Hospital Services (West London)

Stephen Pound Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Slaughter]

I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

[Stephen Pound (Ealing North) (Lab)]

Will my hon. Friend give way briefly on a point of information?

[Mr Slaughter]

Yes.

[Stephen Pound]

At that particular meeting of GPs, the voting figures, which I am sure hon. Members will want to know about, were 47 against and three for.

[Mr Slaughter]

I am grateful to my hon. Friend for that information. I had thought that the vote was 47 against, with three abstentions, but I always stand to be corrected by him.

The bodies that have supposedly devised these proposals are indeed the commissioning groups. As far as I can see, the only people supporting these proposals on a clinical level among the GP community are those who are heavily involved and who perhaps have a vested interest in relation to those commissioning groups, which of course will not take control until April next year.

It is absolutely true that, unlike some other hospital trusts, Imperial College Healthcare NHS Trust is at best acceding to this process and at worst actively supporting it. It is very clear why it is adopting that approach and why it would see the closure of two of its own A and E departments. The Imperial trust is in deep and dire financial trouble. It has a deficit of more than £100 million and the ability to close down significant services and, perhaps more importantly, to free up one of the most lucrative pieces of real estate in London—in other words, most of the Charing Cross hospital site—presumably for commercial disposal will, it believes, allow it to see its way out of its financial difficulties. Therefore, I am afraid that its opinion is coloured by that judgment.

Let me move on to discuss public opinion briefly. At 48 hours’ notice, I called a public meeting by e-mail and 250 people turned up. I also put a petition online and within a day 750 people had signed it. We have set up a consultative committee under the banner, “Save Hammersmith and Fulham hospitals”, which involves 40 concerned local residents. They have no particular political affiliation; they simply care about their local health services.

All that is but the germ of what I am sure will be the largest campaign of public opposition across west London that we have seen. There will be no safe parliamentary seats in west London if the Government pursue this course of action; there will be no limit on the opposition to the proposals, and there will be marches, petitions and protests until they are withdrawn.

I am hopeful that there will be a debate—at least a partial one—next Tuesday on the Floor of the House about children’s cardiac services, and therefore I will not spend as much time today discussing that issue as I had planned to. All I will say now is that the same body that has been involved in the proposals about my area—the Joint Committee of Primary Care Trusts—has taken the extraordinary step of recommending the closure of the children’s cardiac unit at the Royal Brompton hospital, despite knowing that there were no risks attendant on keeping it open. On the contrary, it is a world-class unit with world-class doctors and surgeons. Moreover, the JCPCT also took that step in the knowledge that a range of other world-class services at the Royal Brompton hospital—the respiratory service, the cystic fibrosis service and the neuromuscular services—are also at risk. The Royal Brompton hospital is not in my constituency, but it is used by my constituents and indeed I substantially used it myself when I was severely asthmatic in younger life. It is unthinkable that it should be put at risk by this decision to recommend the closure of services and I am glad to see that there is opposition to the review by the JCPCT from around the country.

Let me also mention the concerns that we in Hammersmith have about the Imperial trust and its use of data. I will quote from an article in last week’s Fulham and Hammersmith Chronicle, a local newspaper:

“An investigation has been launched to determine whether data recording blunders by Imperial College NHS Healthcare Trust could have cost lives. The panicked trust…realised there had been major errors in the way it handled recording files for patients referred for cancer tests earlier this year. People suspected of having cancer are required to be tested within two weeks of being referred by their GP. But Imperial found its records of this treatment path was flawed, with many incomplete, giving no indication of whether the patient was tested or not, and others duplicated.”

Furthermore, as was widely reported in the press last week, there were 25 deaths in that period in the local area that are still under investigation.

The issue of the Imperial trust’s record keeping and referrals was first raised by me in February. I know that there has been some limited improvement in clearing the backlog of cases, but it is simply not acceptable that a trust serving such a large proportion of west London’s population can continue to keep data in this condition.

That brings me to my final point, which is what I am seeking from the Minister. The Secretary of State for Health wrote to me last week and said that the consultation process

“is a matter for the local NHS.”

