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17 Mar 2010 : Column 300WH—continued
"The NHS cannot and should not wait for government action to respond to the financial challenge."
Have we lost political control of the NHS and, therefore, accountability for it? Will the Minister give us some reassurance that he and his colleagues are still ultimately accountable and in charge? If not, and if we are simply constantly reassured that clinicians are involved in the process, my hon. Friends and I fear that clinicians are being held hostage to a process that is about budgets. That is not good enough. Yes, the process should be clinically led; but, it has to be clinically led solely on the basis of clinical judgments. Even when the process is carried out on the basis of clinical judgments, the public deserve the right to be able to test the assumptions. That is what has been missing until now; we need the ability to test the assumptions.
As was mentioned by the hon. Member for Croydon, Central (Mr. Pelling), requests were made for the publication of the McKinsey report in exchanges last week. The Minister indicated that Ruth Carnall, chief executive of NHS London, would, of course, be listening to the debate and would act on the basis of what she had heard. As has been said, in the week since that debate, nothing has been published, nothing has been said and nothing has changed in relation to the nature of the process that is going on. That report should have been published. Although the Minister may feel unable to instruct, I hope he will ask NHS London to put the report into the public domain, because we ought to have the opportunity to see what it has to say.
This is an important debate about the very essence of what we should expect of a public service. Such a service should be open and transparent, so we need full disclosure. Those involved should understand that consultation must be held at a formative stage and that it is not just an end-of-process thing done to tick a box before implementing what they had decided would be done anyway. Such a service should be accountable to us in this place and, more important, to those who send us here. It should be accountable at the ballot box; it is not now, but it needs to be in the future, as that is the only sure-fire way of ensuring we have an NHS that people are confident in and that will deliver the services we demand.
3.38 pm
Mike Penning (Hemel Hempstead) (Con): As other Members have said, it is a pleasure to take part in a third debate on the future of NHS London. I reiterate the comments commending the hon. Member for Hornsey and Wood Green (Lynne Featherstone) for securing the debate. I also commend her for the tone in which she made her speech on behalf of her constituents, which was eminently sensible.
Like many of the discussions we have had on the subject, this debate is about trust and whether people can trust us as politicians and the Government to produce for them the health service that they deserve in the 21st century. The NHS has £110 billion of taxpayers' money, but can people feel safe that the NHS around them is free at the point of delivery and that their needs and those of GPs will be understood?
The Minister has said today and on several other occasions that the reviews are being clinically led. He said that because the public trust clinicians a lot more than
politicians. That is eminently sensible. However, the truth is that the process is not being led by clinicians.
The debate started with Lord Darzi's earlier report on his vision for the future of the NHS in London. I spoke with him before he became a peer when he was an adviser to the Health Committee, of which I had the honour of being a member. He is a highly intelligent and highly skilled surgeon, but when I pushed him on his report bits of it started to flake off, because it was a vision. When he gave evidence to the Committee on the report we asked him how much of the estate in London would go under his vision, but he gave no answer, even though I pushed him extensively.
We have not spoken about the fact that 15 per cent. of the NHS estate in London is currently sitting empty. That is where some of the savings could be made tomorrow morning and where some income could come in straight away. I know the economic climate out there is difficult, but instead of leaving the estate to become even more decrepit and for some developer to come along, let us be forward-thinking about it.
I am afraid that the clinician argument is fundamentally flawed, which is shown on page 3 of NHS London's document "Delivering Healthcare for London", the whole premise of which is the shortfall in funding. Several assumptions are made in that document, the final one being that there will be a shortfall of between £1.5 billion and £1.7 billon in 2016-17. I have no confidence in the document, because when one reads it one finds that it is not only fundamentally flawed in its assumptions, but flawed simply in its maths. It assumes funding growth of 2.3 per cent., but that figure is actually a cut of 2.3 per cent., because the minus sign has been left out. That does not give my constituents, or any others, much faith.
I mention my constituents because we have always come into London for specialist services. With the demise of some of the hospitals in my area, it is obvious that more and more of those services will be required in London.
The hon. Member for Islington, North (Jeremy Corbyn) and others raised concerns about the consultation and about whether the public are being duped. Are we being asked to take part in a consultation on something that has already been decided? That is happening in my constituency, where 82 per cent. of my constituents said no to the closure of the A and E, but it went ahead. As several Members have said, if one loses the A and E, one loses the hospital. Let us have no illusions about that, because the hospital loses its intensive care, its high-dependency unit, its beds and its theatres. Those will all go if the A and E goes, because that is the back-up a hospital requires for an A and E.
My hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett) alluded to the worries in south-east London. He has every right to be concerned, because if those sorts of cuts are made to the front of A and E, the services behind it will go immediately.
