Oral Answers to Questions

Stephen Pound Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Speaker]

I call the victorious team leader, Mr Stephen Pound.

[Stephen Pound (Ealing North) (Lab)]

11. What assessment he has made of the potential effects on public health of his Department’s proposals on the future of community pharmacies.

[The Minister for Community and Social Care (Alistair Burt)]

It is my considerable honour, Mr Speaker, to respond to the hon. Gentleman in his victorious mode.

Community pharmacy is a vital part of the NHS and it plays a pivotal role in improving the public’s health in the community. We want a high-quality community pharmacy service that is properly integrated into primary care and public health. The proposed changes will help us, in conjunction with the pharmacy profession, to do just that.

[Stephen Pound]

I am very grateful to the Minister for that answer. There is always a place for him in our team next year, although we are running trials in the next few weeks.

Despite the generosity of the Minister’s response, does he not accept that community pharmacies are of great and growing importance to our constituents and provide an ever-increasing range of healthcare and advice in accessible high street locations? What message does he have for these dedicated professionals, who, frankly, now fear for the future due to the uncertainty arising from the announcement of a 6% cut in funding for the NHS pharmacy service?

[Alistair Burt]

I am grateful to the hon. Gentleman not only for his question but for the way he put it. The message is that community pharmacy does, and is doing, an extraordinary and important job, but it will change. In 2013, the Royal Pharmaceutical Society said in its publication, “Now or Never: Shaping pharmacy for the future”:

“The traditional model of community pharmacy will be challenged”

due to

“economic austerity in the NHS , a crowded market of local pharmacies, increasing use of technicians and automated technology to undertake dispensing, and the use of online and e-prescribing”.

It pointed to the massive potential of community pharmacists to do more and sees pharmacy as ideally placed

“to play a crucial role in new models of…care.”

All that is to come. We are negotiating with the pharmaceutical profession. A consultation is going on. There is a great future for pharmacy, but, like so much else, it will be different.

NHS Bursary

Stephen Pound Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

I beg to move,

That this House has considered e-petition 113491 relating to the NHS Bursary.

As of this morning, the petition had 154,390 signatures, which shows the depth of feeling and the concern that student nurses have about the proposed policy. Before the debate, we had a fantastic listening exercise, which involved a number of student nurses and other representatives of the health industry, many of whom are here in the audience. Having filled the Public Gallery, we even have an overspill room elsewhere on the estate where the debate is being shown on television. It is a testament to the importance of the matter that so many Members of Parliament are attending the debate.

[Stephen Pound (Ealing North) (Lab)]

I am in no way being critical of the hon. Gentleman, who deserves a great deal of credit for what he has done, but does he agree that instead of using the expression “the health industry”, it might be better to say “the health profession”?

[Paul Scully]

Of course it would be. The hon. Gentleman is absolutely right; forgive me.

Let me read the petition for Hansard. The title is “Keep the NHS Bursary” and it says:

“At the moment, student nurses do not pay tuition fees, and receive a means tested bursary during their training. We are required, by the NMC, to have done at least 4,600 hours whilst studying, at least half of which are in practice.

Student nurses often work alongside our studies, like most students. But unlike most students, we work full time hours in placement for around half the year, and spend the rest of the time in lectures, without a summer holiday, or an Easter break, as well as completing our assignments. Taking away the NHS Bursary will force more student nurses into working 70 hour weeks, as many already do, it will compromise our studies and most of all, our patient care.”

I am sure that everybody here appreciates the work that nurses do in the NHS. I have had had to go to hospital many times with my family. My daughter was born prematurely and had to have a lumbar puncture within hours of birth; my son had his thumb set after he had dislocated it playing rugby—just opposite the local hospital, fortunately—and nurses tended incredibly patiently to my mother when she fractured her hip after a fall late on a Saturday night.

We know the endless hours that nurses work and the endless patience that they show in tending to us when we most need them, and when we are at our most vulnerable. It is important that we pay tribute to them for the work that they do. We must also pay tribute to those who want to enter the nursing service. They do so as a vocation and out of love; they do not do it for preferment, large salaries or anything like that. They do it to pay back and to serve us as members of the public, and for that we are very grateful.

Nurses do incredible work, which is more complex than ever. Many nurses are taking on more responsibilities, whether in adult nursing, child nursing, learning disability nursing or mental health nursing. Often, these days, they have to tell doctors what to do and how to lead on treatment.

--- Later in debate ---

[Paul Scully]

The hon. Gentleman might not be surprised to know that I cannot answer that, so I will pass it on to my hon. Friend the Minister, who I am sure will cover it when he sums up.

As I said earlier, I ask the Minister whether there will be an exemption for loans taken out to cover a second degree. Also, what arrangements will be made for placement expenses, which are a concern for many people going through the process? In Parliament a few years ago, there was some discussion about unpaid parliamentary interns, and a number of changes were made. Greater accountability through the media has led many Members of Parliament to change their practices so that, rather than just getting unpaid interns to do a load of work, they are paying a reasonable wage, even if it is not the full-on salary that someone else might get.

As I have mentioned, the people doing placements are largely not supernumerary. They mostly do full-on nursing work, to our benefit as patients. I will be grateful to hear what the Minister has to say about placement expenses.

[Stephen Pound]

The hon. Gentleman is being extremely generous. I am sure that I am not the only person to congratulate him on bringing this extremely important matter before the House. On the basis of my 10 years’ experience working at Middlesex hospital, may I say that nurses are in an exceptionally unusual position? They cannot simply come and do five days and then go home. Accommodation is an issue. Nurses’ homes such as John Astor House at the Middlesex are long gone. How on earth can we ask student nurses or potential student nurses to come to one of the major five teaching hospitals in London—there are now four, obviously, since the Middlesex is gone—without giving them any support or assistance with accommodation? Nurses’ homes do not exist anymore. With respect, nurses need more at the moment, not less.

[Hon. Members]

Hear, hear!

--- Later in debate ---

[Maria Caulfield]

I will not, if the hon. Lady does not mind, just because I know that so many Members want to speak.

Although not all of those 37,000 will have been rejected because of a lack of places, a significant number of them will. The current system restricts the number of student nurses that enter the profession so, in theory, the changes should increase the numbers of qualified nurses in a few years’ time. From my clinical practice I know, however, that what works in theory will have the opposite effect in reality.

