven principles of public life, one of which is objectivity. But how could Sir Norman be objective? How could he even appear to be so? In public life, it is important not only to be objective, but to be seen to be objective.

My community has fought tirelessly for St Helier, and the least we expect is transparency, honesty and objectivity from the top. Astonishingly, the panel instead considered that there was nothing more than tangential connections, irrelevant to Sir Norman’s role in independently formulating a response for the Secretary of State. Tangential! If there is any doubt over how interconnected the hospitals are, then be aware that the chair of St George’s also became chair of Epsom and St Helier in 2019. Conveniently, it was on the very same day that Sir Norman became chair of the Independent Reconfiguration Panel. Surely the Minister can see that there is nothing tangential in the evidence that I have laid out today. Not only did Sir Norman already know about the proposals before he was asked independently to judge them, he must have known them inside out, having faced them repeatedly at board level and in conjunction with a whole host of the key personnel involved. It was tangential to the tune of millions of pounds of investment on which his former hospital’s support is contingent.

We must not underestimate the importance of a fresh eye. One of the leaders of these plans, Daniel Elkeles, formerly led the infamous “Shaping a Healthier Future” plan, which proposed similar hospital downgrades in north-west London, wasting £76 million over eight years before the Treasury finally put a stop to it.

I draw to a close now. I must say that I respect the Minister. He found time to meet me in the summer when his time must have been so scarce. I explained my reasoning for calling this debate to his office last week so that he could come prepared. I am not trying to catch him off guard. I am asking that he steps away from party politics and recognises that this connection is indisputable rather than tangential. If an independent panel was asked to review the plans, the panel must be independent. I am asking that he consults his Treasury colleagues on why the most expensive option is being chosen at a time of such economic turmoil. I am asking that he reflects on the powerful shoes he is in and the unique opportunity he has to help to close health inequalities in an area where they are so stark. Surely that would make any Health Minister proud of his work, and maybe then we really could improve health together.

Baby Loss: Covid-19

Siobhain McDonagh Excerpts

Thursday 5th November 2020 Westminster Hall

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on people experiencing baby loss.

It is a pleasure to serve under your chairmanship. Before I start, how should I address you—Chair?

[Siobhain McDonagh (in the Chair)]

However you like—it will not be the worst thing I have ever been called.

[Cherilyn Mackrory]

This is now the fifth year the House has marked Baby Loss Awareness Week—as with many things, covid-19 caused some delay, as Baby Loss Awareness Week took place a month ago—and I am pleased and grateful that we are here today. It is extremely encouraging and moving that right hon. and hon. Members have ensured that this important issue has been debated often in recent years, helping to deliver an unmistakable message outside this place about its importance in Parliament, the Department of Health and Social Care and the national health service. Most importantly, that sends a message to bereaved families, letting them know that there are people in this place who truly understand how it feels.

Please forgive me for telling my story today, in as much detail as I dare. It is important to me that my baby’s short story helps to shine a light on what is a really dark situation for many people. “I can see straightaway that something isn’t right”—those are the words that broke my heart and changed my life forever. It was 3 January 2019, and my husband and I were at the routine 20-week scan for our second baby. My first pregnancy had been healthy and straightforward and resulted in our fabulous daughter. At age 42, I had been slightly anxious about my 12-week scan, but happily all tests had come back clear. My midwife encouraged me to birth again at our midwife-led centre, and I was keen to stay healthy in order to do just that.

We had celebrated a low-key but cosy Christmas and new year with family and friends. I felt content and reassured by my kicking baby and wondered what the following year would bring. Three days later, we went for our 20-week scan and would receive the terrible news from the sonographer that our baby had an extremely severe form of spina bifida. I lay on the couch and grabbed my husband’s hand tightly. Tears stung my eyes—not unlike now. When I glanced at him, his eyes were watering, too. We did not dare believe what had just happened.

Just over an hour later, we were sitting in the office at our main hospital, the Royal Cornwall Hospital in Truro, with a wonderful consultant and an incredibly kind bereavement midwife. We were met at reception and taken to a small room and brought some tea. I just knew this was not going to end well, but I did not know what to expect. I was checked again, and any hope we had was extinguished by a slow and silent shake of the head. But my baby was still kicking. So started the most traumatic weekend of my life to date.

We had no idea what would happen next. Our world had started to swim and spiral away, and neither of us knew what questions we should ask.

--- Later in debate ---

[Sarah Owen (Luton North) (Lab)]

I thank and pay tribute to the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for securing this important debate, and also for speaking with such bravery and honesty. It is a real inspiration—she has done Lily proud.

