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As I have indicated, this year's target for the operating deficit will almost certainly not be met. That is a problem, because with generous help from the other parts of London, there is a window of opportunity for the South London Healthcare NHS Trust to pay off its deficit, if it meets its operating targets. It seems as though that may not happen, and the crisis that we face in south-east London will therefore be even greater a year from now.
As far as I am concerned, there has been no real improvement in the trust's performance for patients since its inception. As Members know, it currently has a norovirus problem that has meant the shutdown of many wards and waiting lists rising. That is a difficulty that many hospitals have had to face, but nevertheless I do not see any improvements in performance.
The origins of all that are quite clear. First, the Government have thrown money at the NHS in London, as elsewhere, with no idea of reform. The hon. Member for North Norfolk (Norman Lamb) mentioned PFI, and he gave the overall statistics for London. In my area we have two hospitals, which now form part of the South London Healthcare NHS Trust. The construction cost of the Queen Elizabeth hospital in Woolwich was £96 million, but the taxpayer will have to repay £799 million. The new Princess Royal university hospital in Bromley will cost £118 million to construct, and the taxpayer will repay £780 million-seven times the construction cost. As Lord Warner, a former Minister in the Labour Government, has said, the NHS received more money than it knew what to do with.
Another problem has been top-down political management. Civitas, the consultancy, has said that market reforms have not worked as they should have done, because Whitehall is still exercising too much control. We have had endless and changing targets and endless changes in management. For a period of two or three years, the managing director of the Princess Royal university hospital was being changed every six months at considerable cost. Nobody ever gets sacked at the top level of the NHS. It is astonishing how people appear to perform badly and are removed, but then appear somewhere else in the NHS. No one ever suffers the consequences of poor performance.
Finally, weak structures are part of the problem. Commissioning has not been valued as much as it should have been, and in many ways, as has already been said, it has been emasculated. Lord Warner-I quote from an article in The Guardian-has said:
"We had 300 PCTs to begin with. That was insanity...The first thing I did was to cut them down to 150. But I wanted to go further and cut the number to 50 or 60."
He said, as The Guardian put it,
"that he was thwarted by the Labour backbenches, who feared they would lose vital services from their constituencies."
What is the answer? Briefly, the Government must cease micro-managing. Instead, we need to create opportunities for individuals and companies inside and outside the NHS to come up with more effective solutions, and for the Government to act simply as a regulator. We need fewer targets and quangos; we need commissioning to be more professional; we need to encourage a diversity of providers and for groups of professionals, private charities and so forth to be brought into play; and we need more competition. I suspect that efficiency and better patient care will go together.
The tragedy is that all those things were under way when the Conservatives were in charge of the health service, when we made the split between provider and purchaser. That was the opportunity for those sorts of reform. The Government, including the right hon. Member for Holborn and St. Pancras, with whom I might disagree on this, set back the whole process of reform. It is a tragedy that 13 years have been largely wasted.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I remind hon. Members that the time limit is now reduced to six minutes.
5.36 pm
Jeremy Corbyn (Islington, North) (Lab): I am delighted that we are having this debate and to have the opportunity to put my views on the NHS in London on the record.
I represent Islington, North, and most hon. Members who have contributed so far have mentioned the Whittington hospital in my constituency, as I will in a moment. However, the core of the debate is the question of the accountability of the NHS and how it operates. In London, the background is the Darzi report. Behind that, there are a series of associations-in my case, five north London boroughs have decided, as my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) has pointed out, that they must cut £500 million from their budget in the next five years. I keep asking where that figure comes from, but nobody can tell me. They say, "Well, it's a possibility," to which I ask, "A possibility of what, from where, by whom?" to which they reply, "We have to think to the future."
We all have to think to the future, but I do so in terms of improving health care throughout my constituency, north London and the rest of our capital city. I pay tribute to my right hon. Friend. When he was Health Secretary, he not only ensured large-scale investment in major hospital facilities, GP practices and all the rest of it, but put into operation the Black report, which was hidden by an earlier Conservative Government, and tackled health inequalities through health action zones and public health campaigns. There has been an improvement: life expectancy is greater; infant mortality and child obesity are lower; and a number of other things have improved.
We have a long way to go, as everyone should be well aware. The population is increasing, and desperate inequalities still exist, as does very bad housing, so we need investment in health care across the piece. We do not need senior officials who lead shadowy existences to decide that in the long run, there must be a cut in health expenditure through our part of north London. My plea is on behalf of an awful lot of people who rely desperately on local health services and facilities, who do not have the alternative of private medicine-for them, it is the NHS or nothing, so we need the NHS to be the very best.
Most speakers today, including my right hon. Friend, mentioned the future configuration of local A and E facilities across north London. As has been said, a proposal is lurking somewhere in the background of this debate. Eighty people-I do not know who they are-are being regularly consulted on the future
configuration of health care across north London, and they appear to have decided that the most important hospitals are University College hospital and the North Middlesex, and that they will therefore downgrade or reduce everything else. I find that repugnant and wrong.