My main concerns about moving from a bursary scheme to a student loan scheme are, first, that many nurses go into a degree system simply because there is no other way to become a nurse. They do not necessarily want a degree in nursing; they want to be a qualified registered nurse. If we commit to a student loan scheme, we are committing them to take on debt for years to come. As we have heard, many of them—more than 30%—are mature students, and by mature students we do not mean people in their 40s and 50s. They are people in their mid-20s and early-30s. They have young families; they are single mums; and they have a first degree and have to take on a second one just to become a nurse. It is a crazy situation. For someone who already has a student loan, and/or a mortgage and/or childcare to pay for, the thought of taking on more debt will definitely put them off entering nursing, and to say otherwise is madness.

The difference between student nurses and other undergraduates is that the starting salary for a nurse is £21,000. Most nurses will only ever be a band 5 or 6, and the maximum they can earn as a band 6 is £34,000—that is if they do not have a break to have children or go part time for some other reason. They will never be in a position fully to pay off their student loan. Student nurses are different, therefore, from other undergraduates, and that has not been recognised in the debate. An issue in the wider debate about graduates is that a graduate is, on average, £100,000 better off than a non-graduate, but that is not the case with nurses. Other graduates earn, on average, more than £40,000 a year, but nurses do not earn anything like that and that difference needs to be recognised when decisions are made.

We have heard how much time student nurses spend on clinical placements—more than 50% of their course, including nights, weekends and evenings—which makes it almost impossible for them to get any other income from part-time work. We must recognise that. Being dependent on a loan is not a great way of life either, but other students are able to supplement their loans by working in pubs and shops, and doing other evening work. Student nurses are not in a position to do that.

My second concern is that, if I am completely wrong and we suddenly have a huge increase in the number of student nurses, the placements will not be able to cope. To qualify as a student nurse, not only does someone have to pass their exams and essays and do the required hours, they also have to be clinically assessed by a registered nurse—not just any old registered nurse, but someone who has done their mentoring and assessing course. I know that there are student nurses now who struggle to find placements because there are not enough qualified nurses able to assess them. That needs to be taken into account as well. It is not just about increasing the numbers; it is about having the support services in place.

When I met the Minister, I was hugely reassured by what he said about other schemes that are being proposed. My plea is that he outlines those schemes so that student nurses are reassured that, in order to qualify, they will be able to use schemes other than the student loan system. Routes such as nursing associates and nursing apprenticeships are being proposed. I am probably getting a little old now—

[Stephen Pound]

No!

[Maria Caulfield]

I thank the hon. Gentleman for his intervention. Those routes sounds like the state-enrolled nurse or state-registered nurse route again, and they worked pretty well in years gone by.

Health Service Commissioner for England (Complaint Handling) Bill

Stephen Pound Excerpts

Friday 27th February 2015 Commons Chamber

We must recognise that we are talking about the last stage in the complaint-handling process here. People who make a complaint have a reasonable expectation that their complaint should be dealt with quickly. As my hon. Friend the Member for Bury North (Mr Nuttall) said, quoting from “A voice for change”, the most recent annual report, which is for 2013-14, of some 4,000 complaints accepted for investigation 67% were concluded within one month and 95% were concluded within six months. So the norm is very much for one month, with the outlying cases taking more than six months. Some 5% are taking more than six months, with only 1% taking more than 12 months.

[Stephen Pound (Ealing North) (Lab)]

I am not sure whether the hon. Gentleman heard the comments by the Minister on the previous group of amendments but I think she addressed that point precisely. There is a complexity within the system that cannot be anticipated, and it would artificially fetter the discretion of the commissioner if an arbitrary time limit were put in place. Does he not agree that there are occasions when the complexity is such that we simply cannot fix the rigid metallic corset of a time limit on it without diminishing the value of the investigation?

[Mr Chope]

With the greatest of respect to the hon. Gentleman, I do not accept that, which is why I tabled the new clause. As he says, the Minister was addressing new clauses 1 and 2, and I would not at this stage anticipate her response to the debate we are now having on new clause 3. If a statutory duty is in place, minds will be concentrated. That means that the ombudsman would, for example, be able to explain to a complainant who it was who was not providing the information that was necessary in a timely fashion and say, “If we don’t get a move on, your complaint will be time-barred because we will dismiss it on the basis that we have a lack of evidence.”

Late Stage Hepatitis C

Stephen Pound Excerpts

Tuesday 6th January 2015 Westminster Hall

[Stephen Pound (Ealing North) (Lab)]

I am sure that I speak for everyone present when I say that it is an honour to be before you, Mr Gray. Let me also say that if I could have chosen any Minister to respond to this debate, it would have been the Minister who is here, because her record in this field, as in many others, is exemplary. I am delighted to be able to raise these points in such company.

Hepatitis C is something that is still a mystery to a large number of people. Most people know that in the classical Greek, hepatitis refers to the fire in the blood, and it is considered to be one of those blood-borne diseases of which we know very little because of the multiplicity of presentations. In fact, hepatitis C, the subject of today’s debate, was originally referred to as hepatitis non-A or B, because nobody knew exactly what it was. However, we now know what it is, and it is a great tragedy that today 215,000 people are chronically affected by hepatitis C in the United Kingdom. Of that number, 160,000 are in England.

The majority of patients have become infected through exposure to contaminated blood in various ways. I know that some hon. Members present wish to raise the issue of blood contamination in the health service, but in many cases, where it comes from is not as significant today as where we are going with it. A whole range of issues lead to contraction of hepatitis C.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I am very pleased that my hon. Friend has obtained this debate. Unfortunately, my constituency has a high prevalence of hepatitis C. He mentioned contaminated blood —I know he wants to talk about other issues—and 30,000 people have been infected since the 1970s through contaminated NHS blood products. Perhaps, like me, he hopes that the Minister will say something about that and whether there will be a final settlement before the general election—whether something will finally be done to help those people who suffer from this disease through no fault of their own, but through negligence by Government.

[Stephen Pound]

I profoundly endorse my hon. Friend’s comments and I very much hope that what he refers to will be the outcome. It is a cruel irony if one presents at a hospital in search of good health, and ends up iller than when one went in. I certainly will refer to that later.

