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Westminster Hall

Tuesday 22 January 2013

[Dr William McCrea in the Chair]

Hospital Services (South London)

Motion made, and Question proposed, That the sitting be now adjourned.(Anna Soubry.)

9.30 am

Heidi Alexander (Lewisham East) (Lab): I am grateful for the opportunity to hold this debate today, Dr McCrea, and I am very pleased that other hon. Members are here in Westminster Hall to take part in it.

In the two and a half years that I have been the MP for Lewisham East, I have not known an issue to cause as much anger and concern as the proposals that are currently on the table to close the A and E department and the maternity department at Lewisham hospital. I know from my colleagues, my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd), that in the 20 or so years that they have served the people of Lewisham, they too have not witnessed such outrage and disbelief over an issue.

Lewisham is not the only place in south London where emergency and maternity services are under threat. There has been a long-running dispute about the future of St Helier hospital, and of course changes at any hospital will always impact on neighbouring areas. Patients displaced by the closure of one unit have to go elsewhere. Children who are hurt and elderly people who have had a bad fall do not disappear into thin air; they still need treatment. Mums-to-be still need somewhere to give birth. It is not possible to close and A and E department that sees 115,000 people a year and axe a maternity department in which more than 4,000 babies are born each year and not to expect other hospitals to feel the impact.

This issue affects not only Lewisham but people across south London. The real problem is that there is no free capacity in the other hospitals close by to deal with the demand for hospital services that will be displaced.

Gareth Johnson (Dartford) (Con): I am grateful to the hon. Lady for giving way, and I congratulate her on securing this debate. She is making a very good point about the adverse effect that closing Lewisham hospital will have on neighbouring areas as well, especially, of course, with Queen Mary’s hospital also shutting both its A and E department and its maternity services.

Does the hon. Lady accept that the closure of Lewisham hospital will also have an impact on my constituency, including at Darent Valley hospital, with people seeking out A and E treatment or maternity services? In a hospital such as Darent Valley that already has its own capacity issues, there will be serious repercussions from closing Lewisham hospital—not only for the area that the hon. Lady represents but far beyond.

Heidi Alexander: I very much agree with the hon. Gentleman, and I think that there will be a ripple effect across the whole of south-east London and beyond if the A and E department and maternity services at Lewisham hospital close.

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Ms Harriet Harman (Camberwell and Peckham) (Lab): I thank my hon. Friend for giving way and I join the hon. Member for Dartford (Gareth Johnson) in congratulating her on securing this debate.

On the impact on neighbouring hospitals, my hon. Friend will be aware of the importance—not only to local people but to London as a whole—of King’s College hospital. Is she also aware that the effective closing of maternity and A and E services at Lewisham hospital will hit like a tidal wave at King’s College hospital, because of the numbers of people involved. The health service estimate is that the number of people at King’s College A and E will increase by 45%. The staff at King’s College A and E do a very good job, but they will not be able to cope with a 45% increase in patients. The additional emergency admissions from that increased number of people at A and E will create such a strain on in-patient beds that the proposal is that in-patients—non-emergency admissions—will have to be shipped off to Farnborough hospital, which is an hour away on a bus and a train from Camberwell.

As for maternity services, the situation is even more pronounced, with a 54% increase envisaged in the number of women giving birth at King’s College hospital. The staff there simply cannot cope with that increase. At the moment, many women are turned away and told to go—guess where?—to Lewisham hospital.

Dr William McCrea (in the Chair): The right hon. and learned Member for Camberwell and Peckham (Ms Harman) will know that interventions must be short. Certainly, however, the point she makes is well made.

Heidi Alexander: My right hon. and learned friend encapsulates the issues in relation to King’s College hospital perfectly.

The fact of the matter is that millions of pounds will have to be spent at neighbouring hospitals to enable them to do the job that doctors and nurses at Lewisham hospital are already doing very well. Roughly £200 million has to be spent on making those changes happen, and that is not to mention the £12 million that has just been spent on Lewisham hospital’s A and E department.

In my view, this process is sheer madness. I do not think that there is any guarantee that money will be spent in the right places. If the predictions about where people will go after the closure of the A and E department and maternity department at Lewisham hospital are not right, we will end up spending money on the wrong hospitals. That could result in complete chaos. I cannot see the sense in the proposal, and neither can thousands upon thousands of people in south-east London.

The proposed closure of Lewisham’s A and E department and maternity department would also mean that two thirds of the building and land at Lewisham hospital would be sold off. These plans were hidden in an appendix to the initial proposals document, which was first published at the end of October last year.

I cannot overstate the opposition to these plans. More than 40,000 people have signed a petition against the closures; not one Lewisham GP is in favour of the changes; and the chair of the local commissioning group is also opposed to them. Put simply, these changes are unwanted.

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Bob Stewart (Beckenham) (Con): I thank the hon. Lady for giving way, and I will make a short intervention, Dr McCrea, so that I do not get a finger-wagging from you. Frankly, GPs should be in support of these changes; support from GPs is one of the conditions that is a requirement for such changes. If they are not in support of these changes in Lewisham, that is a big problem.

Heidi Alexander: The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

Jim Dowd (Lewisham West and Penge) (Lab): I am most grateful to my hon. Friend for giving way, and I join others in congratulating her on securing this extremely timely debate. She said a few moments ago that she did not understand where this plan had come from. Has she considered that it is merely a rehash of the scheme that NHS London tried to get past the “Picture of Health” review four or five years ago but failed miserably, both in the review itself and in the subsequent re-examination by Professor Sir George Alberti, and that in its death throes—NHS London only has a few months before it is extinguished by this Government—it is trying to get through the scheme to reduce hospitals in south London from five to four, and for no other reason than that it thinks that that reduction should happen?

Heidi Alexander: My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.

Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.

The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly

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because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.

As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.

Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.

The statutory guidance to trust special administrators and the written statement that the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.

Dame Joan Ruddock (Lewisham, Deptford) (Lab): I congratulate my hon. Friend on securing a debate on the hospital, which my constituents share with hers. When I brought the current Secretary of State for Health to the House to answer an urgent question, he seemed to imply that, in fact, reconfiguration is a major consideration. He said that giving details at that stage

“would prejudice my duty to consider the recommendations with care and reach a decision…I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister…with respect to any major reconfigurations”.—[Official Report, 8 January 2013; Vol. 556, c. 169.]

The Secretary of State clearly does believe that reconfiguration is a major consideration. The next day, I asked the Prime Minister about the four tests, and he said:

“I specifically promised…there should be no closures or reorganisations unless they had support from the GP commissioners, unless there was proper public and patient engagement and unless there was an evidence base.”—[Official Report, 9 January 2013; Vol. 556, c. 313-14.]

My hon. Friend will agree that none of those tests is met in the trust special administrator’s proposals.

Heidi Alexander: I do agree, and it would be incredibly helpful if the Minister confirmed when she responds to the debate that the four tests would apply to any changes made as a result of the TSA’s recommendations.

The thing that really sticks in my throat about the proposals to shut Lewisham’s A and E and maternity departments is that they are fundamentally driven by

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money. If we start by saying that a process is being set up to sort out the financial woes of part of the NHS, how can people ever have any confidence that the clinical input and so-called clinical evidence that come later have not just been moulded to suit the accountants’ bottom line, which was there from the off?

I appreciate that there are financial pressures in the NHS, and I accept that it cannot be preserved in aspic for ever. For example, I support the recent changes to the way in which emergency care in London is provided for major trauma, heart attacks and stroke. However, where is the evidence that the changes on the table will result in more lives being saved and better health care overall?

That brings me to my second main point: the changes are not only unwanted and unfair but unsafe. It is proposed to replace the A and E at Lewisham with an urgent care centre. Initially, the special administrator told us that the centre would see 77% of the people who currently go to the A and E. In his final report, that was revised down to 50%. Based on an analysis of their case load, doctors at Lewisham suggest that the figure would be closer to 30%, so who is right? GPs in Lewisham, including the chair of the clinical commissioning group, suggest that the number of people who would go to an urgent care centre at Lewisham has been overestimated. They suggest that they would be inclined to send people to hospitals where they knew specialist opinion was available.

If I was a mum and my five-year-old woke up in the middle of the night in dreadful pain, where would I go? Would I go to a place that I was not sure had the appropriate staff and equipment to deal with my son or daughter, or would I go to an all-singing, all-dancing unit in central London or at King’s? I am not a mum, but I know where I would go. If people do not use the urgent care centre, the extra demands placed on neighbouring A and Es will exceed the numbers forecast in the plans before the Health Secretary. Ultimately, there may not be enough capacity elsewhere for people to be seen and to be seen quickly.

I should add to that the heroic assumptions in the proposals about reducing the need for acute care in the first place. I am all for tackling the reasons why so many people turn up at hospitals, but I know how hard it is to change people’s behaviour and to organise adequate community-based care to reduce the need for acute admissions.

Dame Joan Ruddock: One hallmark of the work at Lewisham hospital is that extremely important steps have been taken to integrate with community care. That is relevant for the elderly, who may have to be admitted for a short time before going back into the community, and for the young people with mental health problems, who need there to be integration between those who see them when they have an episode and those who receive them back into the community. All that will be lost if the proposals go ahead.

Heidi Alexander: My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

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I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Does the hon. Lady agree that the Government do not want anything at all at this stage, and that the Secretary of State has not made, and will not make, a decision until 1 February?

Heidi Alexander: I acknowledge that a decision has yet to be taken, and I take this opportunity to press the Minister to confirm that the decision will be taken on 1 February. If it will be taken before then, it would be useful to know. We are here to present the case for refusing the recommendation.

Mr Nick Raynsford (Greenwich and Woolwich) (Lab): My hon. Friend has been making a powerful case. I want to pick up on the Minister’s interjection to the effect that no decision has yet been made and to reinforce my hon. Friend’s point that if changes as fundamental as those proposed in the trust special administrator’s report are introduced but are not safe and do not have clinicians’ true support, we run the risk of repeating the

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very mistakes of the last reconfiguration, which created South London Healthcare NHS Trust, and which proved not to be as financially sound as was expected when it was proposed. That is a real risk, and I hope that the Minister will pay attention to it.

Heidi Alexander: My right hon. Friend has consistently made that point in the House, and I totally agree.

It is a fact that maternity services in south London are under enormous pressure. In the 20 months between April 2011 and November 2012 providers of maternity services across south-east London suspended services on 37 occasions. Women in labour were therefore turned away from hospitals and told that they would have to go elsewhere. Of those 37 suspensions, 26 were necessary because of lack of beds. King’s College hospital also tried to suspend services on a further six occasions, but was unable to do so as no other unit had capacity to accept the women it was trying to transfer.

Bob Stewart: As the father of six children, I can tell the House from experience that nothing is more upsetting for a lady who is about to give birth than being shipped around when she tries to get into hospital. That is deeply upsetting to someone at such a fraught time in their life.