When news of those proposals leaked out to us, I called two public meetings in my constituency. Three hundred people attended the first, and 350 the second, which does not include those who could not get in because the room was so full. We held a march and demonstration through Islington, and 5,000 people attended. They were not subject to scaremongering: they were there to show their support for their national health service, their local hospital and its A and E department. My hon. Friend the Member for Islington, South and Finsbury, my right hon. Friends the Members for Holborn and St. Pancras and for Tottenham (Mr. Lammy) and the hon. Member for Hornsey and Wood Green (Lynne Featherstone) and I were all there, as was every political party from the Revolutionary Communist party to the Conservative party. Opinion was unanimous in support for that casualty unit. I know that the Minister has heard us and understands what we are saying about this.
As a result of the march, I received a letter from the chief executive of NHS London, essentially telling me that I should not be so concerned. I read her letter with great care and was left even more concerned, because she talked about opening a hub at the Whittington hospital for north Islington, called a polysystem. I am not against GP-led health centres or improving primary care facilities. On the contrary, I am in favour of effective, efficient local GPs, but we should not close A and E departments. Casualty unit attendance figures in the north London area were 695,000 last year, of which 86,000 were at the Whittington. Do not close casualty units and do not cut our hospitals, and instead recognise that we conquer ill health and inequality by investment, not by cuts and closure. We conquer them by access, not by making services more complicated and less accessible.
5.41 pm
Mr. John Randall (Uxbridge) (Con): I welcome the opportunity to follow the hon. Member for Islington, North (Jeremy Corbyn). I, too, received an e-mail from a commissioner, which contained the worrying words:
"Targets and centralisation have driven morale to an all-time low, with money wasted and no flexibility to be innovative or unique."
I go to regular meetings on this issue with my two colleagues from the other Hillingdon constituencies, and the terminology that we hear worries me. There is talk of turnover, margins and targets, which are of more use in the retail sector.
A secret operation has been going on. The Minister said that it was clinician-led, but I have a copy of a letter sent by the deputy director of service transformation at NHS London to the sector chief executive of north-west London. I have not got time to read much from it, but some of it should strike terror into our hearts, because it shows that the proposals are not about clinical decisions. It states:
"Overall, there is a considerable amount of work to be done to produce a high-quality strategic plan for transforming services in NWL, one that captures priority actions to be taken, by whom and by when. You should work with your PCT chief executive
colleagues to ensure the PCTs' contributions to delivering the strategy for NWL are clear and coherent and that their plans are properly aligned, where necessary, with yours. You are accountable for ensuring that the NWL Sector exhibits the right leadership to ensure that NWL's strategic plan is robust, to ensure the delivery of Healthcare for London at the pace that the changed economic context now demands. We are confident you have the right governance structure in place to make this happen."
Those words mean, "Make sure you get it right, like we've told you to do. These are the plans we want."
"Turning to your proposals for Local Hospitals and Elective Centres, there is no reference to the numbers you believe to be sustainable across the sector. I know that you have a programme in place for reviewing all hospital care settings and the plan should, at least, signal the likelihood that not all the current sites will make the transition to either MAH or Local Hospital."
I could go on, but I do not have the time.
The Government have undoubtedly put money into the NHS, but where has it gone? Like the hon. Member for North Norfolk (Norman Lamb), I think that it has gone into the new structures and bureaucracy and not necessarily where people expect it to be. The NHS has become like a huge sponge, with water being poured in, the money being poured out, and only drips coming down.
I regret that the situation has arisen so near the election, because I do not want this to be a competition-it is not about that. I want to save my local hospital and services more than anybody else. The hon. Member for Islington, North talked about demonstrations and marches in his constituency and about the all-party support for them. In Hillingdon, there is nothing but unity among all the local Members of Parliament and the other parties there. This is about trying to preserve what we want for our constituents and fellow residents; it is not about trying to score party political points.
In A and E departments, members of staff do not hang around waiting for work to come in; they are overstretched as it is. If, as is the suggestion in north-west London, three hospitals are left with an A and E department, Hillingdon will be saved. Of course, I would be delighted were that the case. However, if only two are to remain, I am afraid that Hillingdon will go, according to the plan. If Hillingdon is saved, however, Ealing is on the list to go-and where will all those people currently going to Ealing go? Are they all suddenly going to pour into Hillingdon hospital? There is not the capacity-never mind the difficulties of actually getting there and the geography of it!
The matter must be put into the open. People should know exactly what is being proposed at an early stage.
Stephen Pound: As the hon. Gentleman has mentioned the great and glorious borough of Ealing, may I say that the 100,000 people who currently attend Ealing A and E department would, I am sure, have no objection to going to Hillingdon-we have nothing against Hillingdon? However, we would quite like to keep what we have got-thank you very much.
Mr. Randall: The hon. Gentleman is absolutely right. We want Ealing to keep its hospital, because we do not want lots more cases coming to Hillingdon. The people of Ealing deserve to have their A and E department there.
