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17 Mar 2010 : Column 282WH—continued
"We need to see strong clinical evidence for any change to the status of the Whittington...unless the case for change is established, there will be no change...I do not see any justification for closure of the A and E at this time".-[Official Report, 9 March 2010; Vol. 507, c. 171-172.]
I was jolly glad to hear that, as were colleagues across the House, I am sure. There is no clinical evidence at this point in time. Nor is there any evidence that the 45,000 people who could not be treated at any facility other than a proper A and E department could be dealt with by an alternative hospital.
Mr. David Evennett (Bexleyheath and Crayford) (Con): The hon. Lady is making a tremendously powerful case about the situation in her area. Is she aware that in south-east London, a similar situation occurred, and the consultation there was just a sham?
Lynne Featherstone: I thank the hon. Gentleman for his comments, and yes, I am aware of that, because I attended a debate last week at which I heard hon. Members from across the House say how poor the consultation had been.
Mr. Lee Scott (Ilford, North) (Con): Is the hon. Lady aware that even though a consultation is taking place on cutting A and E and other services at King George's hospital, which services my Ilford, North, constituency, wards are already being closed? There is allegedly a consultation going on in which people's views are being listened to, but those responsible are trying to bring about the closures by stealth before the consultation has even finished.
Lynne Featherstone: I thank the hon. Gentleman for his intervention. Some of us think that decisions have been made behind closed doors.
Jeremy Corbyn (Islington, North) (Lab): I thank the hon. Lady for giving way and for securing this debate. I, like her, heard the Minister's reply last week, and we have had a number of discussions and debates about the Whittington. Does she not think that it would be in everybody's interest if the plan to downgrade the Whittington from a district general hospital with an A and E was simply dropped, and we were guaranteed the continuation of the hospital in its current very successful form?
Lynne Featherstone: That is an excellent suggestion, but I suspect that it will not be the instant reaction to this debate. I wish that it was.
As I was saying, there is no evidence that those 45,000 people who need A and E services could be treated elsewhere. There is no evidence of a business plan, or of other facilities in the community that could deal with the 40 per cent. of cases that the sector claims could be treated by other means. Moreover, there is no evidence of how people would get to the alternative A and E at the Royal Free hospital.
I have to say to the Minister that the proposal is one of the worst presented cases for change that I have ever seen. That is putting aside the magnitude of the change that is envisaged. There is no case for the closure of the A and E, paediatrics, obstetrics or maternity departments. If a medical or clinical practitioner wanted to make a change in procedures or practice, however small, no NHS trust would allow it unless it was evidence-based. Why on earth should health planners not have to operate to that same standard of evidence? We have reached a point at which the options suggest that the Whittington A and E could be closed without that evidence. Lord Darzi was quite clear that any change had to be evidence-based, and that nothing could or should change until other provision was in place.
I want to move on to the specific issue of the Whittington. First, the review is being carried out under a false premise. North central London bases its review on the premise that 40 per cent. of current A and E visits could be dealt with by other means, such as by GPs out of hours, urgent care centres and polyclinics. Even worse, NHS London says that 50 to 60 per cent. of cases do not need to go to A and E. That figure is false. The Department of Health commissioned a report, "Primary Care and Emergency Departments", which has just been published; it is dated March 2010. Paragraph 1.2, under the heading "Main findings", concluded:
"When we used a consistent definition and a consistent denominator of all emergency department cases we found that the proportion that could be classified as primary care cases (types that are regularly seen in general practice) was between 10 per cent. and 30 per cent."
So it is not 40, 50, or 60 per cent. of people who go to A and E who can be treated by other means; it is between 10 and 30 per cent. Moreover, where there is a high level of deprivation, that figure moves towards the 10 per cent., rather than the 30 per cent. NCL is using data that we now know to be incorrect to support its proposal. Anything that follows that is based on that flawed data is unsound.
Susan Kramer (Richmond Park) (LD): I really thank my hon. Friend for the points that she is making. Is she aware that many of the cases where people are identified as possible candidates for treatment in more of a primary care setting can only be put into that category after the person has gone through the high-level testing that is only available in the context of an A and E department? The number is also false from that perspective.
Lynne Featherstone: My hon. Friend makes an excellent point and I will discuss it further shortly.
Mr. Edward Davey (Kingston and Surbiton) (LD): The point that my hon. Friend is making is incredibly important and relates to the problem of the secrecy that we have seen in this area. These assumptions, both in the primary care analysis that she is citing and in some of the financial evidence that we have seen in some of the leaked documents, must be challenged. However, because these documents are being kept secret, the public, Members of Parliament, elected councils and so on cannot scrutinise them properly and hold the people who produce them to account.