Heidi Alexander: The hon. Gentleman makes his point incredibly well.

Just a few weeks ago, both King’s and Woolwich were sending women to Lewisham to give birth. Women should be able to give birth at their local hospital and should not have to go to one hospital for the antenatal appointments only to have to go somewhere else to give birth. With high numbers of teenage pregnancies and a higher than average proportion of older mums in places such as Lewisham that is doubly important. The proposal for a midwife-led birthing unit at Lewisham is not a genuine option for any woman who wants to give birth safe in the knowledge that she would have back-up obstetric support if it were needed. I am told that that would not be an option for first-time mums. If I were to have a baby in two years’ time, I would not be able to go to Lewisham. The report tries to convince me that I would have greater choice, but that is just a joke.

One of my main concerns about the proposals for maternity services relates to where, and to what extent, capacity will be enhanced at other hospitals to deal with the mums who would otherwise have gone to Lewisham. The proposals before the Secretary of State assume a relatively even redistribution of women from Lewisham to King’s, the Queen Elizabeth hospital Woolwich and the Princess Royal university hospital in Farnborough. However, historically, when Lewisham women have not given birth at Lewisham, their main hospitals of choice have clearly been King’s and St Thomas’s. If more women go to those hospitals, projected births there could exceed 8,000 a year. Those would be really big maternity departments, potentially requiring a double rota of staff and consultants to deal with them. The cost of a double rota in maternity units at King’s and St Thomas’s is not accounted for in the plans before the Secretary of State.

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Jim Dowd: On that very point, does my hon. Friend accept that the trust special administrator has deliberately manipulated the figures, in both the draft and final reports, to mask the fact that the proposal would push King’s at least and probably Queen Elizabeth hospital, Woolwich as well over the 8,000 births a year mark?

Heidi Alexander: I do not know whether the trust special administrator has deliberately manipulated figures, but the way that the figures have been presented looks quite suspicious.

The plans are completely unjustified. There has been much talk in recent weeks of the need for things to do what it says on the tin. The metaphorical tin with respect to the recommendations of the trust special administrator presumably says it will resolve the financial problems of the South London Healthcare NHS Trust and put the health economy in south-east London on a stable footing. I do not think the proposals before us do that. It will be necessary to spend £195 million on a one-off basis to make changes at hospitals in south London, to deal with the displaced demand for A and E and maternity care that will result from the closure of services at Lewisham. It is not clear to me where that money is coming from: which Department of Health budget is it to come from? Has the Treasury approved that non-recurrent expenditure? If it has not approved the required capital outlay, the plans fall apart. Perhaps the Minister can deal with that point.

The changes to the Lewisham site would involve demolition of the recently refurbished A and E, so that the land could be sold. Long after the A and E was knocked down, the hospital would still be paying £400,000 a year in loan repayments for the £12 million it borrowed to make the improvements. That is a bit like someone taking out a loan to do up their kitchen and knocking down that part of the house while still paying money back to the bank.

Another big question relates to the continuing year in, year out costs of the changes. The possibility of a double maternity shift at King’s and St Thomas’s, which I have mentioned, is just one example, and would surely add hugely to the bill. How much would it cost to implement a community-based care strategy to reduce the need for hospital services? Where is the money coming from?

If the proposed changes to A and E and maternity care in south-east London cannot be justified financially, do not result in better health outcomes and are unfair and unwanted, why on earth are we here to debate them today? The Government have consistently said that changes will not be made unless four specific tests are met, as my right hon. Friend the Member for Lewisham, Deptford and the hon. Member for Beckenham (Bob Stewart) have mentioned. In the present case, the tests are not met. The chair of the local commissioning group is opposed to the changes, as are virtually all Lewisham GPs. The process should result in strengthened patient and public involvement, but the current process has resulted in strengthened disillusionment among the public, and little else. Proposals should be based on a sound clinical evidence base—but the evidence base in the present case is virtually non-existent. It is also stated that the Government will not make changes to such major services unless doing so will strengthen and improve

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patient choice; the special administrator’s own report recognises that the proposals will result in a weakening of patient choice.

As I said earlier, the proposals are unwanted, unfair, unsafe and unjustified. Last week the NHS Commissioning Board announced a review of emergency care, to be led by the NHS medical director, Sir Bruce Keogh. I welcome that review, but what is the point of it if the Government are just going to push ahead with their proposals in south London? The chaotic handling of the process in Lewisham cannot be right. It rides roughshod over the wishes of the community and local clinicians. For the life of me, I cannot see how it is in the best interests of my constituents or the people of south London. I urge the Minister to reject these rushed and ill-conceived plans and to do as her party’s manifesto says:

“stop the forced closure of A and E and maternity wards, so that people have better access to local services”.

I am not asking for better access; I am just asking for the access that currently exists for people in Lewisham to be maintained.

9.59 am

Simon Hughes (Bermondsey and Old Southwark) (LD): This is an important debate, and I congratulate the hon. Member for Lewisham East (Heidi Alexander) on her speech, on securing the debate and, with her colleagues in Lewisham, on co-ordinating an effective and well argued campaign.

Along with all other south London colleagues, I have long taken an interest in health service matters, including reconfiguration. I have the scars of the battle to keep Guy’s hospital open, which we managed to do, although we lost A and E. I have often joined my neighbours, the right hon. and learned Member for Camberwell and Peckham (Ms Harman) and the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell), to ensure that King’s College hospital improved, which, thank goodness, it has. But I have a more direct interest: my constituents on the eastern edge of my constituency in the SE8 postal district and along the edge of the boundary with Lewisham often go to Lewisham hospital, rather than to King’s or to Guy’s and St Thomas’s. Of my remaining constituents who use hospital services, some go to the Royal London hospital across the river, but most go either to Guy’s and St Tommy’s or to King’s, and the report makes it clear that there would be a major impact, particularly on King’s, if the proposals go ahead.

Obviously, legislation initiated by the previous Government and passed by the previous Parliament anticipated problems in a part of the NHS. Although Labour understood that need, the legislation has not needed to be implemented until now. The legislation has been implemented—to be honest, those of us in other parts of south-east London knew this—because there was a history of bad financial management in the outer south-east London boroughs and in South London Healthcare NHS Trust. We know that to our cost because, twice to my certain knowledge, the health budgets further in—in our parts of south-east London—had to be top-sliced to fund other bits of London, even though they are more affluent and we are less affluent, because of poor management elsewhere. There was better management both in my borough and in Lewisham.

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Dame Joan Ruddock: My right hon. Friend the Member for Leigh (Andy Burnham), who was Secretary of State when the Health Act 2009 was passed, has made it clear that there was never any intention to use the legislation to address major reconfigurations. The legislation was meant to address a financial problem in a specific trust and not to encompass other trusts. Does the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) agree that we need to consider the NHS London-wide? That is where we must find solutions to the financial problems of one trust, quite differently from this particular case. The trust special administrator clearly could not find a solution by considering just the South London Healthcare NHS Trust, but we cannot have the inappropriate procedure that has now been adopted.

Simon Hughes: The right hon. Lady, who is my neighbour, raises an important issue. With the help of the Library, I have carefully examined the whole debate on the passage of the legislation, and that issue was not addressed. If she looks back at the debates and the notes on the National Health Service Act 2006, they are silent on whether a trust special administrator could or could not make recommendations that go beyond a trust. That may not have been in the mind of her colleague, the right hon. Member for Leigh (Andy Burnham), who is a former Secretary of State, but he did not say that on the parliamentary record, although I stand to be corrected. It seems to be an open question.

The current Secretary of State told us that he has had legal advice and that he will take further legal advice, but whether or not the legal advice is that the trust special administrator can go beyond the boundaries of the area affected, there is a stronger argument for the Secretary of State not following the trust special administrator’s recommendation—and that argument starts from the legacy of the last general election in terms of the parties in government and the coalition agreement on how to deal with closures of A and E, and not doing so from the top downwards.

Secondly, the Government have set up the four tests, to which the hon. Member for Lewisham East referred and which have not been met. The Secretary of State has been handed this matter on a plate; it is not of his doing and I am sure it is the last thing he would have wished for. The announcement that the trust was going into special administration was made by his predecessor, and the current Secretary of State has been given a report by someone he did not appoint but with whom he now has to work. He has no choice. He has to deal with it, but he made it clear in his answer to the urgent question from the right hon. Member for Lewisham, Deptford that the four tests, which both he and the Prime Minister have cited, must be met.

The first test—that the proposals must be supported by GP commissioners—fails before we even get to the other three. I have no reason to believe that a single GP commissioner in Lewisham is supportive—GPs elsewhere in London might be found but they implicitly do not comment—the whole idea of the proposal seems to be that if we are handing NHS decisions from the top to the doctors, we must do things that the doctors agree are the right decisions. So the proposal falls at that first hurdle.

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Jim Dowd: Should I catch your eye later, Dr McCrea, I will address the four principles in more detail.

The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) says that the Secretary of State’s predecessor set up the four tests, but does he not accept that one of the previous Secretary of State’s first acts just after the 2010 general election was to suspend the implementation of the “A Picture of Health” process that the South London Healthcare NHS Trust was undertaking? I am not saying that the process would necessarily have led to success, but its suspension undeniably made the trust’s task unbelievably more difficult.

Simon Hughes: I do not dispute that. I am not as close to the process as the hon. Gentleman. I did not follow those issues as closely, because the process did not directly affect my borough, although it directly affected his. I have taken advice from someone who has been involved over the years at Lewisham hospital and in NHS management, and the history of financial poor management in the South London Healthcare NHS Trust stretches back over 10 years. The advice I have received is that poor management should have been gripped seven or eight years ago, but the problems escalated. We are in our present position because of a legacy of poor decisions made over effectively a decade. Things might have been rescued by the Government at the beginning of this Parliament, but they clearly were not and we are left in our present position.

I have a few comments, and I do not want to take time from other colleagues who have a direct interest. I responded to the consultation to make clear the interests of my constituents. The Secretary of State invited those of us with an interest to see him, and we are grateful for that invitation, which we used, I hope, to put our case effectively. The right hon. and learned Member for Camberwell and Peckham and I, and those MPs whose constituents use King’s, have written to the Secretary of State further to that meeting to make clear our concerns about the impact on King’s of any closure of Lewisham A and E, irrespective of the change in maternity services.

There is an alternative approach, which I commend to the Secretary of State. I hope he understands the benefit of going down the alternative route, rather than following the trust special administrator’s recommendations. The alternative, which we explored at our meeting and which I do not believe was adequately answered by the trust special administrator or his colleagues, is that five of the six recommendations—excluding recommendation 5 on the site configuration—leave open the option of amalgamating NHS management between Lewisham and Greenwich. NHS management could then be allowed to work out the best configuration of services across the two boroughs in consultation with, and with the confidence of, the local authorities in question, which now have direct responsibility through health and wellbeing boards under the Health and Social Care Act 2012, and in conjunction with GPs to seek GP commissioning endorsement and support. I hope there would be much more public support than for the present proposal, as is understandable.