Jeremy Corbyn:
Does the hon. Gentleman acknowledge that often plans are drawn up for health service changes from which clinicians themselves feel excluded? The changes seem to have some motor of their own that
pushes them along until they eventually reach the light of day without support from anyone, and yet somehow they end up becoming fact.
Mike Penning: The hon. Gentleman has touched on an important point. Clinicians are not only often excluded, but gagged and not allowed to tell the people they serve about their concerns. If they do, their careers are put at risk. That has happened in my constituency and it is happening today. Some of the clinicians who have been speaking to me have been leaking documents to me that the Minister says he has not seen. If he indicates that he would like me to supply them to him I will be happy to do so. I have all of them but one, for the whole of London. I would have hoped that he had seen them, because the Government cannot exclude themselves from a report from NHS London that is based on deficits in the funding supplied by the Government and the assumptions based on that, which mean cuts proposed for London.
Mr. Pelling: Will the hon. Gentleman give way?
Mike Penning: I will not give way because I want to give the Minister sufficient time to respond. When we go further into the document, we find the assumption that hospitals can only stop-it is stop-people going to an A and E and get them to go elsewhere by physically closing the A and E, because when one is open people will invariably go to it. Some of the assumptions are dramatic, such as the one that polyclinics in the primary care sector could take up to 60 per cent. of A and E attendances. Funding models have been based on that assumption.
However, attendances at A and E increased last year, even in areas where polyclinics are open. In areas of London represented by Members who are not here today, but which I have visited in recent weeks-such as areas of north-west London-A and E attendances went up by 15 per cent. last year alone, even though some of those hospitals have bolted on GP-led triage at the front so that they can get some of the people who we would all accept should not be going to A and E to another triage point.
The point is that the public trust an A and E. They will go to an A and E. We can sometimes address the problems of access to GPs, which can be why people go to A and Es, but to assume that we can get 60 per cent. of the public who need services to decide not to go to an A and E is beyond belief.
One document that has not been withheld is the Government's own report, "Primary Care and Emergency Departments", which they commissioned from David Carson, Henry Clay and Rick Stern. Their assumptions are astonishing, because they actually agree with what our constituents are saying:
"We were surprised to find that there is no evidence that providing primary care in emergency departments could tackle rising costs to help to avoid unnecessary admissions."
That is just one excerpt from the press release for that report. In it, the experts and clinicians state that proposals to try to close A and E departments and get people into primary care fundamentally will not work. The Government want to bury that conclusion. They did not want it to come out or to have the debates we have had for the past three weeks.
Should the policy go ahead? No, it must be stopped in its tracks because the whole premise is fundamentally flawed, as shown in the Government's own documentation. As the shadow Health Minister and the shadow Secretary of State have told NHS London, we have promised a real-terms growth in NHS funding. The Government are not reinvesting money elsewhere in the NHS, which is what the Minister has said they will do. They assume that there will be cuts in NHS funding, and that is stated on page 3, right at the start of the document "Delivering Healthcare for London". It is imperative that the Minister does not shirk his responsibilities.
The hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, said that Ministers cannot tell NHS London to publish those documents, but they can and they should because they are paid to take responsibility. They should tell NHS London to publish the documents so that we know what the proposals are and can debate them. We could then robustly refute most of the assumptions and look at what is best for the constituents of London, from the bottom up, from GPs and patients, rather than from the top down.
It is not a case of scaring people. I have visited many hospitals in the past few weeks and I know that NHS staff are really worried. They do a fantastic job, but at the moment their morale is low and they are genuinely worried that they will be unable to deliver the sort of care London deserves. We must not scare people, and I am afraid that I have to reiterate the point that the Liberal Democrats have been scaring people in Kingston, which is fundamentally wrong. We should have a proper debate so that the clinicians feel comfortable about telling us publicly what London needs. We should listen to them, rather than to the top-down Treasury officials who are trying to cut money from the NHS, which is what the Government want to do.
3.48 pm
The Minister of State, Department of Health (Mr. Mike O'Brien): I begin by congratulating the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate and on recognising the hard work and dedication of clinicians and staff leading the changes to the NHS in that constituency and across the rest of the capital. Her constituents deserve the very best of health care, and that is what we want to ensure they are provided with. Despite the best efforts of NHS staff, I do not believe that they are currently getting the very best.
Until recently, London had some of the worst health care provision in the country. In 2007, London was performing poorly on waiting times, mortality rates and patient experience, relative to other strategic health authority areas. According to a MORI poll conducted in 2009, 37 per cent. of Londoners were unhappy with the time it takes to see a GP. Another result found that Londoners relied disproportionately on A and E. A recent study of unscheduled care concluded that 87 per cent. of children and young people attending A and E could have been better treated in a primary or community care setting. That is simply not an acceptable way for things to continue in our capital city.