One of the highest levels of hepatitis C infection in this country is from injecting drugs. That is part of the stereotype, and it is the case that 49% of identified hepatitis C cases in England, 34% in Northern Ireland and 33% in Wales are from that source. There are significant public health risks of further transmission if hepatitis C is left untreated. This is the astonishing and terrifying aspect of hepatitis C, and if we achieve nothing else today, we can at least ventilate the issue and, I hope, bring it to the attention of a few more people in the country. Hepatitis C is one of the most sinister blood-borne diseases, in that it in effect lies dormant for 20 to 30 years in the blood. A person who lived a fairly rackety life in the 1960s may have no idea that they have been infected with hepatitis C. It may present itself 30 years later, when the symptoms of lassitude, fatigue, inexplicable tiredness lead the individual to go and see their medical practitioner; and it is a simple blood test—it does not require anything other than a spot of blood on a piece of paper—that reveals it. The sinister, long-standing, dormant nature of hepatitis C is something to which I wish to refer.

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

I congratulate my hon. Friend on securing an important debate. Does he agree that one problem that we face in tackling hepatitis C—he has outlined the scale of the problem; more than 200,000 people suffer from it—is the mixed messages coming from the Department of Health and, in particular, the information provided in an earlier debate in this Chamber by the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who said that hepatitis C is not curable when in fact, with appropriate treatments, the cure rates are between 80% and 95%?

[Mr James Gray (in the Chair)]

Order. One must be brief in a half-hour debate.

[Stephen Pound]

One would almost think that my hon. Friend the Member for Easington (Grahame M. Morris) had had sight of my notes, because there will be, in a few moments, a section on that. The bullet point, my aide-mémoire, my prompt, is simply the two words “Good news”, because there is good news. One reason why we are having this debate is to tell people that there is a cure—a very successful rate of cure—but also to say that we need people to be able to access that and we need, above all, to have a plan.

Let me explain why I called for this debate. Many years ago, I had a private Member’s Bill on presumed consent for organ transplants. At that time, the then Secretary of State for Health, rather aggressively, said that it was not the business of the state to decide what happens to a person’s body after they have died. Lord Reid, as he now is, apologised to me afterwards for being quite aggressive, but one thing that it brought home to me was the difficulty of finding livers for transplant. Hepatitis C leads to cirrhosis of the liver in virtually every case, and in some cases that can then become acute liver failure, in which case one of the treatments would be a liver transplant. People think that is an easy solution when in fact it is not. As I discovered, livers for transplant are very difficult to get hold of—very hard to access.

Modern medical advances have opened up a completely new world. I will say more about that, and particularly the new therapies, in a moment, but there is still massive and widespread ignorance, and what I am asking the Minister for today is to have a plan for addressing that. I am reluctant, as is anybody, to give over-much credit to the Scottish Parliament, but on this occasion I have to say that the Scottish plan, the “Hepatitis C Action Plan for Scotland”, which is now six years old, does, if I may say so gently, represent a far more comprehensive and overarching strategy than we currently have in England.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

rose—

--- Later in debate ---

[Stephen Pound]

On the issue of strategy, I am honoured to be joined here today by my friend and constituency neighbour, my hon. Friend the Member for Ealing, Southall (Mr Sharma), to whom I will happily give way.

[Mr Sharma]

I congratulate my hon. Friend on securing this very important debate. Does he agree that there is a large south Asian community living in the UK who, due to many cultural and other barriers, are not getting treatment? I was organising roadshows in London with the Hepatitis C Trust to raise awareness and to offer free testing. Does he agree that if the NHS and the Government take initiatives to promote free testing, people will be able to get an early diagnosis and, we hope, secure treatment?

[Stephen Pound]

I am more than delighted to give credit to the Hepatitis C Trust, which has done exceptionally good work—I have been to a number of its meetings—but also to my hon. Friend and neighbour in Ealing. His document, “The Challenge of Hepatitis C for the South Asian Community”, will be formally launched next week. I believe that the Minister has a copy; if not, I will provide her with one almost immediately. At that launch, the issues that my hon. Friend mentioned will be widely discussed and information widely circulated. It is important to realise why there is such a high prevalence of hepatitis C in the south Asian community. Bizarrely, it is a consequence of improved health provision in that area. There are parts of the world where there is virtually no formal, structured health provision and there is no hepatitis C or, if there is, it is a minute amount, brought in externally. In south Asia, the health service is increasing its outreach: more and more people are accessing it and making use of it. However, the medical advances are not keeping pace with the advances in sterile treatment and sterile methods prevailing in the rest of the world. So, bizarrely, although there is considerable health provision in south Asia, it is not quite there yet in terms of providing a sterile environment and avoiding transmission, whereas other parts of the world have not even reached that level.

[Albert Owen (Ynys Môn) (Lab)]

My hon. Friend congratulated the Scottish Government in relation to hepatitis C—

[Stephen Pound]

Reluctantly.

[Albert Owen]

My hon. Friend did so reluctantly, but he will, I know, join me in congratulating the Welsh Government on their work on the consent issue. The serious point was made earlier about those who suffered contamination in the NHS in the ’60s, ’70s and ’80s. Does he agree with me—the Minister may want to respond to this—that we need a UK-wide approach to the matter so that compensation can be achieved for those who have been suffering for decades as a result of that contamination?

[Stephen Pound]

I enthusiastically endorse the approach of the Welsh Assembly Government on the matter, and their efforts have been widely respected and appreciated. One of the things that I seek today is precisely such an overarching, UK-wide strategy. It is important to note that the United Kingdom is the only country in Europe that is showing an increase in liver disease. All the statistics indicate that cases of liver disease, particularly hepatitis C, will continue to increase until they peak in about 2030. It is hoped that in 2030 they will tail off, partly because if we backtrack 20 or 30 years to the turn of the century, people had a bit more knowledge and understanding. One hopes that debates such as this will extend that knowledge and information outwards.

[Grahame M. Morris]

On that point, I completely agree that we need an overarching national plan and strategy as in Wales and Scotland, but is there not an obligation on the health and wellbeing boards, as part of their joint strategic needs assessment? In my region, my constituency has the highest incidence of hepatitis C, which is often associated with high levels of poverty and deprivation, but less than half of the health and wellbeing boards in our region identify it as any sort of priority.