I hope that the Secretary of State will find that to be an appropriate solution. It may have a small financial disadvantage over the present proposals but, as the hon. Member for Lewisham East said in her speech and as she and her colleagues from Lewisham have made clear

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in their letters to the Secretary of State, the TSA’s figures show a financial gap of only £1.7 million from a break-even position if recommendation 5 were not to be followed, compared with a financial gap of £75.6 million if the recommendations were followed. There are knock-on effects, but we seem to be talking about a sufficiently small amount of money, with little risk of any other financially adverse impact, and if people are motivated to reach a conclusion quickly, that must be a much more satisfactory way of proceeding and much more in line with the four tests set out.

Dame Joan Ruddock: I wanted to give the right hon. Gentleman those figures, so I am glad he has put them on the record, because they are significant. Furthermore, there is real willingness in Lewisham, from the hospital, the GPs, the consultants and all the staff, to work for some kind of merger or co-operation with Woolwich that would reduce costs. Everyone is willing and happy to explore that, but in the right circumstances, in the right time frame and with appropriate consultation, which is what has been missing from the process.

Simon Hughes: I have no reason to disbelieve what the right hon. Lady says, but even more important is returning the decision to the people in the health service who are now meant to be leading it—the GP commissioners and others. That is what all of us, in different ways, believe needs to be done. She made an argument for the issue being London-wide, and that of course is the context, but the practicalities of travel and transport, whether buses, cabs, cars and trains, are such that south-east London works as a segment for health service use in a way that does not really cross over into other parts of London, other than to King’s. The only knock-on bits are the small amount of crossover to the London hospitals for specialist reasons, and some to King’s because it is so near—technically, it is south-east London, but it is in Lambeth.

Secondly, the precedent would be a bad one to set for those parts of the NHS that have been financially well managed, compared with parts that have been badly managed. Lewisham has been relatively well managed, being very nearly in balance. We rely on trusts to do their job locally and on people to manage local trusts, so we have to support those who do that job well and responsibly.

My last point is probably the most important. I have been to Lewisham A and E and visited patients there privately. It and the maternity services have developed a reputation for good clinical care of all who attend it. That was not the case some years ago, but it has been worked on, and not only physically. It has become a university teaching hospital, as well as being a local general hospital, and it has good community links—the point made by the right hon. Member for Lewisham, Deptford in her intervention. It has also built up a good reputation for integrating acute care, hospital-centred care, with community provision.

The Secretary of State could take the clinically easy decision to follow the trust administrator’s recommendation, saying, “This is what has been recommended, therefore I am following what I have been told”, but I hope that he realises the greater benefits to the local community and to the wider health economy and service of south-east London, as well as to the Government if they are seen

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to be listening to the people and to the GPs more than to the trust special administrator. I understand why the trust special administrator takes a hard line, because he is a health economist and his interest is finance. The Health Secretary, however, has a different job, which is to be responsible for the NHS in England, and that means making responsible decisions to secure a good NHS in all parts of south London and elsewhere.

Dr William McCrea (in the Chair): I will be commencing the winding-up speeches at 10.40 am at the latest. Three Members are seeking to catch my eye, so I ask them please to be conscious of that in their contributions, because I would like to get as many Members in as possible.

10.15 am

Jim Dowd (Lewisham West and Penge) (Lab): I will attempt to be brief, Dr McCrea, given your exhortation and out of consideration for my colleagues.

I do not think that the Secretary of State for Health will proceed with the proposed plan, because it is so far off the rails. It is such a ludicrous proposition, so ridiculous in its scope and even its intent and such a shoddy piece of work, frankly, that the Secretary of State will not be so foolish as to proceed with it, even if he can blame his predecessor for lumbering him with it. We have to recognise the threat, however, and to do what we can to make the case against it. That is why, after 10,000 people turned up on the 24 November to march past the hospital to protest against the plan to downgrade—to eviscerate—Lewisham hospital, rather more will be out again this Saturday, marching past the hospital to Mansfield park in Catford, to express what my hon. Friend the Member for Lewisham East (Heidi Alexander) described as anger, although I go beyond that.

My hon. Friend was kind enough to mention that I have been in this place 20—now almost 21—years, but I was also involved with Lewisham council for 20 years before I came here, and, without doubt, the hospital proposal has raised more fury than anger—more so than any other local issue in all the 40-plus years that I have been involved in public life in Lewisham, even more than the madcap scheme of the Department for Transport under the now Lord Parkinson to further the south circular assessment study. That scheme had recommended widening the south circular to six lanes throughout, with eight lanes in some parts, right the way through the middle of Lewisham. People thought that was mad enough, but that pales into insignificance compared with the public response to the proposals that we are discussing.

What fuels the fury is not the incoherence of the plans, or even the gross financial assumptions—I have heard people call them heroic, but some of the claims are lunatic, and in pursuit of so little—but the sense of injustice, the unfairness of the scheme. Lewisham hospital, as in the recent past, has a strong commitment to safety, quality and patient experience. It has been rated in the top 40 hospitals nationally by CHKS—for clinical effectiveness, patient safety and so on—and has a strong record in achieving national and local performance targets. It is operationally lean, the reference costs index making it the most efficient trust in south-east London, delivering financial surpluses in each of the past six

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years—Guy’s and St Thomas’s trust, King’s College trust and, obviously, the South London Healthcare NHS Trust have not done that.

Our hospital has achieved the successful integration of acute and community services, fostering strong links with social care, and the people of Lewisham are already reaping the benefits. It has the reputation for strong and successful partnerships, so much so that many of the people at the Queen Elizabeth look forward to Lewisham management taking over to build links with commissioners, local GPs, the local authority, patients and staff.

Lewisham hospital, or University Hospital Lewisham, now part of the Lewisham Healthcare NHS Trust, with NHS London’s encouragement, was actively pursuing a foundation trust application when the process we are discussing interrupted and completely derailing that application. People are furious at the injustice precisely because Lewisham hospital has done everything in the services that it provides that could reasonably be expected of it by the Department and particularly by the people of Lewisham.

I want Lewisham hospital to survive as an institution, but I am not desperately keen on institutions for their own sake, important as they are. I am more interested in the services that they provide for the people they serve, and the hospital’s record is exemplary. To see that destroyed and devastated by the vandalism of the trust special administrator process is more than most reasonable people can stand or accept.

I have been inundated, as I am sure have my colleagues, with information from various quarters, and all has been hostile. One note from a constituent—I will not be too specific as I do not want to identify her, but she is a clinician at Queen Elizabeth hospital—who did not support the closure but does not want Lewisham hospital to be destroyed, said that the position at Queen Elizabeth hospital is dire, and needs strong leadership and a clear sense of direction and purpose, so that it too can provide the services that the people of Bexley, Greenwich and Bromley deserve. If the closure of A and E at Lewisham hospital goes ahead, 750,000 people in Bexley, Greenwich and Lewisham will have a single A and E department available. That would not be safe by any stretch of the imagination.

I can do no better than to quote an e-mail that I received just yesterday from the GP team in neighbourhood 4 of the Lewisham general practitioners clinical commissioning group that makes the case well. The group covers practices in Bellingham Green, Sydenham Green, Sydenham road, the Vale, Wells Park in Woolstone road, and the Jenner, which is in the constituency of my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and just the other side of the south circular road on the boundary between our constituencies. It says that closing

“the A and E will hit the elderly, disabled…and children of single parents disproportionately”

and that

“although an urgent care centre…will persist, its use its use will decline significantly as neither patients nor clinicians will have confidence to use an UCC unsupported by acute medical and surgical care”.

My right hon. Friend made that point elegantly. The e-mail continues:

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“Loss of obstetric service will result in women in labour having to attend a different provider from their antenatal care, few women will choose this option, as both patients and clinicians are aware of the increased risk of disjointed maternity care and find it emotionally unsettling.”

It also says:

“The projected flows of patients are inaccurate and therefore so are the costings, our Primary Care survey across Lewisham showed 80%+ of patients would attend Kings, 10% St Thomas, 6%”

Princess Royal university hospital, Farnborough, and that only 4% of those currently attending Lewisham A and E would go to Queen Elizabeth hospital at Woolwich.

Bob Stewart: The point about going to Farnborough is that it is a heck of a long way from Lewisham, which makes it difficult. Public transport to Farnborough is not acceptable for people who are weak, disabled or poor.

Jim Dowd: I am grateful to the hon. Gentleman. He knows that many of his constituents attend Lewisham hospital, so the effect will be not just on people who are resident in Lewisham.

In view of the time, I will not go through the rest of my points, but suffice it to say that they are compelling, overwhelming and make sense. The problem with the trust special administrator is that he regards antagonism and opposition from local people, particularly clinicians, as a sign of his rectitude. One of our local football teams is Millwall, which is based in Lewisham, although the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) prefers to disguise that fact. It has an unofficial slogan, which is also a song to the tune of “Sailing” by the Sutherland brothers and was made famous by Rod Stewart. The words are:

“We are Millwall, super Millwall”


“No one likes us, no one likes us

No one likes us, we don’t care!”

I suspect that Mr Kershaw has taken that local aphorism as his inspiration because he could not have gone further out of his way to antagonise all the people of south-east London. The problem is that most Millwall football fans sing it as a joke, but Mr Kershaw clearly believes it. He has succeeded in antagonising and alienating not just the medical community, but everyone in south-east London, because the whole scheme is a shambles. He said that no one came forward with a viable alternative to his plan, which is why the final report is as it is. I can tell him that if they had £5.2 million and rising and the services of McKinsey, Deloitte, Ipsos MORI and other consultants, year 6 at Dalmain road primary school could have come up with a better scheme than his. I suspect that the Secretary of State has enough sense to reject it. Action needs to be taken to secure health services across south-east London, but this is not the way.

10.25 am

Clive Efford (Eltham) (Lab): It is a pleasure, Dr McCrea, to speak under your chairmanship. I congratulate my hon. Friend the Member for Lewisham East (Heidi

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Alexander) on securing this important debate. I want to start by defending South London Healthcare NHS Trust. Its financial difficulties are enormous and there is no disguising that, so people have tended to roll up its performance into something that is failing on all fronts, but that is clearly not the case.

When the hospitals—Bromley hospital, Princess Royal University hospital, Queen Elizabeth hospital in Woolwich and Queen Mary’s hospital at Sidcup—were merged approximately four years ago into one healthcare trust, there were serious difficulties with clinical performance, but very quickly the trust improved its performance significantly, and so much so that it was one of the best performing on many indicators. That is why it was so sad that when the trust was put into administration, unattributable sources in the Department of Health put out rumours that that was about not just financial mismanagement, but the fact that standards of care were failing. That was completely and utterly untrue.