Coronavirus has impacted every part of our lives, often in ways that we did not think or expect. We took things for granted little things, such as holding the hands of loved ones who are in pain or upset, or even those across the political divide. When restrictions were put in place in hospitals for visitors, fathers, partners and support networks in relation to scans for expectant mums, I was not surprised to receive pleas from women in Luton who were saying that they really needed somebody there to support them through their scans and neonatal appointments.

That is especially important to people who have had difficult pregnancies or miscarriages or who have suffered baby loss in the past. Not every scan is one of joy, and the time before a scan can be an incredibly anxious, nervous one, full of dread. Holding someone’s hand during that time is incredibly important. That is why I am so pleased to say that, having worked closely on this issue, the fantastic team at Luton and Dunstable University Hospital was one of the first to enact the new guidance allowing visitors to come to scans with expectant mothers.

As we know, with coronavirus everything is always under review. I really hope that the Government continue to support trusts in enabling that to happen as long as is humanly possible, because it is important. It is not like the films on TV when someone sees two pink lines and then suddenly the film fast-forwards to the very large woman buying lots of baby clothes and then screaming for a couple of minutes, and out pops the baby. For many people, that is not the reality of pregnancy. It is not that simple. Miscarriage and baby loss are part of the pregnancy journey that are often just not talked about. Yet, a quarter of all pregnancies end in miscarriage. If we are to end the stigma, the silence and sometimes the shame, we need to be open and honest.

The first time I miscarried, I was at work. I knew that something was not right, so I booked myself a scan during lunch break. I was by myself then, and they told me that there was no heartbeat. To be honest, what happened next was a bit of a blur, but I still remember the emotional and physical pain as if it was yesterday. I will be perfectly honest: a miscarriage is not like a period. It is incredibly physically and emotionally painful. The second time, we were further along. I was not alone for that scan. It did not make the news any easier, but I cannot describe the difference it made to have my hand held, gently squeezing support to one another.

During these losses, and throughout the pregnancy of my wonderful rainbow baby—the term for a baby born after miscarriage or baby loss—my friends and family were there every step of the way, and held me close to get me through those dark times. But my fear is for all those women who no longer have that support. That is exactly why I urge the Government to hold out for as long as they can to ensure that visitors can come to the scans of expectant mums, and to tackle the cause of the doubling of stillbirths during this lockdown.

I want to pay tribute to the Miscarriage Association. Without its support, I know that myself and thousands of women would still have struggled, and struggled alone. Social media is often a cesspit; but I have to say, for any woman who has miscarried, or is pregnant following miscarriages or baby loss, the Miscarriage Association’s website and forums on Facebook are an oasis of comfort, information and understanding. During this time, I know that we cannot hold the hands of everyone we want to. There are women out there, associations, charities and hospitals doing their best to get us through, and I hope the Government listen to their concerns and work with them so that no woman endures baby loss alone and so that women are no longer an afterthought throughout this pandemic.

[Siobhain McDonagh (in the Chair)]

I have been here 23 years and I have never seen a Doorkeeper distributing tissues to Members during a debate—I thank him. I am sure this is going to be a harrowing debate. There is a limit of about seven and a half minutes on speeches so that everybody can tell us their story.

--- Later in debate ---

[Angela Richardson (Guildford) (Con)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. I congratulate my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) on securing such an important debate, on her moving contribution and on her strength and courage in sharing her story about her loss of baby Lily.

This year will be remembered as a difficult year for so many people, but particularly for those who have lost loved ones—especially a much-longed-for baby. I rise to speak today because my difficult year in relation to baby loss was 2003, which coincided with the SARS outbreak. Stopping in Singapore for a couple of days in February 2003, on our way to introduce our first-born to her New Zealand grandparents, my husband, our baby daughter and I became very ill with a high temperature and a continuous cough. Only a few days later, our baby was coughing up blood and we were straight into A&E, where she was treated for pneumonia for several days. We were not counted in any official statistics, and we were not tested. It could have been any other type of virus that was prevalent at the time, but it was an illness that knocked us for six. It is the most ill I have ever been in my life. I was so ill that I was not well enough to care for my baby. I went on to miscarry in June, September and December of that year.

Although my personal experience is anecdotal, and correlation is not causation, the timing of my experience got me wondering—as we are discussing the effects of long covid and any viral illness—whether a lingering heightened immune response has any bearing on an increased incidence of miscarriages. I would be interested to know of any scientific research, either historical or under way now, that links this issue with repeat miscarriages.

