Accident and Emergency Departments

Virendra Sharma Excerpts

Thursday 7th February 2013 Commons Chamber

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

I beg to move,

That this House has considered the matter of the closure of accident and emergency departments.

On behalf of all my Back-Bench colleagues who wanted time to be allocated for this important debate, may I put on record my thanks to you, Mr Deputy Speaker, and to the Backbench Business Committee for today’s scheduled parliamentary time? The closure of accident and emergency departments is a national issue and one that has profound impacts on the current and future provision of health care across the country. Concerns about the A and E closures and accompanying hospital reconfigurations have been voiced by members of all political parties including Back Benchers and Front Benchers on both sides of the House, so it is crucial that we have this debate.

Weighty decisions are being made about A and E closures across the country by NHS bureaucrats, under the guise of localism and clinically led decision making, without the democratic accountability that is vital for decisions of such importance. In order to bring these decisions to the Secretary of State for Health, local council scrutiny panels have to refer such decisions to the independent reconfiguration panel, which then reports its findings to the Secretary of State. Why are primary care trusts in their dying days making such critical decisions and not clinical commissioning groups? It is vital to have democratic accountability for these decisions and, although it is not sufficient, this debate will shine some much-needed light on these huge decisions that will have profound impacts on all our constituents. I am pleased that the Government have belatedly announced a national review of A and E services, but I am horrified that the review is planning to report by March this year. This is being done in an obscene rush, and it cannot be the considered review that we need.

There are proposed and actual A and E closures in my constituency and in those of other hon. Members. It is clear that this is an NHS-wide change that will affect every constituency in the land. The NHS needs to change and be fit for purpose in the 21st century, and I am not saying that there must be no change. Clearly, we have to provide health care in changed ways, but I am concerned about the pace of change, the impacts on the poorest and the financial drivers of the changes. The financial drivers are clear. The Nicholson challenge means that the NHS is seeking to cut spending by £20 billion by 2014-15.

[Margaret Hodge (Barking) (Lab)]

Does my hon. Friend agree that the care of patients must be at the heart of any changes in the NHS, and not finance? In my part of London, there is a proposal to close the A and E at King George hospital, but it would be madness to do so at a time when Queen’s hospital in Romford has far too many A and E patients and when a Care Quality Commission report has just condemned the quality of care for people who visit that A and E unit.

[Mr Sharma]

I thank my right hon. Friend for putting that case so strongly. I do not think anyone—inside or outside the House—would fail to agree with that suggestion.

In North West London NHS, the proposal translates into a £1 billion cut to budgets over the same time scale. The medical director of North West London NHS said that it would

“literally run out of money”

unless the closures proceeded. The scale of change driven by this financial pressure is unacceptable. It is targeting the poorest and most vulnerable, and it is unfair on the hospitals that have been financially solvent. That last point was graphically illustrated last week at Lewisham hospital, whose A and E was unjustly proposed for closure because of a neighbouring trust’s financial insolvency. That brought tens of thousands of incensed protesters on to the streets.

Sadly, this is happening in Ealing, too, whose hospital is faced with losing its A and E department, yet it is financially viable and has been for many years. It is being sacrificed on account of financial problems in other neighbouring hospital trusts. This threat of closure in Ealing exists even after the Prime Minister assured me, in a response to my question, that there was no such threat.

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

Although this is a debate about the closure of A and E departments across the country, does my hon. Friend accept that it seems particularly unfair that London, with nine accident and emergency departments apparently set for closure, is being hit so hard in losing vital NHS services?

[Mr Sharma]

I agree with my hon. Friend, and I shall definitely cover that point later in my speech.

As in Lewisham, the people of Ealing took to the streets in huge numbers last autumn in protest at the proposals from North West London NHS whereby if the preferred option A is chosen on 19 February, it would mean the closure of four A and E departments in west London: in Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals. The campaign to save our hospitals has been broad and deep, bringing together MPs and councillors of all political parties, and organisations and individuals from all segments of society.

[Martin Horwood (Cheltenham) (LD)]

I am concerned about the future of the emergency department at Cheltenham general hospital. It is not exactly in the same situation as London, but it lies in reasonably close proximity to the Gloucestershire Royal hospital down the road in Gloucester. The consultants and trust management in Gloucestershire tell me that their problem is not financial but the number of consultant posts and more junior medical posts that they can fill, and that there is a national shortage in emergency medicine. Is that a factor in the hon. Gentleman’s constituency, too?

[Mr Sharma]

I disagree with that. The evidence shows that all these decisions are finance-led. It is not to do with the clinicians’ or consultants’ proposals. That may apply in the hon. Gentleman’s constituency, but I can assure him that it is not true of west London.

My hon. Friend the Member for Ealing North (Stephen Pound) will join us later and the hon. Member for Ealing Central and Acton (Angie Bray) will speak later, too. I thank them for their support for our campaign. I would also like to acknowledge the tremendous efforts of my hon. Friend the Member for Hammersmith (Mr Slaughter), who would be in his place here were it not for his Front-Bench duties in the Justice and Security Public Bill Committee. Back in June, when North West London NHS announced its plan to close four of our A and Es, my hon. Friend organised a public meeting, which gave rise to the Hammersmith “Save our Hospitals” campaign. He has been at the forefront of the community campaign in his own constituency and has been instrumental in organising MPs of all parties to come together for this debate. He asked me to mention particularly the threat to Charing Cross hospital, which will lose not merely its A and E but 500 in-patient beds, turning a world-class hospital into a local urgent care centre.

My hon. Friend would have reminded us that this is the second time he has defended Charing Cross from closure. He stands now with his constituents, as he did in the last century during the dark days of John Major’s Government, holding a candle for Charing Cross at its Sunday evening vigils. That light did not go out, and I am sure it will not be allowed to go out now.

Let me now raise some of my specific concerns—as well as welcoming you to the Chair, Mr Deputy Speaker. I have very grave concerns about the way in which the consultation was carried out in north-west London. It was carried out over the Olympic summer months, with an impenetrable document of 80-plus pages and a response document with leading questions that set community against community, doctor against doctor, and hospital against hospital. There were also significant parts of the consultation period when no translated materials were available for many of my constituents who speak various community languages. That was totally unsatisfactory.

Notwithstanding those difficulties, some people in Ealing were able to complete the consultation and overwhelmingly rejected the preferred option that means the closure of Ealing’s A and E, maternity, paediatric and other acute services, and the closure of Central Middlesex, Hammersmith and Charing Cross A and Es. Moreover, a majority of respondents across the whole of north-west London rejected the fundamental premise of the proposed changes—that acute services should be concentrated on fewer sites. I fear that such an inconvenient consultation response will be ignored and ridden roughshod over.

Equally, I fear that the clinical opinion of Ealing’s GPs and hospital consultants who opposed the preferred option will be ignored, despite this being one of the Government’s four tests for such reconfigurations. The clinical concerns are real and should not be brushed over. Let me address some of the key concerns.

First, the scale of change being proposed in north-west London and the associated risks of such large-scale changes is causing great concern. Taking out in one go four of nine A and Es that serve a population of 2 million—set to grow continually over the next 20 years —is a high-risk strategy. Concerns over A and E capacity are growing, as hospitals up and down the country say that their A and Es are full and that they are putting patients on divert to other hospitals. This has happened recently at Northwick Park hospital—one of the hospitals that Ealing patients are meant to be treated at if the four A and Es close. If these proposals go through, yes, there are plans for some increased investment at both Northwick Park and Hillingdon A and Es, but there are well over 40,000 patients a year using Ealing hospital’s A and E alone, in addition to those currently attending Central Middlesex, Charing Cross and Hammersmith—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I think the hon. Member was told that he had a 10-minute limit imposed on him, as applied in the previous debate. Sadly, however, his time is up. If he wants to make a concluding remark, however, I think the House would allow him to do so.

