NHS Wholly Owned Subsidiary Companies

Tulip Siddiq Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist]

I most certainly do agree. I think this is the start of a very worrying process, not just for facilities management stuff but potentially for other staff.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

My hon. Friend is being very generous in taking interventions. Unite points out that over the past five years, more for-profit companies have won contracts to run NHS services, with the total value of contracts awarded in 2016-17 standing at a staggering £3.1 billion. Does my hon. Friend agree that the Government must compel Her Majesty’s Revenue and Customs to close this tax loophole, so that NHS trusts are not forced to consider outsourcing NHS services?

[Liz Twist]

I most certainly agree that the issue is a dangerous one that needs to be looked at, and it is a very worrying one because, whatever happens, the staff who have transferred are in a very difficult position.

In the longer term, the establishment of the wholly owned subsidiaries leaves services open to privatisation in the future, continuing the fragmentation of our NHS, which is not in the long-term interests of all who use the NHS. There is no evidence that the plans will improve efficiency or productivity in the NHS. They exploit a tax loophole and seek to exploit the future workforce.

North Middlesex University Hospital NHS Trust

Tulip Siddiq Excerpts

Tuesday 12th July 2016 Westminster Hall

[Joan Ryan]

That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.

I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.

In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.

Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.

I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.

The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a

“number of serious incidents…which had raised concerns about the standards of care”.

Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.

The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only

“one commode available in the whole of the ED”—

emergency department—

“to serve over 100 patients.”

Most people reading this will find that shocking.

Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.

In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

I thank my right hon. Friend for securing the debate. Even though the hospital is not in my constituency, much of what she describes happens in hospitals in my constituency and just outside it. At Central Middlesex hospital, which is just outside my constituency but serves many of my constituents, healthcare provision has also been affected by cuts. A recent inspection by the CQC similar to the one that she is describing highlighted a lack of experienced medics for seriously ill patients. Does she agree that such staff shortages threaten patient safety?

[Joan Ryan]

I do indeed, and I am grateful to my hon. Friend for that intervention. One point that I argue most strongly is that, although the MPs concerned are banding together to defend our hospital and fight for adequate and safe service, it is obvious that this is not just about North Mid—North Mid is just the first point where the crisis has hit. This is an issue around outer London, across London and probably nationally, particularly for district general hospitals.

NHS in London

Tulip Siddiq Excerpts

Thursday 24th March 2016 Westminster Hall

[James Berry (Kingston and Surbiton) (Con)]

rose—

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

rose—

[Dr Huq]

Who is first? I give way to my hon. Friend; there are two of her.

[Tulip Siddiq]

I congratulate my hon. Friend on securing this debate. I apologise, because I have to run off in half an hour for an appointment at the Royal Free hospital’s maternity unit. The birth rate is the highest since the 1970s, yet maternity wards in London have been closing left, right and centre. Elizabeth Duff from the National Childbirth Trust has pointed out how disruptive that is to women’s pregnancy and labour. Will my hon. Friend share her experience of the closure of the maternity unit in her constituency?

[Dr Huq]

I thank my hon. Friend for that excellent intervention, which is very pertinent to where she is going after this debate. As a mother who has been through these services, I know that it is massively disrupting if the goalposts are suddenly moved, causing people to travel for longer to get to their appointments. The closure of Ealing hospital’s maternity unit was called a consolidation. It was meant to be part of the centralisation of services, but it has had really adverse effects.

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[Tulip Siddiq]

As my hon. Friend is aware, junior doctors are poised to withdraw emergency cover for 48 hours in April. Does she agree that the Health Secretary’s comments, such as those about the British Medical Association being

“brilliantly clever at winding everyone up on social media”,

show his total disregard for medical professionals who are quite capable of knowing a bad deal when they see it?

[Dr Huq]

My hon. Friend makes an excellent point. The Health Secretary is the one who is winding everyone up. It cannot be advisable to make staff feel undervalued and overworked. The health service cannot run on good will alone, nor can pharmacists and other such professions. The imposition of a new contract that is overwhelmingly opposed by the vast majority of junior doctors is part of a pattern. The majority of NHS staff have faced pay freezes or real-terms cuts in recent years. The Government should accept that they cannot keep asking everyone to do more and more for less and less.

With such a vast topic, there is never time to cover everything. As I said, I did not want to make this speech a blizzard of statistics, so I will briefly highlight one constituent’s case, then I will make some concluding remarks. Bree Robbins, from Ealing Common, actually ended up not coming to my surgery because she was in too much pain to make it in person, so we took up her case on the phone. Her issue is access to breast reconstruction surgery, and there is a question for the Minister here. My constituent was diagnosed with breast cancer in 2013. She underwent a mastectomy and then suffered an infection, which meant that the reconstruction was delayed. Eventually, she underwent partial reconstruction in January at Charing Cross hospital. She now needs that to be completed, but she is experiencing continued delays, even though she is in pain.