I know that my year of grief was a fundamental tipping point in my life and caused me to re-evaluate everything I thought I knew, believed, cherished and held dear. Being an immigrant to this country, I understand a little about isolation: I have not had time to build extensive networks, and I do not have the deep roots that many people who have grown up here have. I did have my National Childbirth Trust group, and I will never forget how blessed I was that I was busy hosting our regular gathering when I started contracting at 14 weeks, two weeks after we had announced to everybody that we were pregnant again. One friend scooped up my daughter and took her home to look after her, and the other took me to the local doctor. She was with me when my waters broke. Then she took me to A&E and stayed with me through a difficult labour and delivery. I was not prepared for many things, including my milk coming in afterwards—or that, years later, I would have flashbacks.

I asked for a test to be done on that particular miscarriage, because it was further along than the other two. Unfortunately, I received a note from the consultant a couple of weeks later to say that they had not done the test and that the foetus had been taken to be incinerated. As hon. Members have said, it leaves people left wondering what they have done wrong. What could have been done differently? Not having answers is probably one of the most difficult things. I can only imagine how difficult it is for families who have had to endure this situation through lockdown conditions. We need to ensure that support is in place for such families.

By the time our second child arrived, I had been pregnant, almost continually, for 18 months. I have spoken openly about suffering from both perinatal and post-natal depression. The effects of baby loss are profound and long-lasting. The passage of time has softened my grief, and my mother always said you can’t put an old head on young shoulders, but if I can use today’s important debate to send a message to women who are coping with baby loss during this time of extra concern and difficulty with covid, I would say this: be kind to yourself, and be patient. Do not be afraid to ask for help from your frontline healthcare providers, and get any support that you need with mental health.

Taking the opportunity to tell our stories, as we are doing today, is a wonderful thing that women can do for each other. It lets others know that they are not alone, especially at this time, when we are more concerned about isolation and loneliness than ever before.

[Siobhain McDonagh (in the Chair)]

I apologise to the hon. Member for Sheffield, Hallam (Olivia Blake), but I am going to ask the Member speaking for the Scottish National party, the hon. Member for North Ayrshire and Arran (Patricia Gibson), to come in at this point, because she has to get on to a special flight. I apologise for not having told the hon. Member for Sheffield, Hallam in advance.

Testing of NHS and Social Care Staff

Siobhain McDonagh Excerpts

Wednesday 24th June 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

We now know that coronavirus is not the great leveller. We know that it exacerbates social difference and the problems of health and social inequality. If someone is a black doctor, a black nurse, a black cleaner, a black paramedic or a black person in social care, they are more likely to contract and die of coronavirus than their white counterparts. We also know that if someone is a black man not in the health service, they are more likely to die from coronavirus. If someone is a black woman, they are more likely to die than their white counterparts. If they are taken to hospital, they are more likely to enter intensive care.

We know that it is not fair—it is not a balanced foundation. The Government have pledged to look into the issue with an inquiry, yet in nine days’ time, the NHS in my area intends to agree a plan that will move services away from black and ethnic minority areas to those that are whiter and more wealthy. When asked, “How can you do this without looking at coronavirus and its impact on the NHS?”, they said, “Okay, we’ll do the research, but we are not telling you about it.” Under pressure and embarrassment, they have produced their research: four pages, and not one word about the impact of coronavirus on black or ethnic minorities. There is no defence of their decision to take services away and no acknowledgement of the problem that exists. That is without even considering the fact that the black community in my constituency and around me in south-west London are more likely to have diabetes and hypertension, and black women are five times more likely to die in childbirth.

Do black lives matter? Perhaps we have to prove that they do. I ask the Minister directly: will she intervene to say that, yes, black lives matter, and that we need more than four pages that do not even give any acknowledgement of the problem that exists for black and ethnic minority people in our country and in my bit of south-west London?

Covid-19: BAME Communities

Siobhain McDonagh Excerpts

Thursday 18th June 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

It is the pride of my life to represent the big, diverse constituency that I was born and brought up in, from those like my parents who came over in the ’40s to the newer communities from west Africa and Sri Lanka. Many of the children in those communities are doing well in our schools and will be the professionals of the future—as long as they manage to get through the circumstances in which they find themselves in overcrowded accommodation and houses in multiple occupation. As soon as we heard the advice about how to avoid getting coronavirus, we knew what would be the likely outcome. For those who do not have their own bathroom or kitchen but instead share them with four or five other families, the advice was impossible to follow.

It is not that I believe that people in positions of authority want to be overtly racist; I sincerely believe that they do not. However, even as we stand here, the health service in my area is ignoring the advice in the Public Health England evidence. There are plans to move the A&E, the maternity unit and all the acute services at St Helier Hospital further away into Sutton, in spite of the evidence that that takes them further away from BAME communities who are more likely to be dependent on them. The evidence is damning. Of the 66 lower output areas in the catchment with the highest proportion of BAME residents, just one is nearest to the proposed site in Belmont. Meanwhile, 64 of the 66 are nearest to St Helier, 32 of which are in the bottom two quintiles of deprivation, increasing their likely reliance on acute services.

