Health

Siobhain McDonagh Excerpts

Monday 9th June 2014 Commons Chamber

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

Today I would like to add my voice to those of all who have expressed disappointment and surprise that the Queen’s Speech contained not one word about the NHS. Last month’s local elections in Mitcham and Morden, and in large parts of London, were dominated by the issue of health. The verdict was overwhelming: overnight, Merton went from no overall control to Labour control, with the people of Mitcham and Morden electing 30 Labour councillors out of 30 for the first time in history. In large parts of Merton one issue stood out: the future of my local general hospital, St Helier. Anyone driving through Morden will see hundreds of signs in front gardens and windows—yellow signs with a red heart in the middle, all saying “Save St Helier.”

The Government should have used the Queen’s Speech to listen to the people. Labour would introduce an NHS Bill; the Government included not a word about the NHS. During the local election campaign, Merton’s Conservatives said that, no ifs, no buts, St Helier was safe. Their leader proclaimed that

“St Helier Hospital has been saved”,

but St Helier has been under attack for years under this Government. In 2011, the local NHS said the Government had told it to

“deliver £370 million savings each year...around 24% in their costs.”

A new body called Better Services Better Value was set up. It announced it would close A and E and maternity units across south-west London and Surrey, and St Helier would also lose its intensive care unit, paediatric centre, renal unit and 390 in-patient beds. A save St Helier campaign was launched, and the petition has now been signed by more than 13,000 of my constituents. Three local campaigners—Sally Kenny, Stan Anderson and Mary Curtin—decided the issue was so important that they should stand in the local elections in Lower Morden as residents whose primary aim was to save St Helier. Given the backing they had from Councillor Stephen Alambritis, the Labour leader of Merton council, they stood for Labour. Just before the election, doctors in Surrey, where Epsom hospital was also threatened, vetoed the plans. BSBV was wound down in ignominy. It seemed we had won a reprieve, but when the huge banner covering the front of St Helier hospital that said

“Coming soon—We’re spending £219m on a major development”

was taken down, residents realised that victory was only temporary.

The best any of us could hope for was a few years’ peace and quiet. As it happened, the reprieve lasted until only five days after the election, when the local NHS published a new five-year plan that it says will

“change the way we deliver health services”.

Far from listening to the people, who voted in unprecedented numbers to save St Helier, it ignored the verdict of the people. The plan describes the

“likely need to reconfigure maternity and neonatal services”.

Of course, “reconfigure” is just a euphemism for closures, and it suggests that A and E units will be downgraded by 2018, with what it describes as the introduction of two levels of emergency departments—major emergency centres and emergency centres. The plans do not say which maternity units will be “reconfigured” or which A and Es will be downgraded to emergency centres, rather than full-blown A and Es, but, after years at risk, nobody thinks St Helier’s future is secure.

The leader of Merton council, who won an overwhelming mandate just weeks ago, is so angry that he has told the chair of Merton’s clinical commissioning group, who has headed the local NHS throughout BSBV, that the people had spoken and his job was no longer tenable. Councillor Alambritis said:

“BSBV has been a fiasco and the voters of Merton delivered a devastating verdict...Ultimately, responsibility lies with the Chair, and he has to go…Merton’s residents have demanded change, and the Chair needs to respond to that”—

and so should the Government. They have spent the last four years undermining, rather than strengthening, our NHS.

In 2010, the Conservative party manifesto said it would stop the centrally dictated

“closure of A&E and maternity wards, so that people have better access to local services, and give mothers real choice over where to have their baby”.

The people of Merton remembered that quote, and it is no wonder they voted the way they did a fortnight ago.

This is a democracy. The Government should respect the ballot box. My constituents do not want a Queen’s Speech that has not got a single word to say about the NHS. They want a Queen’s Speech to save St Helier, and save our NHS.

[Jackie Doyle-Price (Thurrock) (Con)]

I have reflected on the comments of the hon. Member for Mitcham and Morden (Siobhain McDonagh) and I really must tackle head-on the belief that because there is no Bill on the NHS, that is a weakness. The reality is that the NHS does not need more legislation. What it needs is good leadership and good performance management so that it delivers what we want it to deliver for our constituents. We will not improve the care of patients by sitting on these Benches and pontificating and giving the benefit of our experience. What we need to do is empower real practitioners to actually deliver change.

[Siobhain McDonagh]

May I inform the hon. Lady that many of my constituents in Mitcham and Morden believe the withdrawal of clause 119 from the Care Bill would have done a lot for their NHS?

[Jackie Doyle-Price]

I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”

I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.

I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will we be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.

I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking, but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.

Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

St Helier Hospital

Siobhain McDonagh Excerpts

Monday 10th March 2014 Commons Chamber

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

At the beginning of this month, on a crisp, cold Saturday morning, I joined a group of residents outside our local St Helier hospital to mark a sad moment in its history. For the past four years, St Helier has been adorned by a 1,000-square-feet banner, proudly saying, “Coming soon—We’re spending £219m on a major development of St Helier hospital”. The residents and I were there to see that banner taken down, and to mark the promise of a better hospital finally being taken away. The story of St Helier is a long one. I have raised it in this House on several occasions. This was a low point, but I fear that it may get lower, and the result of today’s debate does not exactly inspire confidence.

St Helier was built in the 1930s, at the same time as the St Helier housing estate that encompasses it. At that time, it was the biggest housing estate in Europe. The hospital was built there for a reason: it was where the health needs of the surrounding community were. St Helier hospital has had an interesting history. In the second world war, its bold white exterior was painted green owing to concerns that German bombers would use it for target practice or to line up their bombing missions on London. Although neighbouring buildings were destroyed by bombers, St Helier thankfully survived and has continued to serve the community ever since.

St Helier has had its troubles. In the mid-1990s, there was outrage when it was discovered that people were left to die on trolleys abandoned in the corridor. Back then, under-investment in the NHS of the John Major Government was not unusual. If it was bad on the wards, however, what was happening behind the scenes was almost as disturbing.

Even though Mitcham and Morden has always been the most deprived part of the old health area of Sutton, Merton and Surrey, it has always been the poor relation. In my almost 17 years as an MP, and for many before that, I have never known of anyone living in Mitcham and Morden to sit on the board of any NHS body. As a result, we have always had a Cinderella service. No one speaks up for our patients, and we are always first to lose out and last to gain. It was no surprise, therefore, when I discovered recently that health bosses had held secret meetings in the mid-1990s to discuss plans to close St Helier and move services to Croydon. Thankfully, once Labour came to power in 1997, this went no further, but the tone was set.

Not long afterwards, it was suggested that St Helier should merge with the hospital in Epsom. Such a merger was a little unusual, but Epsom was struggling financially, and we were persuaded that a merger would make both hospitals more resilient. The two hospitals were not a great match. People living in Epsom are relatively wealthy, and a little older. The area around St Helier is more urban, ethnically mixed, younger and has more health problems associated with poverty. Nevertheless, we accepted the advice, but it soon became clear that we had been sold a pup.

A new review, “Better Healthcare Closer to Home” was launched. This was in a time of plenty, the early 2000s, when health spending was on the rise, so a grand scheme was drawn up, in which St Helier and Epsom would both close, replaced by a new state-of-the-art hospital in Belmont, a very leafy, very wealthy community two miles south of Sutton. Aside from the terrible impact of closing St Helier, I never thought that the scheme was workable; it was too big, too unrealistic and lacked one key ingredient—any public demand for it.