I go back several years, and I am on my fifth chief executive at my local hospital. All have gone through the same scenario as Mr Kershaw, and all have given me assurances about the areas—I will not go into them because I do not have enough time—where financial performance needed to improve and efficiencies needed to be made. Always, they made the point about the need to treat people close to where they live in the community and reduce pressure on acute services.

All have made that point, and all have needed to improve clinical performance. Just over a year ago, the South London Healthcare NHS Trust had only one case of blood-borne MRSA, which was the best performance in the country. The improvement in the quality of care under the new trust was significant indeed. Waiting times in A and E improved, and Dr Foster reported on a significant and consistent improvement in the standardised mortality ratios over a couple of years. On those performance indicators, it outperformed Lewisham hospital.

When the decision was made to put the trust into administration, its performance on quality of care for local patients was improving. Anyone who was concerned about care for local patients would have worked through the financial difficulties with the trust. It was a big ask in that short period to improve clinical performance as it did, to merge the hospitals as it did, and to improve financial performance as it was required to do. It was always a big ask, and I think it was impossible. That should have been recognised, and the Government should have worked with that hospital trust to work through those difficulties.

We all know that PFI has not caused this problem, but it has added to it. PFI accounts for roughly a third of the deficit, which is not to be ignored, but one issue that has come to light recently, in relation to PFI in general—not just in relation to South London Healthcare NHS Trust—is the effect that the manipulation of LIBOR has had on the rates that hospital trusts have had to pay, in terms of interest, as a consequence. I do not expect the Minister to have an answer to this question, but will she go away and consider what the cost implications of LIBOR manipulation have been for every PFI in the NHS? Are the Government considering taking legal action to retrieve any of that money, as is being considered in the USA?

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I am conscious of time and I want to let the hon. Member for Beckenham (Bob Stewart) speak, so I shall move on. As has been said, the recommendations fail several tests, and they clearly fail the test of satisfying local GPs and receiving local GP support. The chair of the local GP commissioning body, Helen Tattersfield, wrote an article in The Guardianunder the headline: “GPs are already wise to the scam of new commissioning groups”. She absolutely lampooned what is being proposed by the Government.

Jim Dowd: Does my hon. Friend realise that the Government have shifted ground on that? In the response that the Prime Minister gave to my hon. Friend the Member for Lewisham East, he said that the first test was

“the support of local GPs.”—[Official Report, 31 October 2012; Vol. 552, c. 230.]

However, the Secretary of State’s written statement, following the publication of the final report said that the first test was “support from GP commissioners”. The word “local” has disappeared, and what the TSA is trying to do is claim the support of commissioners from outside Lewisham to meet that test.

Clive Efford: The point made by my hon. Friend is self-evident, but if I may, I will not be drawn down the road, because I want to get the next point on record.

Lamenting the fact that local commissioners have not been listened to, Helen Tattersfield says in her article:

“No argument has any weight, however, against the needs of a failing trust, foundation trusts and potential private companies eager to expand their areas of influence, and NHS managers convinced of the merits of their model of fewer larger hospitals. Those of us who have spent hours acquiring the skills supposedly to lead commissioning have been shown that, in fact, decision-making and influence remains where it always was: with central managers, computer-derived models and reasoning that takes no account whatsoever of human behaviour in real life. We are little more than window-dressing for central planning geared to the needs of large foundation trusts, and open to the interests of the private sector.”

That comment alone just about sums up where we are.

I will finish soon to allow the hon. Member for Beckenham to speak, but I just want to ask the Minister whether she will consider a review of proposed A and E closures across London. We are seeing a piecemeal, salami-slicing of A and E services, which is putting the safety of Londoners at risk. As we know, we have seen a 50% increase in people waiting in ambulances for 30 minutes or more outside A and Es to gain access, and we have seen a 26% increase in those waiting for 45 minutes. We know that they are under pressure, so before we see any closures, that review must take place.

We can pray in aid what the Lord Chancellor and Secretary of State for Justice said. The headline on the relevant article read: “Hunt faces Cabinet split over A and E closure after Justice Secretary blasts plans as ‘sticking two fingers up’ to patients”. We also have the right hon. Member for Sutton and Cheam (Paul Burstow)—the former Minister of State, Department of Health—who lamented, when he was still a Minister, the proposed closure of St Helier:

“This is a flawed conclusion from a flawed process. There is still a lot of water to flow under the bridge before final decisions are made. The panel have ignored the pressure on all the A and Es and maternity units in south west London.”

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We can pray those people in aid to defend our A and Es, and the Government should go back and look again.

To make one last point, we have seen the closure of an A and E, despite the promises of local Conservatives. The Leader of the House of Commons, when he was shadow Secretary of State, was going to save the A and E at Queen Mary’s, Sidcup, but it never came about. Under “A Picture of Health”, there was a proposal to have overnight stay, elective surgery at that hospital. It was promised to my constituents, who welcomed it and wanted to see it. I ask the Minister to reconsider removing that planned service from that hospital, because it was beginning to work and people welcomed it. It will be a serious cut to the quality of health care.

Steve Baker (Wycombe) (Con): Will the hon. Gentleman give way?

Clive Efford: No, I will not, because I want to allow the hon. Member for Beckenham to speak. It will be a serious cut to local services, and we should not allow that cut to go ahead.

10.36 am

Bob Stewart (Beckenham) (Con): I thank the previous speakers for allowing me to speak. I was not going to speak, but I felt induced to do so by the excellence of the debate. My constituency is bracketed: on one hand, we have Lewisham hospital, and on the other, the Princess Royal university hospital in Farnborough, so I feel very much like the piggy in the middle. However, we have the Beckenham Beacon, and if I have time, I will mention that at the end.

Lewisham hospital is excellent. Working within its budget, it has a good reputation and serves the local community, which includes people from my constituency. I really am against the idea of its role being changed. The idea that it becomes an urgent care centre is fine. When I asked the special administrator about that, he suggested to me that it was not much of a change, and the only real change was that people would not be admitted into the general hospital. That is not quite as I understood it. Now we do not have the specialist back-up, and there will be a big reduction in people being seen locally. Lewisham requires a hospital, and it should keep its hospital.

Travelling around south London is notoriously difficult, as we have heard. All the routes go in to the epicentre. The eye of the octopus is round about here, and so trying to cross London to go to various hospitals—particularly for those who do not have an easy transport option—is extremely difficult. I am thinking of the elderly, as it is very difficult for them to achieve what they want and get to a hospital—say, if they are sent somewhere other than Lewisham, when they live in Lewisham. I am very concerned about the idea that we can do away with maternity services in Lewisham. Some 4,000 babies is a heck of a lot of babies to cart off somewhere else, as I mentioned in an earlier intervention.

I finish by reminding Members that we have the Beckenham Beacon, which is only 70% used at the moment. It is an outstanding facility, and from what I have heard, I understand that the clinical commissioning group for Bromley intends to take up the services that

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are there now. However, I also commend the people looking at this problem to think about increasing the services of the Beckenham Beacon, to help not only my constituents but the people of Lewisham. I know that I have to stop now, Dr McCrea, so as I am a very good boy, I will sit down.

10.39 am

Andrew Gwynne (Denton and Reddish) (Lab): It is a pleasure to see you in the Chair, Dr McCrea. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this incredibly important debate. The future of accident and emergency and maternity services across south London is of genuine concern to a great many of her constituents and, indeed, for the wider area, as this is definitely an issue of real significance across the capital. I know from a meeting that I chaired with Labour colleagues before Christmas that it goes to the heart of their communities. I applaud the way in which my hon. Friend the Member for Lewisham East, our right hon. and hon. Friends and others from across the party divide have put together a campaign that highlights their constituents’ concerns in such a high-profile and persuasive manner.

It has long been accepted that difficult decisions might well be needed to secure the sustainability of health services in south-east London, as the challenges facing South London Healthcare NHS Trust are complex and of long standing. As we have heard, the proposals to close the A and E and downgrade the maternity unit at Lewisham hospital are intended to assist a neighbouring hospital trust to find its way out of significant debt problems. It is a highly controversial procedure, to say the least, because Lewisham hospital, as we have heard, is well respected and well managed and recently underwent a £12 million refurbishment.

The proposals also introduce wider considerations that could affect the whole of south London’s health care. At the same time as the trust special administrator has been reviewing services at South London Healthcare NHS Trust, plans for changes to management structures and the merger of services have been progressing, led by King’s Health Partners and three foundation trusts—King’s College hospital, Guy’s and St Thomas’s and the South London and Maudsley—in conjunction with King’s college London.

Any plans for the whole area need to take full account of all the potential knock-on effects on the quality of care that people receive, and they need to consider how the merger plans will affect the health economy right across south-east London and potentially limit other long-term options for changes in south-east London. The figures provided by my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) illustrate the real problems associated with some of the changes being presented today: a 45% increase in emergency admissions and a 54% increase in births at King’s if Lewisham closes. Those huge capacity issues would need to be resolved. The Minister needs to look carefully at those figures.

As we have heard today, there are real concerns among the local Members of Parliament about the future of services at Lewisham hospital, so much so

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that recently a delegation of local doctors and my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East presented a petition against the closure of Lewisham’s A and E and maternity departments to 10 Downing street. In only five weeks, the petition against the changes has been signed by more than 32,000 people, and the numbers are still growing.

We have also heard that, as part of the campaign, there have been a number of protest marches against the closures. I believe that there will be one this weekend. I am sure that that will attract equally heavy support as the earlier ones, which I believe from my right hon. Friend the Member for Lewisham, Deptford took place in rather grotty weather. Notwithstanding the snow that there may be this weekend, I am sure that the good folk of Lewisham will still be out in force.

Bob Stewart: I am intervening quickly to support what my friend—I call him that despite his being on the Opposition Benches—the hon. Member for Lewisham West and Penge (Jim Dowd) has said. This is a matter of fairness. It seems extraordinary that failing hospitals are being supported and allowed to continue essentially as they are, but Lewisham—a wonderful hospital that is within budget and is gaining an increasing reputation— is being kicked, slashed and destroyed. I just do not see that as right. It is a matter of fairness.

Andrew Gwynne: The hon. Gentleman is absolutely right. It is also telling that a very substantial number of GPs, including the chair of the new clinical commissioning group and the head of every single clinical area in the hospital, have written to the Prime Minister to express their concerns about the proposals. That clearly shows that the proposals do not have the support of local clinicians. I urge the Minister to read the very passionate article in Saturday’s Guardian online by Lucy Mangan as well. That helps to address some of those points.

As we have heard, more than 120,000 people visit the A and E at Lewisham hospital each year and more than 4,000 babies are born in the maternity department. With the prospect of the A and E being closed and the maternity unit being downgraded, a number of worries have quite rightly been expressed, not least because, as we have heard from my hon. Friend the Member for Lewisham East in the debate, Lewisham’s population is estimated to rise significantly in the next few years as a result of the huge increase in the birth rate.