Lynne Featherstone: I thank my hon. Friend for that intervention and what he says is entirely the case. That is what is so mystifying about the process; why would these people not put these documents into the public domain, so that the documents can be scrutinised and challenged and so that these people can be held to account?
Mr. Andrew Pelling (Croydon, Central) (Ind): I congratulate the hon. Lady on securing this debate. She and her Liberal Democrat colleagues set the bar in terms of community politics.
Is not one of the reasons for the delay in the process the timing of the general election and the desire not to have a full discussion on this matter, so that voters cannot express their view on it? Is it not disappointing that the Labour party is very happy with the delay? Unfortunately, even the Conservative party proposed in a recent motion in the House that the consultation on the issue should be postponed until it was improved, which would further delay it until after the general election.
Lynne Featherstone: The hon. Gentleman makes an excellent point about timing and the general election. I fear that, once this issue is kicked into the long grass on the other side of the election, things will go off the boil and the pressure points will not be quite so powerful.
Mike Penning (Hemel Hempstead) (Con): The hon. Lady is being enormously generous in giving way so often. I need to respond to the comments that were made in the last intervention. The Conservative party's position on this issue was made quite clear in the debate in the main Chamber that the hon. Member for Croydon, Central (Mr. Pelling) just referred to. It is that these documents should be made public now.
Mike Penning: That is categorically our position. Most of the documents are in front of me now and they should be made public now. Then there should be a clinical debate from the bottom up, so that clinicians, GPs and patients, rather than the Department of Health bureaucracy next door in Richmond house, can decide what happens to the NHS in London.
Lynne Featherstone: I thank the hon. Gentleman, but I hear from sedentary remarks from my hon. Friend the Member for Richmond Park (Susan Kramer) behind me that that has not always been his view.
Anyway, as I was saying, NCL is using data to support its proposals that we now know to be incorrect, so everything that follows is unsound. I suggest to the Minister that on that basis alone NCL should be sent back to the drawing board, at the very least. Does he agree?
Looking at that statistical base for the Whittington, we now know that, out of the 83,000 people who visited its A and E department last year, 15,000 people were admitted to hospital and a further 30,000 people were examined, tested and released, which relates to the point made by my hon. Friend the Member for Richmond Park. Those 30,000 people could not have been released without first enjoying the facilities and receiving the care offered by a proper A and E department. Therefore,
if NCL decides to close our local A and E department and replace it with urgent care centres or whatever, it will have to explain in detail how it proposes to care for 45,000 patients a year who need neither to be admitted to hospital as emergency cases nor to be subject to urgent investigations that are not within the scope of an urgent care centre. That statistic is evidence that our local population need an A and E department at the Whittington.
The aspiration to provide local health care services closer to people's homes is admirable, but such services are not a replacement for A and E. Moreover, those services out in the community do not exist-they are nowhere near the required standard.
The Minister of State, Department of Health (Mr. Mike O'Brien): I am very grateful to the hon. Lady for giving way and I congratulate her on securing this debate. I am listening with care to her argument. I just want to be clear about one point. Does she think that there is merit in giving clinicians the ability to have a space in which to discuss what the best proposals are for London?
Lynne Featherstone: I am coming on to the issue of whether this process is clinically led or not. If I really believed that the clinicians had been consulted and had a full part in this process, I might accede to what the Minister is saying. However, every member of staff that I have spoken to, at every level of the Whittington, has told me that that is not the case. Based on my conversations with those staff, my understanding is that they are not at all happy with the proposals.
Mr. O'Brien: I am grateful to the hon. Lady for giving way again. I just want to be clear on one point. She seems to be saying that if clinicians were able to become involved in this process-I appreciate that she is saying that some of them may not be involved-and there was that policy space, she would favour giving them that space to have these discussions.
Lynne Featherstone: I wish that the clinicians had had that space before today. I hope that they will still be engaged, but we would not have arrived at this point if they had been involved in discussions before now.
Mr. Paul Burstow (Sutton and Cheam) (LD): I congratulate my hon. Friend on securing this debate, and she is most generous in giving way. Does she agree that what is concerning is that financial imperatives are driving the process-they come first-so that even if clinicians are involved, they are tied to dealing with the financial problem?
Lynne Featherstone: My hon. Friend makes a good point. One of the fears that stalk us all is that finance is driving the process and that the claim that better clinical outcomes will be delivered is all smoke and mirrors.
I was talking about the 40 per cent. of patients whom NCL say can be treated by other means; in other words, the non-emergency cases that are currently seen in the A and E. But where is the evidence to support that assertion by NCL? Where are the GPs who will field those 30,000 extra cases out of hours? The most recent NHS patient
survey found that there is already widespread concern about the performance of out-of-hours services, particularly in Haringey, which is coming off worse than most other parts of London.
