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I congratulate the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate. The issue is of real concern across the whole of our capital city. In my part of south-east London, the health care trust is amalgamating three hospitals-the
Princess Royal University hospital in Bromley, the Queen Elizabeth in Woolwich and Queen Mary's-for financial reasons, not for reasons of clinical need. The Minister is well aware of the problems in my area, although he does not take them on board. Often, he just trots out public relations spin. His response in last week's debate was rather regrettable, because he did not deal with the concerns of people in my area. There are four key issues. I will be brief, Mr. Howarth, in view of your strictures on getting as many people as possible into the debate.
Mr. Mike O'Brien: I feel that I need to interrupt the hon. Gentleman, because I was not spouting spin, as he put it. I criticised the Conservative party for having absolutely no policy of any seriousness on the NHS in London other than that of taking budgets from GPs. That is just an abdication of responsibility, and that is what the hon. Gentleman did not like to hear.
There are four issues: accountability, consultation, secrecy and the adequate provision of health care-all issues that concern my part of south-east London. On all counts, the Government, the Minister and the people in NHS London making the decisions following the setting out of the Darzi vision, or whatever it was called, have been found wanting.
We recently had a letter from Ruth Carnall suggesting that polyclinics were the answer, and that a polyclinic would go on the site of Queen Mary's, Sidcup. As we know, Labour is downgrading the hospital's A and E and its maternity and children's services, and there are real concerns about that. There was recently an outbreak of norovirus at a nearby hospital, which forced the hospital to send more A and E patients to Queen Mary's. If Queen Mary's did not have an A and E, where would such patients go? That is a real concern in my area. Under the provisions, people will have to travel further to access emergency care.
I very much regret the proposal to have a polyclinic on the site of Queen Mary's. As the hon. Member for Islington, North, said, once we start downgrading services, a hospital is no longer really the proper hospital that people in our areas need, but a local facility. I commend the hon. Member for Hornsey and Wood Green on her exposition of the situation in her area; that situation is, regrettably, replicated in mine.
Since the introduction of the Licensing Act 2003, which allowed 24-hour drinking, the number of hospital admissions due to acute alcohol intoxication has doubled, and the number of admissions wholly attributable to alcohol has increased by 70 per cent. That, too, is having an impact on A and E, particularly during the night, when, under the proposals, hospital A and E departments would not be available to take people in, as the hon. Member for Islington, North said.
I am really concerned that we are rushing through changes without sensible thought, consultation and discussion. I have respect for the Minister, and some of his work has been commendable, but he is, regrettably, blinkered on this issue. He will not look at the whole issue of secrecy and consultation. The proposals for
change in my area are not clinically led, but financially led, because Queen Mary's, Sidcup, is the only hospital in the group that did not come under the private finance initiative. Why have the costs for the PFI-funded Queen Elizabeth hospital in Woolwich spiralled to £799 million, when the building's estimated cost was £96 million? That issue also needs to be looked at. I am really concerned that we are reducing the number of hospital beds across most of the capital, and particularly in my area, when increasing numbers of patients are seeking A and E treatment, and when numbers of emergency admissions are rising.
If an open consultation had taken place, a different decision would have resulted. As in the case mentioned by the hon. Member for Hornsey and Wood Green, there was a consultation, but as I said in my intervention on her, it was a sham, because the decisions had already been made before the consultation took place, and the Minister must take that on board. It appears that the decisions taken were those proposed in the first place. We had four alternative proposals, but one of them-keeping Queen Mary's, Sidcup, open-was not on the agenda.
So we did not have a proper consultation at all in our area on the future of our local hospital. I very much regret that an issue so critical for the whole of London is being quickly swept under the carpet so that the Government can move on without considering patients' needs, real care and the availability of services in the area. Of course we welcome the opportunity to have dialysis and cancer treatment services at Queen Mary's, Sidcup, but not if that is at the expense of a valuable, vital local service. If that is lost, we shall not get it back, and the patients will be the ones to suffer.
The debate so far has been useful. I hope-I beg-that the Minister will consider my area, and that he will not give the party political line that he did when he intervened on me, but will consider the issues of patients and care, and the concerns about secrecy, accountability and consultation. I ask him to respond to those issues-I know that he can, as an honourable chap-for the sake of people in my area who feel that the Government do not care.
Mr. Andrew Pelling (Croydon, Central) (Ind): My arithmetic suggests that I have three minutes and 20 seconds. It is important for me to take part in the debate; I feel that I owe my return to good health to the NHS. There is great loyalty to the NHS, and all parties will reflect that.
The consultation process is a matter of concern. We often had debates 30 years ago about how the ability to influence education was a secret garden. In some ways, perhaps that is applicable to the consultation process that we are considering, which has in many ways already taken place internally, within the NHS. We political representatives are sceptical and wonder whether decisions have already been made. As the hon. Member for Hornsey and Wood Green (Lynne Featherstone) said, people probably feel "consulted out"; they are consulted, but that is an empty process.