[Stephen Pound]

I knew my hon. Friend’s predecessor very well, and we discussed the matter at the time of my Bill on presumed consent. I entirely endorse my hon. Friend’s comments about the health issues that affect his constituency, and I will come to precisely that point later when I refer to clinical commissioning groups.

On the question of how lethal hepatitis C is, there are a range of brand new therapies, many of which are moving rapidly through the health system. Treatments such as daclatasvir and sofosbuvir provide shorter courses of orally administered treatment with fewer side effects than previous treatments. Traditionally, people with hepatitis C have tended to be given treatments such as interferon or ribavarin, which are partly injected intramuscularly and partly oral, and which have some pretty horrific side effects. I made it my business to go and speak to the practice nurse at the hospital across the river who deals with such cases and supervises the courses of treatment. I heard the rather chilling comment that the side effects of interferon included not only nausea, dizziness, sickness and fatigue but nightmares, depression and occasionally suicide.

We have moved on a great deal, and we are no longer talking about purely an interferon or ribavarin treatment. Modern treatments do not cause the awful problems of anaemia and skin reactions that the older treatments did. I give credit to companies such as Bristol-Myers Squibb and others that have undertaken groundbreaking work in the area. Treatment used to take 48 weeks, and it is incredibly difficult to work or even simply to endure while receiving the treatment. The treatment cycle for the new treatments lasts 12 to 14 weeks, which is quite incredible and much more attainable. We reckon that 10% of people who are HIV-positive also have hepatitis C, and the new course of treatment is particularly effective in those cases. Patients will almost certainly continue their course of treatment if it is shorter and less painful. I do not have time to go fully into the economic benefits of somebody being able to remain economically active while they have hepatitis C, but under the new treatments, there is absolutely no reason why a person should not continue in employment, providing a useful function and benefiting the state.

The real difficulty is late diagnosis. The benefits of early diagnosis to the NHS and to the patient are self-evident. If patients do not receive early treatment, we can see the occurrence of cirrhosis, liver cancer and even the need for transplants. If we could only address the issue of early diagnosis, it would be not only cost-effective but good for the humanity of the individual. That is one of the reasons why I am particularly pressing for early diagnosis.

I have mentioned hepatitis A, B and C, and within each of those are genotypes that have different characteristics. There tend to be four different genotypes within hepatitis C, which are known as 1, 2, 3 and 4. Genotype 1 is typically associated with intravenous drug users, and my hon. Friend the Member for Ealing, Southall referred at great length and with considerable knowledge to genotype 3 at the recent launch of the programme of treatment for the south Asian community. Bizarrely, genotype 1, which was supposed to be the hardest to treat, has turned out to be one of the easier to treat. However, genotype 3, of which the opposite was the impression, is becoming extremely hard to treat. That is one of the reasons why “The Challenge of Hepatitis C for the South Asian Community” is all the more important. One way to deal with hepatitis C is to wait until the symptoms present, but the symptoms are very difficult, because there is no typical symptom of someone who has liver disease. Most commonly, the symptoms will be things such as lassitude and fatigue, but there can be numerous other factors.

I have mentioned the hepatitis strategy in Scotland. The effect of that strategy has been to improve access to treatment from 10% to 20% through better integration among health care providers. Of course, I understand that there is a smaller population in Scotland. People often talk about the situation in the Republic of Ireland, which has a very good identification programme. The reason for that is that there is only one place in the entire Republic of Ireland where someone can get the test, which happens to be in the Dublin health district, so all the data are gathered in one place. In GB, the United Kingdom and England there are a multiplicity of areas, so it is harder to get hold of and keep such data.

That brings us to the hepatitis framework document. I am reluctant to criticise the Minister, even tangentially, because she is a good person. However, the document is a little bit overdue. I think we were promised it at the beginning of the year. I blame no one for that; the Government have other matters to deal with, and I know the Minister has been working extremely hard. I do not think anyone would disagree, however, that we are due that document.

There are a number of questions that I would like to raise as we flesh out the shape of that document. What exactly is the timetable for its presentation and implementation? Will there be targets in it? The previous documents have not contained targets. What about the role of the clinical commissioning groups? When the document was first mooted, CCGs were not the powerful agency they are now. There will be no point in having some sort of strategy if we do not address the questions of funding streams and co-commissioning. That will almost certainly happen, and we need to know where we are. We cannot revert to a situation whereby a particular area provides a particular course of treatment that is denied to someone in another area.

Who will be involved with the document? Perhaps it is an illness of politicians that we often take refuge in strategy when implementation becomes too difficult, but a working party can be a useful thing. As part of the Government’s strategy, will they consider the establishment of a working party, which might include the Association of the British Pharmaceutical Industry, Professor Graham Foster from Queen Mary, university of London—the pre-eminent diagnostician in the area—patients’ groups and the Hepatitis C Trust? I mentioned Bristol-Myers Squibb earlier, and I have no financial or other interests in the company, but I admire people who can produce good, life-saving products and I think that such people should be involved.

We need to have a strategy. I would like to suggest that, first of all, the strategy should improve outcomes for people with hepatitis C. That may seem obvious, but let us get it down on the record. We should improve the prevention strategy. We need to tell people that if they get a tattoo in Thailand, it is not enough that the needle and the syringe are clean if the bowl of ink is not. That happens to people. I will keep my shirt and jacket on, but if I did not, Members would see a large number of tattoos up and down my arms that were mostly inflicted on me in Hong Kong in the ’60s. At that time we did not consider the sterile nature of tattoos. People nowadays should be savvier, wiser and more aware, but we need to tell them.

Above all, we need early diagnosis and prompt treatment, which will not only save lives and money but improve the health of the nation. It will improve on an individual, collective and community basis. We have an opportunity, because there is a coming together of a whole range of different streams: advances in medical science, the recognition of the scale of the problem and the possibility of a solution. We are also in a fortunate position because the Minister is extremely sympathetic to this issue.

Wanstead Hospital

Stephen Pound Excerpts

Thursday 4th September 2014 Commons Chamber

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

Thank you very much, Mr Deputy Speaker—Madam Deputy Speaker, I apologise.

[Stephen Pound (Ealing North) (Lab)]

It has been a long day.