The policy that we have set out in "Healthcare for London" is about giving Londoners what they deserve in terms of better health care and high-quality, clinically appropriate treatment when they need it. But change is
difficult. It makes people feel insecure. After the 1980s, when everything was based on cuts, the assumption was that the NHS was all financially driven, and then a bunch of politicians stand up and say, "Of course it is, because it is the Labour party." That is not the basis of what Lord Darzi set out, nor the basis upon which he got clinicians all around the capital and, indeed, the country to support his approach.
Mr. Pelling: Will the Minister give way?
Mr. O'Brien: I will give way in just a moment.
Lord Darzi did that by engaging clinicians on the quality of care, and that is the basis upon which change must be made. However, let us be clear about this and, just for once, be honest with our constituents. It is important that hon. Members are honest with their constituents. Change does require change. It requires that hospitals and what people have been used to in the past must change, and that means-[Interruption.] Perhaps the hon. Member for Croydon, Central (Mr. Pelling) should settle down. I have said that I will give way in a moment, if he will just calm down a little. He is chuntering from a sedentary position. I realise that he is now independent, and I can see why his party would want him-
Mr. George Howarth (in the Chair): Order. The Minister has indicated that he intends to give way. The hon. Gentleman should accept that assurance and await the opportunity to speak.
Mr. O'Brien: Perhaps a little less aggression from the hon. Gentleman might be in order on this occasion.
It is important that NHS provision in London is clinically based on quality, and not financially driven. I have been very clear with managers in London and around the country that the NHS has priorities. The first priority is patient safety and patient care, and the second relates to targets and finance-in that order.
Today, thanks to major improvements in A and E and waiting times and, for example, the inclusion of cancer scores as of last summer, NHS London has improved significantly. Not only are 28 new hospital schemes, worth £1.8 billion, already open to patients and another three, worth £1.2 billion, under construction, but we are also seeing improvements in the constituency of the hon. Member for Hornsey and Wood Green at University College hospital in north central London and with the £30 million scheme at the Whittington, which I shall return to in a moment.
In January, only three people waited more than 13 weeks for an out-patient appointment, down from more than 40,000-indeed, 43,639-in 1998. That is a massive improvement in health care in London. We have also seen improvements in terms of strokes and heart attacks. Significant changes are taking place in London.
Mr. O'Brien: I promised to give way to the hon. Gentleman. He has now calmed down and let the vibrations settle a little, so I shall give way to him.
Mr. Pelling: I think that the Minister is quite wrong to describe my behaviour as aggressive, and I greatly resent the suggestion.
The Minister is being very earnest, and I believe that the electorate understand and appreciate that approach. Nevertheless, would it not be right to say that the information that we are not allowed to share strongly leads with the financial concerns of NHS London? It is unfair to state that the changes are not driven by finance. The officials' papers that we are not allowed to discuss deal with the significant financial pressures that the London NHS faces. Therefore, finance is a significant driver of the changes. Does he accept that?
Mr. O'Brien: I have not said that managers should be unconcerned about finance-that would be ridiculous. One expects managers and clinicians to care, first and foremost, about the quality of health care in London. Secondly, and in that order, finances and how care is delivered come into it. The taxpayer does not have unlimited money, nor does the NHS. Perhaps we all wish that it did, but at the same time, such issues have to be looked at in terms of priorities.
Lynne Featherstone: The Minister is being very sincere about the fact that we cannot have change without change-I totally accept that-but the thesis of my 25-minute contribution was that there is no evidential base in the public domain on which to argue for that change or to bring people along with it. That is the point that the Minister needs to answer.
Mr. O'Brien: I have already said that health care in London is improving. I should add that NHS budgets for PCTs are increasing by 5.5 per cent. overall this year and by 5.5 per cent. next year, if this Government are re-elected. I cannot speak for the other lot, if they were to get in. Things are improving.
I can also tell the hon. Lady that it is clear that clinicians are behind the process of change. A number of eminent clinicians have today written a letter calling for "Healthcare for London" to be developed and become the basis on which change takes place. They say that it is
"the best opportunity for a generation to truly transform the NHS. It is now or never."
The messages in the letter, which is signed by leading clinicians, are clear: the NHS must invest in prevention, not just treatment, and concentrate specialist expertise for those who are ill in centres of excellence; people who do not need to be treated in hospital should be treated as close to home as possible; and clinicians should be at the heart of all decision making. Londoners endorsed the overall vision in an extensive consultation, with more than 40,000 people attending meetings and roadshows, and visiting the website.
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