Various bureaucrats argued that the site of a hospital is not important, because new community primary care services, such as GPs and local care centres, would see the patients that normally go to hospitals instead. The public never agreed, and in fact the reverse has happened: the number of people who would rather go to hospitals is rising. The public consultation at the time clearly showed that the most popular site for a hospital with an A and E was St Helier. The public knew that the people who need hospital the most are the most disadvantaged, with the worst health. They are the most likely to need A and E and the most likely to need acute maternity services.

Everyone could see that St Helier was the best location for a hospital if we wanted to reduce health inequalities, and it was backed by all the MPs in Sutton, Merton and Wandsworth. Local managers overruled us and, even though their initial assessments showed that St Helier was a 7% better option than Belmont, they voted for Belmont instead. Thankfully, in those days we had a Secretary of State for Health who was prepared to step in and stand up for the NHS. The health managers’ decision was finally called in by Labour councillors in the London borough of Merton, and the then Secretary of State decided to save St Helier, recognising that the area around St Helier had the greatest health needs in the whole catchment area and people there had up to 10 years’ less life expectancy. In contrast, Belmont is one of the wealthiest areas in the country. Indeed, people living there also made it clear they did not want a major new hospital built in their backyard. So we were all delighted when the then Government came down firmly on the side of reducing health inequalities and chose St Helier.

In early 2010, that decision was further boosted when a subsequent Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), announced the £219 million renovation. At the time, we were all very aware that the economy could no longer afford the same generous public sector funding we had in the mid-2000s. Decisions had to make financial sense and, in the case of the £219 million, the numbers stacked up. As well as improving people’s health, the scheme was shown to offer value for money. It would mean new wards, with single rooms to cut down on infections and improve patient privacy, along with various other improvements. The scheme was so well thought out that just months later it also gained the support of the new coalition Government—the Chancellor still includes the funding in the Treasury’s books—but it was not long before St Helier’s future was again at risk.

In 2011, the local NHS admitted that it had received Government instructions

“to deliver £370 million savings each year...a reduction of around 24% in their costs.”

A new body was soon set up, this time called Better Services Better Value, or BSBV— it might properly be abbreviated to just BS for all the good it has done. Its task soon became clear: to close services such as accident and emergency, and maternity units, in one or more hospital. At the same time, finally recognising that they served different demographic groups, the St Helier and Epsom hospitals started to de-merge from the trust. Both had found new trusts willing to merge with them, St Helier with St George’s Healthcare NHS Trust and Epsom with Ashford and St Peter’s Hospitals NHS Trust, but, thanks to BSBV, those new mergers soon broke down. Nobody wanted to merge with a hospital that was under threat, particularly when it was revealed that Epsom’s debts were far worse than originally thought.

Originally, BSBV would look only at south-west London, covering St Helier, Kingston, Croydon and St George’s in Tooting; one of the four would lose its accident and emergency unit. But after the de-merger fell apart, the review was extended into Surrey, and two out of five hospitals were to be downgraded—inevitably, BSBV recommended that St Helier should be one. Not only would its A and E and maternity units go, but so, too, would its intensive care unit, paediatric centre, renal unit and 390 in-patient beds.

I have always said that the sums do not add up. Some 82,000 patients go to St Helier’s A and E each year, with the NHS saying that figure will rise by 20%—100 emergency patients are admitted every day. Neighbouring hospitals are already overcrowded, and are more expensive per patient, so it was never clear how the other hospitals could meet clinical targets, let alone cut costs, if they had to treat St Helier’s patients as well as their own. Figures quoted by BSBV—that an astonishing 60% of patients would use primary care instead of A and E departments—were ridiculed by the National Clinical Advisory Team, who said:

“Elsewhere in the UK a consistent finding is...far lower, usually...15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

In fact, NCAT went a lot further than that, saying:

“Successful implementation...depends on a multitude of supporting improvements...that are not well defined in the proposals.”

Given the growing birth rate and the higher cost of giving birth in all other hospitals, closing St Helier’s maternity unit was also never going to deliver clinical targets or cut costs. Experts say that maternity units should not deliver more than 6,000 babies per year. However, if St Helier closed, the remaining hospitals would have to deliver 6,500 babies each per year, plus 2,500 in midwife units and nearly 1,000 home births. It was no surprise, therefore, that NCAT said the plans were

“based on an optimistic view of capacity.”

Everyone in my local community knew the plans were bonkers. Local campaigners such as Sally Kenny, a former deputy head and Lower Morden resident, set up local groups to fight the plans. Sally has printed thousands of “Save St Helier” posters that are currently in windows across Morden and St Helier. People cannot drive through the area without seeing the words “We Love St Helier” displayed on garden stakes.

As well as a petition signed by more than 30,000 people, thousands of local residents attended a protest picnic organised by local mums, where the leader of Merton council, Stephen Alambritis, a former football referee, waved a red card at the plans. Merton council has always shown its support. Last year, it passed a strongly worded motion backed by Labour, Liberal Democrat, Conservative and Independent councillors, saying any decision on St Helier must go to the Secretary of State. Thankfully, salvation came from an unlikely source—a clinical commissioning group in Surrey.

In Merton, the new system of CCGs has not been a great advert for the Government’s reforms. Last May, I attended one of the worst public meetings I have ever been to—and that is really saying something. Merton’s CCG was due to decide St Helier’s future, but it would allow only a handful of the hundreds of people who came to the meeting into the public gallery. The chair would not allow cameras or recordings, and the microphones did not work. Members of the CCG refused to register their personal interests, even though it was alleged that some would gain personally if St Helier were shut and services were moved to other providers such as private companies or GP surgeries. Then, just as they were due to make a decision, they suddenly walked out of the room to boos and shouts of “cowards”. Some said that they had adjourned the meeting to a quiet staircase, others that they went to the kitchen. Wherever they went, they made the decision there, in secret, without any public witnesses, to accept plans to close services at St Helier and to go to public consultation.

If Merton’s CCG was not exactly the blueprint of an open, transparent community service, thankfully others did not follow suit. Having seen the power of GPs in Lewisham, the CCG in Surrey Downs, recognised that BSBV was barking up the wrong tree and voted no. As a result, earlier this year, BSBV was wound up; it will not be mourned. However, the threat still hangs over us.

I have been shown a letter from NHS England to the CCGs complaining about their decision not to approve closures at St Helier. The letter says:

“Your approach carries significant and unacceptable risk, both financially and clinically.”

Castigating the CCGs for their decision, it goes on:

“We consider your proposed approach would make it difficult for South West London CCGs to formulate a coherent strategic plan.”

According to NHS England, the decision

“carries unacceptable risks to your ability to develop and deliver a strategic plan. We also believe the approach carries significant operational risks. Firstly that your providers will not be able to meet the London Quality Standards...Secondly, that providers will not be able to recover their costs against income and therefore...will be unable to become Foundation Trusts.”

Most damning of all, it says:

“This could be interpreted as commissioners planning for clinical and financial failure in some of its providers.”

