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The NHS later set up a public consultation on where the hospital should go. To no one’s surprise, St. Helier was the favourite choice and Belmont the least favourite, but the NHS wanted to stick to its decision. At that point, all the local boards rowed in behind the official
NHS view that the hospital should move further into Surrey, despite the opposition of thousands of residents. Depending on whether or not one is charitable, one can believe either that the health service appointed consultants to re-examine the evidence or that it appointed them to manipulate the consultation results in order to suggest that people had voted for Belmont when they clearly had not. Because most people had answered the question “Would you like a hospital near to where you live?” in the affirmative, it was suggested that that constituted evidence that Belmont was near to where they lived, and that that justified the move. Even people living in the Belmont area did not want the hospital there. A staggering number of people wrote to me saying “We do not want our nice residential area to be bulldozed to pieces, we do not want ambulances with blue flashing lights, and we do not want more bus services.” No one wanted Belmont, except, of course, the NHS.
Over the years, we had more and more arguments about the issue. Members who have been involved in arguments about hospital reconfigurations, or in any similar campaigns, will know how daunting it is to be faced with a wall of experts and professionals, given the limited resources possessed by many of our communities and, in many instances, by Members of Parliament. My local residents, however, had one thing in their favour. In 2004, the London borough of Merton had a Labour council, which, after being consulted by residents, used its powers to have the decision to close the hospital called in to the Secretary of State. The decision was reconsidered by my right hon. Friend the Member for Airdrie and Shotts (John Reid) and subsequently by my right hon. Friend the Member for Leicester, West (Ms Hewitt): they had listened to the people.
Late in 2005 the then Secretary of State, my right hon. Friend the Member for Leicester, West, instructed the NHS to rebuild the hospital at St. Helier. She agreed with residents that it was better for it to be there, because that was most likely to reduce health inequalities. After all, the life expectancy of people in my constituency is 10 years shorter than that of those living in the Belmont area.
One would have thought that that was the end of the matter, because the Secretary of State had made her decision. However, the local NHS did not give up that easily. There is nobody from our area on its boards, and there is no constitution to say this was unreasonable, so although Ministers told it to build a hospital at St. Helier and to stop working on Belmont, it continued to make progress with its initial plans. It held meetings with Transport for London where it made it clear that Belmont was still the favoured option. It then announced that—lo and behold—planning issues meant that the hospital simply could not be built at St. Helier. It asked the Secretary of State to reverse the Government’s decision, and to build the hospital in leafy Belmont as it had originally hoped would happen.
Again, local residents were up in arms. After all this time, why would the local NHS not listen to us? How could it be that there was nobody in the NHS establishment who would represent us? The Government had represented us; the local council had represented us; even the former Mayor of London, Ken Livingstone, had supported us. He told the local NHS, “Look, I’m in charge of London’s planning policy, and St. Helier is the right place to have this hospital.” The local NHS just would not listen to
us, however, so we campaigned, fought and lobbied, and eventually, after years and years, it looks as if we have won.
I have to say that I think we now have an excellent deal. Not only has St. Helier been saved, but it is going to be rebuilt and refurbished. There will be new wards with single rooms, to cut down on infections and improve patient privacy, a new local care centre, and a new 24/7 GP service. There will also be four care centres, including one at the Wilson, the hospital the Tories closed down in the early 1990s. These care centres will have diagnostics and treatments, and dentists and GPs, open when people want them. Moreover, the Wilson is not just getting a care centre. It will reopen as a hospital, performing minor operations, and with more than 50 intermediate care beds for people recuperating from operations or needing care they cannot get at home.
My constituents have seen a stark contrast between how their views are treated by local and national Government on the one hand and by the NHS on the other. That is because democratically elected organisations are far more likely to represent the views of those who are least able to express their own views. Sometimes it has seemed as if our achievements were in spite of, rather than because of, the NHS. As I reflect on our 11 years in power, I think it would have been much better if there had been a constitution for our NHS earlier, and in particular a constitution that forced the local NHS to listen to patients and staff, and which obliged it to be representative of the communities in which it is situated.
Why, after all these years, have we not had even one local person on one of our NHS boards? Why, too, should the local NHS professional bodies be packed with people who have little connection with my constituency? I am particularly concerned about the composition of my primary care trust’s professional executive committee. It is dominated by a practice far away from Mitcham and Morden. The medical committee comprises eight clinicians. The last GP from Mitcham to serve on this board was taken off it more than a year ago. Now all its members are white, even though the majority of the GPs in the PCT are not, and they represent an area that has the best health in the PCT area, rather than the worst. Six of the eight PEC members are from the same commissioning group, the Nelson, even though this group covers possibly the most affluent neighbourhood in the PCT. I should have thought that allowing a single commissioning group to dominate such an important committee was extremely dangerous. Indeed, I have received complaints that this very powerful practice-based commissioning group is at an advantage. It certainly appears to have a disproportionate influence.