As I have said previously, there is no doubt whatever about the unanimity among the professionals and the population about the importance of maintaining services at Lewisham hospital—something that Ministers have always stressed they would fully take on board. As we have heard in the debate today, the right hon. and hon. Members who represent the areas affected believe that the plans are based on inaccurate data and flawed assumptions and that the whole issue has been misunderstood and largely mishandled.

We have the final report from the trust special administrator, urging this closure at Lewisham, and the Secretary of State is to make the final decision by 1 February. However, it is difficult to understand how the Government can consider that that report constitutes a full strategic review of the sustainability of services

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across south-east London. Labour Members believe that the trust special administrator has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital. In addition, the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.

It is quite concerning when the rules on making changes to hospitals seem to have been changed to allow back-door reconfigurations in the way that I have described, without the proper scrutiny and consultation that would ordinarily take place. Indeed, the trust special administrator used powers passed by the Labour Government in a way that was never intended. I take the point made by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). Nevertheless, what has happened sets a worrying precedent whereby the normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services could be pushed through. This is a worrying situation, as it takes the NHS over a very dangerous line and is potentially the first back-door reconfiguration in that manner. If it is allowed to go ahead in that way, it could mean that any hospital services could be changed for purely financial reasons, which has never been the case in the past. We need to ask where the clinical case for change is in these proposals.

The 2009 Act clearly says that administrators must make recommendations relating to the trust that is failing. That has not happened in this case. Reconfigurations need to be based on solid clinical evidence that they will save lives. Where there is a clear clinical case, I think that that is right, and we should look carefully at changes before deciding whether we should oppose them. However, the TSA’s actions are leaving a very confusing and worrying situation surrounding hospital reconfigurations.

My hon. Friend the Member for Lewisham West and Penge got it right. We are starting to see a situation in which primary care trusts are moving quickly to try to secure service changes before the clinical commissioning groups take over, and it is becoming all too clear that it is financial pressures that are starting to lead to closures and health service changes. That is clearly wrong.

On the four tests for reconfigurations, does the Minister really think that they have been fully met and does she believe that this change has the support of local commissioners?

10.49 pm

The Parliamentary Under-Secretary of State for Health (Anna Soubry): As ever, it is a great pleasure to serve under your chairmanship, Dr McCrea. I congratulate the hon. Member for Lewisham East (Heidi Alexander) on securing this debate. I have about 10 minutes to respond to all the points. In the normal terms of any debate, there is an airing of conflicting views, different ideas and different points of views, but today there has been no such disagreement; we have had an outbreak of complete agreement among all the speakers and all those who have intervened. Everyone who has spoken this morning has done so with great passion and sometimes with ferocity in defence of the maternity unit and the A and E department at Lewisham hospital.

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Let me make it absolutely clear that we are not in this position because of a Government decision or proposal, or as a result of some set of Government cuts. I made that same point a couple of weeks ago in an Adjournment debate that was called by the hon. Member for Lewisham West and Penge (Jim Dowd). I hope that those in the public domain who report these matters make that point very clearly, too. Anyone who seeks to make political capital out of this exercise does so at their peril, because, in many ways, this transcends party political divide and should not be used for party political advantage.

The trust’s special administrator published his report on 8 January, and a decision will be made by the Secretary of State for Health on 1 February.

Jim Dowd rose

Anna Soubry: Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

Heidi Alexander rose

Dame Joan Ruddock rose

Anna Soubry: I will give way, but please be brief, because I do not have much time.

Dame Joan Ruddock: Will the Minister confirm that the four tests are relevant? Will she also note that the Secretary of State has said, “on or before” 1 February? It would be good to have clarity.

Anna Soubry: I agree. In such cases, it is imperative that a decision is made sooner rather than later. What is most important—

Jim Dowd: rose

Anna Soubry: I have not finished my sentence; do forgive me. What is most important is that the right decision is made after careful consideration. I am pleased that the Secretary of State was true to his word and had a meeting with Members who are rightly concerned about the future of Lewisham hospital on 14 January. I know that it was effectively a listening exercise, because he could not express an opinion. That meeting was held with Matthew Kershaw, who is the TSA, and his officials.

Jim Dowd: The Minister mentioned that a decision is to be made on 1 February, which is a sitting Friday. Statements can be made on a Friday, as we saw with the urgent matter last week. Sometimes, statements about issues relating to London can be made, but will the

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Minister accept that this is an issue of national import? Will she prevail on the Secretary of State to ensure that, whenever the statement is made, it is not on Friday 1 February? Will she give us that assurance now, or seek one from the Secretary of State?

Anna Soubry: That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.

Heidi Alexander: No one disputes the existence of financial problems, but the closure of A and E and maternity departments affects people’s lives and health. Will the Minister confirm that, were the Secretary of State minded to agree to the proposals put before him, the four tests set by her own Government will be applied?

Anna Soubry: I am happy to remind us all of those four tests and principles; they remain as firm as ever. First, any reconfiguration should have the support of GP commissioners. Secondly, there should be full public

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and patient engagement and proper consultation. Thirdly, there should be a clear clinical evidence base. Fourthly, any reconfiguration should be in support of patient choice.

The hon. Lady comes to the House to represent her constituents and to put forward their views, which she undoubtedly shares, and their anger and concern about their hospital. In her speech, she understandably uses the words outrage and disbelief to say that those four tests, in all or in part, have not been made. She speaks with passion and with detail about the lack of support from GP commissioners and consultants at Lewisham and beyond. She says that this is a hospital that has had many successes and a long-standing investment. She makes the point that, given all the arguments that have been advanced by her and other hon. Members, the decision clearly has no merit.

Let me mention here the interventions by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Dartford (Gareth Johnson), the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who speaks in accord with others in support of the hospital, and the right hon. Member for Greenwich and Woolwich (Mr Raynsford). There were speeches by the hon. Members for Lewisham West and Penge and for Eltham (Clive Efford) and by my hon. Friend the Member for Beckenham (Bob Stewart).

This is a very serious subject and I do not want to be flippant. The views of all are certainly taken on board. In due course, the Secretary of State will announce his decision. Therefore, as I said at the outset, I cannot be of great assistance in addressing the various comments that have been made, because I am not allowed to give my opinion. I should, however, mention the contribution of my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes)—I think that I missed him off my list. He gave a thoughtful and frank speech in which he talked about his concerns about the legislation that brought about the appointment of the administrator. He has looked at an alternative and he advanced that.

Finally, the hon. Member for Eltham calls for a review of A and E, but he should do so with great caution. There might be merit in that, but when one embarks on such a review, we have to make it clear that, in those circumstances, some tough decisions might be made, and everyone involved in that would have to sign up to it on that basis.

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Personal Independence Payments

11 am

Julie Hilling (Bolton West) (Lab): It is a pleasure to serve under your chairmanship, Dr McCrea. I am very pleased to introduce this short debate about personal independence payments and blind and visually impaired people, because although the Government have made some very welcome improvements to the descriptors in relation to people with sight disabilities, many questions remain, and I am afraid that my speech mainly consists of questions.

The principle of disability living allowance and—one hopes—of PIP is that it goes a little way towards levelling the playing field, enabling disabled people to do the things that non-disabled people take for granted. As my constituent, Alison, told me:

“Many blind and partially sighted people rely on DLA to meet the extra costs they face every day as a result of their sight loss. The help they get from DLA is not a luxury; it means that they can live independently. Without it, they would be unable to do everyday things that people with sight take for granted, like being able to get out to do food shopping, getting to doctor or hospital appointments, being involved in local groups, looking for work; in short, living a life that enables them to do more than just stay at home.”

So my first question to the Minister—it is one that has been raised with me by a number of people—is this: do the Government have any intention of means-testing PIP now or in the future?

The Government state that the receipt of PIP will be based on an assessment of individual need, and the support required as a result of the particular health condition. The new assessment will focus on an individual’s ability to carry out a range of key activities that are necessary to everyday life. But will the assessment be truly based on the needs of an individual or on the “condition” that they have?

We all know that disabilities can affect people in different ways. The first constituent who contacted me about this issue—she did so well over a year ago—is Margaret. Margaret progressively lost her sight over a period of time. Initially, she continued to work and even went to college. She used to take the local bus service, but she found that impossible as she was reliant on drivers seeing her white stick, and slowing down to tell her what number bus they were driving and whether it was the bus she was waiting for. Such experiences became too much for Margaret and she developed agoraphobia, making her unable to work.

Margaret is reliant on the DLA she receives to interact with the outside world and to communicate with her extended family, many of whom live outside her area. She has enhanced audio-visual equipment on her TV and computer, which allows her to send e-mails and enjoy TV programmes. That makes life just a little bit more bearable for her.

Ms Margaret Ritchie (South Down) (SDLP): I thank my hon. Friend for giving way and for securing a debate on this important subject. Does she agree that PIP assessments must assess adequately the needs of blind and visually impaired people, and that there is a need on the part of Government to recognise properly the extra costs of mobility for people with severe sight impairment?

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Julie Hilling: I thank my hon. Friend for that intervention, and I will go on to talk in much more detail about some of the issues that she has raised.

Going back to my constituent, Margaret, she says that without her current rate of DLA she would not be able to afford the TV and internet package that she has, which would make her even more isolated from family, friends and the rest of the world. Her partner and carer, Jim, suffers from serious mobility problems; effectively, they care for one another. They are very worried about the potential effect of PIP, and they are also worried that some bright spark at Atos or the Department for Work and Pensions will actually declare Margaret fit for work.

Let us compare Margaret with John, who has been blind from birth and depends on his DLA to live independently and get to work, or with Michelle, who lost her central vision in 2005 and took a while to get back into employment. Michelle told me that she is registered blind, but apparently she is not blind enough to qualify for higher rate mobility, although she uses a long cane and frequently falls over. There is also Barbara, who had to leave nursing in her early fifties because of deteriorating vision but who then worked part time as a support worker to blind and visually impaired students.

We know that eye conditions can be very different: some rob people of central vision; some block out other parts or make looking at life like looking through lace curtains; and some cause a loss of depth of vision. There are many different ways that vision can be affected. So my question for the Minister is whether PIP will be flexible enough to focus on individual needs.

Peter also contacted me to raise concerns that blind and partially sighted people who cope with their condition may be penalised and lose benefits because they have made the effort to cope and have been able to do so. He is worried that people who have coped in the past will now refuse to cope, so that they can retain benefits. What is the Minister’s view on that?