I know Hillingdon hospital. I was first a customer there in 1967, and my family and I have been using it since then. It is doing an excellent job. It has never had a particular golden age. In 1967, I had to wait a very long time to have my wrist reset, because there had been a major accident. However, David McVittie, at Hillingdon hospital, has been putting a lot of time and investment into ensuring that services are improving. We had hoped that a new hospital would be built-it was talked about-on the RAF Uxbridge site. That dream has disappeared. We hoped then that Hillingdon hospital itself would be improved-that was talked about, too-but that idea seems to have gone now. There is also talk about having one polyclinic in each area, but where they might be has only been talked about. What about the people who do not have to go to A and E? There is nowhere for them to go.
We want the health centre in Yiewsley up and running. We have just opposed the move of a health centre from the green at West Drayton. I could go on about mental health services in London. While we are talking about our own hospitals, we should be talking about mental health services. Twenty one per cent. of NHS mental health beds in London have been lost over the past four years. My message to the NHS and the Minister is stop fiddling around with the systems and concentrate on delivering the service that my constituents and I, and all Members of the House and their constituents, expect and deserve.
5.48 pm
Siobhain McDonagh (Mitcham and Morden) (Lab): I want to tell a tale of two hospitals. Mitcham's Wilson hospital was endowed by a local benefactor, Sir Isaac Wilson, back in 1928. He specifically donated it for health purposes, but in the 1990s there was a Conservative Government. The public campaigned long and hard to keep this much loved cottage hospital open-but the Tories would not listen, and they closed it.
Now, however, there is a different Government, and later this month the Wilson hospital will reopen as a general practitioner-led health centre, open from 8 in the morning till 8 at night-the hours that patients want-365 days a year. However, that is just the first stage of the plan to improve the Wilson, and it will ultimately be a full care centre offering diagnostics, a variety of medical treatments, dentists and GPs, out-patient treatments, physiotherapy, speech and language therapy, X-rays, electrocardiography, ultrasound, a baby clinic and even minor day surgery.
What is more, the Wilson is not just getting a care centre; it is going to reopen as a proper cottage hospital, performing minor operations and offering more than 50 intermediate care beds for people recuperating from operations or in need of care that they cannot get at home. The first stage-our local GP-led health centre-opens on 31 March. The remainder of the hospital will be open by 2013. That is still three years away and subject to planning approval, but I want to commend Ministers, officials and NHS staff for all that they have done so far, and take this opportunity to encourage them to keep up their good work. We are delighted with our new GP-led health centre, but we want the rest as soon as we can have it. The Wilson is in one of the most deprived wards in the whole of south-west London, and will make an enormous difference to many people's lives.
That was the tale of the Wilson; now I want to tell the House about St. Helier hospital. St. Helier opened in the 1930s to serve one of Europe's largest council estates, but by the 1990s it had become shabby, and in 1996 it became infamous when patients were left on trolleys in the corridor because there were no beds. If anybody wants a reminder of what a Tory Government means, it is patients dying in the corridor because there is no room in the hospital. St. Helier was at rock bottom, so NHS bosses under the previous Government developed plans to shut it and move its services across south London to Croydon. Things happen slowly in the NHS, but a process was set in motion, and eventually the local NHS proposed moving everything to Belmont, in the Surrey suburbs. However, when residents across the region were consulted, Belmont was the least favourite choice. St. Helier was the favourite choice.
Luckily, in 2004 there was a Labour council in Merton, and it called in the Belmont decision. A year later my right hon. Friend the Member for Leicester, West (Ms Hewitt) agreed with residents, instructing the NHS to rebuild St. Helier rather than relocate, because this would help reduce health inequalities. Unfortunately, as I am sure the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), would admit, things do not always run smoothly in an organisation as big as the NHS. There have been a few jolts along the way, but last year London's NHS finally approved the full plans for St. Helier hospital, and last month the Department of Health gave them the green light.
I would like to thank my right hon. and learned Friend personally for his enormous help. He has repeatedly met me, as well as the hon. Members for Sutton and Cheam (Mr. Burstow) and for Carshalton and Wallington (Tom Brake), who have been assiduously helpful themselves. He has been very hands-on, and has done his best to ensure that officials deliver the health service that people in Mitcham and Morden, Sutton and Carshalton all want. Now we just have to wait for the final rubber stamp from the Treasury. I thank Ministers for all their support.
I have invited my right hon. and learned Friend to meet my constituents to hear what they think about our local NHS. I am pleased to say that he has agreed to join us later this month. He is very welcome. In many ways he is the personification of the tale of two hospitals, but it is also a tale of two Governments. The first was a broken Government running a broken NHS, shutting a cottage hospital that had been built to help poor workers in south London and plotting to close a general hospital where people were dying on trolleys because they could not find beds-the worst instincts of a Conservative Government.
Those were the worst of times, but that was the 1990s. Now it is 2010. Our broken health service is slowly being put back together under a Labour Government, with the Wilson reopening and St. Helier not only safe from closure, but likely to be completely rebuilt. It might be stretching the point to say that we are now in the best of times, but things are certainly a lot better than they were. I am proud of the progress that we have already made and hopeful about future progress. On behalf of my constituents, I would like to thank everyone who has supported our local NHS in the past 13 years.
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