That letter is very revealing. It proves that those in charge still cannot bring themselves to rule out the possibility of St Helier closing. They are planning to fail, and if they do not fail, they will not allow St Helier to become a foundation trust anyway. Either way, the hospital will fail. That indicates that the announcement not to close St Helier is not real. As if we needed more evidence that the Government are not committed to St Helier, we heard, just a few weeks later, that the £219 million had been withdrawn. After I had repeatedly asked about the lack of progress, the head of Merton’s CCG finally conceded the truth. Ruefully, she admitted that the work was now “probably unaffordable” and no longer featured as

“one of the...scenarios being worked up by the Trust at this stage.”

The whole community knows what is going on. St Helier is not “safe”. It does not have the Government’s backing. If the Government truly still supported St Helier, why is it not full steam ahead with a scheme that has funding from the Treasury and that has proven its clinical value? They are failing to plan, and planning to fail. All this ends in one place: the demise of St Helier. If St Helier loses emergency services, 200,000 people will face longer journeys in an emergency. A and Es across south London will struggle to cope with the extra workload, and that will affect millions of patients, including the Minister’s constituents.

The Minister has a chance today to offer some hope. She is a significant person. A word from her could make all the difference. All she has to say is that St Helier will stay open and that she will not allow it to lose its A and E, its maternity unit or any of its other services. She can say today that the £219 million must be spent. When that money was announced four years ago, construction was due to begin in 2012. Nothing has happened, but this evening she can turn nothing into something with just a word. She will probably say it is for others to decide, but that is her decision. A decision not to act is just as much a decision as any other. What she should do is show leadership, because leaders decide. Without ministerial commitment to St Helier, it is clear where this will end. They are planning to fail, and that is why the fight goes on.

All the while, the population in south London is rising, demand for hospital services is increasing, demand for A and E is going up by 20%, and the birth rate is rocketing. Doctors oppose the closure of services, Merton council unambiguously opposes any closure, and all parties want to save St Helier. We thought things were bleak before; they are just as bleak now.

All the while, instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. The UK Statistics Authority has made it clear that the Prime Minister has broken his election pledge to increase health spending. If St Helier loses its A and E or countless other services, my constituents will know why. They are angry. In Mitcham and Morden we demand nothing less than a moratorium on A and E closures. We want our hospital, St Helier, to continue. The German bombers never destroyed it, nor should this Government. The Minister needs to say, “Yes, the £219 million is still there, and yes, the building work will start now.”

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her some assurance about the potential for the future, if not about some of the specific points that she asked me to address.

Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.

As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.

I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.

At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.

As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.

The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.

The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.

[Siobhain McDonagh]

It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.

[Jane Ellison]

The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.

Accident and Emergency

Siobhain McDonagh Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s

“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”

Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.

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

If the right hon. Gentleman feels that scrapping the 48-hour rule for GP appointments was wrong, what would he say to my constituent Mr C, who has e-mailed me today imploring me to get an appointment with his GP because his wife needs a new prescription for her blood pressure drugs and he has spent the past 48 hours on the phone attempting to gain one? How could he help my constituent?

[Mr Hunt]

I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.

--- Later in debate ---

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

The public look with incredulity at many issues relating to the Government and public services, but highest on the list is the proposal to close A and Es in our NHS when demand for them is becoming greater and stronger.

St Helier hospital in my constituency has asked for evidence and proof of why its A and E department—which sees 90,000 people a year, meets its four-hour target and has a great safety record—should be closed. We are told by the medical establishment that it will be much better for everyone and that primary care will take up the slack. At no point are the public told—I am sure this is also true of other reconfigurations—where their care will be provided, which GP practices will stay open for longer and which extra services will be available. The public, therefore, are being asked to make a leap of faith and lose their A and E, which they know is there for them in times of desperation and need, in favour of wishful thinking that things will be different in the future. The gap between the Government’s credibility and the public is growing.

What evidence do the Secretary of State and the Government have that closing A and E departments that nobody believes to be small will provide better medical services? No research shows that to be the case. All the work done by the university of Sheffield and—I never thought I would say this—The Mail on Sunday in its campaign indicates that wholesale A and E closures, not only in rural areas, but in built-up urban areas such as mine, are not in the best interests of patients, and not just in terms of waiting times, but in terms of outcomes.

We all accept that some specialist services, such as the stroke service, should be concentrated, but there is no evidence to suggest that that needs to happen for what most people go to and A and E for. For those attempting to get a GP appointment in my part of south London, the situation is desperate. I have already referred to an e-mail I received from a constituent only today. It has come to something when constituents are contacting me to ask whether I can get them a GP appointment.

I challenge the Secretary of State to explain why his holy grail of closing A and Es is a good or wise decision. For as long as those GP services are not available, and for as long as the public do not know which surgery to attend or which services will be provided, they will never accept changes. There must be a presentation of the facts, not just a hope that somehow GPs will do more.

St Helier hospital is supported by everyone in my area—not just those who use it, but those who understand that demand on St George’s and Croydon university hospitals will increase should it close. For everybody, A and E is a safety valve to the NHS—it is there when other services are not—and for as long as that is the case, we need to keep our local A and Es.

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

The approach that must be adopted to ensure that health and social care services are joined up in the way that we need will vary in different parts of the country, and in accordance with differing health care needs and demographic challenges. I look forward to discussing that and other issues further when I meet the hon. Gentleman and my hon. Friend the Member for Kettering (Mr Hollobone) tomorrow or on Thursday.

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

9. What assessment he has made of the roll-out of the NHS 111 telephone service.

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS 111 is now available in more than 90% of England. Despite some problems with the sites where it was launched around Easter, performance has now stabilised significantly. NHS 111 is now the principal entry route for access to the urgent care system, and nearly 600,000 patients accessed the service in May.

[Siobhain McDonagh]

Let me take the opportunity to make a confession to the House. Six weeks ago on Friday, I rang 111 as I watched one of my best friends vomit. She had been vomiting for 10 days, had been to see her GP four times, and had telephoned 111 on two occasions, on each of which she was told to go away and take antibiotics.

I did what no Member of Parliament wants to do. I said to the operator, “I am an MP, and I will take this up in the House if you do not deal with it properly.” Forty minutes later an ambulance arrived, and my friend was saved from a massive heart attack. What happens to people who have no one to speak for them, and no one who can say “I am an MP”?

[Mr Hunt]

The hon. Lady makes a very important point and I do not want to defend that service in the instance she cited at all. It is completely unacceptable if that kind of thing has to happen. The principle of 111—which is for people to have an easy-to-remember number and to be able to be connected to a clinician directly if they need to be, which did not happen with NHS Direct—is a good one, but it is not happening in practice as much as it needs to be. We are broadly meeting our operational standards, but it is not good enough and she has given a very good example as to why.

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I could give my hon. Friend a long answer, but in short, the matter will be raised at the next G8 meeting. Further to that, as a result of his excellent debate earlier this year, I undertook to write, and have done so, to my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs. He has replied that the Government recognise that we should look at the guidance issued to farmers. I am more than happy to share the Minister’s letter with my hon. Friend.

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

16. What the status is of the capital programme for the refurbishment of St Helier Hospital.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sorry, Mr Speaker, I am all over the place and do not have now the answer to give the hon. Lady. I believe the programme was signed off in 2010—[Interruption.] In fact, I am right—[Laughter.] Well—[Interruption.] Now, now; that is very naughty from the right hon. Member for Leigh (Andy Burnham). As you get older, Mr Speaker, you sometimes start to forget things—[Laughter.] Not you, Mr Speaker, of course; you would never do such a thing, and in any event you are much younger than I am.