Let us focus on mobility for a moment. The criteria refers to familiar and unfamiliar routes, stating that an individual who qualifies cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid, or cannot follow the route of a familiar journey. John and others have talked to me about the reality that, for people with severe sight loss, there is no such thing as a “familiar” journey. Let me quote him:

“What is a familiar route? For me there is no such thing as a familiar route. For me, “familiar” is based totally on sound and feel. These constantly change. No route is the same two days running - disruptions are caused by wind, rain, people and traffic and I cannot use sight to check that it is safe or to update my knowledge of the changing environment en-route. Feel, via a long cane, is disrupted by ice, snow, leaves and standing water which disguise important orientation points like kerbs and tactile paving. “Bin day” turns pavements into dangerous, practically impenetrable obstacle courses with heavy randomly placed bins. Despite Highway Code regulations, cars are often parked with impunity well onto the pavement, vans leave ramps down and rear doors flung wide open. These obstacles are silent, invisible to me. With no sight, no auditory warnings, I regularly walk straight into these and have the scars to prove it. There is a limit to the amount of adapting one can do! I am vulnerable when asking strangers for direction. They may be ignorant or undesirable. I have never successfully, independently accessed a supermarket because the act of moving around brings me into contact with all manner of objects and people which are in close proximity. I’m not aware until I have

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actually hit them. This is neither appropriate nor socially acceptable behaviour and causes me great anxiety. Trying to travel on a bus or a train throws up the challenge of accessing transport information and bus stops, finding the right bus, recognising stops, finding a space to sit or a person to ask. A talking mobile phone is indispensible but very costly.”

John very kindly took me on the “familiar” route from his house to the main road, which was an absolute education for me. Because he needed to access different surfaces to understand where he was on the route, he was unable to take the shortest route and in fact some of the places that he ended up walking were, for me, far more dangerous than the straightforward route; however, he needed to access different surfaces. In order to cross a piece of land diagonally, he had to ensure a piece of wall was in the middle of his back at just the right angle so that he would end up at the right position for the next stage of the journey. A walk that would take an able, sighted person 10 minutes took him about half an hour.

I appreciate that, with the change in descriptors, John will be entitled to the higher rate of mobility, but what about Michelle? She only has peripheral vision and cannot see at night. As for the daytime, she said to me:

“If I see a puddle, I don't know if it’s a hole or a puddle.”

I have mentioned Barbara, who is a long-cane user and who has talked to me about hazardous journeys where, for example, there are shared pavements or traffic lights that do not have audio or tactile light-changing indicators. Of course, there are also cyclists who do not adhere to lights or—it seems to me—any other elements of the Highway Code, and of course they are another danger. Does the Minister expect partially sighted people who always use a long cane for familiar and unfamiliar journeys to qualify for the higher rate of mobility?

Concern has also been raised that the criteria of being able to do something reliably—safely, to a necessary and appropriate standard, and repeatedly, in a timely manner—will not be in the regulations. They are welcome descriptors, but how can the Minister assure us that those criteria will not change if they are not explicit in the regulations?

Anas Sarwar (Glasgow Central) (Lab): I thank my hon. Friend for giving way and I congratulate her on securing this important debate. As she knows, guidance notes for the PIP assessors play a key role in ensuring that we get a fair deal for those who are blind or partially sighted. Will she press the Minister to publish those guidance notes as soon as possible?

Julie Hilling: I thank my hon. Friend for that intervention, because it is really important that those guidance notes are printed. However, I also question whether we actually need to put those criteria in the regulations themselves.

Jim Shannon (Strangford) (DUP): I thank the hon. Lady for giving way and, like other Members, I congratulate her on bringing this matter to the House. The Royal National Institute for Blind People and Action for Blind People have both indicated that they will be able to help people to fill in forms. Does she feel that the Government should consider assisting those organisations to help people to fill in forms and to get the forms right, so that the assessment can be right?

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Julie Hilling: The hon. Gentleman raises a really important issue. All of this—particularly with the computerisation of the forms—will be far more difficult. These things are hard enough for people with visual impairment, but they will become even more difficult. Organisations that support people with disabilities are themselves facing tremendous cuts.

As Michelle told me—this is demonstrated by John’s journey time—everything, including cooking, ironing and inspecting food, takes a person with visual impairment longer. What weighting will be given to the time element?

I turn now to the daily living component. Many people have spoken to me about the extra costs of being blind or partially sighted, but some of those costs do not appear in the assessment criteria. A number of people talked about the damage caused to clothing by catching it on railings or overhanging trees, and by falls and such like. There seems to be no recognition of such additional costs.

The assessment criteria appear to award a relatively low score for aids and appliances. The Government state:

“This recognises that the majority of aids are relatively low cost”.

Blind and partially sighted people would hotly dispute that the majority of their aids are low cost. I have mentioned the talking mobile phone and enhanced audiovisual equipment on TVs and computers. Specialist IT software and hardware are expensive. What about talking scales, magnifiers, Braille machines, accessible telephones and all the other devices that people need to lead their lives? Even a white cane costs more than £20. Has the Minister considered other funding sources that could assist blind and visually impaired people if such costs are not met through PIP?

As regards cooking and preparing a simple meal, I am not clear which category blind and visually impaired people could expect to find themselves in. If they can only put a meal prepared by someone else in the microwave, what would they score?

Probably the most significant element in this section for blind and visually impaired people is the cost. By the nature of their disability, many will be unable to find the bargains that sighted people will. They will also have difficulty with use-by dates, and they will often not be able to see whether food is fit to eat. John told me he has to purchase ready-chopped, ready-grated cheese and ready-prepared meat. He has to buy in single-use portions, otherwise he will subsequently not be able to tell whether the food is fit to eat. Of course, all that makes food far more expensive. Is that taken account of anywhere?

What about the washing and bathing section? Focusing only on washing and bathing takes away the elements of grooming. What happens to those who need help with shaving, doing their hair or putting on make-up?

In the dressing and undressing section, will the criteria relating to needing assistance to select appropriate clothing apply to blind and partially sighted people who need someone to prepare their clothing in advance, even if they can dress themselves on the day because their clothes are already sorted by colour and type?

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On reading and understanding symbols or words, will the Minister confirm that someone who can read at home with a magnifier, but who cannot read labels in shops or see signs in the street, will be deemed not to be able to read at all?

As regards engaging with other people face to face, what happens with blind and partially sighted people who need someone there to describe the environment? Would they be covered by the words

“Needs prompting to engage with other people”


“Needs social support to engage with other people”?

Of course, other, additional costs are involved in keeping a safe, clean home environment. Will allowance be made for the additional costs of paying people for cleaning, laundry and ironing?

Although the debate is about PIP, I ask for the Minister’s indulgence because I also want to raise concerns about people such as Alison losing incapacity benefit and being told they are fit for work. There is no denying that many blind and visually impaired people work, but some are unable to. Are blind and visually impaired people being put into the work-related activity group or taken off employment and support allowance altogether? I have received reports that they are losing DLA. If benefits are supposed to be about what people can do, and not their condition, how can such decisions be made?

Finally, Atos does not have a good reputation for evaluating the needs and capabilities of ill and disabled people. Following the Atos debate, one person wrote about his experience, saying:

“I suffer from RSD/CRPS”—

reflex sympathetic dystrophy/complex regional pain syndrome—

“(an incurable chronic pain syndrome in both feet) which leaves me in constant pain every day and has reduced my mobility. I scored 0 points at the WCA”—

the work capability assessment. He continued:

“You have probably heard of the artistic license the Atos”

health care professionals

“take in documenting the Work Capability Assessment. Mine was no different. The HCP missed out relevant information I divulged in relation to pain, mobilising and standing and sitting. None of the timing in the report was accurate and he even went on to add information about me that I never stated. Mercifully I covertly recorded it all so have an accurate record”.

That is the sort of experience that many people are reporting currently about their Atos assessment, so blind and visually impaired people are rightly worried. How will Atos be monitored? Will the destination of blind and disabled people migrating to PIP be logged, assessed and reported?

As the Government have stated, the likely outcome of the assessment of DLA recipients under PIP is that 510,000 people will have awards increased, 270,000 will have awards unchanged, 510,000 will have awards decreased, and 450,000 people will have no award. How many blind and partially sighted people does the Minister expect will gain, lose or get no award?

I apologise for presenting so many questions to the Minister, but I hope that she will be able to answer the concerns of my constituents and the thousands of other people who will be affected by the changes to benefits.

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11.16 am

The Parliamentary Under-Secretary of State for Work and Pensions (Esther McVey): I congratulate the hon. Member for Bolton West (Julie Hilling) on securing the debate on such an important issue and welcome all the contributions that have been made. It is a pleasure to serve under your chairmanship today, Dr McCrea.

The UK remains a world leader in rights for disabled people, and we currently spend almost £50 billion a year on services and benefits for them. Those valuable support mechanisms enable disabled people to make their own choices and live as independently as possible. However, for those valuable services to continue to be available, they must be provided in a sustainable way that reflects the needs of disabled people in today’s society.

It is generally recognised by hon. Members on both sides of the House and by the Select Committee on Work and Pensions that disability living allowance needs reform, to reflect today’s understanding of disability better. DLA has not been fundamentally reformed since its introduction more than 20 years ago, and it is a complex, poorly targeted and inflexible benefit, for some. There is confusion as to purpose and sometimes unfairness in the awards that are given, which has damaged public confidence in the benefit. The changes in the treatment of blind and severely visually impaired people, from DLA to PIP, should be welcomed, for we are giving the clarity that the hon. Lady seeks.

If there had not been a need to deal with the faulty structure of DLA in the first place, it might have taken slightly less effort to bring about the changes that we need in PIP. There has been a rigorous consultation over nearly two years, taking into view representations from charities and organisations that have all had a say.

Anas Sarwar: Will the Minister join me in congratulating the Royal National Institute of Blind People, which has campaigned extensively on the issue and has managed to get some concessions, although there is still work to do?

Esther McVey: I will indeed congratulate the RNIB and other charities and organisations that have represented the needs of blind and partially sighted people. The hon. Gentleman makes a good point.

The approach taken in the DLA to recognise the mobility difficulties of blind and severely visually impaired people does not look at people as individuals; it looks at their conditions. What we are doing—and, I believe, what the hon. Lady seeks—is requiring that everyone needs to be looked at as an individual: how has their condition affected them? That really is what PIP is intended to do. It is personalised. It is about the individual: what help that person needs.

At the moment, for DLA, 50% of claimants do not have medical support for their condition. More than 70% have an award for life. We seek to serve the public, including the hon. Lady’s constituents, as well as we can by making an award that is personalised.

The hon. Lady’s first question was about means-testing: no, the award of DLA and PIP is non-means-tested and that is how it will remain. It is intended to help those people with the most barriers to overcome them and live independent lives. As I said, it is very much about the individual, about what is fair to that individual and

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about the needs arising from the condition. To that extent, it is very much personalised. It will be flexible enough to reflect individual needs—that is what PIP is specifically designed to do. It is about having clarity, so that people will be certain of what they will get, but also about flexibility.

I thank the hon. Lady for bringing her constituents’ concerns before the House, because that is what we are here to do, to put a face and a person behind the needs, so that we can explain things clearly.

Jim Shannon: Can the Minister answer my intervention on the hon. Member for Bolton West (Julie Hilling)? What can the Government do for RNIB and Action for Blind People to help people to fill in forms? Those organisations will be inundated with people needing help, so whatever assistance the Government can give will be money and time well spent.