The people running the programme know this; it just does not matter enough for them to want to do anything. Their own impact assessment states clearly:

“As higher densities of the BAME community and those with long term health conditions…live within areas in the highest quintile of deprivation, these groups may also be expected to be disproportionately impacted compared with others”.

But the programme carries on. Despite the overwhelming pressures facing the NHS, the programme’s consultation culminated at the peak of the pandemic. Yet the impact assessment states:

“A reduction in the number of hospitals providing…acute services could potentially have a negative impact on the resilience of services, if for example, there is an unplanned event…on the single major acute hospital site which may restrict service delivery. It is recognised that the likelihood of such a situation occurring is unlikely”.

It happened, we saw it, and it may come back again—and perhaps in an area with higher BAME density where the services will then be gone.

On 4 June, those at the programme confirmed that they will not have concluded their analysis of the impact of the pandemic on their proposals and that they have no intention of releasing the analysis they are undertaking. Their runaway train carries on full steam ahead, coronavirus or no coronavirus, no matter who dies or who does not; it is irrelevant, it is their plan and they are going to have it, come what may.

In conclusion, I want to ask the Minister about two cases in my constituency. The first is that of Mr Salih Hasan, a cleaner at St George’s Hospital for the past 18 years. He worked for two outsourced contractors ISS and Mitie, but he was a part of the team at St George’s. Will his family be the beneficiary of the lump-sum payment for those who die of coronavirus in the NHS? The second is that of Mr Antwi, who worked for a private transport company in hospital transport. He died, leaving his family to pay for a funeral they could not be afforded. Surely, his family too should receive some of that fund.

Coronavirus Bill

Siobhain McDonagh Excerpts

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Jonathan Ashworth]

My right hon. Friend makes an excellent point, and we are seeing it in my constituency. I have had complaints from constituents about exploitative profiteering, so I hope the Government will come forward with some proposals to stamp it out. It is an absolute disgrace that it is happening at this time of national crisis.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

May I raise, once again, the issue of housing? Social isolation is great, but it is really difficult for people who happen to live with their family in one room in a deeply overcrowded shared house—sharing a kitchen and sharing bathrooms—as so many of my constituents do, particularly when the kids are off school. There needs to be some thought about letting them out in parks and stuff like that, because they do not have gardens.

[Jonathan Ashworth]

My hon. Friend makes an excellent point. I represent an inner-city seat, and I appreciate that her seat is on the outskirts of London but, none the less, our seats have similar demographics. I know full well that many, many families are living in cramped, small flats. There are intergenerational families living with elderly mums, elderly grandmothers and so on who have various comorbidities and who need to be shielded.

If we enter a situation in which we force people to stay at home, I hope the Government will look at how to support such families, because it is quite outrageous that, in many parts of the country—especially in London, but also in my constituency—there are flats with families of nine or 10 people sleeping on the floor, and so on, while property developers have flats standing empty. Why cannot we take over some of those empty flats to house some of these very vulnerable families and to help us get through this national crisis?

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 10th March 2020 Commons Chamber

[Edward Argar]

My hon. Friend is absolutely right. It is indeed excellent news. As he will be aware, the public consultation process is under way. It would be wrong for me to prejudge that, but I encourage everyone to participate.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

Does the Minister agree that it is important to spend taxpayers’ money well, and that to spend it on a site that is going to cost 20% more than St Helier—away from the people with the greatest health needs—is not the best way to spend public money?

[Edward Argar]

I gently say that I am not going to prejudge the outcome of the consultation, in which I am sure that the hon. Lady would encourage others to participate. Regardless of the outcome, I am sure that she would want to welcome the £500 million investment from the Government that will benefit her community and others.

Health Inequalities

Siobhain McDonagh Excerpts

Wednesday 4th March 2020 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

The £500 million promised by the Government for Epsom and St Helier University Hospitals NHS Trust provides the perfect opportunity to begin to address health inequalities in my part of south-west London. Instead, my local NHS has proposed moving services away from the most deprived areas to leafy Belmont, where life expectancy is longest. If that goes ahead, St Helier Hospital and Epsom Hospital will be downgraded, reducing two A&Es to one, with St Helier Hospital losing major A&E, acute medicine, critical care, emergency surgery, maternity services, in-patient paediatrics and child beds. That 62% reduction in beds would leave a shell of a hospital more accurately described as a walk-in centre.