The Government re-approved the business case for the redevelopment of St Helier hospital in May 2010—I was right—as part of the review the previous Government’s spending commitments. As the hon. Lady knows, because of the various configurations and proposed configurations, no final decision has been made yet. We need to ensure that all the plans come to some sort of fruition.

[Siobhain McDonagh]

At my age, I share with the Minister a problem with memory loss, but I do not forget the years when we were trying to get the £219 million redevelopment of St Helier hospital agreed, or that the proposal was supported by the Chancellor in his first Budget. The money is now being used as a slush fund by Better Services Better Value, but its idea is to increase the sizes of A and E and maternity units of all the hospitals around while closing those at St Helier. Does the Minister agree that that was not the intention of the money, and that any future development plans must go back to the Department of Health for agreement?

[Anna Soubry]

I pay tribute to the hon. Lady, who campaigns hard for her hospital, and quite rightly so. I have met my right hon. Friends the Members for Sutton and Cheam (Paul Burstow) and for Carshalton and Wallington (Tom Brake) and am more than happy to meet her to discuss all the important matters she raises.

Accident and Emergency Waiting Times

Siobhain McDonagh Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

I agree entirely. That decision was catastrophic for the NHS. Not only did it siphon £3 billion out of the front line to pay for back-office restructuring; it took people’s eyes of the ball. When they should have been focusing on the front line and patient care, they were worrying about their jobs and which organisations they would work in. The Government were warned about this reorganisation and I will come on to that. I have new evidence, which I will put before the House today, that says that this Government were explicitly warned about the risks to A and E of proceeding with their reorganisation at a time of financial stress. It is pretty damning and I will come on to it later.

What I want to do today is achieve something for NHS staff watching this debate. Let us try to reach some agreement about the causes and the practical steps that now should be taken. First, on social care, which my hon. Friend the Member for Warrington North (Helen Jones) has mentioned, the survey of NHS financial directors says that this is the single biggest cause of the pressure. More than £1 billion has already been taken out of budgets already by this Government, and the Association of Directors of Adult Social Services says that councils are planning further spending and services cuts this year. This is simply not sustainable. It is a false economy. Social care is the preventative part of the care system. If the Government continue to hammer councils, the problem will simply end up on the doorstep of the NHS and it will get bigger and bigger. The human cost will be huge.

We heard at last week’s summit that more and more people with dementia are presenting at A and E. That is intensely sad and it is the wrong place for them to be.

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

Does my right hon. Friend agree that the most upsetting comment made at the summit was by the nurse at Kingston who told us of a lady with dementia who, when she is hungry or lonely, phones 999 for an ambulance and says that she has heart pain?

--- Later in debate ---

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

I will be very brief, as I want all Members who wish to contribute to the debate to be able to do so.

It feels as though we are telling the public that somehow they are being irrational by attending A and E. They are being entirely rational, however, if they live in urban London. They are being rational because they cannot get access to their GP services. Their GPs have contracted-in times and their walk-in clinics have been closed, so their only alternative is A and E. The 111 service is also, in effect, A and E, because it is so risk-averse. Our current system is not based on what is best for the patient; it is based on what is going to cause the least legal damage to the NHS if things go wrong.

My local hospital, St Helier, is up for closure despite the fact that its A and E is the only one in south-west London that meets the targets. Its maternity unit is also to close, even though it is the most clinically safe unit in the country. It is very difficult to explain that that is a rational decision to any member of the public, including me.

On issues to do with the NHS and how consultations are carried out, we are told and implored to see things differently. How can we see things differently when consultations do not include the public and when consultations are held over the school summer holidays rather than at a time when people and halls are available, and those of us who rely on voluntary assistance in making our arguments can get people to provide it? Better Services Better Value in my constituency intends to start its consultation at the end of the month and run it over July and August, dismissive of the arguments of the public that they cannot meet that timetable. Better Services Better Value has meetings without announcing where they are or what time they are at, and it does not even use microphones. I have been a publicly elected politician for more than 30 years and some of these NHS meetings I have attended have been the worst I have ever encountered during that time. If we wish to bring the public with us in difficult decisions, we have to be reasonable, fair and straightforward in our proposals. Nobody in my constituency understands why the solution to longer A and E waits is the closure of A and Es that are effective and actually work.

A and E Departments

Siobhain McDonagh Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I agree with my hon. Friend: Frimley Park is a terrific hospital and Andrew Morris a first-class chief executive. In fact, I am visiting Frimley Park in the next month and I will certainly have that discussion with him. My hon. Friend is right that one issue that A and E departments frequently raise is the tariff and the fact that they get paid only 30% of it for any A and E admissions over the 2009 baseline. That was why NHS England announced an important change a few weeks ago. Previously, hospitals had no say over how the money that is withheld from them is spent—it is meant to be used to reduce demand. We are now setting up urgent care boards, and hospitals will have a seat round the table to ensure that the money is spent in a way that reduces pressures on their A and E departments.

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

Can the Secretary of State say how the numbers attending A and E in south-west London will be reduced by the closure of St Helier hospital’s A and E department, which saw 80,000 people last year?

[Mr Hunt]

I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.

Merton and Sutton PCT (Prescribing Policy)

Siobhain McDonagh Excerpts

Friday 1st March 2013 Commons Chamber

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

Like many Members, I have a lot of concerns about what is going on in the NHS at present. My local NHS has to save £370 million a year and two out of five of our general hospitals are about to lose both their accident and emergency and maternity units. I am sure I will want to raise my concerns about that in the future. The long-promised reopening of Mitcham’s local Wilson hospital as a local care centre has still not happened, even though it is in the Merton ward with the lowest life expectancy, while the redevelopment of the Nelson as a local care hospital in neighbouring Wimbledon, one of the wealthiest places in south-west London, is under way. Also, after one of the biggest top-down reorganisations in NHS history, GPs are being forced to become managers rather than clinicians, so I think it is fair to say I have a lot of concerns.

In the case I am raising today, however, the problem is much more fundamental. It is about the price of a man’s life. Is £5,000 too much to pay to keep someone going? It is also about a controversial drug and the terrible way the NHS deals with patients who slip between the gaps. In a small way, it is about how NHS managers avoid their responsibilities and ignore elected representatives such as me. But most of all it is about my constituent, Mr Liakuat Aziz, and whether he should be allowed to have the treatment he desperately needs.

Mr Aziz is 61 and lives in lower Morden. In December, he came to my advice surgery. He is a nice man who has worked hard, and he has a family. He has been through a lot, and just at the point he thought he was making progress, he has hit a brick wall. His story touched me straight away. Mr Aziz explained that he had had numerous long-term health conditions, although when I saw him he seemed well. In 1995 he had a coronary artery bypass graft. After the operation, he had numerous setbacks and developed severe lung injuries. He had a tracheostomy and was found to have significant restrictive lung disease. He also suffers with ischaemic heart disease and underlying emphysema. He underwent right heart catheterisation, and he had significant pulmonary hypertension.