[Jane Ellison]

Yes, it has.

I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this debate on issues that are clearly of great importance to him and his constituents. Before I try to address some of the issues he has raised—I have listened carefully to what he has said, and if there are issues to which I cannot respond now, I will certainly take them up with NHS London—I would like to put on the record my thanks to all those who work in the NHS, not only in his constituency but right across the service, for their dedication to providing first-class services to his and all our constituents.

As the hon. Gentleman is aware and as he described in his speech, Wanstead hospital closed in 1986 so the services that are the subject of this debate are provided from the Heronwood and Galleon unit on the site of the former hospital. As he said, it houses 48 rehabilitation beds in two wards, and it is one of three community rehabilitation units providing intermediate care for people in the three boroughs of Barking and Dagenham, Redbridge and Havering. The two other units are located at Grays Court in Dagenham and the Foxglove ward at King George hospital. The proposal put forward by the clinical commissioning groups for the three boroughs is to centralise these services at King George hospital, and that is the subject we are addressing this evening.

As the hon. Gentleman described, the three local CCGs outlined five possible options for the future of intermediate care services in the document issued on 9 July. I understand what he says about the preferred option steering people, but we would also probably be critical if local health leaders did not tell us what their preferred option was. I suspect we would want them at least to tell us what their thinking was in order to guide the public and be transparent. The proposals are currently the subject of a full 12-week public consultation. I understand that he has recently met Redbridge CCG and has expressed his concern, as he has done again tonight in the House, about the current length of the consultation, asking for an extension. That is being considered by the CCGs and I have asked that they respond to him as soon as possible after this debate, having given that further consideration and heard the strength of his feeling on the subject.

On support for the proposals, I know that in June, as partners on the local integrated care coalition, the three local authorities all agreed the content of the intermediate care pre-consultation business case. That includes the case for service change and the proposal for the local CCGs to go to public consultation. Subsequently, the three local CCG governing bodies all agreed to go to consultation and to consult on the preferred option, which we have described. I also understand that the Havering health and wellbeing board is very supportive of the proposals, urging the CCGs to get on with the proposed changes more quickly. Discussions are to be held next week with the health and wellbeing boards for Redbridge and Barking and Dagenham.

The head of nursing at the Partnership of East London Co-operatives has described the proposals in positive terms, and a number of positive comments have been made about the innovative ideas on home care, which the hon. Gentleman has been fair to describe as positive and good for his constituents. I know that in Redbridge the CCG is continuing to engage with community groups, some of which he has alluded to, in order to explain the proposals in more detail, and that is quite right. I was concerned when he said that members of the public locally are not clear about what is happening and do not feel that they are in the know, because these processes should always have at their heart the desire to convey what is being proposed to the public in order that they can comment meaningfully on them.

Under the preferred option, the overall number of rehabilitation beds provided would reduce from 104 to 40, with the capacity to increase to 61 should the need arise. On the face of it, that does sound like a very significant reduction, and I can understand why the hon. Gentleman and other local people may be concerned when they hear those figures. Local people needing intermediate care have generally been cared for in beds at community rehabilitation units, which means that the number of intermediate care beds across his area is relatively high compared with many other areas. However, I am advised—he made mention of this in his speech—that many of those beds are not being used because there is insufficient demand. The latest bed figures for August show that 49 intermediate care beds—47% of the total capacity—were unused across the area for that month. I note that he disputes those figures, and he makes a fair point about the waxing and waning of demand across the year. I would certainly hope that the local clinicians and managers who put these plans together would take into account those shifts in demand across the year.

The CCGs have also heard from the public that people want to be cared for and supported in their own homes wherever possible. That is a consistent message we get from the public across a range of health services. Keeping people at home helps them to stay independent for longer, and they recover just as well, and in some cases better and more quickly, at home. That is why the CCGs are developing a model of care where people are cared for and supported in their own homes, not in hospital. That model has been developed by clinicians, with, properly, input from patients and carers. However, patients who need a community bed will still be able to get one. The CCGs believe that concentrating all the rehabilitation beds on one site is the best way to develop high-quality care for the hon. Gentleman’s constituents and other patients who need to stay in a rehab unit.

Clinicians locally believe that that is the safest way to provide care and the best way to provide care of consistent quality. Concentrating the service on one site would enable staff to maintain their practice standards and share expertise more easily. The hon. Gentleman referred to the fact that the CCGs have been trialling two new services—the community treatment team and the intensive rehabilitation service. The community treatment team provides short-term intensive care and support so that people can be cared for in their own home, rather than in hospital. That is something that my constituents, his and other Members’ constituents say all the time: they would much prefer to do that. The intensive rehabilitation service provides support, such as physiotherapy, for people in their own homes and further reduces the need for patients to stay in community beds.

Figures for the last seven months are very encouraging. They show that nearly all patients supported by the community treatment team—90%—do not go on to be admitted to hospital. There are important issues to consider such as knock-on effects and the sustainability of local health services. The intensive rehabilitation service is similarly successful, with 90% of patients able to recover at home without needing to go to hospital.

Before the trial of the new services, patients waited an average of five days to access bed-based care. Since the trial, patients are able to access community beds or the intensive rehabilitation service in less than two days on average. Most people who need the community treatment team are contacted within two hours. We should pay tribute to the innovation that has taken place and to some excellent local service delivery.

I understand that patient satisfaction ratings for both the new services have been consistently high across the three boroughs since the trials began. The results of the latest satisfaction survey, published in June, were taken from patients recently discharged from the community treatment team, and it is good to hear patients being positive about their experience. In Redbridge, patient satisfaction with the service scored an overall average of 9.5 out of 10; 94% of patients and relatives said they would be “extremely likely” to recommend the community treatment team service to family and friends—the new family and friends test is being introduced across the NHS and is a good measure of what people really think of the service—and 100% of community treatment team patients were responded to within two hours.

Most of the patients surveyed felt that they either would have attended A and E or would have been admitted to hospital if that service had not been available, which goes to my point about the sustainability of local acute services. Since the trial started, 7,600 patients have been seen by those two new services, 1,000 from Redbridge. Only 1,300 patients would have been seen in a “beds only” service. Therefore, we can see service change bringing great quality of service to the hon. Gentleman’s constituents and others in the area.