The response from Imperial College Healthcare NHS Trust explained that the delay was due to an increase in urgent cancer cases in the plastic and reconstruction department. That is highly unsatisfactory for my constituent and prompts the question, what are the Government doing to ensure that those awaiting breast reconstruction surgery will undergo it in a timely manner, without having to face delays of three years, as my constituents do?

Ealing has an expanding population. Today, the House of Commons Library confirmed that, paradoxically, the number and percentage of the population aged under 18 and aged over 65 are increasing. Those are the two demographics that need NHS services most. The young and old populations seem to be getting bigger—I feel that I am “the squeezed middle”, to coin a phrase, as I am a mother and a daughter who has to run off to NHS services for offspring and parents.

No one doubts the need for comprehensive weekend care and for efficiencies to be made, but too often such plans amount to cutting corners. We heard in the Budget statement about the need for devolution, but the centralisation that we have discussed today is at odds with that. Pharmacists in my constituency fear that, ultimately, they will be merged with GP surgeries—or co-located or whatever it is called—contrary to popular need. People like to have such services at the end of their street.

Cuts are being targeted at the most deprived communities. There is a lot of distrust about the public consultation, “Shaping a Healthier Future”, because it was so flawed. We have mentioned the escalating costs, and the changes are not good value for taxpayers; they are a waste of precious public resources and involve no business plan.

I have not gone into the Government’s long-standing ambition to integrate NHS health services with council-run care services for the elderly. Ealing is not one of the pilot boroughs, so I will leave that subject to my colleagues. Nor are we a pilot borough for the health devolution deal, announced at the end of last year by Simon Stevens, but I will end with his words at the launch. He said:

“In London’s NHS, we’ve got some of the best health services anywhere on the planet, but also some of the most pressurised. London is the world’s most dynamic and diverse city—why shouldn’t it be the healthiest?”

I am sure that both Opposition and Government Members agree, and I am interested to hear other contributions to the debate.

NHS Bursary

Tulip Siddiq Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

I totally agree with my hon. Friend. The new system will certainly help with overseas applicants and agency staff and, as is the aim, it will release extra people into the profession. One concern that we need to address and that I will touch on a little bit later is about the placements and opportunities available after graduation. It is important to ensure that those opportunities are there for nurses. There is no point having a paper-based exercise if there are not enough positions for nurses.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

My reading of surveys and academic studies shows the complete opposite of what the hon. Member for Morley and Outwood (Andrea Jenkyns) said. The different funding arrangements for healthcare courses means that they attract applications from a diverse range of people. The average age of people applying is higher than that of most students—higher than 28. Does the hon. Member for Sutton and Cheam (Paul Scully) think that changing the funding arrangements will deter people from different backgrounds from applying for these courses?

[Paul Scully]

I do not believe so. There were similar predictions for students in general when the student fee loan system came in, but that did not happen. People thought that student numbers would decline. They have not; they have increased. I do not believe that diversity in university courses in general has declined and I do not see any reason why that should be the case with nursing, although I understand the concern. A number of people have raised that concern both in Twitter conversations that we and nurses have had and in a number of events that have been held in the lead-up to this petition debate, including the one immediately before the debate. I understand the concern but I do not see the evidence.

Oral Answers to Questions

Tulip Siddiq Excerpts

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

The “Five Year Forward View”, written by Simon Stevens, takes particular account of rural areas, but of course not all rural areas are the same. It is down to clinical commissioning groups to judge the needs of their local areas and make sure that they are reflecting the specific circumstances in which they find themselves.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

11. What progress his Department has made on expanding access to non-invasive pre-natal treatments in hospitals.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Non-invasive pre-natal testing is not currently offered routinely for screening women in pregnancy for Down’s syndrome and other trisomy conditions within the NHS. However, it is available to detect genetic changes leading to specific skeletal abnormalities and certain forms of cystic fibrosis. The UK national screening committee has reviewed the case for implementing NIPT as part of the existing foetal anomaly screening programme and will provide its advice shortly.

NIPT is not currently offered for Down’s syndrome routinely within the NHS. Some NHS trusts have piloted the test for screening and a number of maternity units offer NIPT privately. NIPT is available through the NHS to detect genetic changes leading to specific skeletal abnormalities and also to detect certain forms of cystic fibrosis.

The UK national screening committee—UK NSC—which advises Ministers and the NHS in the UK about all aspects of screening policy, has reviewed the case for implementing NIPT as part of the existing NHS foetal anomaly screening programme and will provide its advice in the new year.

[Tulip Siddiq]

At my 12-week scan, I was told that I faced a risk of Down’s syndrome in my child. I was given two options. One was an invasive test available on the NHS—the amniocentesis test, which carried a risk of miscarriage. The second was a non-invasive test, which was not available on the NHS and cost £400. Does the Minister agree that the non-invasive test should be rolled out across the country so that mothers, regardless of wealth, can have equal access to screening and do not have to face the unnecessary risk of miscarriage?

[Ben Gummer]

I thank the hon. Lady for bringing her personal experience to the House, and I hope that all is well. She will understand that screening has to be a non-political matter. That is why we have a specific, clinically led committee to look at whether a screening programme should be implemented. It has been looking at NIPTs over the past year and will be making its decision very shortly. On the principle, though, I completely agree with her; it lies at the foundation of the NHS and we support it.