I am especially anxious because this extremely unrepresentative committee is taking decisions about health care in my area. Both locally and nationally, we have been told to demonstrate that there is equal access to health services. Even the Conservatives who run Merton council say that bridging the gap between my constituency in the east and the far more affluent west of the borough is the top priority. As I have said, the Government have instructed the local NHS to take more account of health inequalities, but I am not convinced that the PCT can eradicate inequality in the local NHS, because it is not representative of either the local NHS or local people.
I hope that a new constitution will offer us an opportunity to achieve that. I want the NHS to listen to local people and to come from local people. I want it to reflect the people whom it serves and the people who work in it. I support the Government’s plan to introduce a new constitution for the NHS, but I want it to ensure that local residents are represented. I want my local NHS to reflect the area that it serves. Over the last four years, foundation hospitals have shown that communities want to be involved in their NHS as a whole, not as a particular interest group or with a particular agenda. The 108 foundation hospitals have more than 1 million members, with turnouts in elections that often exceed local election numbers. If we can get far more people involved and having their say in an institution that unites this country, we will have a much better chance of having a service that reflects the needs and demands of local residents.
4.36 pm
John Hemming (Birmingham, Yardley) (LD): I am pleased to see that the Secretary of State for Children, Schools and Families is back in his place, because, as hon. Members will not be surprised to hear, I intend to talk about the child protection system. For some years, I have been concerned that the system makes the wrong decisions, including both false positives, when it intervenes when it should not, and false negatives, when it fails to intervene when it should.
For some time, I have been trying to identify how many serious case reviews have taken place following the death of a child, because that would provide a threshold from which we could track trends. The Department has been singularly unhelpful. In fact, when I gave up trying to get information out of it and went to all the local children’s services authorities, the Department kindly instructed them not to give me their lists of serious case reviews. I am pleased to say, however, that the Chairman of the Select Committee has agreed that the Committee will work to try to find out that information. Ofsted has given us all the figures—including the 210 figure from yesterday—but it has only been tracking the figures from 1 April 2007. The serious case review process has been going on for some time, but it was strongly emphasised by the Laming report. It is a good process and it gives us a mechanism for tracking what is going on.
We should not focus only on one case: we must look at the system and where it is going wrong. We also have to consider the wider aspects, such as the Laming review. Lord Laming is obviously the ideal person to review the extent to which his proposals have been implemented, but he is not the ideal person to review to what extent other proposals should be implemented. The Government have gradually moved towards the idea, which I proposed, that we need to look at the whole system of public family law. That starts with the initial references, moves on to the assessment processes and the integrated children’s system, and—if there is a reference—it moves into the family courts, and we have not yet decided to look at how those work. I am still hoping that in January the Committee on Legal Affairs and Human Rights of the Council of Europe will agree to investigate the family division of the High Court. I shall go into some of the reasons why the family division is part of the problem.
In the initial process, the local authorities initiate proceedings. They often start with child protection conferences, which are often organised to prevent extended family members from attending. I had such a case today. One of my members of staff agreed to go to a child protection conference in Birmingham with a constituent—I do not know what has happened because I have been in the Chamber—and the time was changed at the last minute. We could say, “Well, that happens sometimes,” except that it also happened previously with another constituent. We arranged to accompany that constituent to the child protection conference and act as an advocate, but the authority—this was Solihull rather than Birmingham—changed the time of the conference. We were told, “You’ve missed it, it’s already happened.” That is an abuse of process and it should not be tolerated. In a sense, though, it is a symptom of the attempt to drive out the extended family.
We need to be straight about the fact that such things do not always happen. I work with many social workers, and there was a conference in Stafford—also attended, not surprisingly, by the hon. Member for Stafford (Mr. Kidney)—arranged by Rachel Bramble that looked at why things are going wrong in social work. The fact that people are being driven out of the profession is evidenced by all the vacancies that exist, but why do people not want to work in the sector?
The existing process is almost designed to exclude people, but then cases go into a court environment that is frightening and bewildering for people who have never been there before. Indeed, it has taken me some time to understand the processes involved. The House will be aware that I co-ordinate the Justice for Families campaign, and we are approached by people from across the country who are facing care proceedings. We refer matters to local constituency MPs, try to find volunteer McKenzie friends and so on, because there are great difficulties with the legal processes in the courts.
In an earlier intervention, I said that the single-expert system meant that people could not get a second opinion without the judge’s permission. Judges tend to refuse that permission, and they pride themselves on the efficiency of the system under which an expert is appointed jointly by the local authority and the parents involved. The problem is that the system is a machine for miscarriages of justice. A number of social workers have complained to me, and last year one explained how he used to collude with parents’ solicitors to ensure that the parents would lose their case. That is a criminal offence, but it is very difficult for me to take the matter further, as that would mean the social worker involved having to give evidence against himself.
A case in Oldham would serve well for a review of the single-expert system. The parents were refused a second opinion in both the county court and the Court of Appeal. When they applied again to the Court of Appeal, they were told that they could have a second opinion, which confirmed that the baby had not and could not have been hurt by them. Not only were the parents not guilty; they were provably innocent.