However, he acknowledged that

“there is an independent scrutiny and review process…which is overseen by local Health Overview and Scrutiny Committees (OSCs). OSCs have the power to refer proposals…which I am then able to pass…to the Independent Reconfiguration Panel for advice.”

I have no doubt that will happen at some stage, because there is such overwhelming opposition to these proposals from local authorities as well as from MPs and their constituents across west London. However, given the farce of this purported consultation and the way that this matter has been handled so far by NHS North West London, it would be better for the Government to act now and call off this consultation, review the proposals and engage genuinely with MPs, clinicians and local authorities in reaching a sensible set of conclusions and proposals. We are not luddites; we do not oppose change in the health service for the sake of it. But our NHS and our local hospitals are very special places. People who have used those hospitals—sometimes over generations—have a unique relationship with them. I am sure that is true. I know that the Minister is familiar with the area and has past associations with it, so he will know what I am talking about. I know that he will also be aware of my constituents’ special and particular problems in terms of complex health needs.

I ask the Government in what I hope is an open-handed spirit to look now at what is happening, not only in the Imperial trust but in NHS North West London, because this situation cannot be allowed to continue.

--- Later in debate ---

[Stephen Pound (Ealing North) (Lab)]

It is an honour and a pleasure to serve under you, Mr Gray. Like all other right hon. and hon. Members, I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this debate. I assure him that although I was not present at the inauguration of the “Paupers’ Paradise” in Hammersmith, I was present at Queen Charlotte’s hospital on the same day that the national health service was born, having also been born on that day.

We have heard a great deal of extraordinary information that underlines the seriousness of the situation facing us. The hon. Member for Ealing Central and Acton (Angie Bray) put her finger on it: the root of the problem is finance. This is about money. It is not about clinical need, clinical determination or a reconfiguration of the health service. As many have said, there is no luddite tendency facing the health service. It has changed massively. I spent 10 years working at Middlesex hospital, which may or may not have been in the constituency of the hon. Member for Cities of London and Westminster (Mark Field), although he certainly knew that hospital. It closed because people realised that there was alternative provision at University college hospital.

The situation in north-west London has been dramatically illustrated by the range of geographical interests represented here. Although Ealing hospital is in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), it is the hospital used by my constituents. Those who do not use Ealing tend to use Northwick Park hospital, which is in Brent, although it is used predominantly by people from Harrow. We have extraordinary crossover. If the toothpaste tube is squeezed in one place, the shape changes in another.

This is the message that I want to give the Minister, who is a decent man. I have known him for a long time, and in many ways I respect his instincts on this matter. We must recognise that London is different. The days of “predict and provide” may have changed and we may not consider it a fashionable option any more, but the reality is that we in west and north-west London face health problems. We face the resurgence of rickets, tuberculosis and illnesses that we thought did not exist any more. We have a massively mobile population, but above all a growing population. Every single school in my constituency is having to expand. Looking around, I see colleagues on both sides of the Chamber whose schools are having to expand. The population is increasing.

What possible clinical case can there be for reducing accident and emergency services, which at Ealing provide succour for nearly 100,000 people every year, as we heard from my hon. Friend the Member for Hayes and Harlington (John McDonnell)? Those people will wash up at West Middlesex university hospital and Hillingdon hospital, with appalling, dire consequences.

Can it be that we have changed so much in terms of clinical delivery that an ambulance service is a mobile operating theatre and that it does not matter how far an incident or accident is from the hospital, because the ambulance service is now so brilliant? That is very different from when a former Conservative Health Minister referred to ambulance staff as lorry drivers with first aid certificates. I cannot believe that moving people at speed, however efficient the vehicle, will help the problem. In many cases, it will make it worse. How many times have we seen people on the blues and twos hammering through our streets, which at the moment are crowded, congested and dangerous? It can only make matters worse.

I have less than a minute left to speak. I say to the Minister through you, Mr Gray, that the public are not persuaded that there is a clinical case. The Secretary of State has said that there are four criteria. There should be

“support from local clinical commissioners; strong public and patient engagement; clear evidence of the clinical benefit; and reflecting current and prospective patient choice.”