Demand for rehabilitation beds has further reduced during the trial of the new services as more people are being cared for at home. I am advised that, during July, 46 of the available 104 beds were unused, as I have mentioned.

The Government are clear that reconfiguration of front-line health services is a matter that should be led by the local NHS. It is best placed to know the needs of local people and it knows how to deliver them. Putting the patient first is central to that, although it always concerns me when hon. Members bring to the House their worries that consultation and transparency have not been as good as they could be. I note the hon. Gentleman’s points, as will local health leaders, with concern. I know that they have met him on a number of occasions. I am sure that we will meet him again to take up those points, but at the heart of reconfiguration is the all-important issue of putting patients first and delivering a better service for all patients. The NHS in London, as elsewhere, has to constantly evaluate the way in which services can best be tailored to meet the needs of local people and improve standards of patient care.

I recognise that proposals for service change inevitably arouse public concern, and that is why it is important that we get consultation processes as good as they possibly can be. It is absolutely the role of hon. Members to express those concerns, to hold all of us who are involved to account, to engage with local clinical and operations leaders and to test the NHS’s response to those concerns.

I know that the hon. Gentleman has both corresponded and met senior staff from the local NHS, and I have met local health leaders, and I hope the response he received from the chief officer of Redbridge clinical commissioning group has gone at least some way towards addressing his concerns about the proposed reconfiguration of intermediate care services. The consultation on the proposals is open until at least 1 October and, as I said earlier, an extension is being considered. I undertake after this debate to further draw to the attention of local health leaders the strength of feeling the hon. Gentleman has expressed tonight about the need for more time for him and his constituents, but I urge him to participate and to make his constituents’ views known during the course of that consultation, as he has done tonight in the House.

Question put and agreed to.

Health Care (London)

Stephen Pound Excerpts

Wednesday 8th January 2014 Westminster Hall

[Stephen Pound (Ealing North) (Lab)]

I entirely associate myself with the earlier comments about the quality of my hon. Friend’s address so far. She talks about trying to have a logical and sensible planning process. Is she aware that London boroughs such as Ealing, ably led by Councillor Julian Bell, have had to divert intense amounts of resources to oppose something that is the antithesis of good planning? That is an additional double whammy against responsible local authorities, which have to divert scarce resources and face up to a desperately uncertain future.

[Ms Buck]

I totally agree. Local authorities are on the front line of delivering the social care made necessary by some of the planned hospital changes and they are under pressure. The councils have expertise and knowledge and they are, as my hon. Friend says, sensibly involved in planning services, so they are making thoughtful objections when they see that services cannot be delivered as we want. Indeed, they have to divert resources to make the case on behalf of their populations.

In conclusion, London’s NHS continues to save lives and to provide the same quality of care it currently provides. That is a tribute to tens of thousands of men and women on the front line, whether in the NHS or employed directly by local authorities, but it owes absolutely nothing to a Government who have let us down with a change process that we should have been able to work through. They have done that by the way they have treated local authorities and by the way that, through this unnecessary reorganisation, they have diverted attention and resources from the leadership that could ensure that London’s health care is delivered in line with the wishes of Londoners. The Government have let down London’s patients and the men and women who deliver health care to them.

--- Later in debate ---

[Mary Macleod (Brentford and Isleworth) (Con)]

I congratulate the hon. Member for Westminster North (Ms Buck) on securing this important debate. I will keep my comments brief because I want to be fair to other Members who want to speak, not because I do not care deeply about this subject. Previous speakers have talked ably about a lot of the statistics, so I do not need to go over them.

I was actually born in a London hospital, across the river in St Thomas’. I was pleased to go there again recently to visit my hon. Friend the Member for Bournemouth East (Mr Ellwood)—I hasten to add that I was visiting the maternity ward because his wife had given birth to their new son, Oscar. It was lovely to be back at St Thomas’, albeit after so many decades.

Some important issues have been raised in the debate. Health care is critical to all of us—it touches each and every one of us, our loved ones and our constituents. It is crucially important and we must get it right. In London, there are specific problems, as has been said.

I was pleased that in 2010 the Government made £2.7 billion extra available in real terms in the NHS budget across the UK. That has allowed us to have 440,000 more clinical staff, and we also have 23,000 fewer administrative staff, including 7,700 fewer managers. That was absolutely the right approach and what the NHS needed.

The average stay in hospital is shorter than in 2010, although that puts pressure on community care, so we must make sure that that is dealt with. The cancer drugs fund is also critical to the debate, and we have helped more than 38,000 patients through it.

The debate is about London and the issues specific to this great city. In my constituency, in west London, the key health care issues tend to be focused on tuberculosis, obesity—including in children—diabetes and alcohol-related harm. As Members might expect, we have above average problems with healthy eating, given the issues with obesity. Other issues include smoking during pregnancy, smoking deaths and skin cancer. There are therefore specific issues in west London, and I will focus on them.

In my constituency, we have one main hospital—the West Middlesex university hospital, where two thirds of my constituents go when they need to. My Chiswick residents—about a third of my constituents—tend to go to Charing Cross hospital. I want to reiterate what previous speakers have said: we have some excellent patient care and services across our London hospitals, but there are, absolutely, also areas we should focus on.

The West Middlesex has outstanding maternity and midwifery services. One of the best parts of our job as Members of Parliament is rewarding people who have done incredible work in the health service, whether they are clinicians or support staff, and I recently handed out awards at the West Middlesex, which is ably led by Dame Jacqueline Docherty.

I also want to pay tribute to London’s air ambulance service. During the Christmas period, there was a fire and a massive explosion in Chiswick, and the air ambulance was called. The service deserves as much support as possible, because it serves 10 million residents in London, and it has only one helicopter. It is world class, providing high-trauma, acute care. Everywhere else around the country has one helicopter for 1.5 million people, but the figure in London is 10 million, so there is an absolute need for another helicopter. I would push everyone to support the London air ambulance service, which has its 25th anniversary tomorrow.

[Stephen Pound]

I entirely agree, and I think most of us would associate ourselves with the hon. Lady’s comments on the London air ambulance, but does she not agree that it might be better if it were run by the state, instead of relying so much on charity?