That feeling that the process is an empty one is highlighted by the way in which the Government seem happy for the issue to be delayed until after the election. The Opposition Front-Bench spokesman may think
that I am being irksome, but I was surprised that, in the motion that went before the House, the Opposition suggested that there should be a delay in the consultation until the proposals that were being pushed forward were cancelled. It would be unfortunate if that led the Conservative party to say that there should be a delay until after the election. It is important that the consultation should happen as part of the election process; that is the real empowerment of electors.
The debate would be helped by a realisation that the work done by Lord Darzi relied on quite a small database to justify the centres of excellence approach. In many medical matters, it is much better to be treated quickly by a medically qualified person than to be taken miles across busy suburban London to be treated.
I now come to how we could inform the debate, given the suggestion that there is to be a significant change in provision. It was not the case when I was at Oxford, but students these days are often required to include academic references when they make certain propositions. The Government seem not to be doing that. They are not willing to publish the McKinsey report, but even Labour Ministers and Members are calling for it to be brought forward. There have also been freedom of information requests. Will the Minister of State say now that the report can be published?
Many of us have copies of the proposals, which we have been given in confidence. Bearing in mind that they have now been widely circulated, is it not best for the Minister to give the London NHS some guidance? Please may we now be allowed formally to publish the proposals, so that the quality of debate can be higher?
Justine Greening (Putney) (Con): The hon. Gentleman makes a good point. We had an Opposition day debate last week; perhaps there could have been better communication after it, but nothing has really happened as a result of raising those concerns.
Mr. Edward Davey (Kingston and Surbiton) (LD): I congratulate my hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), who is an excellent campaigner for her constituents on this issue. What is happening in the area that she and the hon. Member for Islington, North (Jeremy Corbyn) represent should be a warning to the rest of London about what could happen if we do not campaign cross-party and work against such threats, and for greater openness.
This is the third debate in the past two months in which my hon. Friend the Member for Richmond Park (Susan Kramer) and I have argued the case against the threats to Kingston's accident and emergency and maternity services-and, indeed, its in-patient paediatrics, and potentially its elective surgery services, too. I make no apology for wanting to speak on the subject again, because yesterday we took a petition of more than 15,000 signatures to Downing street to try to make our points to No. 10.
We want to keep raising the issue for three major reasons. First, when we raised it initially we were accused by our political opponents of scaremongering. The
evidence that we have now heard from hon. Members across the House is that that is not true. I wish that those who made the accusation would apologise, so we could get on with the campaign and work in a cross-party way in Kingston.
Secondly, as the hon. Member for Croydon, Central (Mr. Pelling) said, the documents that set out the detail of what is going on need to be put in the public domain. My hon. Friend the Member for Richmond Park and I have benefited from leaks from senior NHS people, which we have made public. We have put them on our websites to show the sorts of threats that are faced in south-west London by Kingston hospital, Mayday University hospital in Croydon, and St. Helier hospital in Carshalton. They are clear about those threats. We have heard that there is much more: we have heard about the McKinsey report, and those documents should be put in the public domain. My hon. Friend the Member for Richmond Park has tried 57 freedom of information requests, but the Government and various elements of the health service refuse to publish the documents. The Minister should put his foot down today and show leadership. He should ask NHS London to publish those important documents.
We also need to make things clear to the public. The consultation timetable in many areas is relatively short. My hon. Friend the Member for Richmond Park and I attended a briefing with two senior NHS executives last week, and they talked about putting their shortlist of closure proposals into the public domain in October, with the formal consultation concluding by next January. Those things are upon us. The assumptions behind the work and the proposals that are to come out in the autumn are already there, but we cannot challenge them. As I have said, some of those assumptions deserve to be challenged, because they are flawed.
The third reason why I want to keep arguing the case is the excellent services at Kingston hospital. I have said from the start that it is unthinkable that they should be closed, because they are so good, whether that is judged by reports from independent groups such as Dr. Foster, or by NHS inspectors. It is not that we resist change. In my area-at least on the Surbiton site-polyclinics are being introduced not to undermine the hospital, but to support health services locally. The polyclinic that is proposed for Surbiton hospital is really an excuse for us locally to put modern investment into the site; it will not replace services at Kingston, but take some of the excess pressure from it.
The number of attendances at A and E goes up year by year, and that is very difficult for the Kingston site. With a rebuilt polyclinic on the Surbiton hospital site, we can get better GP premises and more investment in primary care services. That makes sense and would work if we kept Kingston hospital. Kingston hospital's chief executive and board are happy with the proposal for the polyclinic at Surbiton hospital, and see it as something that could improve their services. I accept that things may be different elsewhere, because all areas are different, but the polyclinic on the Surbiton hospital site could support the future of Kingston hospital.
