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Westminster Hall

Wednesday 31 January 2007

[Frank Cook in the Chair]

Health Services (North-East London)

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Heppell.]

9.30 am

Harry Cohen (Leyton and Wanstead) (Lab): I thank Mr. Speaker for granting me this debate on the fit for the future programme in north-east London, and how it impacts on Whipps Cross and King George hospitals. Whipps Cross is in my constituency, but the area that it serves is much wider, as my hon. Friend the Member for Walthamstow (Mr. Gerrard), the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) and the hon. Member for Ilford, North (Mr. Scott) will testify. The King George is an important hospital for a different population. The populations served by those hospitals have high degrees of deprivation and serious health needs. Indeed, the full functioning of those hospitals is highly relevant to the Government’s policy of tackling health inequalities. If they do not function fully, health inequality will be exacerbated.

The fit for the future programme that covers those hospitals, and the newly built Queen’s hospital in Romford, began last summer. Its alleged purpose is to make the best use of NHS assets, but it came very swiftly in the wake of uncovered serious financial deficits in several local health trusts. I believe that those trusts are the driving the programme, and that the real purpose behind it is to run down either Whipps or the King George.

On 15 February 2001, the then Health Secretary, my right hon. Friend the Member for Darlington (Mr. Milburn), announced on the Floor of the House that there would be a major new investment in a number of hospitals, including Whipps Cross. Some £328 million was promised. That figure fluctuated in subsequent years as the plans were drawn up, but the Government commitment was maintained.

As recently as 22 March last year, my hon. Friend the Member for Walthamstow and I met the then Health Minister, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who assured us that

She told us that the hospital modernisation would begin in late 2008 and be fully completed by 2016, with the most important elements of the hospital renewal completed earlier.

The modernisation is necessary, but not because the hospital is bad or the performance of its staff is poor. On the contrary, last October, the Healthcare Commission gave it a “good” score for the quality of its services in the local community. Let me make it clear that only 4 per cent. of NHS hospital trusts scored “excellent”, and only 30 per cent. scored the next
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category of “good”. So, for the delivery of services, Whipps Cross is among the top 34 per cent. of hospitals in the country.

In the sub-ratings, Whipps Cross got an “excellent” for meeting new Government national targets such as: reducing mortality rates from heart disease, stroke and related disease; achieving year-on-year reductions in MRSA levels; and ensuring that nobody waits more than 18 weeks for hospital treatment from when they were referred by their general practitioner. It also scored an “excellent” for its medicines management, and a “good” for meeting core standards and existing national targets.

I emphasise those scores because I believe that some health officials, in the Department and locally, are prepared to run a campaign of denigration against Whipps and to claim that it is amongst the worst hospitals in the country. That is a lie and the Minister needs to be aware of that. Indeed, he should be. In 2004, the Department of Health described Whipps as

The hospital was given a “weak” score on its “use of resources”, but then so were many others—37 per cent. of trusts in the country—including Waltham Forest primary care trust. The hospital trust is addressing that problem, albeit with considerable pain.

Whipps needs to be modernised because it has long Victorian corridors and wards. It could be more efficient and run at a lower cost. That reform is needed, but, instead, we have been presented with a fit for the future process that was born out of panic because of the financial deficit. The firm promise of major investment is being reneged on, and the option of running down Whipps is being mooted. That has led, quite properly, to enormous public protest.

The Waltham Forest Guardian and the Wanstead and Woodford Guardian, collected 18,515 signatures in just six weeks on a petition that my hon. Friend the Member for Walthamstow and I fully backed. My hon. Friend and I have presented further petitions bearing about 2,000 signatures. The London borough of Waltham Forest Labour party has launched an “I Love Whipps Cross” campaign to support the development and maintenance of a modern general hospital at the Whipps Cross site.

The leader of the council, Clyde Loakes, told the Secretary of State in a letter this month that

The right hon. Member for Chingford and Woodford Green recently presented his own petition, which is reported to contain 21,000 names. The letter handed in by the editors of the local Guardian newspapers stated:

It went on to put succinctly the case against that happening:

The letter goes on:

I support the Government’s policy of increasing the number of medical treatments given in the community, GP’s surgeries and people’s homes, rather than hospital, but the consequent improvements in the locality are decidedly modest, although welcome. Councillor Loakes pointed out in his letter that the number of people attending accident and emergency has increased by 39 per cent. in 10 years, so the extra non-hospital provision has had a negligible impact on that.