Across the catchment of the trust, deprivation varies greatly. Given today’s debate, does the Minister agree that health inequalities must be at the heart of the decision on how to spend those funds? The key point is that of the 51 most deprived lower-layer super output areas in the trust’s catchment, just one is nearest to the chosen site. Meanwhile, 42 out of the 51 are nearest to St Helier Hospital. Any decision to downgrade St Helier, therefore, would exacerbate existing health inequalities. Rather than comparing deprivation by proximity to each of the three possible sites, it has been compared by CCG area, disguising the 76.5 year life expectancy of men in parts of Mitcham compared with the 84.4 year average in Wimbledon Park. The thousands of A&E attendances from the deprived areas in Croydon have been discounted, but the comparable number from prosperous Wimbledon have been included. The reality that the area of higher deprivation in the trust’s catchment area has, on average, a far higher attendance at A&E has been dismissed.

The Prime Minister’s amendment today states that the Government are committed to levelling up

“outcomes to reduce the health gap between wealthy and deprived areas”.

With just one month to go until the end of the St Helier consultation, the Government have a decision to make. Will much get yet more, or will the Government insist that vital services are left where they are most needed and any available funds are used to improve St Helier Hospital on its current site?

Acquired Brain Injury

Siobhain McDonagh Excerpts

Thursday 6th February 2020 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I thank the all-party parliamentary group on acquired brain injury for its continued determination to ensure that the issue is given the time and attention it deserves; I particularly thank my hon. Friend the Member for Rhondda (Chris Bryant), who has campaigned admirably. Politicians’ stock is low at the moment, but anyone who heard his contribution, with its passion, hard work, determination and sincerity, would feel a lot better about what we do.

As the right hon. Member for South Holland and The Deepings (Sir John Hayes) said, one person is admitted to hospital in the UK every 90 seconds as a result of brain injury, so it is imperative that the recommendations in the APPG’s report, “Time for Change”, are implemented without delay. I fully support the excellent report and endorse all its recommendations.

As hon. Members may know, I have a long-standing association with the brain injury charity Headway, mainly through its chief executive, Peter McCabe, who has been my friend and colleague in Mitcham for more years than I care to say. His charity does incredible work across the UK to support individuals and families affected by brain injury. The help provided by Headway is seen as a lifeline to those who receive it, whether through its helpline—inquiries to which have more than doubled in the past decade; through the provision of free, award-winning publications to help people understand and adapt to life after brain injury; or through grants distributed via its emergency fund.

Many hon. Members will also testify to the exceptional work done by Headway groups and branches in their own constituencies. The APPG report rightly calls for a national review of neurorehabilitation to ensure that service provision is adequate and consistent throughout the UK. This report must not confine itself to acute care settings. Headway groups and branches are under severe financial pressure as a result of cuts to local authority budgets. The fact that they continue to provide such vital support, through rehabilitative therapies and social interaction programmes, is a testament to their determination to support this vulnerable community.

Let us be clear: the pressure under which Headway groups operate must be eased, and they must be afforded the funding they need to continue to support people who may otherwise be cut adrift from society. “Time for Change” also calls for improvement to how the criminal justice system meets the needs of brain injury survivors. In a previous debate on acquired brain injury, I highlighted Headway’s brain injury identity card, which helps to identify brain injury survivors when they come into contact with the criminal justice system. To date, more than 7,000 such cards have been distributed to vulnerable adults in the UK.

The ID card is part of Headway’s Justice Project, which is helping to increase understanding of brain injury within the criminal justice system. That includes the provision of training to the police, liaison and diversion services, the Crown Prosecution Service, the Public Prosecution Service in Northern Ireland and other agencies. As highlighted in the report, this work is vital and charities such as Headway must be supported in delivering the training required.

I have also previously spoken of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in the acute stage of care following a brain injury. Since it was established, the fund has distributed more than £400,000 to almost 2,000 families with limited income or savings. About 82% of those grants are spent on travel, accommodation or parking at hospitals when no alternative transport is available—an issue I would like to focus on.

In December, the Government announced a new approach, giving access to free hospital car parking for thousands of NHS patients and visitors. I congratulate the Government on that announcement, which stated:

“From April, all 206 hospital trusts in England will be expected to provide free car parking to groups that may be frequent hospital visitors, or those disproportionately impacted by daily or hourly charges for parking”.

Each year, thousands of patients admitted with ABI will have sustained severe brain injuries, putting them at the greatest risk of a fatal outcome. If they survive, they face many weeks or months in acute care and rehabilitation. The development of major trauma centres and specialist brain injury units results in improved outcomes for patients. However, the emergence of such centres has meant patients being treated many miles from the family home, resulting in families facing financial hardship to be by the bedside of their loved ones.