Other hon. Members may want to contribute quickly, so I shall keep my final remarks short, but I want to question the Minister. He says that the proposal should
be clinically led, and we wish it was, but clearly it is not. It is financially led. In all the documents that we have seen, and at all the meetings that we have held, the arguments have not been made on a clinical basis at all. They are very different from the arguments made for centralisation of stroke and cardiac provision, or for polyclinics. The arguments in this secret exercise are not clinical, and it is about time that the Minister faced up to that.
Mr. John Randall (Uxbridge) (Con): I shall use my minute as best I can. It is a shame that we have to rush these things, because the issue is obviously of great importance to everyone in London. I notice from the annunciator that the business in the main Chamber seems to be about to finish. It is a shame that three hours will be wasted there, when we could be discussing this matter in the main Chamber.
When we have these debates, it becomes very clear that our hospitals in London are much loved and much used. Yes, there will sometimes be criticism-we all have criticisms that something has gone wrong here and there-but our hospitals are much loved and much used.
There have been some excellent speeches, and I agree with everything that has been said, but one thing we must think about is whether we are dealing with the issue from the viewpoint of what people want. In other words, we want to keep the good local hospitals we have, and we should be considering how we can maintain them, not how we can get rid of some of them. I have no problem with the concept of stroke and major trauma departments going to specialist hospitals, but I do have a problem with accident and emergency and possibly maternity departments disappearing from all those hospitals-regardless of where they are in London-because once they go, the viability of that hospital will go.
I say to the Minister that we know what our constituents want, what we want and what the country wants. We and the NHS have a duty to try to continue to use the hospitals we have. It is no good trying to cover the issue up in some way and saying that it is a wonderful exercise, because that simply will not wash with the general population.
Mr. Paul Burstow (Sutton and Cheam) (LD): I echo the remarks of the hon. Member for Uxbridge (Mr. Randall): we need more time to debate the issue properly, so that the expressions of concern can go further and we can dwell on the detail. An awful lot of detail needs to be challenged and, frankly, exposed. I congratulate my hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate, and all hon. Members who have taken part.
The speeches made today have demonstrated the clamour among local communities for greater accountability. There is a demand for full disclosure and an absolute belief that we should have genuine, robust public consultation that is not just about rubber-stamping an outcome, but about influencing an outcome, so that people feel some ownership of the decisions that are being made. None of that is happening in the processes
that hon. Members have described today. Undoubtedly, that is driving their concerns about the real threats that are articulated in documents, such as the one from Kingston. Such threats would lead to the closure of A and E departments and maternities around London.
My first point is a local one. I thank the Minister for the very engaging and engaged way in which he has taken forward the outline business case for investment in a patient wing at St. Helier hospital. My hon. Friend the Member for Carshalton and Wallington (Tom Brake) and the hon. Member for Mitcham and Morden (Siobhain McDonagh) also appreciate that. It has demonstrated what Ministers can do when they engage with strategic health authorities and local NHS organisations. That leads us to ask why the same thing does not appear to have happened in relation to the wider genuine concern welling up in communities around London that the processes of consideration-dressed up in clinical language-about how to make the books balance are about to lead to deep and damaging cuts in services.
Mr. Pelling: The clinical language itself shows the falsity of the approach. There is talk of a 70 per cent. reduction in A and E visits and a 30 per cent. reduction in visits to GPs. Surely that is just unobtainable.
Mr. Burstow: That is a fair point. One of the frustrating things is that Ministers understandably tell us that decisions about budgets and how services are organised are local decisions. My hon. Friend the Member for Hornsey and Wood Green and others who have contributed to the debate pointed out that, therefore, the argument is made that Ministers are not directly accountable for those things. Yet how can we have genuine local accountability when primary care trusts are made up of people who are nationally appointed and who are largely, if not entirely, unknown by the communities that they are meant to serve? As a consequence, PCTs cannot offer genuine and meaningful accountability for the choices they make about the allocated resources that they are spending.
A good example is the £150 million that was trumpeted by the Minister of State, the hon. Member for Corby (Phil Hope) to pay for respite breaks for carers. Hon. Members were challenged to go back to our PCTs and dig out the figures. It was impossible to find those figures; many PCTs were reluctant to provide them. The same is true when it comes to the proposals for the reconfiguration and reorganisation of services. We are finding that it is difficult to get the detail on to the public agenda and out into the public domain, so that people can start to ask meaningful questions.
My hon. Friend the Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats on these issues, is genuinely concerned about the lack of accountability and transparency surrounding the whole process. After reading last week's debate and the exchanges between the Minister and my hon. Friend, I am led to ask whether the Minister or his ministerial colleagues have authorised the processes that are going on in London. Is he aware of them in any detail, and can he say what the strategic health authority, which he oversees, is telling him about those processes and what the timetable is? Alternatively, is the Minister being kept in the dark like the rest of us? Have NHS managers gone AWOL and decided to take control of the matter, as seems to be
suggested in the NHS Confederation pamphlet that came out this week. That document states:
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