GPs have had more money but are limited in the improvements that they can provide. For example, some GPs’ premises cannot fit in the latest equipment. In my deprived area, the workload of GPs remains high, and they do not have the extra time to perform numerous new medical treatments. The Secretary of State rightly says that community nurses can do much, but as the “Save Whipps Cross Hospital” campaign pointed out in its December newsletter,

My own survey of local GPs revealed that they are not employing any extra community nurses, and rely instead on the PCT, which is cutting back. The situation certainly does not warrant hospital rundown. The Government’s policy of using more community treatments can be achieved without any local hospital rundown, because of the population growth in north-east London. The indications in relation to Thames Gateway are that the population will be more than 20 per cent. higher in 2016 than in 2001. The planned Stratford city proposal will also add to population growth. As no extra hospitals are planned, it makes sense to maintain the existing ones.

Stratford is also the site of the 2012 Olympics, to which Whipps Cross is the second-nearest hospital. For a successful Olympics, we need a fully functioning Whipps Cross as part of the back-up infrastructure. The recent policy of the Department, which I believe to be simplistic and ill-considered, is that one hospital can be emergency only and the neighbouring one elective only. It is claimed that such a separation reduces
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waiting lists because emergencies can lead to the cancellation of elective work. Local figures show very few cancellations for that reason.

The policy of separation ignores the reality of where people will present for treatment, and several neighbouring hospitals have said that they could not cope or that they would be adversely affected by it. Worse still, it breaks up the team of medical practitioners—it currently works well, but people would move on. There needs to be collaboration in emergency and elective work. It works well in a district general hospital such as Whipps but may very well not do so under the fragmented system that could be created under this separation policy.

Public anxiety is high and staff morale low as part of this fit for the future process. There is no cause for it to be rushed, ahead of the full-scale review of Londoners’ health needs over the next five to 10 years, which is to be conducted by Professor Sir Ara Darzi of Imperial college and was announced last month. In this context, “Fit for the Future” just amounts to a pre-emptive strike.

There is also no confidence locally in how the health chiefs are conducting the process. They are all in the fit for the future team, but behind that is a turf war with no one taking responsibility for the local NHS overall. That really should be the primary care trusts’ role, but they are intent on the cheapest provision for patients, even if it is a false economy and if the local hospital goes under.

The Government’s choice agenda of four treatment choices for patients risks not including the local hospital, which most local residents want to use. There is also the suspicion that these health chiefs waver with the wind. Whipps has come out top in their initial assessment on non-financial criteria and again on the financial criteria. Public and MP reaction might have had an effect, but now there is similar reaction in the King George hospital area. I remain suspicious that some further criteria may be found or that a decision may be taken against their own assessments in the future. In any case, I resent this being set up as a competition between worthy hospitals and their needy, distinct, populations. I believe that the health chiefs genuinely hope to release cash via hospital rundown for community medical use, but I do not believe that such cash would go, to any significant extent, to such community treatment.

The Government have new pet projects, such as intermediate treatment centres, and the private finance initiative bills for new hospitals, such as Queen’s, to fund. The bills for doctors, drugs and new treatments remain high. Furthermore, the growth period for the NHS is coming to an end. The Government should have ensured that they could fund its core services, such as local hospitals, and change them in a planned way when replacement provision is fully in place. This speed of change, without replacement provision, is leading to crisis. That is a reason why this fit for the future process is not acceptable.

It is unbelievably negligent to think that the people who rely on Whipps could do without its emergency and elective provision. It is understandable that local people are anxious; I, too, think that if Whipps were rundown on this basis, it would lead to unnecessary local deaths, so I urge the abandonment of the process.

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9.43 am

Mr. Iain Duncan Smith (Chingford and Woodford Green) (Con): I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this debate. He knows that all of us bid for it at the same time. We have co-operated fully, regardless of party, on the key issues. I think that we are all united in our rejection of what has been happening. He laid out in detail all the relevant issues, giving specific emphasis to the situation at Whipps Cross hospital. I know that our colleagues representing Ilford constituencies will set out more detail concerning King George hospital.