Esther McVey: The hon. Gentleman may not know that the people seeking the award can say how they would like the form delivered to them and in what context. If people so wish, they can be accompanied by someone from a charity or organisation or by a friend to help them with the assessment. The process is about finding out as much as we can about the individual to help with the assessment and the decision so that we can give the correct award. Again,

“reliably, repeatedly, safely and in a timely manner”

is key to the decisions—that phrase is in the guidance and in the contract with the providers. The hon. Member for Bolton West asked whether that could be put in regulation, and I announced before the Select Committee on Work and Pensions yesterday that we are examining whether that would be of benefit. The matter is with lawyers at the moment, because we do not want to introduce something that could go against what we are seeking to do, to ensure

“reliably, repeatedly, safely and in a timely manner”,

which is key to the assessment. We are therefore looking at whether it can be put in regulation or whether it is better staying in the guidance notes. The hon. Lady also asked about those notes, which will be published as soon as they can be, possibly by the end of the month.

This is a principled reform, which we have developed in consultation and collaboration with disabled people. We have listened to their concerns, and those of their representatives and organisations, and we have made a significant number of changes as a result of the feedback from groups that represent visually impaired people. Indeed, that was recognised by RNIB, which stated in its report to the secondary legislation scrutiny Committee that

“the final criteria include a number of significant improvements for blind and partially sighted people.”

We were told that our draft communication activity did not take appropriate account of the barriers faced by people who cannot access written information. As a result, we introduced an additional activity to assess ability to read and understand signs, symbols and words. Therefore, someone who is completely unable to read because of their disability—for example, because of blindness—will get eight points towards their daily living

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component score. The score from that activity alone will mean that they get the standard rate of the daily living component. That is only one of the criteria; there will be a further nine in that section.

We also acted on the feedback that the effect of visual impairment for people who use long canes was not appropriately reflected in the mobility activities and that the barriers such people face are similar to those faced by people who have a support dog.

Julie Hilling: I appreciate what the Minister says about people who are totally blind, but what about those who can read at home only with the use of a magnifier? A magnifier clearly cannot be taken to the supermarket or into the street. Will such people be deemed unable to read?

Esther McVey: That will be recognised, because what an individual can do inside the house with a magnifying glass might be significantly different from what they can do outside the house, such as following a journey, reading signs or reading labels in a shop, all of which have now been taken into consideration and will lead to points being accrued during an assessment.

The final draft of the assessment criteria includes specialist orientation aids, such as long canes, in the “planning and following journeys” activity. Therefore, someone who is blind and needs to use a long cane to follow journeys, even in familiar places, will receive 12 points, which will qualify them for the enhanced rate of the mobility component.

We have acted on concerns about the speed of reassessment by extending the reassessment timetable, so that we can learn from the early introduction of PIP by fully testing our process. We will be able to consider the outcomes of our first independent review in 2014 and act on its findings before reassessing the majority of current DLA claimants. The extended strategy means that the main bulk of reassessment will not start until autumn 2015.

Julie Hilling rose

Esther McVey: I will give way, although time is running out.

Julie Hilling: I thank the Minister for her generosity. On mobility, what about people who are severely visually impaired but who have some vision and who need to use a cane for familiar and unfamiliar journeys? Will they be entitled to the highest number of points?

Esther McVey: Again, the benefit is based on the individual, so I cannot give an all-encompassing answer. We have taken on board all the factors that have been raised today, and they have been reflected in the assessment. We have made that very clear, and each person will be viewed on how they are affected by their condition. The likelihood is that the answer is yes, but we have to view people as individuals. There have been strong representations from all the blind charities and partially sighted organisations, and those representations are reflected. The news of how we have changed the assessment has been welcomed by the groups themselves.

We are also seeking to learn from the experience of delivering the work capability assessment—and, yes, from the failings that we have had to address—to ensure that we get PIP right from the start. As part of that, we are looking closely at the findings of both the independent

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reviews of the work capability assessment by Professor Harrington to see where we can improve the design of the PIP claim and assessment processes to make them better, more effective and a more positive experience for claimants.

I hope that I have reassured hon. Members that we have listened and acted on the concerns of visually impaired people and that PIP will take appropriate account of the barriers that they face on a daily basis. As material on the RNIB acknowledges, the changes now mean that the

“blind and partially sighted should see their needs recognised when PIP is introduced.”

11.29 am

Sitting suspended.

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Taxation (Living Wage)

[John Robertson in the Chair]

2.30 pm

Robert Halfon (Harlow) (Con): It is a pleasure to serve under your chairmanship, Mr Robertson.

Tax cutting is as much about politics as about economics. Of course, the economics have to work too, but here is a statistic that should worry us: the Institute for Fiscal Studies and the Joseph Rowntree Foundation have shown that almost all the growth in household income since 2001 was wiped out by the financial crisis. At kitchen tables up and down Britain, it feels as though the last decade of growth simply did not happen.

It is hard for any Government to tackle that situation. Why? Partly because we—I am talking about the Conservative-led coalition—have allowed our political opponents to caricature tax cuts as measures that are only for our rich friends in the City, rather than a means of creating and sharing the wealth in society. Now, more than ever, we have to show that tax cutting is a moral creed that is about lifting workers on low incomes out of poverty and creating jobs for the unemployed. Hence my campaign to restore the starter rate of income tax at 10p, which was scrapped in 2008 by the last Government.

I believe that restoring the 10p rate would help the coalition to counter the war cry of its political opponents that it is only interested in cutting taxes for millionaires. It would prove to the public that “lower taxes for lower earners” is not just a soundbite but that it can be a reality, first by raising the threshold to £10,000 and then by bringing back the 10p rate for the lower-paid.

The Treasury has confirmed to me in a written answer that the move would cost around £7 billion a year, if it benefited everyone. Interestingly, the Chancellor told the House last year that the same amount of money was lost when Labour brought in the 50p rate of tax, and that has been confirmed by the IFS. I am arguing that when the top rate of tax falls to 45p the extra revenue that the Government say will be raised ought to be put towards restoring the 10p rate of income tax.

Not everyone agrees with my view. The campaign for a 10p tax rate has been opposed from the left, from the right and by our colleagues, the Liberal Democrats. Let me deal with each one in turn.

When Labour was in power, its main response to low wages was tax credits. The aim was a noble one—to help the poor—but the policy was flawed. For example, Dr Jamie Gough from Sheffield university recently told The Guardian:

“Tax credits enable employers to pay below a living wage, and thus subsidise their profits.”

Tax credits have also left the Department for Work and Pensions with a hugely complex system of overlapping handouts that taxes workers on low pay only to recycle the money back as benefits. Reporting on tax credits, the ombudsman has said:

“Many are unaware of them and DWP staff often fail to invite claims.”

The idea is fine in theory, but many people lose out in practice.

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Other people take a gentler approach. The Living Wage Foundation has been asking employers to voluntarily pay £8.55 an hour in London. Again, that is a worthy aim, and perhaps larger corporates can afford it, but what about smaller firms and micro-businesses that cannot? I am a supporter of the minimum wage, but recently the Low Pay Commission warned against forcing it higher, because

“Firms may be reluctant to create jobs by recruiting inexperienced or young staff, because they are put off by the increased wage bill.”

John Stevenson (Carlisle) (Con): I am grateful to my hon. Friend for giving way and for securing this debate on an important subject. Does he agree that linking the personal allowance with the minimum wage would be an excellent way to take everyone who is on the minimum wage out of income tax?

Robert Halfon: My hon. Friend has an interesting idea, which I would like to explore further, but I believe that the focus of all the resources that the Treasury has, which of course are not much, should be on restoring the 10p rate, for the reasons that I will go on to describe. I have argued that we need a solution for everyone, not just for the lucky few. That is why I was pleased to see Kevin Maguire in The Daily Mirror today supporting the 10p campaign.

Mr Andrew Smith (Oxford East) (Lab): I congratulate the hon. Gentleman on securing this debate on an important subject. I want to take him back to the point that he was making about tax credits supposedly allowing employers to pay lower wages. Presumably the basis for that argument is that tax credits raise the take-home pay for the worker at no cost to the employer. However, why does he not employ the same argument to the tax reduction that he is advocating, which again will raise the take-home pay of workers? In a properly competitive labour market, would that not allow employers to pay less?

Robert Halfon: That is where the philosophical difference between the right hon. Gentleman and me lies; I believe that we need to move away from a handout society, in which people’s taxes are recycled to hand out to various groups, to a hand-back society, in which people are handed back their own money through the tax system.

Some people on the right, especially in the think-tank world, oppose the 10p tax rate on the grounds that it is not radical enough. They say that it might undermine the case for a flat tax in some future Parliament. The problem with that—again, as the IFS has set out—is that a flat tax would be deeply regressive and it would be hard to defend as fair. While that remains true, a flat tax is unlikely to happen.

For example, the IFS has shown that merging income tax and national insurance contributions to a flat rate would literally take from the poor and give to the rich, unless the state was shrunk to a size that is politically impossible. Where I agree with people on the right, and with thoughtful commentators such as Ryan Bourne from the Centre for Policy Studies, is that the Government must do much more to generate support for broader tax

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cuts. My point, however, is that surely the best way to achieve that is to show that tax cuts are moral—to use a Blairite phrase, “for the many and not the few”—and that they will help millions of hard-working people, not just millionaires.

Mr Jim Cunningham (Coventry South) (Lab): I do not have any difficulty with the hon. Gentleman’s proposal that there should be a 10p tax rate; in fact, it was a Labour Government who actually introduced that rate. Regarding a living wage, which the hon. Gentleman alluded to, I understand that there are no proposals—certainly, they would not be put forward by Labour—to legislate for a living wage. It is a voluntary thing, and it is down to employers, in fact, to decide whether to pay it.

The hon. Gentleman also referred to the minimum wage. I can certainly remember in my constituency many years ago that under the previous Conservative Government there was—what was it called? I think that it was called a “family supplement”, or something, for people on low wages. On one occasion, which really led Labour to legislate for a minimum wage—

John Robertson (in the Chair): Order. Will the hon. Gentleman finish his intervention?

Mr Cunningham: I will do in a minute. The fact was that in my constituency we had people on £1 an hour. As I say, I have no difficulties with the hon. Gentleman’s proposal, but whatever Government are in power, at the end of the day, the big threat is from the Exchequer. It is the Exchequer that will probably try to torpedo his proposal.

Robert Halfon: I thank the hon. Gentleman for his intervention. As I said before, I agree fundamentally with the minimum wage; it is a moral right that people are paid a certain wage, and I am glad that my party now supports that, but I have questions about the living wage. First, how do we set it? I believe that it puts enormous burdens on smaller businesses; the big multinationals will be able to deal with it. I do not want it to act as a disincentive to employment, and I believe that the burden of responsibility for the living wage should not be on businesses but on the Government: the Government should reduce taxation.