[Mr Deputy Speaker]

We will give the hon. Member two minutes to conclude.

[Mr Sharma]

Thank you very much, Mr Deputy Speaker.

Let me finally say to the Minister that there should be a moratorium on all A and E closures until a proper, considered and full review of A and E services has been carried out, as opposed to the current rushed review. I hope that the Minister will listen.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am extremely grateful to you, Mr Sharma, for your understanding.

From now on, Back-Bench speeches will be limited to eight minutes.

--- Later in debate ---

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

[Mr Sharma]

Is this not the story of every trust, including Ealing and other west London hospitals, where the local consultants and GPs have totally opposed such proposals but the threat of closure still exists?

[Stephen Lloyd]

I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.

--- Later in debate ---

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

[Mr Virendra Sharma]

rose—

[Anna Soubry]

I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.

Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.

[Mr Virendra Sharma]

How disappointed I am that the Minister failed—utterly failed—to address the issue—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sadly, time has defeated us.

Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

My hon. Friend is absolutely right to highlight those issues and the emerging findings from the survey. It is important to say that data will be a key consideration in how the next spending review is shaped, along with the priorities that the Government will give to different demographic pressures as a result.

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

13. What recent representations he has received on the reconfiguration of children's heart services.

[The Minister of State, Department of Health (Mr Simon Burns)]

I have received representations about the review of children’s heart services via letters, parliamentary questions and e-mails from hon. Members, via letters and e-mails from organisations and the public, and via meetings. My right hon. Friend the Secretary of State has received two overview scrutiny committee referrals, one from the Yorkshire and Humber joint health and overview scrutiny committee and one from the royal borough of Kensington and Chelsea.

[Mr Sharma]

Is the Secretary of State confident that the committee has properly balanced the clinical decisions with the practical transport issues faced by families of children with heart problems?

[Mr Burns]

The assurance I can give the hon. Gentleman is that we certainly believe so, but these are matters for the joint committee of primary care trusts, which carried out this review. As he will appreciate, it is totally independent from the Department of Health, and rightly so.

Adult Social Care

Virendra Sharma Excerpts

Monday 16th July 2012 Commons Chamber

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

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate.

I am often contacted by my elderly constituents and their families about social care and its funding, and I can tell the House that it is a massive worry to many of them. While I welcome many of the “in principle” recommendations in the Government’s White Paper, their lack of commitment to reforming the long-term funding of social care means, in effect, that they are kicking this urgent reform into the long grass. Dilnot recommended capping social care contributions at £35,000 and increasing the means-tested savings figure to £100,000. Supporting that in principle is all well and good, but the fact that the Government are not proposing anything specific until the 2013 comprehensive spending review and not implementing anything this side of the general election means that thousands of my constituents will continue to face anxiety about the potential cost of their social care and a substantial loss of their lifetime savings. One in 10 of them will face catastrophic social care costs of over £100,000. That is not acceptable and shows that the Government are out of touch and ducking the issue.

Social care funding is in crisis. Councils across the country have been forced to cut £1 billion from social care. In Ealing, the Labour council has had its overall budget cut by 30%. With a substantial proportion of its budget being spent on adult social care, it is struggling to protect the most vulnerable, who depend day in, day out on the social care that it provides. It has found 70% of the £85 million that it must cut over four years from efficiencies and has cut a smaller percentage from adult social care to try to protect the vulnerable.

The spend on social care is decreasing while the number of elderly people in need of social care is increasing. The Local Government Association recently released a report on local government financing that made it clear that with the elderly population and the cost of social care both increasing, unless the Government reform social care funding urgently, by the end of the decade, councils will be able to pay only for social care and all other council services, such as refuse collections, will have to stop. That is not a sustainable situation for social care or for other council services. The Government cannot afford to do what they have done in this White Paper. They have not grasped the financial nettle, but have kicked social care funding into the long grass.

One action that the Government could take immediately would be to use some of the £1.7 billion underspend from the NHS—£1.4 billion of which has been returned to the Treasury—to tackle the funding crisis in social care. Labour is sensibly calling for £700 million of that underspend to be given to councils immediately to tackle the crisis in social care funding. That would be a significant step that would help my constituents who have social care needs. The need for a long-term funding solution is critical. I hope that the Government will engage urgently in all-party talks so that a solution can be found without further delay. I therefore support the motion.

National Health Service

Virendra Sharma Excerpts

Monday 16th July 2012 Commons Chamber

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

Thank you for giving me the opportunity to speak in this important debate, Mr Speaker. I wish to bring to the House’s attention some of the realities on the ground.

NHS North West London is currently conducting a flawed consultation, which is cynically being held during the Olympics and the summer months, on proposals for the reconfiguration of acute hospital services. The proposals would mean the closure of four out of nine accident and emergency departments, including Ealing’s, and the effective closure of Ealing hospital, my local hospital. My right hon. Friend the shadow Secretary of State recently described those shocking proposals, accurately, as “butchery”, not reconfiguration.

The proposals are put forward as clinically led, but that is far from the truth. At a recent meeting convened to discuss them, consultants at Ealing hospital and GPs from right across the London borough of Ealing voted unanimously against the proposal to close Ealing hospital. Other clinicians from right across north-west London are also opposed to the changes, and the hon. Member for Ealing Central and Acton (Angie Bray), who has just left the Chamber, has rightly said that they are financially driven. I take this opportunity to congratulate and thank the staff at Ealing hospital, who are working hard to provide services to patients during this time of uncertainty.

The Nicholson challenge means that across the country, £20 billion of savings must be found in the NHS by 2014, and £1 billion of that is earmarked to come from north-west London. It is clear that this is a top-down restructuring of hospital services, driven totally by financial considerations. The proposals are being railroaded through by the remnants of the old PCTs before they are abolished next April and replaced with clinical commissioning groups. That is a top-down reorganisation of local hospitals by an unaccountable body that, after making these major decisions, will no longer exist. That flies in the face of what the Prime Minister said to me at Prime Minister’s questions—that such a decision should have the support of local doctors and patients. Local GPs and patients are overwhelmingly against the proposals, so they should be withdrawn immediately. The Prime Minister has also repeatedly told me that there are no plans to close Ealing hospital. Given that after his visit to Ealing he said that he liked what he saw, I expect him to join me, local doctors, patients and all political parties in opposing the plans.

The Secretary of State, too, is on record as saying that there were no plans to close Ealing hospital’s A and E, and as asking where all the people who use it would go. Approximately 100,000 people a year attend there, of whom 55,000 use the urgent care centre and 45,000 are treated in the full A and E department. Where will all those people go for treatment if Ealing’s A and E is closed? Other A and E departments that are not proposed for closure are already under pressure from their own population and would not be able to cope with the extra numbers. Services would suffer, and waiting times would become intolerable.

The preferred option being consulted on also includes the closure of the Central Middlesex, Hammersmith and Charing Cross A and Es. That would be reckless and dangerous, and would leave a large swathe of west London without adequate A and E cover. Three London boroughs—Ealing, Brent and Hammersmith—would be left without any A and E. What would happen if there were a major incident similar to the Southall rail crash in Ealing or elsewhere in west London, or, God forbid, an air crash or terrorist incident?

The plan is opposed by clinicians, patients, politicians of all parties and members of the public, and it should be scrapped immediately. I will support the motion this evening.