Fortunately, Mr Aziz was placed under the care of some amazing doctors. In particular, he is being treated by Dr Stephen Brecker, Dr Phil Marino and by one of the leading practitioners in this field, Professor Brendan Madden, at the St George’s and Royal Brompton hospitals’ joint pulmonary hypertension clinic. Despite all that treatment, Mr Aziz was still in a very precarious condition, with severe pulmonary hypertension group 2 and group 3 disease. In addition, he had long-term lung fibrosis from cardiac surgery, ischaemic cardiomyopathy and a biventricular implantable cardiac defibrillator in place—that is not very easy to say, let to alone live with. By January 2011, his condition had worsened. He suffered from breathlessness and he could not get around. His doctors decided to try a new treatment—sildenafil.

To you and I, Mr Deputy Speaker, the word “sildenafil” might not mean very much, but we have probably heard of its other name—Viagra. Most people think of Viagra as a fun drug or as a relatively trivial treatment for erectile dysfunction. I do not want to go into the rights and wrongs or the merits of Viagra today. It is well known as a sex aid, but what a lot of people do not know is that Viagra is also a very effective treatment for pulmonary hypertension. It is not the only treatment, and for many patients it will not be suitable or cost-effective, but given Mr Aziz’s numerous lung and heart conditions his doctors thought that sildenafil was a solution. Indeed, numerous medical studies have shown that it has a role to play.

Professor Madden himself conducted one such study in 2006, with Allenby, Loke and Sheth. After looking at the evidence from a group of patients, they concluded:

“Sildenafil offers potential to treat patients with pulmonary hypertension by selectively inhibiting phosphodiesterase type five pathways in the lung.”

Between them, they concluded that it should be recommended for selected patients with pulmonary arterial hypertension. Every one of their patients saw reduced pulmonary vascular resistance, and all could walk further and faster as a result. The same conclusions were made by the much larger Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology, and the European Respiratory Society, endorsed by the International Society for Heart and Lung Transplantation. Their 2009 report is the basis for commissioning policy, and is responsible for the current guidelines into the treatment of pulmonary hypertension. Their conclusion was that

“Sildenafil is an orally active, potent, and selective inhibitor of phosphodiesterase type-5.”

They found that various studies

“confirmed favourable results on exercise capacity, symptoms, and haemodynamics.”

So the medical community agrees that in certain circumstances it is a legitimate treatment.

Professor Madden duly began Mr Aziz on sildenafil and, thankfully, Mr Aziz responded.

St George’s hospital’s department of cardiothoracic surgery has written to me to say that Mr Aziz

“had an extremely good symptomatic response to Sildenafil”.

By March 2012, his mean pulmonary artery pressure had dropped to just 28 from 40 the year before. His pulmonary vascular resistance was down to 2.9 Wood units from 4.5. He could walk without being out of breath and all was well, until suddenly Mr Aziz was contacted by his local GPs at the Cannon Hill Lane surgery to say that they could no longer prescribe him with sildenafil as Sutton and Merton primary care trust had instructed them to stop prescribing it.

It transpires that throughout 2012, the PCT had been advising the GPs not to prescribe the drug but Professor Madden and other doctors had repeatedly stepped in. I have been shown letters and applications on Mr Aziz’s behalf throughout 2012, one from March, one from July and one from October. I believe there are more, but in the end, despite it being pointed out that discontinuing the prescription would be

“a threat to Mr Aziz’s life”,

and despite his having been on it for nearly two years, the NHS decided it would not fund it. Viagra, even for a sick man, was not the sort of thing it wanted to be seen prescribing.

That is where I came into the picture two and a half months ago. As MPs, we see lots of people. I take up thousands of cases a year and I write tens of thousands of e-mails and letters on behalf of my constituents, but only very rarely do I get involved in such a story, which is really about life and death. I knew I had to work urgently. I wrote to all the doctors, the PCT and the NHS. Professor Madden wrote straight back, and what he said only added to the urgency:

“Mr Aziz has benefited significantly from Sildenafil therapy, and it is my opinion together with that of my colleagues Dr Phil Marino and Dr John Wort, Consultant in the Pulmonary Hypertension Unit at the Royal Brompton Hospital and Dr Stephen Brecker, Consultant Cardiologist at St George’s Hospital that Mr Aziz should continue on Sildenafil therapy.”

I was shown notes that showed that before he was put on 50 mg doses of sildenafil, Mr Aziz

“experienced a marked and constant deterioration in both symptoms and functional capacity...despite aggressive optimisation of his cardiorespiratory co-morbidities.”

Before taking sildenafil, Mr Aziz had exercise tolerance of under 50 yards. According to the notes, he had

“genuinely disproportionate and at least moderate pulmonary hypertension out of keeping with his existing co-morbidities”.

He was, in short, in a very bad way.

Even after Mr Aziz was put on 50 mg doses, the doctors sought out other solutions as they wanted to be sure the treatment was not too extravagant. They twice reduced the dose to just 20 mg, but both times, according to the notes,

“he rapidly experienced an increase in symptoms and functional decline that only resolved on restoring the dose to 50 milligrams.”

It was obvious to the doctors that Mr Aziz had

“shown a clear response to Sildenafil based on symptoms, functional capacity and right heart catheter data.”

The doctors clearly concluded that, in line with the medical studies I mentioned earlier, Mr Aziz was an exceptional case and was best treated by what we would call Viagra. His course of sildenafil, which costs less than £5,000 a year, was making a difference to him and it was not insignificant.

Chillingly, Professor Madden wrote to me to say:

“We are all of the opinion that his condition could deteriorate precipitously if the medication were to be stopped, and indeed this could bring about his premature death.”

When I received that letter, it brought home to me what I was dealing with. Professor Madden, one of the most eminent practitioners in his field, had told my constituent he could die and, naively, I thought that meant that the case would be dealt with urgently, so I waited for my local NHS to get in touch.

I waited. I wrote e-mails and letters reminding the NHS that the issue was quite urgent, and I carried on waiting. My caseworker phoned virtually every day and, on 23 January, we started counting the calls. We called Ann Radmore, the chief executive of NHS South West London. She would not take our call, but her office asked us to speak instead to the chief officer of Merton’s new clinical commissioning group, Eleanor Brown. We left a message, but did not get a call back. We called Tony Foote in Ms Radmore’s office and he promised we would get a call by 30 January. We did not, so we rang and rang every day, and they said we could speak only to Mr Foote, but he was never in and he never rang back.

At one point, things looked up. On 8 February Ms Radmore’s PA actually spoke to my caseworker and promised to get back to me. But then nothing, and the waiting continued. No one answered the phone. No one got back to me. Here was a man who could die without this drug, but the bosses at Sutton and Merton primary care trust would not even deign to talk to his MP. Eventually, I had no choice. Two months after first contacting them, I raised the case at Prime Minister’s questions. I complained that I had been

“defeated in my attempts to get a response from NHS South West London”

and asked if he would help me get a response. Otherwise, I said,

“my constituent might die”.

He replied that he would

“try to get a better answer”.—[Official Report, 13 February 2013; Vol. 558, c. 853.]

I am not necessarily a fan of the current Prime Minister, but I have this to say about him: he has astonishing powers. Within five minutes of my asking him, while he was still standing at the Dispatch Box in this Chamber, my office had a call from the local NHS. Yippee, I thought. Finally someone was taking this seriously. All the stops would be pulled out. Progress would be made. Somebody would talk to me. We would clear things up. Mr Aziz would be all right. No, the caller simply said, “Ah yes, about your case. We’ll try to find out what’s going on.”

