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17 Mar 2010 : Column 287WH—continued
We are told that the situation is all about improved clinical outcomes and that it will be good for us. The sector points time after time to stroke and trauma specialist centres as evidence of improved outcomes. Those emergencies are relatively easily diagnosed, and we know that early intervention is critical and can make a difference. The problem comes when NHS bosses extrapolate from that across the A and E health spectrum. It is a complete red herring, as the vast majority of A and E patients do not present with clear symptoms; that is the whole point of A and E.
The volume and nature of cases currently arriving in our A and E departments demand that 24/7 A and E be continued on safety grounds. No one, least of all NHS London, has produced evidence of health care benefits to support the proposals. I have not met a single local person who does not think that closing the A and E is sheer madness.
To me, and seemingly to the entire population of Hornsey and Wood Green, the clue is in the title "emergency". That means nearby, local and accessible, not only by ambulance. At no point when developing options has the sector team made proper use of the information it already holds or can access on the location of service users, the location of users of specific forms of delivery and delivery locations, users' social and ethnic make-up and the accessibility of existing and proposed new delivery systems to public transport service users.
Using Google, the Highgate Society researched journey times from a wide number of postcodes where users would normally access the Whittington, and what those journeys would look like if those users had to transfer to the alternative A and E at the Royal Free hospital. Journey times for all but four of the 23 postcodes sampled were longer by up to 40 minutes. On the Transport for London route planner, Crouch End Broadway-not the most difficult part of my constituency from which to access the Whittington-is 21 minutes from the Whittington but 50 minutes from the Royal Free hospital and 39 minutes from UCH. The journey involves a bus, two tube lines and a six-minute walk at the end.
Lynne Featherstone: On that basis alone, any proposal to send A and E cases to the Royal Free hospital would threaten health outcomes, not improve them. In addition, the Royal Free hospital is already under pressure, with 90,000 cases of its own. It is on a confined site to which access by public transport is terrible. Parking is impossible, and even the London ambulance service does not like going there.
On finance, the Minister said in an Adjournment debate on 2 December:
"I have made it very clear to managers in the NHS that there should be no slash-and-burn cuts".-[Official Report, 2 December 2009; Vol. 501, c. 1257.]
At the same time, NHS London is saying that savings of £355 million a year until 2017 are being required of the acute sector of north central London. Can the Minister confirm that? Have the Government made any other requests in terms of reducing costs or lowering funding?
Mr. Mike O'Brien:
The hon. Lady is being generous in giving way. To make it clear, we are seeking savings in order to reinvest them in NHS facilities. It is not about
taking money out of the NHS; it is about finding savings within the system, particularly from back-office processes, to reinvest in front-line health care. The money will stay in the NHS.
Lynne Featherstone: I understand about seeking savings from back-office amalgamations across the deal, but the complexity of the new arrangements often eats up any savings made from the merger in the first place.
The 82-page "North Central London NHS Strategy Plan 2010-2014" barely touches on funding issues. At no point when developing the options does the team appear to have accessed information from the NHS regarding the unit costs of delivering different classes of service to service users, the aggregate costs of different service delivery units, the current account costs of disruption while personnel are reconfigured into new locations, teams and specialities or the capital costs of closing some facilities and opening others. Until those costs are known, it seems somewhat unprofessional not to include, at the very least as an option, leaving the current configuration as it is. For all we know, that might yield the best savings.
Nor has any serious analysis been made of how required savings will be found while improving quality of service, what savings might be garnered from the change to urgent care centres and polyclinics, how much it will cost to reconfigure services or what the potentially huge costs will be of re-engineering the Royal Free hospital and improving access for the London ambulance service, which would have to make an additional 120 journeys a day.
The report says nothing about where the resources will come from. There is no evidence that health care will be improved by any of the measures that I have mentioned. I have seen no work on what cost-benefit might be attributed to the well-being that a patient derives from being in a hospital near home, relatives and friends.
We in Hornsey and Wood Green are extremely cynical about consultation. Does the Minister agree that the much-vaunted public consultation by NCL, which comprised 80 people from across five boroughs, was derisory? It cannot possibly be considered of any value to consult 80 people from five boroughs. At no public meeting has any research been quoted regarding user preferences or user satisfaction. That is wholly contrary to practice in the commercial sector and the Government's own guidelines on personalisation of public services. Collecting satisfaction data through diverse contact points should be a routine element of the management of service delivery.
At the public meeting I organised, which nearly 400 people attended, one questioner asked what would happen if everyone opposed the proposal to close the A and E. Richard Sumray, chair of Haringey PCT, refused to say that it would be enough to stop the process, answering that he could not say what would be in the consultation. No wonder we are cynical. Perhaps the Minister will be more direct. What volume of opposition does he consider necessary before he would be willing to uphold the wishes of local people?