Hospital Services (West London)

Virendra Sharma Excerpts

Wednesday 11th July 2012 Westminster Hall

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

Thank you for allowing me to speak in this important debate, Mr Gray. It is important to my local constituents and to me personally. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing the debate and thank him for allowing me to join him and speak in it. I agree with everything that my hon. Friends have said. As hon. Members have repeatedly said, this is not a scaremongering debate and we are not taking a party political line—these are the genuine concerns expressed by constituents and health professionals.

I will not repeat my colleagues’ arguments on whether the consultation is fair and transparent, but I hope that the Minister will take this one point on board about the way that people are being asked to access the document—by making a request, downloading and then responding online. I do not know about other areas, but in my constituency the people who are going to respond are those who are very keenly concerned because they have used the services before and they have lived in the area for many years. Many of my constituents will not have access to the documents and will not be able to respond.

I hope the Minister will take that point on board and understand the reasons for it. There are old people who do not have access to computers. Ethnic minority communities, whose first language may not be English, will not have the access to do that, either. It is not easy. There is always the response that they could ask friends, relatives and others, but it is not that simple to respond to the fear that the hospital services are going to close. Those people should be taken into account as well.

The future of all the hospitals in north-west London lies in the balance. I am particularly concerned about Ealing hospital, which is very close to my heart. My two grandchildren were born in Ealing hospital, my daughter worked there and I live just a short walk away. Many of my constituents depend on Ealing hospital for life-saving treatments.

It is therefore with shock and anger that I speak about the current proposals to close Ealing’s accident and emergency unit, maternity unit, paediatric services, intensive care unit and other acute services. If the proposals go through, they will mean the effective closure of Ealing hospital. It will cease to be a district general hospital and be little more than a glorified polyclinic, with the surplus land sold off for luxury flats. I am deeply concerned about the proposals, and fear that they will have a significant detrimental impact on the health care that my constituents receive. It is being said that the proposals are clinically led, but the House should be aware that Ealing hospital consultants and local GPs almost universally oppose them. It is clear to me that the proposals are financially driven and that clinical care for my constituents will suffer.

I have been warning for some time about the significant threat to Ealing hospital. I have had numerous exchanges on the subject with the Prime Minister at Question Time. In October 2010, in answer to my specific question about whether there were any plans to close Ealing hospital, the Prime Minister gave a broad answer. He stated that the purpose of the health reforms was to put decisions about A and Es in the hands of patients and doctors, and that decisions to close A and Es that did not do so were often wrong. I agree.

[Seema Malhotra]

My hon. Friend rightly raises the particular circumstances of Southall and the surrounding areas, where there is a distinct community that operates in a particular way. Decisions about health care must take into account not just clinical issues but how a community behaves and how its members access health care.

[Mr Sharma]

I am sure that the Minister will take note of that and will respond.

Ealing is a case in point, as the decision is being made by the unaccountable north-west London primary care trusts in their dying days before they are abolished, and not by patients and doctors. Patients and doctors are firmly against the proposals. I ask the Minister to listen to them and abandon the proposals.

After the Prime Minister visited Ealing hospital in May 2011 to deliver his keynote speech on the Government’s health reforms, I again asked him specifically at Prime Minister’s Question Time whether there were any plans to close Ealing hospital. In his answer to me on 8 June 2011, he said that he was impressed by what he saw, stated twice that there were no plans to close Ealing hospital and said that the maternity service was undergoing phased redevelopment. Those assurances and answers now seem hollow and almost worthless unless the Prime Minister intervenes to stop the closure of Ealing hospital.

The Secretary of State for Health has also said on the record that there were no plans to close Ealing hospital’s A and E, and asked where all the people would go who use it. My hon. Friend the Member for Hayes and Harlington (John McDonnell) has given the figures on how many people use the services, and I am sure that the Minister will have taken note.

My constituents, local GPs and hospital consultants, local Members of Parliament and councillors of all political parties are totally opposed to the proposals, and there is a massive campaign against them. I ask the Prime Minister and the Secretary of State to listen to local people and intervene to safeguard our health services at Ealing hospital and other hospitals in west London. Lives are at risk and the future of the health service is at stake. With the support of Ealing Hospital SOS, Ealing trades council, Ealing council and West London Citizens, I will not stop campaigning, and neither will my hon. Friends and constituents, until the proposals are stopped dead in their tracks.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

As ever, it is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this important debate. As we have heard, there is widespread concern in his constituency and throughout the capital about the future of hospital services in west London. He has been doing a great job in raising the issues, and has done so again today.

NHS North West London claims that its proposals, as outlined in the “Shaping a healthier future” programme, will improve NHS services for the 2 million residents of the area and save lives. As we have heard, the proposals will lead to the loss of accident and emergency departments at Charing Cross, Ealing, Hammersmith and Central Middlesex hospitals. That means that people will have to travel further for treatment. I ask the Minister: how will that help save lives, and does he agree with NHS North West London’s analysis?

It is not only my hon. Friends who are concerned about the future of A and E departments in west London; the local authorities in Ealing and Hammersmith and in Fulham are also formally opposed to the proposals and committed to fighting the downgrading of their hospitals.

We all know what happens to hospitals after they lose their A and E departments. We have seen in other cases hospitals lose their A and E departments and, sadly, subsequently become glorified health centres without proper resources to provide immediate health care to the local community.

Charing Cross hospital has a 200-year history of providing a wide range of services and is one of the capital’s largest teaching hospitals. It has one of London’s busiest A and E departments, which had 69,300 cases last year. Under the proposals, it will be downgraded to a local hospital. Ironically, while in opposition, the Conservative party often produced and perpetuated unfounded scaremongering about the future of Charing Cross hospital—my hon. Friend mentioned it in his opening remarks—yet now seems content for it to be downgraded under its watch.

It is understandable that there is such widespread concern about the proposed closures in my hon. Friend’s constituency. The whole of the borough of Hammersmith and Fulham will be left without an accident and emergency department; facilities that both the Prime Minister and the Secretary of State had promised to save as recently as last year will close. Travel times to the nearest alternatives could be far too long. As we have heard from both Government and Opposition Members, journeys to the hospitals run by the Chelsea and Westminster Hospital NHS Foundation Trust can be subject to delays of up to an hour in heavy traffic. That could put the lives of many west London residents at risk. What action does the Minister’s Government propose to take to ensure the safety of my hon. Friend’s constituents and the residents of west London as a whole?

The Secretary of Sate has not, to date, taken a clear position on the proposals, and I understand that he wrote to my hon. Friend on 3 July to say that they are a matter for the local NHS. I appreciate that the consultation closes on 8 October and that, according to the Secretary of State, no final decision will be made until early next year. The plans, however, are not only unpopular with local people; other Conservative politicians, such as Councillor Joe Carlebach of Hammersmith and Fulham council, have not refrained from taking a position and have openly voiced their opposition to the plans.

[Mr Virendra Sharma]

My hon. Friend may recall that, during his visit to my constituency, many constituents voiced their opposition to any threat to Ealing hospital.

[Andrew Gwynne]

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

Cancer Treatments

Virendra Sharma Excerpts

Tuesday 19th June 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray, and to contribute to this important debate. I congratulate the hon. Member for Southport (John Pugh) on securing it.

Macmillan Cancer Support estimates that 2 million people in the UK today have had a cancer diagnosis—the number is expected to continue to rise by 3% a year—and that nearly 4 million people will be living with cancer by 2030. Currently, 8,000 people are living with, or beyond, cancer in my constituency alone. Those figures show clearly that the NHS has a demographic challenge on its hands. It will need to become ever more efficient in treating and supporting cancer patients if it is to continue to meet clinical and non-clinical needs and deliver improved outcomes.