Oral Answers to Questions

Tulip Siddiq Excerpts

Tuesday 13th October 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

9. What additional financial support he is making available to the NHS to help it deal with winter pressures.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

17. What additional financial support he is making available to the NHS to help it deal with winter pressures.

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

Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.

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[Tulip Siddiq]

The Royal Free hospital in my constituency is at the cutting edge of medical research and is currently treating Ebola patient Pauline Cafferkey. I am sure the Secretary of State will join me in wishing her a speedy recovery, yet the hospital faced considerable winter pressures last year. Will the Secretary of State work with the fantastic nurses and doctors at the Royal Free to ensure these winter pressures do not happen again this year?

[Mr Hunt]

I thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.

A&E Services

Tulip Siddiq Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Wright]

My hon. Friend makes a very important point. Having fewer A&E departments puts further strain on other parts of the system, such as A&E at James Cook hospital, and other parts of the NHS, such as ambulance services. They are queuing up outside James Cook hospital, but it does not have the throughput it needs.

It is important that A&E returns to the town of Hartlepool. Given the level of health inequality, as well as the high proportion of older people relative to the rest of the country, there is a greater risk of accidents and, therefore, I think it is fair to say, greater reliance on A&E than other areas.

To be frank—this is not a party political point—the closure was based on clinical safety factors. The number of medical staff to cover two rotas at both Hartlepool and Stockton was deemed insufficient, and the supervision of junior medical staff was deemed inadequate, as it did not meet modern guidance criteria. Additional resources will need to be provided for adequate staffing to ensure that A&E can return to Hartlepool. North Tees and Hartlepool Hospitals NHS Foundation Trust has a financial deficit of £4 million, which is expected to worsen over the coming years.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

In the coming winter months the Royal Free hospital in my constituency will once again face pressure in A&E and other services. Does my hon. Friend agree that the extra winter NHS funding should be allocated sooner rather than later so that hospitals can start planning, and that it should be included in the forthcoming Budget?

[Mr Wright]

My hon. Friend makes a really important point. On the additional resources, the north-east region has not been provided with anything, despite the level of health inequalities and the additional pressure on resources.

Lynne Hodgson, the director of finance at the trust, has said:

“The whole system is stretched financially.”

The situation is so bad that the trust has recently taken out a £2 million loan. That is not for investment in health services—it is not helping to pump prime the return of A&E to Hartlepool—but for paying the wage bills of current staff. When an organisation has to borrow to meet obligations for something as fundamental as its staff’s monthly pay packets, something is fundamentally wrong with the system.

I am arguing for the services to be returned to the town, but given the precarious finances of the trust I am fearful that most services will move further away or simply cease to operate, putting further pressures on the local health economy, such as James Cook hospital, and other parts of health and social care. What will the Government do to ensure that the finances of the North Tees and Hartlepool trust are put on a more secure footing while at the same time allowing such essential services to return to the town?

I fully accept that clinical safety for A&E services is paramount—I will never argue against that—but I have to question the model of acute accident and emergency services in my area. Over the past two decades or so, there has been a tendency to centralise services at North Tees, to the detriment of patients from Hartlepool and those slightly further away in south-east Durham. The momentum programme was going to centralise services on to a single site, culminating in a new hospital at Wynyard that would serve the populations of Hartlepool, Stockton, Easington and Sedgefield. The Government have made it perfectly obvious through their actions that Wynyard will not go ahead, which, together with NHS England’s “Five Year Forward View”, shows that smaller hospitals can thrive. Indeed, we have seen that across the region and the country. Darlington, whose population is only slightly larger than mine and which comes under the County Durham and Darlington NHS Foundation Trust, is able to maintain an A&E. Hexham has a population not of 92,000 like Hartlepool, but of 13,000, and it is able to maintain an A&E at Hexham general hospital. Clearly, centralisation is not the answer everywhere. Different clinical models and reconfigurations are available to allow smaller towns to retain their A&Es.

Oral Answers to Questions

Tulip Siddiq Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

I welcome my hon. Friend to his place. I am very sorry to hear of his constituent’s diagnosis of secondary breast cancer. It is of course vital that the NHS supports all patients in the best way possible, but clinical commissioning groups need to make decisions on whether to commission a particular hair-replacement service for patients based on their clinical benefit and cost-effectiveness. I very much hope his CCG will be looking carefully at that.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

The planned closure of a GP surgery in my constituency means that more than 1,000 patients will have to go elsewhere to seek basic primary care needs. Local doctors are particularly concerned about the impact this will have on the A&E department at the Royal Free hospital. Will the Minister agree to meet me and local doctors to address those concerns and to ensure that the future of GP surgeries in my constituency is protected?

[Alistair Burt]

I welcome the hon. Lady to her place. As has already been covered, the closure of GP surgeries is an issue. They happen from time to time. As my right hon. Friend the Secretary of State said, there will be an opportunity to meet inner-London MPs to discuss this matter.