[Mary Macleod]

The London air ambulance service is an amazing organisation, so I would not change its structure. It rightly gets some funding from the NHS, but it also derives funding from many other sources, and it is important that we support that. The service does an incredible job, so if the hon. Gentleman knows anyone who can give it a spare helicopter, it would really appreciate that.

My local CCG is chaired by Dr Nicola Burbidge. It started early, it has been absolutely focused on patients and it has been very responsive to any issues I have raised with it.

On reconfiguration, I was recently thankful when, after a lot of campaigning by my hon. Friend the Member for Chelsea and Fulham (Greg Hands) and others, the Secretary of State announced that the A and E at Charing Cross hospital would not be closed, thus helping residents in my part of London. Saving lives and improving patient care is paramount.

Changes to Health Services in London

Stephen Pound Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.

[Stephen Pound (Ealing North) (Lab)]

Your House, Mr Speaker, is being made dizzy this afternoon by the surfeit of spin we are suffering. We are being asked to believe that this benevolent Government are partly motivated by a desire to end uncertainty. The death sentence ends the uncertainty of life, but it is not necessarily something I would recommend. Will the Secretary of State please provide a little information about what exactly a different shape and size A and E department looks like? The people of Ealing deserve to be told precisely what it means, otherwise they will think the worst.

[Mr Hunt]

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

Health Services (North-West London)

Stephen Pound Excerpts

Tuesday 15th October 2013 Westminster Hall

[Ms Buck]

I totally endorse my hon. Friend’s words.

To return to my point about how Hammersmith council is presenting its achievements in winning services for Charing Cross that no one in Westminster or at St Mary’s hospital knows about, Hammersmith continued:

“Charing Cross will also become a specialist centre for community services which means that the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel. It will mean local people will be better supported to live independently at home”.

It was good of Imperial to share that vision with Hammersmith and around Charing Cross, but it is a great shame that it chose not to share a single word with Westminster city council.

Reinforcing my hon. Friend’s point about chaos, however, I am not sure that even that is the true picture, because when I showed the press releases on Charing Cross from Hammersmith council to the chief executive of Imperial in September, I was told that it was spin on Hammersmith’s part and that what was proposed was only a 23-hour ambulatory care model, with no new beds at all. It is hard to square that with Hammersmith council’s vision and harder still to know what is true.

I do not begrudge Hammersmith residents their hospital—quite the reverse—but I am concerned about any sense of deals being done to secure their future, at the expense of local residents in Westminster and, critically, without so much as an opportunity for Westminster council even to consider the matter or to think about support services or the community care dimension, which Hammersmith so rightly talks about as important in a local hospital context and which can be applied to Westminster. If Hammersmith council can proudly claim that its new hospital means that

“the many thousands of older and chronically ill patients, who need regular visits to hospital, will have less far to travel”,

surely that cannot mean that older and chronically ill Westminster residents, who also need regular visits to hospital, should have further to travel—with no debate and no chance to put in place social care support or travel arrangements.

Things get worse. Four weeks after my meeting with the chief executive of Imperial, all my follow-up questions about what that means, whether decisions have been made or what services will be located where still remain unanswered. That is no doubt partly a consequence of the unexpected departure of the chief executive, who has been replaced in what is clearly a holding operation, in a manner that does not indicate a smooth and planned transition.

[Stephen Pound (Ealing North) (Lab)]

Is my hon. Friend aware that one of the justifications for the closure of the A and E department mooted for Ealing hospital is that it will be possible for ill Ealonians to glide effortlessly through the gentle traffic of west London and rock up at St Mary’s in Praed street for their essential treatment? Will she enlighten us as to whether she feels that the closure, or proposed closure, of some of the St Mary’s beds should have been put to the good people of Ealing?

[Ms Buck]

I absolutely agree with my hon. Friend. It is surely impossible to make decisions about one hospital after discussion with only one local authority—with its statutory responsibilities on consultation and delivery of services—and simply fail to talk about them to anyone else. I am afraid that that prompts so many questions about whether Imperial and, possibly, the north-west London clinical commissioning groups have buckled under the political pressure in Hammersmith— I understand that, political pressure is a reality—and have simply failed to recognise that they have responsibilities elsewhere in north-west London.

Things get even worse, I am afraid. I then had a letter from a north-west London CCG to say that the “Shaping a healthier future” programme did not include the St Mary’s site as one of those that would undertake routine planned elective surgery, but that that work was modelled to transfer to the Central Middlesex hospital, which was designated as one of the elective centres in north-west London—the first that any of us had heard about the Central Middlesex being part of the equation, and a fact not mentioned by Imperial. The letter went on to say:

“As the Trust are still undertaking this work and have not reached any conclusions they are yet to consider whether it should propose changing the location of any clinical services between their sites and therefore are not yet in the position to ask the relevant OSCs”—

overview and scrutiny committees—

“about consultation on this”.

Note again, the use of “any”.

Since then, however, further questions have emerged, including the suggestion that almost all elective specialties have already moved. So far from being the subject of future consultation and decision making, they have already moved, without any formal consultation on anything with Westminster council since 2011. That implies that no one actually knows where Westminster residents are being treated—an absence of grip that I find worrying.

Westminster council was therefore prompted to write to Imperial at the end of last week to say:

“We are at a loss to understand the presentation made to the Westminster Adults, Health and Community Protection Committee on September 25th”

when it was told that

“options as to what elective work could be located at Charing Cross Hospital were being investigated.

Westminster were informed by the North West London Commissioning Support Unit that Imperial were on course to develop a first view of the Outline Business Case…for the private meeting of Imperial’s September Trust Board. It was planned that this will take place alongside a discussion on the emerging clinical strategy. Following feedback from the Board, the complete OBC would be finalised to go back to the Board in the autumn for approval—Imperial are required to obtain NHS Trust Development Authority sign-off by Christmas and the OBC needs to be fully aligned as part of the FT application. Westminster are still of the view that the Outline Business Cases for the Alternative Proposals to Ealing and Charing Cross Hospitals (which did not include the transfer of Elective from St Mary’s) are yet to be agreed and are not confirmed.”

That is of substantive importance, and not only as an illustration of a monumental communications breakdown, precisely because health care is supposed to be moving in the direction of greater integration between primary, community and local authority-provided social care. How can such a model exist when a local authority, and, for that matter, some GPs, do not even seem to know where their patients are being operated upon?