Surprisingly, the findings of the international cancer benchmarking project 2010 revealed that survival rates of cancer patients in England continue to lag behind countries such as Denmark, Sweden, Australia, Canada and others. Decisive steps are needed to ensure that England matches the European average and to prevent the country letting down people affected by cancer. The Government have acknowledged that, despite some improvements, cancer outcomes in England remain poor when compared with the best outcomes in Europe, highlighting a significant gap that remains in both survival and mortality rates. In response, the Government put together a cancer strategy that set out a commitment to improve the outcomes and experiences of cancer patients and an ambition to save 5,000 additional lives a year by 2014-15.

I wish to focus first on how we plan to measure how well the NHS has responded to that cancer challenge and whether providers and commissioners are sufficiently incentivised to meet the Government’s ambition. The updated NHS outcomes framework for 2012-13 includes two cancer-specific measures to drive improvements in the earlier diagnosis and more effective treatment of cancer: for one and five-year cancer survival rates for breast, lung and colorectal cancer; and for the under-75 mortality rate from cancer. Although that is a welcome first step on the road to meeting the cancer challenge, I understand from charities such as Macmillan that those indicators are currently too limited, as they measure survival rates for the three most common cancers only. The NHS should be encouraged to improve earlier diagnosis of rarer cancers, which account for almost 50% of all new cancer diagnoses.

I have learnt recently that the commissioning outcomes framework for 2013-14, which will be used to measure improvements in cancer services and outcomes locally, might not even include one and five-year survival rates for breast, lung and colorectal cancer. That unhelpful disparity could result in clinical commissioning groups not placing enough emphasis on the early cancer diagnosis and, ultimately, undermine the ambition of saving 5,000 extra lives a year by 2015. At present, the cancer-specific indicators are too limited to truly measure how well the NHS is responding to the cancer challenge. I should be grateful if the Minister updated hon. Members on the plans to extend one and five-year cancer survival rates to cover more cancers and to include those indicators in both the NHS and commissioning outcomes frameworks.

The cancer strategy also provided that early diagnosis would continue to be a top priority and

“will be included in the mandate for the NHS Commissioning Board for the future”.

Ahead of the Department of Health consultation on the mandate, will the Minister provide assurances that the mandate will include an objective to improve early diagnosis for all types of cancer, as a way of improving outcomes?

Alongside improving early diagnosis and outcomes, the Government have placed a welcome emphasis on improving the experiences of cancer patients. I, too, congratulate the Government on agreeing to run the national cancer patient experience survey again in 2012-13. The national cancer patient experience survey 2010 revealed that

“white cancer patients report a more positive experience of care than other ethnic groups—particular differences were noted on questions around receiving understandable answers, being given enough care after discharge and staff working well together.”

Similarly, people with a disability or mental health conditions, people from the lesbian, gay, bisexual and transgender community and people with rarer cancers also reported a less positive experience.

In Ealing Hospital NHS Trust, only 48% of patients responded that they got understandable answers to questions all or most of the time and only 51% responded that patients had confidence and trust in all ward nurses. The Department of Health has stated that

“commissioners will wish to encourage providers to take note of the differences and to consider positive action to address the distinct need of people from different groups.”

I believe that the Government’s approach to improving patient experience could be even more proactive. The national cancer patient experience survey should be developed as an indicator and included in the NHS outcomes framework. That is the only way that commissioners, providers and the NHS Commissioning Board will have a clear incentive to address areas identified for improvement. Will the Minister explain whether there are plans to correlate the cancer patients experience survey with the NHS outcomes framework to improve outcomes?

Now that the Health and Social Care Act 2012 has been passed, the Government have an opportunity to refocus on effective implementation of their reforms and, more specifically, on delivering their commitments to improving cancer outcomes. It is my view that every cancer patient—regardless of who they are, where they live or what cancer they have—has the right to high- quality care, support and treatment. I ask the Minister to consider the contributions that he hears today to make sure that England’s health and social care system is not just meeting the European average for cancer outcomes, but taking the lead.

--- Later in debate ---

[Liz Kendall]

I thank the hon. Gentleman for his intervention. He was lucky enough not to experience the 16 weeks of the two Public Bill Committees that considered the Health and Social Care Bill, when I regularly raised the key concerns, such as how to improve outcomes for cancer and heart disease and how services, not structures, needed to be reformed to do that. If he has a spare moment and reads the report of those debates, I am sure that he would become aware that I was very concerned about how to improve patients’ lives, their experience and the quality of care, which is always the issue for me. My concern was always about whether the reforms would do that.

I return to the point that I was making about local authorities’ role and the concern that, under the mandated public health services that local authorities will have to commission, public awareness campaigns, including those for cancer, are not included. There is a real worry among public health professionals and those working for and with cancer patients about whether public health awareness campaigns, such as the bowel cancer awareness campaign, which certainly attracted my attention, will continue.

A second issue is how to improve GPs’ skills and their awareness of cancer. Many GPs see cancer patients relatively infrequently, particularly those with rare cancers. Will the Minister explain what national or local action may be taken to ensure that skills and awareness improve?

We want to ensure that, when people are referred by a GP, they have swift access to diagnostic tests. That is about not just good outcomes, but the quality of their experience. Anyone who has had the misfortune of themselves or a family member waiting for cancer diagnostic tests knows that it is a frightening experience and that it should be done as quickly as possible. There were big improvements under the previous Government in speeding up diagnostic tests, but there is evidence that the service is going backwards. Some 78% more patients now wait more than six weeks for diagnostic tests compared with May 2010, and there are even bigger increases in the number waiting for vital tests to diagnose cancer. Some 230% more patients now wait more than six weeks for endoscopic diagnostic tests, and that includes a 242% increase in the number waiting more than six weeks for colonoscopy and a 140% increase in the number waiting more than six weeks for MRI scans. What action could and should be taken to reduce those diagnostic waits, which is vital to improve one-year survival rates?

Turning to the important issue of treatment variation, I want to put on the record the excellent briefing from the King’s Fund, “How to improve cancer survival”, which goes through the issues in detail, with the best clinical evidence and the implications for services on the ground. Treatment factors can be divided into four main groups: surgery, radiotherapy, cancer drugs and the overall co-ordination of care. On surgery, there is a lot of evidence that the outcomes for many types of cancer might be better in centralised, specialist centres, particularly for complex surgery, because their use can lead to better training for surgeons. If they have a higher case load, doctors develop greater expertise and experience. More specialist support is available, such as nursing and intensive care, as well as superior equipment. One concern that we raised when discussing the Health and Social Care Bill and reorganisation was who will lead the strategic configuration that is needed to centralise some services, such as cancer, into specialist centres.

Radiotherapy has a significant although modest overall impact on five-year mortality rates. Obviously, the optimum proportion of patients with cancer who should receive radiotherapy varies by tumour type and stage, but it is thought that overall around 50% of patients with cancer would benefit from radiotherapy. However, in 2005, the radiotherapy access rate in England was 38%. That was one reason why the former Government introduced a new strategy, “Radiotherapy: developing a world class service for England”, in 2007. Can the Minister update me on any progress on that?