In an answer to my early written questions to the Minister about the issue, I was told that it was a matter
for local decision making. As a Liberal Democrat, I would love it if it actually were local decision making, but it is not. My hon. Friend the Member for North Norfolk (Norman Lamb), who leads on health for the Liberal Democrats, said in response to the Minister's assertions that such decisions were local:
"Who are these local decisions taken by? They are taken by people who have no legitimacy; they have been appointed nationally, so there is no accountability to the communities".-[Official Report, 9 March 2010; Vol. 507, c. 181.]
We want to be able to hold such organisations to proper account. We will oppose any loss of services imposed by unelected, unaccountable quangos. Such decisions should be local and determined openly and transparently by democratically accountable bodies. If it was up to us, we would simply stop the process dead in its tracks until that happened.
In conclusion, the process is critically flawed, untested, unwanted and dangerous. Does the Minister agree with me that time, energy and resources would be far better spent in finding ways to keep the Whittington A and E, paediatrics and maternity services open if local people want them, and that we should focus on delivering the health care that local people need, want and deserve?
Mr. George Howarth (in the Chair): Order. A number of people are trying to get in. I intend to call the two Front-Bench speakers for the winding-up speeches-[Hon. Members: "Three."] Yes, at 3. Hon. Members who catch my eye and contribute to the debate must be as brief as possible to enable as many people as possible to speak.
3 pm
Jeremy Corbyn (Islington, North) (Lab): Thank you, Mr. Howarth. I think that you extended the debate by some time.
Mr. George Howarth (in the Chair): Sorry, 3.30. I was referring to the three Front Benchers.
Jeremy Corbyn: It is good that we are discussing health, not education or maths. I will be brief, Mr. Howarth.
I congratulate the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing this debate. She rightly concentrated on the local issues facing the Whittington hospital, which is in my constituency and serves many neighbouring areas. I will say a few words about it and make a couple of general points. I will be as brief as I can because other hon. Members wish to speak and it is important that they do.
We debated this matter in the House last week, and I secured an Adjournment debate on the Whittington hospital not long ago. The Minister has acknowledged that he is fully aware of the huge strength of local feeling from all sections of the community, all political parties and all leading opinion formers in the relevant boroughs of Camden, Islington and Haringey on the plans for the Whittington hospital and the north London area. There have been two public meetings in my constituency with an aggregate attendance of about 700 or 750. The hon. Lady held a meeting attended by 400 people and 5,000 people attended a public demonstration in March.
On the march, all sections of the community, all ages and a huge variety of political opinions were represented. There was a genuine feeling of support and affection for the local hospital, and a feeling that the way in which the NHS operates is not accountable to the public, local representatives or anybody else. I am sure the Minister sometimes feels that decisions are made in the NHS without the degree of accountability that there would be in a local authority. There is no feeling that those who make the decisions will be held to account for what they do. That sense of frustration is behind a great deal of what is being said and done locally.
The health situation in my borough is difficult. It is not the most prosperous part of the country, despite what the media and popular press say about the Islington lifestyle, with the restaurants, coffee bars and the pine furniture around Tufnell Park.
Jeremy Corbyn: Well, in my area, we are talking about Labour voters. My point is that the borough is one of the most deprived in London, and is therefore one of the most deprived parts of the country. Its image belies a great deal of poverty. The same can be said about most parts of London, which is an interesting microcosm of the world in that rich and poor live side by side and there is desperate poverty alongside huge personal disposable wealth.
I thank the Government for recognising since 1997 the link between poverty and ill health. As Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) recognised the importance of putting more money into deprived areas, putting more effort into improving public health through anti-smoking campaigns and obesity campaigns, giving instant cancer treatment where possible and all the other improvements that have been introduced. There have been tangible improvements: the death rate, the infant mortality rate and the instance of many notifiable diseases have done down as a result of those campaigns. They have gone down everywhere, although not anywhere near fast enough.
We still have huge problems with alcohol, substance misuse, teenage pregnancy, hypertension, obesity, cancer and heart disease. There are a series of issues to be dealt with. Improving people's living standards, housing conditions, diet and health knowledge are key in improving the health of the nation. I am sure there is common ground on that point. It is also important that we have a national health service that is fully accessible.
I have been the Member of Parliament for Islington, North since 1983, an elected representative in Haringey or Islington since 1974 and have been in and out of the Whittington hospital on hundreds of occasions. I know the place very well and I know many of the local health services and facilities very well. We have been through difficult times: parts of the Whittington hospital have been closed, various wards were closed because of funding crises in the 1980s and early 1990s, and we have been through a desperate shortage of GPs. Those things have changed and the health service has improved-I am the first to recognise that.