If the patient is the main breadwinner or self-employed, the financial stress placed on the family can force them into impossible choices. The families of patients who have sustained potentially fatal acquired brain injuries will be desperate to be by the bedside of their loved ones at such a critical time, often for periods of several weeks or months. I am sure everyone agrees that they should be classified as “frequent hospital visitors” who are

“disproportionately impacted by daily or hourly charges for parking”.

Will the Minister confirm that that will be the case? It is vital that we receive confirmation today that it will, so that that vulnerable group receive the support they so clearly deserve.

--- Later in debate ---

[Caroline Dinenage]

Yes, I am very happy to commit to doing that.

Before I go on to talk about the health implications of ABI, I want to deal with a couple of other things. They are not within my realm of expertise, but I want to touch on them.

The hon. Member for Mitcham and Morden spoke about the Headway brain injury identity cards—how important they are and how important it is that they are recognised across the criminal justice system. I wanted to mention how Headway has been integral in partnering NHS England’s health and justice liaison and diversion services programme team, to provide workshops in London and Leeds to raise the awareness of the prevalence of ABI within criminal justice populations. The objectives were designed in a “train the trainer” format, so that the attendees could return to their services and cascade the learning on how to identify people with brain injury, how to identify the brain injury cards that Headway has brought forward and how to understand the implications. I thought that was quite positive.

My right hon. Friend the Member for Hemel Hempstead was right to mention the positive progress that has been made in some sports. The Rugby Football Union’s Headcase campaign and the British Horseracing Authority have also made great strides in this area. However, he was also right to say that other sports have a long way to go.

The hon. Member for Rhondda spoke about trauma centres. As he knows, in 2012 22 regional trauma networks were developed across England to ensure that those with the most serious brain injuries received the best care. Two years after their introduction, an independent audit showed that patients had a 30% improved chance of surviving severe injuries. Since then, as he says, the network has saved literally hundreds of lives.

For people who have ABI, neurorehabilitation that is timely and appropriate to their circumstances is a massively important part of their care. Access to high-quality rehabilitation saves money and, more importantly, significantly improves outcomes for patients. NHS England commissions specialised rehabilitation services nationally for those patients with the most complex level of need. As we have already heard, trauma unit teams work to assess and develop a rehabilitation prescription for brain-injured patients. At the unit, patients can access care from specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription.

These rehabilitation prescriptions are an important component of rehabilitation care, because they reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient. The APPG argued that all patients should benefit from an RP; as I understand it, at discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialist or local rehabilitation, supported by the RP. However, I take on board what the hon. Gentleman says about ensuring that the letter and the prescription itself are written in language that people can understand, are easily accessible and are available to them and their family members.

The “National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury”, published in 2016, found that, on average, 81% of patients had a record of a rehabilitation prescription. That audit appears to have had a significant impact, because the latest data shows a rise to an average 95% completion rate. In April 2019, the third and final report of the Audit Commission to NHS England’s audit programme was published, and it is encouraging to see that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

However, the audit report also suggests that much more work needs to be done to ensure that all patients who could benefit from specialist rehabilitation can access it. Using data provided from participating centres, the audit’s authors estimate that the current provision caters for about 40% of those who need the services. To address the capacity issues highlighted, the audit makes a range of recommendations.

It is important to recognise that these audits play a massively valuable role in helping services to improve. They shine a light on variation and help to support services to best meet the needs of patients. However, there will always be different models of improving access to specialist rehabilitation, depending on the set-up of the services around the country. Therefore, local service providers and commissioners should review capacity in the pathways for specialist rehabilitation in the light of this audit, taking action where they can.

The majority of rehabilitation care is commissioned and managed locally, and NHS England has produced some documentation and services plans to help with that. “The Principles and Expectations for Good Adult Rehabilitation” describes what good rehabilitation care looks like and offers a national consensus on the services that people should expect. The NHS long-term plan has also set out some key actions on this, designed to improve care, treatment and support for people with long-term conditions such as ABI.

Community services, which play a crucial role in helping people remain as independent and well supported as possible, are going to receive significant investment, with £4.5 billion of new investment in primary and community care. Furthermore, NHS England has set out plans to roll out the NHS comprehensive model of personalised care, which includes self-care care planning, personal health budgets and social prescribing. It will reach 2.5 million people by 2023-24 and is particularly relevant to people with acquired brain injury. The model is currently implemented across one third of England, but by September 2018, more than 200,000 people had already joined the personalised care programme.

The hon. Member for Mitcham and Morden asked about free car parking. From April, all hospital trusts will be expected to provide parking to groups who may be frequent visitors. I interpret that to mean families visiting people who are in hospital for a long period of time, which I think is what she was asking me.