I am sure that the Minister will talk about the cancer drugs fund and the Government’s aim of improving access to such drugs. He will know that concern remains that the fund has not removed variations from the system. There have been underspends in some parts of the country, and some regional cancer drug funds approve drugs that others do not. The King’s Fund raises a bigger question in its document. It says that it is more important to improve access to surgery and radiotherapy overall. It is worried that there has been almost too much attention on the cancer drugs fund and not enough on the variations in radiotherapy and surgery.

I am really concerned about older people and the variation in their care. Will the Minister say whether the Government will look into that specifically? Older people are under-treated, and their outcomes for cancer are worse as a result, even when account is taken of the different types of tumour and the presence of other diseases or co-morbidity. Older people are less likely to receive intensive treatment and more likely to be admitted as an emergency.

Crucially, major international studies show that differences in survival rates between the UK and other countries are greater for older people. We are not sure of the reasons for that based on the evidence, but the King’s Fund suggests that there may be three key issues: even later presentation; co-morbidity with older people having two, three or more other long-term chronic conditions, which may lead to cancer then being misdiagnosed or not diagnosed; and age discrimination and the feeling that, because someone is getting older, their health is perhaps not so important. I am pleased that the Minister will implement the ban on age discrimination in public services that the former Labour Government introduced. I am very keen that the Government look more into that issue as part of their work on cancer.

I wish to say something about co-ordination of care, which, as we know, is important for patients and the patient experience. During debates on the Health and Social Care Bill, we asked whether cancer networks would continue in the NHS and, if so, how they would be funded. In May last year, the Secretary of State for Health said that the Government would fund and support cancer networks in 2012 and that, after that, the NHS Commissioning Board would continue to support and strengthen them. Over a year later, however, the future of cancer networks is still unclear.

The NHS Commissioning Board has recently published early proposals for clinical networks, which include the new strategic clinical networks prescribed by the NHS Commissioning Board. The proposals also mention 14 to 15 overarching networks in England that will cover a specific geographical area and review the work of the prescribed strategic clinical networks every six months. I think, however, that people are still quite confused about how that will work, and the Government’s proposals do not refer specifically to the 28 cancer networks. I therefore ask the Minister whether all 28 current cancer networks will become prescribed strategic clinical networks, or will their number be reduced? How will they fit into the umbrella networks?

Funding is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-13, just as in the previous two years. Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states:

“Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.”

That seems to imply that the £10 million is to run not only cancer networks but all clinical networks and senates and that would be a cut of £8.5 million to the cancer networks. Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.

I will conclude by mentioning the patient experience. Several hon. Members have rightly mentioned the need for the patient’s experience of a service to be placed at the heart of what the NHS is trying to achieve. I agree with the call from Macmillan Cancer Support and Breakthrough Breast Cancer for the NHS cancer patient experience survey to be included as part of the fourth domain of the NHS outcomes framework, which is about ensuring that people have a positive experience of care.

The cancer patient experience survey shows that the NHS does well on issues such as waiting times, pain control and patients who feel that they have been treated with dignity and respect. It does not, however, do as well as it could on issues such as patients receiving written information about their condition, financial help, clinicians who work well in a hospital and the community and whether there is enough nurse support. Those are important matters for patients.

[Mr Virendra Sharma]

Does my hon. Friend agree with expectations that the system will work more closely in partnership with the third sector, so that when patients come into the community they get support from that as well? We need a partnership that works together to improve the condition of patients once they are released from hospital.

[Liz Kendall]

I absolutely agree. Last year, I visited the oncology and radiotherapy wards at Leicester royal infirmary, and I saw the work done by Macmillan Cancer Support to help patients with cancer and their families. It had a multi-disciplinary team that worked around the needs of the individual patient and their family and involved not only doctors, nurses and radiographers in the hospital, but GPs, physiotherapists, occupational therapists, dieticians and pharmacists in the community. Macmillan Cancer Support does excellent work to improve the information and advice that is given to patients and their families, and it deals sensitively with issues such as when patients might want information, how it is provided and what is wanted by different family members. I am very supportive of that.

NHS (Foreign Nationals)

Virendra Sharma Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

Thank you, Mr Streeter, for calling me to speak. It is an honour to serve under your chairmanship.

I very much appreciate having the opportunity to speak on the issue of foreign nationals’ use of the NHS today. I know that it is of concern to all Members of the House, regardless of political party, because for many of us it is a huge issue for our constituents, who are genuinely concerned about the NHS, which is free at the point of use.

Obviously, the constituents I speak to accept that we should never turn away at the door anybody who is in genuine need, whether they are asylum seekers or not. Obviously, there are big public health issues and I welcome the fact that the Government have extended HIV treatment to those people in need regardless of nationality, because that will benefit the whole of our society. However, we cannot get away from the fact that there is a large issue, and one that is growing, regarding the use of NHS facilities by foreign nationals who are ineligible for free care.

As a member of the Health Committee, I am particularly concerned about this issue and I have put down several parliamentary questions, dating back to last year. The Government responded that roughly £35 million had been written off by hospital trusts, in terms of debts that had been accrued by foreign nationals and that had neither been paid back nor claimed back. The trusts involved did not include foundation trusts, so I made a freedom of information request of all trusts across the country. The data that I received back from the 118 NHS trusts that replied to me showed that just over £40 million of debt accrued by foreign nationals had been written off.

Those data also showed that there is a huge variation in relation to the collection of debt accrued by foreign nationals. The highest figure for such debt was for Guy’s and St Thomas’ NHS Foundation Trust, which had written off almost £6 million of such debt since 2004. My own local trust, North Bristol NHS Trust, had written off £1.7 million of such debt. The data showed that some trusts were acting contrary to the regulations and the current guidance, which

“place a legal obligation on the trust providing treatment to identify those patients who are not ordinarily resident in the United Kingdom; establish if they are exempt from charges by virtue of the Charging Regulations; and, if they are not exempt, make and recover a charge from them to cover the full cost of their treatment.”

That is what trusts should be doing when foreign nationals who are ineligible for free care come through their doors. However, it was clear from the information that I received in response to my FOI request that many trusts were not even collecting those data, which is contrary to the guidance. Of those trusts that were collecting the data, some had gone back to 2000 to collect them and some had gone back to 2004. There was a large variation in the data that cannot simply be explained by the fact that some trusts were more willing than others to claim back the debt that they were owed from foreign nationals.

There is anecdotal evidence, too. I have heard from some Members who wanted to be in Westminster Hall today for this debate but were unable to make it, and they asked me to raise some issues. In particular, one MP had a constituent who had come to them regarding an American visitor who was staying with them. During their holiday, the American visitor became ill and attended NHS facilities for treatment. They then contacted their medical insurer in the US, which suggested that they provide proof of the cost of their treatment; the American visitor would need a receipt from the NHS, so that they could claim back the money from their medical insurer. However, when they contacted the trust in question, they were told that no such receipt was available and the trust itself had not collected the data about the nature and cost of their treatment, even though this visitor was a foreign national and ineligible for free NHS care, and actually wanted to pay the bill because they were very grateful for the fantastic treatment that they had received. Consequently, a receipt could not be provided.

So there are examples of how trusts are clearly not following the guidance and collecting NHS debt from foreign nationals. It is particularly worrying that a 2008 survey of NHS managers suggested that a third of them did not even bother to ask patients whether they were eligible for free treatment when they arrived at hospital.

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

Is the hon. Gentleman now talking about those foreign nationals who arrive here specifically to receive treatment, or those foreign nationals who come here as visitors, become ill and are then unable—for whatever reason—to pay for their treatment? We must not mix the foreign nationals with political asylum seekers, overstayers and others who, for whatever reason, live here for many years but are not eligible to receive NHS treatment. Is the hon. Gentleman mixing those two groups, or separating them?