Polyclinics are central to NCL's vision for London, but there is no statistical base on which to judge whether they will work or deliver improved health outcomes. The evaluation of polyclinics has barely commenced. The contract to carry out the evaluation of polyclinics was only awarded in January, and I understand that the specification is still being debated. The King's Fund report, "Under One Roof: Will polyclinics deliver integrated care?" is sceptical about polyclinics. The report argues that
"a major centralisation of primary care is unlikely to be beneficial to patients".
The report examines polyclinics abroad, as well as health centres that were created under the local improvement finance trusts. Dr. Laurence Buckman said:
"The report provides scientific, logical and international evidence that polyclinics won't deliver the things the government believes they will".
Is the Minister concerned not only that there is criticism of polyclinics but that, as yet, they have no evidential basis? There are no data sets and no proof that polyclinics will deliver beneficial outcomes, yet we already have draconian proposals. Moreover, a Department of Health spokesperson has said that it was not policy to impose polyclinics outside London. So will the Minister say whether it is policy to impose them in London?
Angela Watkinson (Upminster) (Con): I wonder whether the hon. Lady has found any confusion among her constituents about what a polyclinic is. Many people do not understand the term, and if they had something wrong with them, they would not be clear whether they were supposed to go to their GP, to A and E or to a polyclinic.
Lynne Featherstone: I am not sure that the clinicians or health powers, let alone ordinary people in my constituency, understand what a polyclinic is.
David Simpson (Upper Bann) (DUP): I thank the hon. Lady very much for giving way, and I congratulate her on securing this debate. Although there is consultation, the Government are insisting on a lot of these changes. Does she therefore agree that the primary concern is the morale of the ordinary staff? The ordinary doctors and nurses are already under pressure, and this process certainly does not help.
Lynne Featherstone: Indeed. That is why openness, accountability and transparency would be extremely helpful. I will now make progress, because other Members want to speak.
Urgent care centres are also central to NCL's vision for London. Data suggest that Government plans to replace A and E departments with new urgent care centres run by GPs and nurses could actually swamp existing practices with unresolved cases. One of the first urgent care centres in the country to open is sending up to 40 per cent. of its patients back to their GPs. Such new centres are being developed as a gateway to emergency and urgent care, in a bid to free up A and E departments. However, GPs' leaders have attacked those plans as
lacking an evidence base. That follows a recent warning from the College of Emergency Medicine that it had "serious concerns" about urgent care centres, which it said were being imposed for reasons of cost and without evidence of "clinical or financial benefits".
I now want to talk about the need for A and E, because why would anyone go to A and E if they did not need to? The answer is that the Whittington is situated in one of the most socially deprived areas in the United Kingdom. Many patients are not registered with a GP; many of them are probably not registered in this country. Many people who are not registered with a GP cannot get appointments. People get sick out of hours. Many people do not speak any English and many people are elderly or infirm. A and E staff know that, when people who are so disadvantaged get ill, they wait until their symptoms are extremely bad before they see a doctor. Consequently, when they present themselves, they are at a critical stage in their illness and need urgent care. The Whittington is there to give it to them, but they must go to A and E first.
Moreover, the north central sector is culturally and ethnically diverse. The 2001 Haringey census said that 51 per cent. of the population came from black and ethnic minority communities. That is important for health care, as many people from black and Mediterranean backgrounds can be affected by sickle-cell anaemia and thalassaemia; the Whittington hospital treats more people with those conditions than any hospital in the country. Access to A and E is essential for them, as those who go into crisis need urgent and appropriate attention. That is evidence that the Whittington A and E is vital.
Why damage University college London medical school? It is world-class: fifth in the UK, first in London and 20th in the world. If we want to make London a world-class city, what on earth are we doing destroying one part of it that is already world-class? Some 33 per cent. of UCL medical students are on the Whittington campus. The hospital is central to the university. We cannot teach the doctors of the future without A and E. If it goes, education at UCL medical school will be thrown into crisis, because students there cannot be pushed over to the Royal Free hospital or University college hospital. Where is the evaluation work on that aspect of the proposals? Does the Minister share my concern about what closing the A and E will do to the overall standing, status and education of our doctors of the future?
Why damage Middlesex university? It may be less well known, but the Whittington is also a key partner in that university, which teaches nurses, radiographers, dieticians and physiotherapists. The Whittington cannot function without those professionals, who work with the hospital in teams, and they cannot be taught without an A and E. If the hospital closes, that will all fall apart like a house of cards.
Why damage a hospital of national excellence? In national comparisons of hospitals, the Whittington has consistently performed superbly. In October 2009, the Care Quality Commission confirmed the Whittington's good quality of service and excellent financial management. In November 2009, the Dr. Foster quality accounts, which rank every hospital in England, identified the Whittington as one of the safest hospitals in the country, giving it an overall rating of 21st out of 145. That is all evidence-based.
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