[Siobhain McDonagh]

I thank the Minister for giving way on this important issue. There are many terrible stories of people spending their life savings in an effort to keep being able to visit children and partners. Could the Minister specifically say, or could we have a response in writing to this effect, that that includes the families of people with acquired brain injury? I have been seeking some clarification from the Department, but all the responses have so far been obscure.

[Caroline Dinenage]

I will certainly seek to get that in writing for the hon. Lady.

My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.

NHS Funding Bill

Siobhain McDonagh Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Jonathan Ashworth]

We lost the general election, but that does not give Tory Members a free pass on the state of the NHS. We have seen an increase in trolley waits in hospitals in December of 65%, and trolley waits in the past year, on this Secretary of State’s watch, have risen to 847,000—the highest number of trolley waits in hospital corridors on record.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

Is my hon. Friend aware that twice in the past fortnight St George’s Hospital in Tooting has been on OPEL—Operational Pressures Escalation Level—alert in A&E? It has been one level below having to close its doors to all emergencies because the hospital was so full. Such a closure would have a devastating impact on south-west London.

[Jonathan Ashworth]

My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.

--- Later in debate ---

[Jonathan Ashworth]

The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.

As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.

The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.

In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.

This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.

We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.

Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.

[Siobhain McDonagh]

Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.

--- Later in debate ---

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I am really grateful for the opportunity to participate in this debate, because it has particular relevance to my constituency. My mum came from Ireland to London in 1948 to train in the first generation of NHS nurses. She spent her whole working life as a state-enrolled nurse in large, long-stay mental health hospitals. She loved her patients. She loved the NHS. She loved her country, which gave her the opportunity to work and raise her family. The same cannot be said for her views on Mrs Margaret Thatcher, who she blamed for making her redundant in the early 1980s, when my sister Margaret and I were still at university.

My mum had a phrase: “Much gets more”—those who have get more, and those who have little get least. We know that the life expectancy of more well-off people is getting longer, with longer periods of good health. We know that the life expectancy of poorer people is going down—in the 21st century!—and the period that they live in ill health is getting longer. We also know that those who are well off have better GP services. We know that poorer people access the NHS in different ways, often via A&E, so one would have thought that the moneys for acute services would be allocated to the poorest areas.

That brings me back to my mum’s phrase “Much gets more”, because in my constituency, my local NHS trust is still consulting on a plan that moves the A&E, the maternity unit, paediatric services and in-house surgery from St Helier Hospital to Belmont. To those who have more, more will be given. So what is the answer? The answer appears to be, from the trust’s deprivation research, to be partial with the truth.

The Minister will know that our constituencies are broken down into areas called lower layer super output areas, which are ranked by levels of deprivation, so that those relocating health services can consider the impact that their decision will have on the most deprived communities. The latest consultation in my area acknowledges that requirement and has even produced a deprivation impact analysis. The title is promising, but the contents are utterly bewildering.

The statistical reality is that, of the 51 most deprived lower layer super output areas in the catchment area, just one is nearer to the site in Belmont that the NHS wants. Meanwhile, 42 out of 51 are nearer to St Helier Hospital, which affects my constituency. Does the Minister agree that acute hospital services should be based where they are most needed and that deprived communities must not be negatively and disproportionately impacted? If so, now that I have put the flawed evidence on record, does he agree that the consultation should review the deprivation analysis before proceeding further? What is more, the consultation assumes that my constituents will travel to the new site, regardless of where it is, but they will not. These plans will put severe pressure on St George’s and Croydon University Hospital, both of which are regarded as having too many people arrive at them right now.

Let me make this clear: I am providing concrete examples of missing and flawed evidence in the consultation analysis, and yet that same analysis has been used to determine Belmont as the preferred site for capital funding. Will the Minister meet me urgently to discuss these proposals? I appeal to him to step in before another penny of taxpayers’ money is spent on this bogus consultation. I hope that my mum’s phrase “Much gets more” is not true of the NHS in south-west London, but Breda was normally right about everything.

--- Later in debate ---

[Edward Argar]

Because the cash set out in the Bill is the money that the NHS is going to be getting as a floor.

The shadow Minister rightly raised the issue of mental health. My right hon. Friend the Secretary of State was rightly clear that spending on mental health provision will increase the fastest under the proposals in the Bill, with spending on children’s mental health increasing the fastest of all. I am sure the Opposition will welcome that.

My right hon. Friend the Member for South West Surrey (Jeremy Hunt) rightly highlighted the quantum of spending and how that compares to other countries around Europe and, indeed, in the OECD. I pay tribute to him, because a lot of what we are talking about today is based on the foundations that he built when he did such a fantastic job as Secretary of State.

The hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) rightly alluded to the Bill’s impact on Barnett consequentials and spending in Scotland. As the hon. Lady will know, the Barnett consequentials will apply. My hon. Friend highlighted the fact that not only the NHS in England but the NHS in Scotland faces challenges that we must all step up to meet.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) highlighted the need for us to focus not just on inputs but on outcomes and what we achieve with the money that we invest. That is exactly what the Secretary of State is determined to do.

The hon. Member for Nottingham South (Lilian Greenwood), a fellow east midlands Member, highlighted the need for capital investment in her local hospitals in Nottingham. I am happy to meet her to discuss that further, if that would be helpful to her.

Let me turn to maiden speeches. My hon. Friend the Member for Darlington (Peter Gibson) made an excellent maiden speech. As Members have said, his predecessor Jenny Chapman was respected and well liked in the House. I suspect that, given his speech, he will achieve exactly the same distinction. He spoke forcefully and powerfully on behalf of his constituents. I am sure that they will find him a doughty local campaigner in their interest.

My hon. Friend the Member for Ashfield (Lee Anderson) paid tribute to his predecessor, Gloria De Piero, who was my shadow when I was a Justice Minister. He was right to pay tribute to her, because she was a fantastic colleague to have in this House. None the less, he achieved a fantastic result. As a fellow east midlands MP, I know his constituency well. It is a fantastic place and his constituents are very lucky to be represented by him. He is a local man standing up for his community. He also spoke movingly of his journey—if I may put it this way—from pit to Parliament, and the power of social mobility, of aspiration and of opportunity. He reminded me of a former colleague of ours and a good friend of mine, Sir Patrick McLoughlin, who made the same journey. He ended up in the Cabinet, so I will be watching my hon. Friend’s inevitable ascent carefully.

The hon. Member for Feltham and Heston (Seema Malhotra) touched on, among other things, Heston health centre. Again, as ever—as in my previous role—I am happy to meet her to discuss that. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), in an eloquent but forceful maiden speech, clearly put this House on notice that he will always speak up for his principles and his beliefs, and, while we may on occasion disagree on policy, I doubt we will disagree on his passion and determination to champion his constituents’ interests.

My hon. Friend the Member for Dover (Mrs Elphicke) also focused on achieving outcomes. She touched on the tragic death of Tallulah-Rai Edwards. I extend my condolences to the family, but may I also say that my hon. Friend the Parliamentary Under-Secretary of State for patient safety will be happy to meet her to discuss that in more detail.

It is always a pleasure to meet the hon. Member for Easington (Grahame Morris) and to hear from him. We have met previously, and he and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), are due to meet again to discuss this matter in a few weeks’ time when we will pick it up further.

Let me turn now to my hon. Friend the Member for Birmingham, Northfield (Gary Sambrook). May I pass on my congratulations to his sister on the birth of Freddie and pay tribute to all staff, as he did, working in our amazing NHS for the work that they do. Many hon. Members paid tribute to them, including the hon. Member for Rhondda (Chris Bryant), and my hon. Friend the Member for Banbury (Victoria Prentis)—I have no doubt that I will be hearing from her about the Horton on many occasions in the future. My hon. Friends the Members for North Dorset (Simon Hoare) and for South Dorset (Richard Drax) made powerful pleas for investment in their community hospitals and in their local health infrastructure. I am a regular visitor to the constituency of my hon. Friend the Member for North Dorset, so I look forward to visiting both colleagues in due course.

As well as talking about Crawley Hospital, my hon. Friend the Member for Crawley (Henry Smith) highlighted the need for Gatwick airport to be included in the conversations on the coronavirus, and I know that my right hon. Friend the Secretary of State will have heard what he said, and is already factoring that in.

Before concluding, I will touch very briefly on two other contributions: my hon. Friends the Members for Stoke-on-Trent Central (Jo Gideon) and for Stoke-on-Trent North (Jonathan Gullis)—and indeed my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), who was not in his place. They have all highlighted the issue of the private finance initiative. I am happy to meet them to discuss it further.

Let me turn now to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) and the hon. Member for Mitcham and Morden (Siobhain McDonagh). I have to say that my hon. Friend made a very strong case for the benefits that this investment will bring for all those who are served by his local trust. I encourage the hon. Lady to engage with this process and engage with the benefits that this investment will bring.

[Siobhain McDonagh]

Will the Minister give way?

[Edward Argar]

I am afraid that, with one minute to go, I will not give way.

The nation’s health and social care is the people’s priority and it is also our priority. Key to delivering on our long-term plan, and the NHS’s long-term plan, is giving the NHS the investment that it needs. This Bill does exactly that. We are delivering on the people’s priorities and on our pledges to the NHS, and I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.