[Chris Skidmore]

No, I am certainly not mixing them and I will come to the issue of eligibility that is defined around the term “ordinarily resident”. I want to talk about that in terms of the historic issues that determine whether foreign nationals should be charged for treatment. Obviously, there have been various reports in the past decade, including a 2007 report by the Joint Committee on Human Rights that examined services available to asylum seekers, and those reports have raised that very issue. If access to care and treatment was denied to those who are vulnerable and in genuine need of care, that would undeniably make the situation worse and cause them far greater distress and harm. In those circumstances, we have a right and a moral duty to ensure that people are treated.

On the other hand, we have what some red-top newspapers might call “health tourism”. I use that phrase with some trepidation, because the situation is certainly more complicated than that phrase implies; it suggests that people are simply flooding in across our borders to ensure that they can receive NHS treatment, and that is certainly not the case. There are eligibility criteria that apply, but my concern is that they are not being applied strictly enough by various trusts. On the back of the previous Government’s consultation on this issue, between February and June 2010, the current Government have now decided to tighten certain eligibility criteria, particularly regarding asylum seekers and specifically when asylum seekers have their right of asylum refused.

There is obviously an issue with border security as well, and I welcome the fact that the Government have introduced measures, through the Home Office, in relation to those who have left the country with unpaid debts to the NHS of more than £1,000. I put down a written question that suggested that each year there are 3,600 foreign nationals who accrue such a debt for their NHS treatment and that they should not be allowed re-entry to this country unless those debts were paid off. There is a spectrum through which one has to view who is a foreign national and who is “ordinarily resident”.

I do not deny that establishing the difference between those two groups can be very difficult and that there is a very fine balance to strike. Nevertheless, it is clear from the data that I have received in response to my FOI request that the current system is not working. If there is a situation, as there is at the moment, whereby debts are being accrued and not reclaimed, and whereby a third of NHS managers are not even asking patients whether they are eligible for free treatment or whether they are a foreign national, that is a very big issue.

In many ways, one can understand why someone working within an NHS trust would not want to ask someone about their nationality; it might simply be easier to provide treatment. That is because of the simple fact that, once someone has been categorised as a foreign national and therefore they must be charged because they are ineligible for free care, those charges must be recouped. The costs of recouping those charges could far outweigh the charges themselves.

Moreover, I do not deny that some patients will turn up at an accident and emergency department or trust with a particular complication, which becomes severely worse. For whatever reason, they happen to die and there is no way in which the charges for which they would have been liable can be recouped. All those particular situations need to be taken into account.

In the Health Committee, we looked at how different trusts operate and collect their debts, or even monitor which people coming through their doors are eligible for free care and treatment. West Middlesex University hospital has what is called a “stabilised discharge system”. If a foreign national is admitted to hospital, the doctor first establishes whether there is a need for urgent life-saving treatment, which is obviously a priority for the NHS. If that is not the case, the person is told what treatment is required and how much it costs. If they are unwilling to pay, they are asked to leave. That policy in the hospital nearest Heathrow airport has saved the hospital £700,000 in each separate year. Even within the existing guidance and criteria, there are the means and possibilities by which trusts can ensure that the criteria are followed correctly and that savings can be made. I am sure that if every trust acted in the same way as the West Middlesex University hospital, we would see the amount of debts incurred by foreign nationals drop significantly.

The hon. Member for Ealing, Southall (Mr Sharma) mentioned the criteria around a foreign national and who is and is not eligible for care. The context of this debate, as I mentioned, is an historic one. It was not until 1989 that the British Government began to require certain overseas visitors to pay for hospital treatment. That was defined in regulations in 1977, when legislation permitting persons not ordinarily resident in the United Kingdom to be charged for NHS services began to be looked at.

How we define someone who is not ordinarily resident, as opposed to someone who is ordinarily resident, is interesting. In a way, it is a common law concept, but in NHS health care legislation there is no definition of “ordinarily resident”. The only definition comes from a 1982 judgment in the House of Lords, which was actually in the context of the Education Bill that was passing through the other place at the time. The definition of “ordinarily resident” was:

“living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, whether they have an identifiable purpose for their residence here and whether that purpose has a sufficient degree of continuity to be properly described as ‘settled’ ”.

That means that UK citizenship and past or present payments of UK taxes or national insurance contributions, contrary to what many of our constituents might think, are not directly taken into account in the way that “ordinarily resident” has been defined.

In the review that they are currently conducting, I urge the Government to consider how we will define “ordinarily resident” in future. The NHS is a contributory system that people pay into to receive free care at the point of treatment. That is right. The NHS is free for citizens who have paid into the system. It cannot be a free-for-all for everybody to use. Our constituents wish us, as legislators, to address that concern.

It is clear that the current rules and regulations, having been addressed and re-addressed over time, have caused some confusion. In 2007, the Joint Committee on Human Rights produced a report on services to asylum seekers. It suggested that the new rules introduced in 2004 regarding asylum seekers and whether they were eligible for free care—or, once their asylum application had been turned down, whether they were still eligible for free care—caused confusion about entitlement. It suggested that the interpretation of the rules appeared to be inconsistent, and that in some cases people who were entitled to free treatment had been charged in error.

At the time, the Labour Government began a consultation looking at the use of primary care by foreign nationals using the NHS. It is clear that in acute and secondary care, charging regulations apply. The problem is that the implementation of those charging regulations has not been effective, and we need to be more stringent about the implementation of current guidance.

Currently, there are no charges for primary care, whether people are eligible or not. People can register with a GP for primary care, regardless of status. The Labour Minister at the time, in 2004, held a consultation on whether there should be charges for foreign nationals and people who were ineligible for free care. He suggested that the consultation was necessary because

“the rules about entitlement to primary care are best described as a muddle.”

I agree. In my own experience as MP for Kingswood, I have found a firm of lawyers in Bristol—Deighton Pierce Glynn—that has been writing to doctors urging them to register patients and saying that if they do not, it will take legal action, regardless of the patients’ nationality and eligibility for free care. I raised the matter in the local media, in the Bristol Evening Post. It is wrong, and I am concerned that our NHS will become a legal paradise for lawyers piggy-backing on doctors who are doing the best that they can with the resources that they have. They know that NHS resources are stretched and need to be rationed and that there is a big problem.

One lawyer responded in the Bristol Evening Post by saying that lawyers were not trying to change the law:

“We are trying to apply the law as it is. Nobody is excluded from GP treatment. It is very clear. Hospital treatment is different. People come to us when they have been refused registration with a GP. There is nothing in the law that permits them to do that. Refusing them isn’t lawful.”

This particular case concerned asylum seekers who had had their asylum applications refused. When the GP in question received the letter from Deighton Pierce Glynn, an unnamed member of staff said:

“Someone at the PCT read the letter and panicked. Do we just register everyone who is illegal?”

There is clearly confusion being stoked by certain members of the legal profession who seem to be taking advantage of the uncertainty of eligibility within primary care so that they can profit when their clients wish to apply to the NHS.

On the situation in primary care, I was interested in a question asked by the right hon. Member for Birkenhead (Mr Field) on 23 April 2012. He asked the Secretary of State for Health

“(1) what documentation a foreign national who seeks to register with a GP is required to provide;

(2) whether a foreign national on a six month visitor's visa is entitled to register with a GP;

(3) on what grounds a GP whose list has not been closed may refuse an application to register from a foreign national.”