A day or two later I got a letter from Eleanor Brown. It is not a very helpful letter, but it is a classic of its kind. It starts with a belter of an apology:

“I must apologise firstly for the undue delay in providing this response.”

It continues:

“I understand that your letter was not, for reasons at present unclear to me, received in this office at the time of posting.”

Not a good start, but she goes on:

“However, once received by email . . . there were, unfortunately further delays.”

She does not specify what these were, but continues:

“Although there were certain extenuating reasons for these”—

again, she does not say what these were, but it is nice to know there were some reasons—

“this was clearly unacceptable, particularly in circumstances such as Mr Aziz’s.”

The letter goes on to say:

“Please pass my sincere apologies to Mr Aziz for any distress and inconvenience this may have caused.”

Nothing about all the phone calls, nothing about my having to go to the Prime Minister himself, but we will let that pass because at least I had been given a clear and thorough explanation of the case, hadn’t I? Well, not quite. There follow two pages of droning procedural equivocation, but no answer to the basic question: was the treatment right in this exceptional case, and is £5,000 too much for a man’s life?

Instead, I am treated to long passages of tedious linguistic somersaults desperate to pummel me into accepting that, despite all the evidence, this is not an exceptional case. For instance,

“The fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for an exception”

and

“If a patient’s clinical condition matches the ‘accepted indications’ for a treatment that is not funded, their circumstances are not, by definition, exceptional.”

There is even the most remarkable leap of logic, when Ms Brown says:

“NHS Sutton and Merton was not withdrawing funding as funding had not been approved initially.”

It seems to have been overlooked that this was a letter that would be read by a human being. The letter concludes:

“I hope I have been able to reassure you, and Mr Aziz, that in reaching the decision regarding funding all correct procedures, as used throughout the whole of the NHS South West London area, were followed and done so in a timely manner. Yours sincerely”.

Crikey. Now that I think about it, if there is one thing that has impressed me about my local NHS in this case, it probably has not been its procedures.

A number of issues remain. Professor Madden, who remains one of the most learned doctors in this field, continues to believe that Mr Aziz’s only hope is sildenafil. Professor Madden has once again re-applied for funding. He continues to argue that Mr Aziz’s case really is exceptional, owing to his heart disease, his lung disease, his diabetes, his emphysema, and so on—all his very particular conditions. Mr Aziz did receive the treatment, and it did work. Professor Madden continues to believe that without treatment Mr Aziz would deteriorate, and that the cost of his inevitable hospitalisation would far exceed the cost of the drug. According to Professor Madden, only 4,500 people in the country suffer from pulmonary arterial hypertension, and Mr Aziz’s co-morbidities are extremely rare.

I have no doubt that the NHS receives many requests for Viagra, but this one is truly exceptional. Perhaps the Minister will enlighten me—is it only my local NHS that says £5,000 is too much for one man’s life? Would Mr Aziz have a better chance if he lived somewhere else? Based on my experiences over the past two and a half months, I know whose opinion I trust. Is it that of one of the country’s leading experts in chest conditions or that of the people who lose letters, do not reply to phone calls or e-mails, specialise in extenuating circumstances and do not communicate in human?

Mr Aziz is a good man with an extraordinary medical history: group 2 pulmonary hypertension and group 3 disease, on top of massive cardiac and lung disease. He is a testament to our NHS. However, he needs a drug that most people, if they are honest, think is a bit of a joke: Viagra. He needs it not for recreational purposes, but to stay alive. My local NHS would rather let him suffer than allow him the only drug that works on him. It would cost thousands of pounds a day to look after him in hospital, but they will not provide £5,000 to keep him out. They have behaved appallingly to him and treated me and my office with a basic lack of respect.

We all know that the NHS is facing pressures it has not had to face before, but in this case Viagra is not a sex tablet; it is a life-saver. The medical consensus is clear that in exceptional cases, such as Mr Aziz’s, it should be prescribed. I hope that the Minister will be able to concentrate her reply on this specific point: even though it is for Viagra, is £5,000 really too much to pay for a man’s life? Thank you, Mr Deputy Speaker, for the opportunity to make the case.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate and on rightly bringing this matter to the House’s attention. I hope that I can offer her, if not the answer to her question, a number of points and perhaps arrange some sort of meeting between her, the local PCT and all those involved in Mr Aziz’s care to establish why he is not receiving the treatment that he and Professor Madden believe he should have. The PCT should be held to account for why it has not provided that treatment. That really is where the problem, if it is a problem, and certainly where the responsibility lies.

The hon. Lady will know that PCTs have been around for some time. One of the reasons why the Government were so keen to introduce the Health and Social Care Act 2012 was to abolish PCTs and have exactly these sorts of commissioning decisions, which have frustrated so many Members on both sides of the Chamber, made by those best placed to make them: clinicians, effectively through GP-led clinical commissioning groups. As a result of the Act, those people will make such decisions in future.

The hon. Lady started her speech with a political point, so I will make a political point as well. We wanted to get rid of PCTs because too often they are overly bureaucratic and they are certainly not accountable. It was our desire to change that by taking the decisions away from bureaucrats and putting them back in the hands of clinicians. That was one of the fundamental underlying reasons why we were so keen to get the Act through this place and on to the statute book. Far from damaging the NHS, and far from denying patients medications and, perhaps most importantly, explanations, the Act will ensure that these types of problems no longer exist.

It is not for me, as Minister for Public Health, or through any other role that falls within my brief in the Department of Health, to make a case for or against the PCT’s decision. Its members will certainly receive a copy of the Hansard report of this debate so that they can read the hon. Lady’s remarks and mine. I understand that there is a chance that they may be watching this debate. If so, no doubt many of them will be hanging their heads in shame. If they are not, then frankly they should be, if the hon. Lady is accurate in her description. I think that she must be, because I too have a copy of the letter from the Sutton and Merton borough teams that she quoted. It seems that they have a profound problem somewhere in their system, because they clearly did not answer her letters or e-mails or respond to her telephone calls. She is the Member of Parliament. This is about her constituents and her local PCT, and if there is anybody they should respond to, it is the Member of Parliament. MPs are the people who come to this place to represent the people in their wards and absolutely to do what she has done, which is to advance the case of Mr Aziz.

For all I know, there may be a very good reason, not just financial but clinical, as to why this particular gentleman should not receive this particular drug—I know not. I know it sounds awful to say it, and I hate saying it, but it is not my job to know. It is not the job of a Minister to say that somebody should or should not receive a treatment. However, it is my job to make it absolutely clear that whoever someone is in the NHS, they should treat that person with care and compassion. That means that they should sit down with somebody like Mr Aziz and explain to him, or perhaps to his elected representative or his general practitioner, the good, solid reasons as to why or why not a particular decision has been made. It is absolutely vital for them to have the courtesy, never mind the care that we would hope for, to do that.

I admit that it might have been late in the day, but I specifically asked my officials to contact NHS South West London to obtain some sort of statement that I could present, because I do not want to do anybody any injustice—Mr Aziz or, indeed, the PCT. Unfortunately, the statement that I have is handwritten and I am having difficulty reading it, so I will not read it out. In fact, it does not tell me anything that I have not already been told.