I should say at the outset that I do not believe in the divide-and-rule policy that health chiefs are undertaking in our local area. I am for retaining Whipps Cross hospital and King George hospital. If either one fails to remain as a district general hospital, it will be for the worse. My comments will focus mainly on Whipps Cross, but I want to make it clear that I am wholly with my Ilford colleagues—and, I believe, with all hon. Members present—in wishing to retain King George hospital.

I want to pick up three points. Why is this process taking place? I agree with the hon. Member for Leyton and Wanstead on this. He outlined why this is happening: a short-term, sudden, snap panic over the idea that the acute trusts have been running particularly strong financial deficits for the past two to three years. When one examines what the deficits are about, one begins to understand that the whole accounting process in the NHS has made this a ludicrous process.

Let us consider the reality of how most of this is run. We are shifting one set of problems from the PCT to the acute hospitals. In the past two to three years, they have told people endlessly about their problems in getting the PCTs to pay for the treatment that they have undertaken in good faith, so they say. I accept that there have been inefficiencies and that there has been poor accounting in some of those acute trusts—particularly, in this case, at Whipps Cross.

The PCT is running a deficit of £1.8 million and trying to claw that back from the acute hospitals by saying that it will not pay for all the treatment that they undertook. In its refusal to pay, the balance of deficit shifts on to the acutes. It is absurd to suggest that we can simply split the two bodies and say, “This lot have bad accounting practice and are not doing very well whereas this lot, who control and run what the acutes do, can decide who will bear the cost.” What has been hidden is a problem for both the PCTs and the acutes. The PCTs, which are running the process, can shift a huge amount of the blame on to the acute trusts.

The second aspect that I want to highlight, which has been raised, is the nonsense about how this process is taking place. The London area is doing its own survey and summary of what needs to be done. I believe that at the same time, running ahead of that, four areas are examining the need for treatments in our areas, driven by the PCTs—how ludicrous. Given that they are running ahead of what London is doing—we are now told that this will dovetail back into London’s review—it beggars belief as to how this can be done. They will arrive at conclusions that might not directly relate to London’s conclusions, unless a nudge and a
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wink is going on here. We rather suspect that that is the case and that they are clearing the way for London to be able to publish a review that has already assumed certain changes in our area. Either way, this is the wrong way to do things.

Any strategic consideration of what health systems and health care should be in London must examine a London standpoint first and foremost to decide what the needs are. One of the things that would emerge in such a consideration is the peculiar problems of transport—getting from A to B—in parts of London. I shall give hon. Members an example of how little is thought about that.

A meeting with the PCT took place on 9 November as part of the fit for the future programme. MPs were not allowed to attend, but there was a discussion about what would happen if Whipps did not continue as a district general hospital. The answer given by one of the PCT’s members was that plenty of health treatment was on offer in the several acute hospitals that surround our area.

That point has been made to us on many occasions. First, it was said that North Middlesex hospital would be able to take people, but people at the meeting had rung North Middlesex to ask whether it could absorb the demand if Whipps Cross ceased to be a district general hospital in the sense that it is today. The answer given was that it certainly could not do so because for at least the next five years, during which time it will be going through changes—there will not be any spare capacity. The people at North Middlesex were not sure even about what would happen after that.

When that information was presented to the individual whom I mentioned, he turned around and glibly said, “Well, of course there is University College hospital.” That was interesting and it made me wonder about things. UCH is difficult to get to, but of course one would know that only if one had bothered to try to get there by public transport from our borough, particularly from the northern part of it.

I then asked the fit for the future team whether it had corresponded or had discussions with, or drawn in, any of the other acute hospitals in the fit for the future programme going on in our area. By the end of December, it said that it had corresponded with the hospitals. I then decided to write to a number of the hospitals that might be affected. Most interestingly, I asked UCH what correspondence or involvement it had had with the review team. I quote a recent letter:

That was on 18 January, when we were heading towards the conclusion of the report. One of the hospitals, which it was said people from Chingford would magically head off to, knowing that North Middlesex could not take them, was UCH, which did not know anything about it and was not even involved. What a brilliant way to go about it. That proves our point that unless the review is done on a London-wide basis we cannot possibly consider the difficulties in hospitals such as North Middlesex and UCH.

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