The reply was:

“Under the terms of their existing contract, general practitioners (GPs) have discretion in accepting applications to join their lists. However, they cannot turn down an applicant on discriminatory grounds. They can only turn down an application if the primary care trust has agreed that they can close their list to new patients or if they have other reasonable non-discriminatory grounds.

There is no formal requirement to provide documentation when registering with a GP. However, many GPs, when considering applications, request proof of identity and confirmation of address, but in doing so they must not act in a discriminatory way.

A decision on whether to register a foreign national who has a six-month visitor visa is therefore currently for the GP to consider.”—[Official Report, 23 April 2012; Vol. 543, c. 701-02W.]

That raises issues. I do not like to quote Sir Andrew Green, the chairman of Migration Watch UK, but he stated:

“What this means is that someone getting off a plane with a valid visitor’s visa is, in effect, able to access the GP services of the NHS without ever having paid a penny into the system. Over one and a half million such visas were issued last year.”

Once someone is registered with a GP, the regulation and guidance mean that if they need further secondary care, it is the relevant NHS body’s duty and not the GP’s to establish the requirement for free hospital treatment. That raises the issue of the extent to which that takes place. Once someone is on the GP’s books, that is almost a rubber stamp into receiving secondary care.

I am not suggesting that GPs act as pseudo-immigration officials checking people’s eligibility for free care, but there clearly needs to be a more joined-up approach between the people who end up on GPs’ books and who are then referred by GPs to secondary care specialists, and what that then involves in terms of charging. When it comes to the issue of primary care and foreign nationals, I do not believe that foreign nationals should be entitled to free primary care. We should extend the charging regulations further.

[Mr Virendra Sharma]

I apologise; I should have congratulated the hon. Gentleman earlier on securing this debate, which is important not only to his constituents but to people all over the country, who take the issue seriously. It is also important in my constituency, where it is discussed every day.

I am a bit confused; I hope that the hon. Gentleman will clarify. He is mixing foreign nationals and those who have been here for many years. As I see it, in this debate, foreign nationals are those who come especially to register themselves for a few days, who receive treatment and who disappear without paying, due to system failures, although I will not get into that debate. For those already here, if GPs act as immigration officers or work on behalf of the UK Border Agency, that will mean health problems.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

--- Later in debate ---

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

We are all proud to have such a wonderful NHS in Britain. It is a unique service compared with those available in the rest of the world. Everybody appreciates that, but at the same time we need to consider how much it costs us and how best we can improve it. This debate is not only about the NHS, but about immigration, the role of the UK Border Agency and the Home Office, and the delays in the Ministry of Justice that mean that people have to wait for years before learning whether they can stay, until which point they need the services. That is why I intervened on the hon. Member for Kingswood (Chris Skidmore) to ask which foreign nationals he was talking about. My main concern is to control those people who abuse NHS services by coming here especially to receive treatment.

Other foreign nationals, however, have been here for many years, yet their position has still not been recognised. There is no clarification about whether they are entitled or not entitled. We have all heard about GPs who have a dilemma when somebody approaches them and says, “I’m living in this area. I want to register with a GP”, but from a health service point of view, everyone must receive a good quality of health provision. We—and GPs—need to consider whether we can deny such families or individuals the ability to register. That is what needs to be clarified before we can find the solution.

Through the Minister, can we put pressure on the Minister for Immigration to ensure that the Home Office takes such cases seriously and decides on them as quickly as possible? In my experience—and I am sure that of many other Members who deal with immigration cases—people are waiting for many years for a decision. What will happen to those people? We need to clarify that point.

I did not intend to make a major speech, but I was impressed by the contributions made. I can assure the hon. Member for Kingswood that there is no question about his credibility on the subject or about there being any intention on his part to criticise an individual or a particular community. He has raised a serious issue that affects all of us in our constituencies and our lives. I hope that the Minister will note that it is not only a question of the £40 million or £60 million, but of how we can solve the problems relating to immigration and health together rather than separately.

Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Burns]

I am not quite sure which word in my last answer the right hon. Gentleman did not understand, so I will repeat it. Like previous Governments, we do not comment on leaked documents. Instead of coming to the Dispatch Box and talking down the fantastic work that nurses and doctors do day in and day out, why does he not read the quarter, the latest copy of which is full of facts about how the NHS is improving its performance and delivering better quality care for patients throughout England?

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

3. What assessment he has made of progress in tackling tuberculosis in England.

[The Minister of State, Department of Health (Paul Burstow)]

Provisional numbers of tuberculosis cases in England in 2011 increased by 556 compared with 2010, although the number of cases is lower than in 2009. This may indicate that TB is stabilising, but it is too early to draw firm conclusions. We expect local NHS organisations, in partnership with other agencies, to sustain their efforts to control TB. On 23 March, the National Institute for Health and Clinical Excellence published new guidance to help the NHS manage TB in hard-to-reach groups, including collaborative commissioning.

[Mr Sharma]

I thank the Minister for his answer. London has the highest rate of TB of any city in western Europe, with more than 3,000 cases a year. When faced with the same problem in Paris and New York, respective Governments committed to increasing resources and a clear model of care. Given the scale of the problem here, and the growing concern about drug-resistant TB, will the Secretary of State commit to implementing the London model of care for TB services that was developed by TB health professionals and advocacy groups to stop this ever-worsening problem?

[Paul Burstow]

I know that the hon. Gentleman takes a close interest in this matter. He is a member of the all-party group on tuberculosis, and I believe he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) to discuss these matters further. He is right that this is a big issue in London as well as a global issue. The Department is working closely with TB Alert, the tuberculosis charity, which is running a series of programmes to raise awareness. It is working with the NHS and the voluntary sector, particularly in communities with higher risk populations, and we are working with the Royal College of General Practitioners to develop an online resource to promote the better detection and treatment of TB in primary care. I hope that he can explore these issues further, but the Government take them very seriously and are working with other agencies to make progress.

HIV

Virendra Sharma Excerpts

Wednesday 1st December 2010 Westminster Hall

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

I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing a debate on such an important topic. HIV policy has long been close to my heart, and it is a pleasure to be able to speak in the debate. It is important that I can speak on an issue that affects my constituency so greatly. Although we are discussing the effects of HIV in the UK, we cannot do so in isolation; we need to discuss many global issues as well, and I am sure that we will have an opportunity to do so. Today, however, I want to address issues relating to the UK and particularly to my constituency.

Ealing primary care trust has the seventh highest prevalence of HIV in a country that has more people living with the disease than ever before. Rates of new infections in the UK remain high, and, as my hon. Friend said, the number of over-50s infected with HIV trebled between 2000 and 2009. It is obvious that a new policy has to be developed to deal with these pressing new issues.

One of the most important factors in this complex issue, which we must acknowledge straight away, is diagnosis. Roughly one in four people with HIV in Ealing do not even know that they have it. That is roughly the same ratio as at the national level. When HIV is discovered early, people can be treated and go on to live normal lives with near-normal life expectancies. On the other hand, late diagnosis leads to more AIDS-related illnesses, increased pressure on the NHS and a higher rate of onwards transmission. We have too high a rate of diagnoses being made at a point when treatment should already have started. As hon. Members have said, in 2009, 52% of people diagnosed with HIV were diagnosed too late, and 73% of those who died were diagnosed too late as well.

What can we do to ensure early diagnosis for all cases of HIV? The Health Protection Agency believes that all new members of GP surgeries in PCTs with high prevalence rates, including Ealing, should be offered an HIV test. We need to go further, and provide incentives to GPs and other health care workers to encourage HIV testing. We also need to improve antenatal testing. We already have good provision for HIV testing of unborn babies. Even though one in 450 women who give birth is HIV-positive, only 30 babies born last year had the virus. However, we could go further.