It is important to explain that the National Institute for Health and Clinical Excellence provides the NHS with evidence-based guidance on the clinical effectiveness and cost-effectiveness of drugs and other technologies. NICE, as an independent body, makes the decisions on whether a particular drug has a clinical or cost-effectiveness basis on which it should be prescribed. Where treatments have been positively appraised by NICE, PCTs are legally obliged to provide funding for them. However, NICE has not issued any guidance to the NHS on the use of sildenafil nitrate for the treatment of pulmonary arterial hypertension. That is the problem. It is because NICE has not given that advice to the NHS that the treatment is at the discretion of the PCT and we are in difficult times. There were difficult times under the previous Administration. There always are, because we do not have a bottomless pot of money, and treatments—often brilliant treatments—increasingly cost huge amounts of money.

[Siobhain McDonagh]

On that precise point, Mr Aziz, who is here listening to this debate, said to me on the way in, “Siobhain, I have paid my taxes for 35 years. I do not want a drug that makes me look better—I want a drug that is going to save my life.”

[Anna Soubry]

I was coming to that in due course.

Apart from making these comments at the Dispatch Box, I cannot advance Mr Aziz’s case, because I do not know his case. I know what the hon. Lady has said, and I know that he has been through, to use these awful words, due process. His application has been considered. Having looked at what the PCT says in its letter, I can see that his case has been through all the sorts of processes that one would expect. I hope and pray that in the course of all that and through the various appeals that he has made, everything has been properly considered by the PCT.

It strikes me, however, that the most obvious thing that should have been done has not been done. Nobody seems to have sat Mr Aziz down—this is not the hon. Lady’s job, because she knows no more than I do—and explained things to him. If there is a good reason, he should be told. If it is about the money, we need to know exactly what the problem is. I suggest that those who may be listening, whether they be in this building or watching on television, should sit down with this man and discuss the way forward for his treatment. They should provide him with an explanation, because he is not just a human being—and it does not matter whether he is a good or a bad man—but one who is extremely ill with a life-threatening disease. Somebody needs to sit down and do a proper job on this, just like the hon. Lady has done in bringing the case to the House.

I despair—we should not have to be here, but we are. The emergence of the clinical commissioning groups will lead, I hope, to a far better system. They will make decisions based on their own knowledge and understanding as clinicians. They will also, in many ways, be far more accountable than primary care trusts have been. Every CCG will have a representative on the upper-tier local authority’s health and wellbeing board. The theory that generated the highly controversial legislation that went through this place is that it would be much better for decisions to be made at a more local and accountable level by those best placed to make them, namely health professionals.

I fear that I have not been able to answer the question asked by the hon. Lady and Mr Aziz, whom I wish well, as we all do. I hope that, as a result of this debate, which the hon. Lady quite rightly called for, people will sit down and not only perhaps have a rethink, but certainly give a human being an explanation, if for no other reason than because, at the end of the day, he pays their wages. On those somewhat positive remarks, I hope that this matter might be concluded to everybody’s advantage.

Accident and Emergency Departments

Siobhain McDonagh Excerpts

Thursday 7th February 2013 Commons Chamber

[David Morris (Morecambe and Lunesdale) (Con)]

Thank you for calling me, Mr Deputy Speaker. My constituents will be paying close attention to this debate.

For some weeks the press in my constituency has been awash with allegations about both maternity and accident and emergency services at our local NHS trust. What concerns me is not that the services will change, but the scare stories surrounding all this. I have received a letter from Jackie Daniels, the chief executive of the trust, confirming that it will not shut the A and E department at Royal Lancaster Infirmary. She wrote:

“‘The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster.

We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”

So the chief executive of the trust has said that not only has she no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.

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

May I urge the hon. Gentleman to be careful about this? Most Labour Members face closures of A and E departments that serve twice that number of people.

[David Morris]

I shall come to that in my speech.

A concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E department is likely to close. The campaign involves press briefings, an online petition, a Facebook group, and even people walking around the centre of Morecambe with clipboards inviting people to join it. I want the e-petition to be removed from Directgov, and I have written to the Cabinet Secretary asking him to intervene. We cannot allow a dishonest campaign to be fought on Directgov e-petition platforms. If the A and E department is not under threat, it must be concluded that people are being frightened for the purpose of political advantage, which, in my view, is morally wrong.

Perhaps it is time to admit the truth: the trust is getting better under the present Government. A new and better management was introduced by the former Secretary of State. Only a few weeks ago, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) opened a new minor injuries unit in my constituency. A new health centre in Heysham, costing £20 million, was opened last year, and four new wards have just opened at Lancaster hospital. I pay tribute to my hon. Friend—for he is my hon. Friend outside the Chamber—the Member for Barrow and Furness (John Woodcock) for ensuring that maternity services in Barrow remained secure.

All that was paid for by a 2.8% increase in funding for the NHS under the present Government. This debate is part of a national campaign to scare people into believing that the NHS will be deconstructed.

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

I join this debate as another Member whose A and E is targeted for closure. My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.

Last summer, the bad news came that it would be my local hospital, St Helier, that would lose its A and E, maternity, intensive care unit, children’s unit, renal unit and 390 in-patient beds. To be honest, it has all been a bit of a shambles. NHS South West London was due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed. Then, in September, it proudly press released that a decision was imminent and that the public consultation would start on 1 October. One doctor was quoted as being

“excited by the huge potential of the BSBV programme.”

The decision was put off. I would love to say that it was because of what local residents had to say, but actually it was because of a scathing national clinical advisory team report on the plans, which mocked BSBV’s claim that an astonishing 60% of emergency patients would use primary care instead of A and E, saying:

“The Assumption that 60%...can be managed by clinicians from primary care demands…local analysis. Elsewhere in the UK a consistent finding is…far lower, usually…15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

What really put a block on the plans was the sudden collapse of another nearby hospital. Epsom hospital has long had financial troubles. In the 1990s, they were so bad that it was forced to merge with the more financially viable St Helier to form the Epsom and St Helier University Hospitals NHS Trust. The merger was never ideal, as Epsom has more in common with other Surrey hospitals than with St Helier. In 2011, it was finally decided that the Epsom and St Helier should de-merge and that Epsom should merge with a hospital in Surrey—Ashford and St Peter’s hospital.

All was going well until last year, when it was revealed that Epsom’s debts were far worse than originally thought. The merger deal with Ashford and St Peter’s collapsed, and Epsom was left out in the cold. This made Surrey panic about what BSBV was planning. After all, if St Helier lost its A and E and Epsom collapsed, there might be no hospital between Tooting and Guildford—so BSBV was put on hold again. In retrospect, that only made matters worse. Instead of closing one A and E out of four hospitals, the local NHS has just decided to close two out of five. That will be catastrophic.

We all know that Epsom, with its MP in the Cabinet and its wealthy population who can afford a judicial review, will put up a big fight, so the consequences for south-west London will be disastrous. There are parallels with what happened in Lewisham. Patients will suffer because of the financial problems of a hospital miles away. We thought things were bleak before; they are even bleaker now. With St Helier singled out for service closures even before this latest development, it is going to be even more difficult for our community than ever before. The argument remains the same, and my local community will not stop arguing. Closing services at St Helier is a false economy, as 200,000 people will have further to go in an emergency.

If things were bad enough even before Epsom’s problems were thrown into the mix, we will now find that an A and E will close, even though A and E visits are due to go up 20% in the next five years, and a maternity unit will close, with thousands of patients giving birth further from home, even though birth rates will go up 10%. Even when just St Helier was under threat, the National Clinical Advisory Team said:

“Successful implementation…depends on a multitude of supporting improvements”

and these

“are not well defined in the proposals.”