Ealing Hospital Save Our Services has been mentioned, and Colin Standfield, the organiser, is here in Westminster Hall today. I say to the Minister that there is no evidence at any level that anyone is committed to the proposals to cut the A and E department. We heard earlier from the hon. Member for Cities of London and Westminster that there might be political grief. The Minister and I have both sat in the House for a while, and we both remember an Independent Member who represented one hospital anti-closure campaign. Hospital closures are a massively toxic issue. That is not a threat; it is a reality.

People are not with the Government on this issue, they are not with a shadowy PCT and they are not at all confident that the process is anything other than the biggest, crudest, roughest and most brutal rubber stamp. That is the impression that we in west London have. I implore the Minister to put our minds at rest and tell us that the consultation is genuine, and that there is a prospect of something other than an evisceration, an amputation without anaesthetic and a destruction of what we in north-west London hold so dear.

--- Later in debate ---

[Andrew Gwynne]

Absolutely. I enjoyed my visit to Ealing hospital with Ken Livingstone in the run-up to the London elections, although I am not sure whether my support did Ken’s campaign much good.

[Stephen Pound]

We did win the Greater London assembly seat.

[Andrew Gwynne]

Yes, as my hon. Friend confirms, we did win the GLA seat.

Councillor Carlebach told the BBC in April:

“We have some serious concerns at closing that many A and Es in such a large region.”

The hon. Member for Cities of London and Westminster (Mark Field) has expressed similar concerns.

The scale of the problem is easily grasped when one considers that NHS North West London serves a population of 1.9 million people in eight boroughs: Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster. Does the Minister agree with the remarks made by his colleague on Hammersmith and Fulham council?

The chief executive of NHS North West London, Anne Rainsberry, has been clear on what is driving the decisions. She told the BBC in February:

“The financial challenges in London are pretty much unprecedented.”

The local Joint Committee of Primary Care Trusts has said that there will be a £332 million gap to plug by 2014-15 if no changes are made.

My hon. Friend the Member for Hammersmith, and the Labour party, are not opposed to change. He said a few weeks ago that there was

“nothing wrong with economies of scale if you can join forces and do something cheaper that provides more resources,”

and I associate myself with those remarks. The chief executive of the King’s Fund agrees that

“London’s NHS is in urgent need of change,”

but, he goes on to say,

“the risk is no-one will be in the driving seat”.

My hon. Friend the Member for Westminster North (Ms Buck) also warned about the lack of leadership and the timing of the changes when she said:

“The question is how do we get there from here at a time of chaotic reorganisation in the health service, when planning is falling apart, when north-west London hospitals alone have to save over £120m between now and 2014.”

I am afraid that what we are seeing goes much further than, and is in direct contradiction to, the Prime Minister and Health Secretary’s general election promise to halt the closures of hospitals, A and E units and maternity departments. What happened between the general election and now that caused both those right hon. Gentlemen to change their position? Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London, at a time when the NHS is being put through an unnecessary upheaval?

It is obvious from what the Government have had to say to date that Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished PCTs for the forthcoming closures. We all know what happened between the general election and now: the unpopular and, frankly, unnecessary Health and Social Care Bill—the biggest threat to the NHS in its long history—was introduced. It was a disastrous decision on the part of the Government to spend £3 billion on an unnecessary top-down reorganisation that has led to the loss of financial grip on the NHS.

In the case of west London, we are seeing another broken promise on the part of the Prime Minister, who spent millions during the general election putting up posters throughout the country reassuring the British electorate that, under the Conservatives, there would be a moratorium on hospital and A and E closures.

Does the Minister think that the proposals in the “Shaping a healthier future” document will save money in the long term? If all the closures go ahead, would that not leave Imperial College Healthcare NHS Trust with just St Mary’s hospital as a single site, and pose huge financial and practical problems for the expansion of its services to cope with the extended case load?

The Opposition warned Ministers repeatedly during the Bill’s passage that it would lead to the break-up of the NHS, and the “Shaping a healthier future” proposals seem to be a missed opportunity to improve care by reducing duplication where it occurs and ensuring that hospitals work together for the benefit of patient care.