I have read with great interest the plans for changes in health care in London. Obviously, we want everyone to go to a local health centre where possible and to be
treated and dealt with appropriately. We all want a better public health system. I have here a copy of the weighty north central London strategic plan. It outlines the kind of changes the health authorities want to develop. I agree with the hon. Lady that the plans seem to have been developed behind closed doors by planners without obvious signs of clinical support from anybody. That is the point I make to the Minister.
Hordes of GPs have not been telling me that they want the Whittington hospital to be downgraded, that they want A and E facilities to be concentrated at University College hospital and North Middlesex hospital, or that other matters should be transferred to regional trauma centres. I have not come across that, but I have come across professors in various departments, surgeons, consultants, administrators and many others who have the deepest concern about what is going on and want transparency and openness in the process. They correctly feel that if the Whittington A and E department is closed, the large population of 80,000 people who use it every year will have nowhere to go. That compares with 70,000 people who use the Royal Free, 100,000 who use UCH and a large number who use North Middlesex. If the Whittington A and E department closes, there will be no A and E department in the boroughs of Haringey and Islington.
The former chief executive of Islington primary care trust, who is now chief executive of the north central health authority, said that there would be waking-hours surgeries in place of the services that are lost. That conjures up the image of people ensuring that they have heart attacks before 8 o'clock at night because after that they would have to go somewhere else. People are given the illusion that there is an A and E department when it is not there all the time. In my book, either there is a blue-light 24/7 department or there is no A and E department at all. I hope that the Minister will acknowledge that. I am sure he understands the point I am making.
The consultation was not due to start until the summer. I had an Adjournment debate in the House, which provoked flurries of letters from people in various parts. We had the demonstration, which provoked a statement on the NHS Islington website acknowledging that a large number of people were upset about the proposals and inviting further comments. That was good, although it is a pity it did not happen some months before. I understand that some kind of consultation is going on today, although I am rather unclear about who has been invited to it or how they got invited.
It is simply not good enough to take a semi-secret approach to developing plans and to spring them on the public at a later date; local people's wishes are out in the open now. I have no problem whatever with improving GP services, and I have no problem with developing regional trauma centres, because I can see the sense in high-quality treatment for people with serious, major conditions, but such things should not be an alternative to an A and E department.
I am told that, behind all that, the proposals are all to do with saving £500 million from the north central area health authority budget. I do not know where that figure has come from; it has not come from the Minister or the Treasury, and nobody, as far as I am aware, says that a Government source has said it is the figure we must work from. Somebody somewhere is second-guessing
the future, deciding what the expenditure will be and developing plans to fit in with it, and that is not good enough.
We live in a democracy, so we expect public officials to be accountable and public services to be developed in the public interest. As elected Members of Parliament, we expect those responsible to make their plans open to the public, just as elected councillors would expect local authorities to do. We expect the public to respond to the plans and we expect that decisions will ultimately be made, presumably in Parliament. However, it sometimes seems to me, as a local MP, that we do not really know what is going on and that the secrecy applies just as much to MPs as it does to anybody else.
Whatever the outcome of this process, I hope that the big lesson learned across the whole of London is that we want much more effective accountability for how the NHS plans and develops its services. The development of borough scrutiny committees is a good thing, as is the development of borough to local PCT scrutiny in cases where boundaries are coterminous. Such things work well, but we also have regional groupings in London, which have no parallel scrutiny whatever, unless all the local authorities-five in this case-successfully get together to set up a wider scrutiny arrangement. So far, that has not happened, although there are suggestions that it might.
I am proud to represent my area in Parliament. I am proud of the work that has been done at the Whittington hospital. I am proud of the amount of money that has been put into the hospital over the past 10 years-the new wards, the new facilities, the new equipment and the increased staff numbers. The hospital has a very good performance record on treating casualties, on maternity, on the children's A and E department and on all the specialties that go with that. If the A and E is closed, however, the hospital is dead, because it will not be a general hospital any more.
I appeal to the Minister to look carefully into this issue. If there is some way in which he can intervene and say, "We are not going to destroy this valuable A and E department and, with it, the hospital," I would be very happy. Above all, however, tens of thousands of people across north London, who do not have access to cars and who cannot easily go to a local hospital because there is none, will feel a lot happier and a lot more secure. We have a rising, increasingly young and diverse population, and we have a yawning gap between the rich and the poor. The NHS is our NHS, and it should be accountable to us, not anybody else.
3.13 pm
Mr. David Evennett (Bexleyheath and Crayford) (Con): It is a pleasure to follow the hon. Member for Islington, North (Jeremy Corbyn), because we have similar problems in south-east London. If the A and E at Queen Mary's, Sidcup, is closed, Bexley will be the only borough in the area with no A and E.
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