It concluded:

“The reconfigurations are based on an optimistic view of capacity”.

Next Monday, I will host a meeting for my local constituents to try to update them about what is going on. Obviously, the fight goes on.

The NHS admits it must save £370 million in my part of London alone. The UK Statistics Authority has made it clear that the Prime Minister has broken his electoral pledge to increase health spending. Demand for A and E is up, and the birth rate is up; but instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. If St Helier goes the way of Lewisham or worse, and loses its A and E and countless other services, my constituents will know why. My constituents are very angry: they know this will not work, and they want to hear from the Minister today that it will be stopped.

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[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I greatly enjoyed the speech of the hon. Member for Ealing Central and Acton (Angie Bray) and share many of her sentiments, but I hope she will forgive me for saying that her contribution lacked a sense of regional and national context. Despite the pretence of a national review, to which my hon. Friend the Member for Ealing, Southall (Mr Sharma) alluded, closing substantial numbers of A and E units is clearly now Government policy. Professor Matthew Cooke has been advising the Department of Health on A and E issues—he did so last year, at least. He has spoken to NHS North West London, supporting its plans to close four of our nine A and E departments, and he was reported in the Daily Mail as saying that those plans were in line with national Government policy.

At the 2010 general election, the Conservative party manifesto promised to stop the closure of A and E departments. Indeed, I think the Prime Minister insisted there would be a moratorium to stop further A and E closures. If I remember rightly, during the election campaign the Prime Minister visited Chase Farm A and E department in London and Queen Mary’s A and E department in Sidcup, promising to stop their closure.

[Siobhain McDonagh]

And Kingston, too.

[Mr Thomas]

Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.

My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.

We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.

--- Later in debate ---

[Mr Charles Walker (Broxbourne) (Con)]

rose—

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

health

Siobhain McDonagh Excerpts

Tuesday 18th September 2012 Commons Chamber

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

My local NHS says that it needs to reconfigure services because it has

“to deliver £370 million savings each year...a reduction of around 24% in…costs.”

As a result, it plans, through a programme ironically called “Better Services Better Value”, to close a wide range of services at my constituency’s local hospital, St Helier. Most of the controversy has focused on the closure of our A and E and maternity units, but we also face losing our intensive care unit, neonatal ICU and renal unit, as well as about 50% of St Helier’s 390 in- patient beds.

Since I last raised this subject in the House in July, a number of interesting things have happened. First, the right hon. Member for Sutton and Cheam (Paul Burstow)—whose constituency, like mine, is on the borders of St Helier—lost his job as a Health Minister and launched a withering attack on the plans, describing them as “dangerous and flawed”. As a Minister in the Department for Health, he would know; although I imagine that he wanted to stay and to continue to be collectively responsible for St Heller’s demise.

Then the right hon. Member for Carshalton and Wallington (Tom Brake), whose constituency contains St Helier, decided that he was so upset about the plans that he would take a principled stand by joining the Government as deputy to the man who is responsible for what has happened in the NHS over the past two years. Congratulations are due to him for showing his disapproval so strongly.

Ten days ago, Michelle Baker and Karen Russell, mums from my constituency and part of the Save St Helier campaign, organised a picnic with a purpose outside the hospital. Thousands of local residents joined in, and although it was billed as a fun day, we were deadly serious. The leader of Merton council, Councillor Stephen Alambritis, a former football referee, was cheered as he brandished a red card at the plans, while the medical director of “Better Services Better Value” was booed as he was handed our petition, signed by more than 30,000 people.

In other developments, it is becoming increasingly clear that, behind the scenes, the case for the closure is falling apart. NHS South West London was originally due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed at the last minute. Then, last month, the team proudly issued a press release stating that a decision would be made on 27 September and that

“the aim is for it to go out to public consultation from 1 October”.

Dr Finch said that he was

“excited by the huge potential of the BSBV programme.”

Now even that decision has been put off for at least another month. Perhaps the delay is connected to polls of GPs and patients that showed that a majority were against the closure, but I suspect that that it is mainly due to the publication of the National Clinical Advisory Team’s report on the plans.

NCAT reports represent a key step in any hospital reconfiguration and need to be properly scrutinised, so on 17 July I requested a copy of the report under the Freedom of Information Act. Under FOI rules, I should have received a copy by 14 August, but it was not until a week later that I received one, along with a press release claiming that NCAT had

“given the Better Services Better Value review the green light to move forward”,

and that

“we are very pleased that the NCAT team have agreed that our proposals should be supported”.

However, although the press release gave the impression that everything was running smoothly, that impression was extremely misleading.

The most fundamental criticism of the closure plan is that it is predicated on the assumption that 60%—yes, 60%—of emergency patients can use primary care instead of A and E services. Obviously, it is very much in GPs’ interests for BSBV to succeed. It is led by local GPs, and they clearly have an interest in ensuring that more patients use primary care rather than hospitals, whether or not that is what patients want, because the money follows the patient.

NCAT has looked at the 60% target and, ever so politely, has laughed it off. The report says:

“The assumption that 60% of ED”—

emergency department—

“patients have conditions that can be managed by clinicians from primary care demands detailed… analysis. Elsewhere in the UK a consistent finding is…far lower, usually in the order of 15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

NCAT goes on to say:

“The ED consultants interviewed suggested that the primary care workload in their departments is in the order of 15-20%”

and that

“The estimate of 60% is often derived from coding data...patients who have no x-rays, no specific treatment, no follow up and are not admitted are regarded as ‘minor’ and therefore it is assumed that they could be seen by primary care clinicians. It is recognised throughout the NHS and particularly in emergency care, that such data lack reliability”.

The report also questions the assumptions behind the proposal that St Helier could be saved by becoming South West London’s elective hospital. It is hard to see why any patient would choose to travel so many miles from Croydon, Wandsworth or Kingston to a hospital that had lost so many services, to receive treatment that they could receive at their local hospitals, or why any ambitious staff member would want to work there.

NCAT says:

“The concept of a planned in-patient care or elective hospital serving the whole area was generally supported”

by clinicians. It continues:

“However there was no evidence that this would free enough in-hospital capacity to absorb the additional acute workload for the remaining three hospitals.”

The report adds:

“There was concern that the links between acute medical services and the community were not dependable.”

NCAT admits that, although most experts consider it a bad thing for maternity units to deliver more than 6,000 babies a year, South West London’s three remaining maternity units would have to deliver 6,500 babies each—in addition to the 2,500 babies delivered in midwife units and the 880 delivered at home.

NCAT concludes:

“Successful implementation…depends on a multitude of supporting improvements in primary care, community services and professional practice that are not well defined in the proposals.”

Worse, it admits:

“The reconfigurations are based on an optimistic view of capacity, recruitment, meeting increased demand in primary and community care and the challenges posed by the introduction of new ways of working.”

I could go on and on.

On the basis of such optimism, 200,000 people will have to make longer journeys to hospital in an emergency. An A and E department will close, although the number of A and E visits will rise by 20% in the next five years. Tens of thousands of women will have to worry about how they will give birth at hospitals further from home, and a maternity unit will close, although the number of births will rise by 10%. Thanks to the combination of cuts and GP commissioning, a flawed decision to close St Helier is about to happen. It will not work, and it must be stopped.