I want to comment briefly on the growing link between HIV cases and mental health. Obviously, meeting the mental health needs of a population is important in itself, but concentrating on people with HIV can have a particularly beneficial effect, both clinically and in cost-effectiveness. People with depression have a more adverse reaction to their HIV treatment in general. It is cheaper for the NHS to invest in 10 sessions with a clinical psychologist than to pay for costly treatments further down the line because someone did not take the initial treatment properly.

Those sufferers receiving the right psychological support are less likely to miss their medication, more likely to react positively to treatment, and less likely to pass on the disease by engaging in unsafe sex; such aspects of the matter can cost more in the long run if the right support is not established immediately on diagnosis. It is therefore important for the Department of Health to integrate HIV sufferers into long-term mental health strategies.

Although I am pleased that drugs for HIV sufferers will be ring-fenced in the health budget, social care and protection for HIV sufferers, which is often provided through local authorities, will not be. Social services are hugely important for people with HIV, and a squeeze on their budget is likely to have a detrimental effect on the mental health status of many HIV sufferers and cost much more in the long term. I am aware that through the CSR an announcement was made of an increased allocation to social care for people with HIV.

I now want the Department of Health to inform local authorities of their likely budgets as soon as possible, so that councillors can start to plan a thorough care plan for people living with HIV. Only through that long-term planning for mental health cases, more social care and a greater push for early diagnosis can we really start to tackle the problem of HIV in this country, and ensure that nothing stops people with HIV living normal lives.

Health (CSR)

Virendra Sharma Excerpts

Thursday 11th November 2010 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

It is good to be here this afternoon under your chairmanship, Mr Gale.

First, let me congratulate my hon. Friend the Member for Easington (Grahame M. Morris) on having the foresight to table this subject for debate. The Minister and the rest of those present will be pleased to know that I shall not be quoting from the King’s Fund during this debate—yes, I see that he is quite pleased about that. Instead, I have a brief from the Nuffield Trust about the likely effect of the comprehensive spending review on health, on top of what we have just been discussing. My hon. Friend talked about a 0.5% increase over four years, or something like that, but the Nuffield Trust argues at one level that there might be a bit more to it. Let me go into the brief it published last month, although it is not related to this particular debate:

“The 2010 Spending Review announced that the NHS will receive 0.4 per cent… growth over the next four years—0.1 per cent a year. This compares to an average real-terms increase of 5.7 per cent per year from 1997/98 to 2009/10. This is the lowest four years’ increase for the NHS since 1951-56. The Spending Review also allocates £1 billion a year from NHS funding to social care. The real-terms change in NHS funding, net of the social care support, is therefore a reduction of 0.5 per cent over the next four years.”

[Interruption.] The Minister says that that is rubbish. Perhaps he can stand up and tell us whether he disagrees with it. I want to continue with this brief and ask him about something that is directly related to this. The next paragraph states:

“The Spending Review also announced important changes to the treatment of past underspends.”

Many of us will know from talking to the NHS locally over the past few years that, because of the generous funding over the past decade, there are such things as underspends. The brief continues:

“Health has accumulated underspends of £5.5 billion, of which £3.7 billion is classified as ‘resource’ (ongoing expenditure on staff, medicines, equipment and the like) and £1.8 billion as capital. There is also a planned underspend for 2010/11 of £1 billion. According to the Spending Review, these accumulated stocks—known as end-year flexibility (EYF)—have been abolished. This means that any previous underspend that is honoured by the Department of Health will have to be made within the settlement outlined in the Spending Review.”

Will the Minister tell us whether the current underspends that our primary care trusts, or perhaps hospitals, hold at the moment—I hope they will be spent on expanding services, as they have been over the past decade—will be clawed out?

The other issue that I would like to raise relates to the changes in commissioning. I am in a peculiar position on this. Some Members will know that I chaired the Health Committee in the previous Parliament. In March, we brought out a report on commissioning. The Government responded some time in July. When the Secretary of State was on the Floor of the House making his statement on the White Paper, he talked about the Health Committee and said:

“Before the election, when it had a majority of Labour Members, the Select Committee on Health said that PCT commissioning was weak and that it was not delivering what was intended. He set up a programme called world class commissioning—it never worked.”

He was replying to the then shadow Secretary of State for Health. The Secretary of State went on:

“Central to delivering better commissioning in the health service is ensuring that those people who incur the expenditure—the general practitioners, on behalf of their patients—and who decide about the referral of patients are the same people who”

blah, blah, blah, blah. In reply to a comment from the current Chair of the Health Committee, the right hon. Member for Charnwood (Mr Dorrell), the Secretary of State said:

“In his capacity as Chair of the Select Committee on Health, we will be responding to him very shortly regarding the Select Committee’s report from before the election on commissioning... What he has just said is absolutely right; we have been able—this is a central task in commissioning—to bring together the responsibility for management of patient care with the responsibility for the commissioning of services.”—[Official Report, 12 July 2010; Vol. 513, c. 665-66.]

I have mentioned that because he has used my name on at least two occasions on the Floor of the House, basically to say that the report on commissioning that we published supports GP commissioning. I want to put it on record that, in my view—it was obviously my draft report and it was not challenged at the time—it does not support GP commissioning in the way that the Government are bringing forward the changes in commissioning.

We looked at four areas in that report, in relation to commissioning: whether to abolish PCTs and reintroduce health authorities; retain PCTs but introduce more integrated care; retain PCTs but introduce local clinical partnerships, under which GPs would directly control commissioning; and retain PCTs but commission services from hospitals. There was also the option to retain and strengthen PCTs. We did not come to a hard conclusion on any of that. I will not bore this gathering with the conclusions we did come to, but it is a gross misrepresentation to say that we were arguing for GP commissioning.

Maybe the nearest scenario that we looked at was the one in relation to local clinical partnerships. The Nuffield Trust informed us:

“There are key changes to the policy environment that are required if commissioning is to stand a chance of becoming effective.”

That was one option, but local clinical partnerships, as we quoted in the report, look very much like the system of GP fund-holding, which had failed to improve commissioning, in our view and that of many other people. We also said that it might be expected to have the advantages and disadvantages of that system.

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

My right hon. Friend is talking about the GP’s role. Does he agree that GPs are not trained for many of the roles asked of them, and not qualified to play those roles? There are no extra resources made available in order to gain the skills.

[Mr Barron]

That is absolutely true. There are fewer resources, because more is being taken out of administration than was planned before the spending review came along.

I am intrigued by the idea of giving clinicians power or giving GPs power. The British Medical Association is not saying no to the idea of GP commissioning. That is good—I have some quotations from it in front of me—but it would want to look at having a real local clinical partnership that included clinicians who worked in the local provider—the local hospitals. It believes that if we are going to do this, that ought to be looked at. I am interested to see whether the Minister agrees. One reason I say that is because, when we took evidence from his favourite organisation, the King’s Fund, the Royal College of Physicians and others thought that PCTs should be retained, but that hospital clinicians and GPs should work more closely together. Professor Ham, who is obviously one of the Minister’s favourite authors in these matters, said:

“There should be progressive migration towards clinically integrated systems, building on the most promising aspects of current reforms and drawing on evidence that shows the benefits of integration and the challenges of making a commissioner/provider split system function effectively.”

He was arguing for real integrated care, but my understanding is that that is not what the White Paper is proposing. It is proposing that only GPs will have the power to spend 70 or 80% of the NHS budget, not other local clinicians as well. I would like the Minister to reply on that specific point.