Will the Minister ensure that Westminster council and the local CCGs, together with the Westminster MPs, get an accurate status report immediately, including what service changes have taken place over the past two years and without any going to formal consultation? What action can she take to ensure that the whole process of statutory consultation is not undermined by hospitals such as Imperial not even telling councils such as Westminster that substantial service changes have taken place, and that there is clarity on what decisions will be taken when, including in the context of the foundation trust application?

I have one last thing to say before the Minister’s reply, which I am looking forward to. This letter from Imperial, dated 15 February, made me smile:

“Clearly we need to reassess aspects of our attitude to our health care partners in NW London, including the bodies that are newly established as a result of NHS reform. Stakeholders clearly expect more engagement and visibility from me”—

the chief executive—

“and my team in order that we may win and cement your trust. Equally we are too often perceived as defensive and not good listeners in our approach and we are resolved to address that issue at all levels where we interact with the external world”.

That letter, I am afraid, turned out not to be worth the paper it was written on. In fact, we have had something of a car crash on communications over recent months. This matters not for us—not for our sense of probity or self-importance—but for the delivery of health care to patients. This is a serious and structural problem, and I hope that the Minister will not only respond today, but get a grip on the situation, so that we can learn from the mistakes and make urgent improvements.

Tobacco Packaging

Stephen Pound Excerpts

Friday 12th July 2013 Commons Chamber

[Jacob Rees-Mogg (North East Somerset) (Con)]

May I welcome the wise statement made by my hon. Friend today, and remind her that it is often the case that parties in opposition are all in favour of freedom, and when they get into government they are suddenly in favour of the nanny state?

[Stephen Pound (Ealing North) (Lab)]

You had a nanny.

[Jacob Rees-Mogg]

I did indeed; I was very fortunate. [Laughter.] It is a pity some Opposition Members did not, but never mind.

When liberties are removed, it should always be done, as my hon. Friend says, on the basis of evidence, because freedom is very precious, and the state does not have the right to interfere willy-nilly.

Accident and Emergency Waiting Times

Stephen Pound Excerpts

Wednesday 5th June 2013 Commons Chamber

[Stephen Pound (Ealing North) (Lab)]

I think that most people who have heard this debate would agree that we have generated more heat than light. That is a shame, because when one hears the words of my right hon. Friend the Member for Cynon Valley (Ann Clwyd), one realises that this is way beyond a party political issue. This is not about game playing or seeking political advantage for one side of the Chamber or the other. I have sufficient respect for the Secretary of State and the shadow Secretary of State to know that neither of them wishes to go down that road. This matter is simply far too serious.

We have heard tonight that A and E services are often the indicator or signifier—like the canary in the coal mine—that warns about the condition of the rest of the national health service. We have heard about a number of factors. One accusation is that there is a lack of knowledge about A and E.

I spent 10 years working in the A and E department of the Middlesex hospital and University College hospital. I must say that I worked in an ancillary capacity, rather than as a qualified medic, although I did wear a white jacket and would occasionally bluff. There is a huge difference between A and E then and now. Like a lot of MPs, I mystery shop in my local A and E once a month, just to sit and listen to what is being said. The difference between then and now is that virtually everybody who came into the Middlesex was brought in by ambulance and there were very few walk-in patients. I am not saying that it was not in a residential area, because it was. We had an excellent Member of Parliament in my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). Plenty of people did the right thing and voted for him. There is a difference of attitude now. That is exemplified by what we saw last week, when a mother took her daughter to a north London A and E department to ask that a doctor remove canine faeces from her daughter’s shoe in the safest possible way. There is no question but that there is a problem. People’s expectations have changed.

There have been some suggestions today. The prescription of the hon. Member for Colchester (Sir Bob Russell) was risible. The idea that we should lie back with a scalpel in one hand, biting on a bullet and perform our own abdominal surgery was fairly ludicrous. At least, that is how I heard his proposal.

I agree that we should make more use of community pharmacists, but above all we must recognise that we are now in a different world. People do not come to A and E in the middle of the night because they want to; they come to A and E because there is not a walk-in centre they can access during the day and there is no out-of-hours GP service because most of the GPs in London are elderly, single-handed GPs. People go to A and E out of sheer desperation. Yes, there is always a fool who comes in with a headache or something, but if Members go to their local A and E, as many of us do, they will see people who are on the edge of absolute seriousness.

We have to address the totality of the issue. The hon. Member for Southport (John Pugh), in one of the best argued speeches that I have ever heard, pulled the whole thing together. He did not refer to a mosaic of misery, but to all the competing factors. That is what we have to consider.

I do not see the Secretary of State as some Gargantua or Godzilla, crashing through Nye Bevan’s glorious creation and seeking to destroy it at every opportunity; I see him as a man who might be overwhelmed by the scale of the problem facing him. Let us step back from party political advantage and think about the people out there—the exhausted staff in the A and E departments and the patients in pain and agony.

--- Later in debate ---

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

I am grateful for the opportunity to follow the hon. Member for Bracknell (Dr Lee). Given the views he articulated, I hope he will come and canvass for my opponent at the next general election; we would be very happy to have him there. I say that in the context of the situation in the North West London Hospitals NHS Trust, which in 2010-11 was well within the waiting times targets for A and E. Just 2.9% of patients waited more than four hours, but by 2011-12, that figure had risen to some 10.8% at the end of the year, while for the whole of the last financial year the figure is 12.2%—the second worst set of statistics in London, surpassed only by the Barking, Havering and Redbridge University Hospitals NHS Trust, where almost 16% of patients had to wait over four hours.

[Stephen Pound]

I am grateful to my hon. Friend and neighbour for giving way. In view of what he has just said, does he think that the best possible prescription is that currently recommended by the Government whereby the existing A and E departments at Ealing, Park Royal, Hammersmith and Charing Cross all close? Does he think that will improve waiting times in A and E departments?

[Mr Thomas]

My hon. Friend, as ever, is ahead of me. He makes the perfectly reasonable point that if the Northwick Park and Central Middlesex A and E departments are not achieving the 95% target now, how can our constituents have any more confidence about reaching that target should the Central Middlesex and Ealing hospitals close?