In one sense, the failure to allow a second opinion is based on practice on the continent, where the parties involved have their own experts as well as the one appointed by the court. The idea is that the court-appointed
expert can make a decision about the truth of the other expert evidence. In this country, what happens with experts meetings is a move in that direction.
I see a great many cases, of which the Webster case is a good example. Once initiated, a case like that will trundle through the system. Everything happens and the children are adopted, but then all of a sudden it becomes apparent that once again the court has got it wrong. Such problems are driven by the single-expert system.
I proposed an amendment to the Children and Young Persons Bill that would have enabled people to get expert evidence. At present, when the court has gathered all the expert evidence, it is illegal for a parent’s solicitor to telephone a doctor and ask whether he or she knows anything about a case. That would be a contempt of court, and it is another example of how the single-expert system is a machine for generating miscarriages of justice. Given that some solicitors also conspire against parents in such cases, the House will see that the situation can be very difficult.
I received a letter from the eastern region of the Legal Services Commission, dated 31 October 2008, that refers to legal aid for a case involving a Mrs. M. It states that
“funding will continue on the basis that Mrs. M should accept that her case is being publicly funded, and that contesting Interim Care Orders, where there is no change of circumstances, is not an issue on which she would expect to be legally represented.”
Basically, that means that Mrs. M is allowed non-means-tested funding as long as she does not say no to the interim care order. In other words, she can have a solicitor at the hearing, but she has to agree to the order. That is not the way towards a proper judicial process, and, as I have said, such an approach drives everything else. The Department for Children, Schools and Families has done some good statistical work. Earlier this year, it analysed about 400 cases, and table A2.42 of its report shows what a low proportion of cases are chucked out of court.
There is a problem with the single-expert system. Sometimes, people cannot get legal aid when they want to contest a case; they simply have to accept it and work with it. We need to look at the criteria used to determine when a child is taken into care. The phrase in the section 31 threshold is “risk of significant harm”, but that could mean many different things. Obviously, everyone accepts that baby P and Kyra Ishaq should have been in care, and there are many similar situations, but should we put a 16-year-old in care because his parents have split up and he will not talk to one of them? I do not think so, but some judge does.
Domestic violence is a difficult area, and it is challenging for kids. If parents split up and do not see each other because Mum was a victim of domestic violence, should we still be trying to take her children away from her? I do not think so. We learn from women’s refuges that women are so frightened of losing their children that they do not actually report domestic violence. Margaret Halliday of the Salisbury women’s refuge will provide that information, and I, too, can provide lots of evidence.
Another criterion is secure care for welfare reasons. In some of those cases, children should not be in secure care. There is no evidence that it does anything for them, and they are, in effect, suffering imprisonment without having committed an offence—much like the
boy who will not talk to his mum. Not co-operating with professionals is another reason that does not seem sensible. The mere fact that somebody does not immediately snap to and do exactly what they are told should not be good cause to remove their children and have those children adopted. That does not mean that if the children are missing medical attention because the parents never take medical attention seriously, there is not a grave issue. Another reason is “comments eroding children’s self-esteem”; so if the parent tells the kids they are stupid, the children need to be taken into care. I do not think so. Then there is missing school. Obviously kids should be going to school, but we have a one-trick pony—a system whereby at a certain point the child is taken into care. We need much better scrutiny of the operation of the section 31 threshold.
There are important reasons why the system correlates with the false negative environment. It is in part caused by the way the integrated children’s system pressurises practitioners into making an early decision about the truth of the case and not changing it thereafter. That is the basis of an article that I have written with Sue White, who is professor of social work at Lancaster university, and Allan Norman, who is a social worker and lawyer based in Birmingham, where he runs his own practice—Celtic Knot. The article has been published on the Community Care and Family Law websites and in The Birmingham Post, and I have also sent a copy to the Minister, so there is no sense in my re-reading out what is available on the internet.
Haringey, like many authorities, has a target, for the number of children in care, which is kept for budgetary purposes. The target for March 2007 was 365, and the target for March 2008 was 352. In part, the objective of reducing numbers in care is laudable. That is also true of trying to reduce the weekly costs, which have run at higher than £800 per child per week. On 3 October 2006 it was noted that the deficit forecast for Haringey council was £4.6 million, which included a forecast overspend for children’s services of £2.3 million, including a figure of £500,000 for looked-after children. The executive member for finance said, “I will be working closely with the services concerned, and I will be looking to them to identify ways to bring the budget back on target.” It was recognised at that time that the placements budget was running at 381 children and was very tight, and the figure had crept up to 392 by November 2006.
By 31 March 2007, the financial situation had improved, although there was still an overspend of £500,000 on legal fees. The number of children in care had reduced and a new target was set of 352. At the end of the 2007-08 financial year, however, the number of children in care had increased back up to 373, which was 21 more than budget. It appears that controls on the number of care proceedings were tightened up in November 2006, with the 12-month rolling number from November 2006 going below 40 for the first time when they were released in August 2007. The number then went back up above 50, its historical level in recent years. Sadly, baby P died in August 2007.
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