Mr Cunningham rose

Robert Halfon: I give way again to the hon. Gentleman.

John Robertson (in the Chair): I hope that the intervention will be shorter this time.

Mr Cunningham: Frankly, if it is voluntary, then it is not forced on small employers. It is the big employers who can pay it.

Robert Halfon: Of course, if businesses want to pay their employees a living wage, that is all well and good; I would be delighted at that and would have no problem with it whatever.

My hope is that once the threshold reaches £10,000, we will consider bringing back the 10p rate for the lower-paid. Some Liberal Democrats disagree; they have suggested that the best way to help families is to raise the personal allowance even further, to something like £12,500 a year. I absolutely agree the coalition should

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fulfil its £10,000 commitment, but it would be unwise to raise the personal allowance even further. Everyone should feel that they have a stake in the state, and they should have some stake in the tax system even if they pay only a small amount, because they need to realise that public services are not free and that there is no magic money tree. My fear is that the Liberal Democrats want to pay for their policy, which will cost £14 billion if applied to everyone, by dragging even more workers into the 40p band. That is what has happened historically. The problem is that we will soon have families with not very high wages paying a marginal rate of 40p, and that will include police officers, shop owners, managers and senior nurses in the national health service.

George Eustice (Camborne and Redruth) (Con): That point goes right to the heart of my hon. Friend’s argument. The aim of this policy should be to encourage people on low incomes to take higher-paid work, to work longer hours and to start the transition up the income scale. That is why he is right that we need to introduce a 10p tax rate in the interim; otherwise, people will go straight from their tax-free allowance to being taxed on any income above that. Does he agree that, in an era where there is downward pressure on many benefits, some of which affects the working poor, the 10p tax rate could be a good counterbalance, so that people keep their income in the first place?

Robert Halfon: My hon. Friend is exactly right. What he is saying is that we will create a hand-back society, where we give people back their own money, rather than just a handout society, which recycles benefits through the tax system.

Taxing the people I describe at the 40p rate is a brake on aspiration, and it has hit single-worker families the hardest. We started this Parliament with about 3 million workers paying the 40p rate, and the number will be closer to 5 million by 2015. We should not add further to that figure, as my hon. Friend says. Restoring the 10p band is more affordable than raising the personal allowance to £12,500. Most low-income workers would still have a stake in the tax system, and it would avoid dragging more families into the 40p band. That is why I support it over the Liberal Democrat proposals.

The fundamental point is, as the Government say, that we lost £7 billion when the high tax rate went up to 50p. If we get more revenue from having a 45p tax rate, the moral thing to do will be to put those extra billions towards funding the 10p tax rate.

Of all the things the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) did, the one that genuinely amazed me was that he scrapped the 10p band, given what the Labour party stood for. I accept that he introduced it in the first place, but when I watched him scrap it, I genuinely could not understand why he was doing it. Overnight, the change crushed working people with a £232 tax rise. Why should the Government not set themselves the goal of reversing that unpopular decision? There is a strong case for doing so. As I said, tax credits are flawed; small firms cannot afford the living wage; a flat tax is not going to happen and is unfair; we do not want to drag any more families into the 40p band; and everyone should have some stake in the tax system.

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I suggest to my hon. Friend the Minister that the policy would be popular, that it would be a symbol of the Government’s economic mission and that it would help to tackle the desperate stagnation in incomes that Britain has suffered in the past 10 years.

2.44 pm

Jim Shannon (Strangford) (DUP): I congratulate the hon. Member for Harlow (Robert Halfon) on bringing this matter to the House for consideration. I want to give a Northern Ireland perspective and to discuss the importance of small and medium-sized businesses, particularly for my constituency, but also for constituencies across the rest of the United Kingdom.

Times are tough for many families throughout the UK. They face stagnating wages, coupled with rising costs. Many small businesses are struggling and cannot afford annual pay rises. The question in many families is, is it better to be in or out of work? The cold reality of the market out there has pressed many of them to make a decision about that.

The Government have shown that they are attempting to address the situation through the uplift of the personal allowance threshold. That should mean that approximately 250,000 workers on low pay no longer have to pay income tax, which has to be good news. The same uplift will also mean that most basic and higher-rate taxpayers will pay £47 less tax from April, after the Chancellor increased their tax-free limit to £9,440 a year.

The Chancellor has indicated that the steps the coalition has taken have increased the number of low earners lifted out of tax to 2.2 million. Again, that is good news, and things are going the right way. The amount of tax paid by people on the minimum wage will have been cut in half by next year. From next April, the personal allowance will rise by a further £235, so the total increase next year will be £1,335—the highest cash increase ever. Over the past two years, the Government have announced total increases to the personal allowance of £2,965, with the aim of reaching a £10,000 allowance in this Parliament.

I read the report of the debate about paying a living wage, which would help many people. Northern Ireland has the highest proportion of people earning below the living wage in the UK, at 24%, and is followed by Wales, at 23%. The lowest proportion of sub-living-wage earners is in London and the south-east; in both cases, it is 16%. However, the number of people affected in London is 570,000. In the north-west, it is also 570,000, while in the south-east, it is 530,000. In terms of the numbers, therefore, those are the most affected areas, but they do not compare with Northern Ireland in percentage terms.

A study showed that workers in the hospitality industry are the worst affected, with 90% of bar staff, and more than four out of five waiters and waitresses, or 85%, paid less than the living wage. The study also showed that 75% of kitchen and catering assistants, as well as launderers and dry cleaners, were paid less than the living wage. Similarly, 70% of cleaners and florists received less than the living wage. Clearly, those figures are of some concern.

Mr Jim Cunningham: There has been a whole range of price increases on things such as travel, as well as benefit cuts. In tax terms, would the reintroduction of the 10p tax rate offset that and take people to the level of the living wage?

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Jim Shannon: I wish I knew how that would work. I cannot answer that question; the person who can is perhaps the Minister. I hope that that would happen, but I cannot say that it definitely would. Perhaps the Minister can comment on that when he responds.

Small and medium-sized businesses make up more than half the UK’s business population. As such, they are not a minority, and they should not be overlooked or ignored. That is what I want to focus on. The Federation of Small Businesses has said that Northern Ireland has the highest concentration of SMEs—companies with fewer than 250 employees—in the UK. There is not one business in my constituency that employs more than 250 people, so SMEs are very important for the people I represent. Those SMEs account for 81% of all private sector employment and 79% of all private sector turnover. In contrast, less than 1% of the private sector consists of large firms, which account for less than 20% of total employment and 21% of turnover.

Small businesses employ 65% of the private sector work force in Northern Ireland, compared with 62% in Wales, 48% in Scotland and 46% in England. Small businesses account for a greater proportion of turnover, contributing 60% of all private sector turnover, which is, again, higher than in Wales, at 46%, in Scotland, at 40%, and in England, at 36%. Some 54.5% of gross value added was produced by small businesses, which are those with nought to 49 employees, while a further 27% was produced by medium-sized enterprises, which are those employing between 50 and 249 people. In total, SMEs accounted for 81.6% of GVA.

Those figures indicate the importance of SMEs, which are critical for the future, particularly in my constituency. The Prime Minister has indicated that he wants to build up the private sector, but we need to do that before we try to downsize the pubic sector. The statistics show how essential those businesses are to the economy. I wonder how many of them could afford, in these difficult days, to up their wages bill when they are already struggling to stay afloat.

This year will be critical for a great many industries, in my opinion and the opinion of many others more expert than I am. I know of more than one business in my town that has downgraded from two shops to one, but which has kept the same staffing levels in the hope of reducing overheads and not having to make staff redundant. For the owner, the most important thing is not to make staff redundant—not to send people to the unemployment queue. He cares about his staff and does not want them to be out of work. However, he has children to feed, as they do, and if we asked him to pay his eight staff more wages, he could not. He would either have to lay some off, or close altogether. I know that that story is being replicated throughout the UK, as even businesses that were thought to be established call in the administrators and close their doors. Can we honestly expect the small retailer to take up the slack? We hope that he or she can do it, but we are not sure.

Can we force the onus of economic recovery on to shop owners, or does it lie in this place? I believe it lies in Parliament and with the Assemblies. We must encourage small businesses to pay their staff what they can; but there is also a need for decisions for growth and the encouragement of business investment in local economies, and for the creation of employment and spending power. A living wage is a great target to aim for, but that will be

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brought about not through legislation but through good governance from the House and the devolved Assemblies; the Northern Ireland Assembly has a particular role to play. We need to focus on those issues, and when economic conditions are right—which we hope will be soon—we can expect employers to play their part in making things better for their employees.

2.51 pm

Guto Bebb (Aberconwy) (Con): I congratulate my hon. Friend the Member for Harlow (Robert Halfon) on securing this important debate. It is a great pleasure to follow the hon. Member for Strangford (Jim Shannon) who always speaks so passionately on behalf of his constituents in Northern Ireland. I noticed time and again from the statistics he offered that Northern Ireland and Wales are often classified as the poorest parts of the United Kingdom. That makes the 10p tax rate an incredibly important issue for my constituents in north Wales.

We must congratulate the coalition Government on the significant increase in the personal allowance. It has meant a huge cost to the Government, but it is the correct decision and it highlights the coalition’s strong belief that the best way to help people is to allow them to keep more of the money they earn. That is the big difference between the coalition and the Labour Opposition, who believe that the best way to help the poorest in society is to take money from them and give some of it back, depending on their circumstances. I strongly believe that we should try to ensure that people keep as much of the money they earn as possible. However, my hon. Friend the Member for Harlow made another important point: I support the aspiration of a £10,000 personal allowance, but we must ensure at some point that people understand that they must contribute to society.

I welcome the movement in the personal allowance, which means, for example, that the husband and wife who run a small business as owners of a small guest house in my constituency can earn £20,000 from it without paying tax. That is an incentive for them to work and make a success of the business; but it is important that people understand that there is a point where they must contribute towards what the state provides. It is all very well to ask and demand more from the Government, but there is an understanding, which includes everyone, of a need to contribute. That is why it is important to focus our attention, once the £10,000 personal allowance is secured, on continuing to support the lowest paid, but in a possibly more cost-effective manner. Let us be honest: a 10p tax rate would cost half the amount of an increase in the personal allowance. There would be an impact on more people. We should support the aim of securing a new 10p tax rate, because it would help the poorest paid but also emphasise the need for everyone who works to contribute to society at some stage. I strongly support that aspiration.

I have nothing but sympathy with the Minister on the issues that the Treasury faces. The previous Government left them with a terrible situation—and I am not talking just about the financial deficit. The complication beyond recognition of the tax system is frankly shameful. In a recent article Philip Booth included a table that highlighted the fact that the marginal tax and benefit withdrawal rates are now out of tune. That results in a situation where someone earning between £8,000 and £38,000 is

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paying, between benefit withdrawal, tax payments and national insurance payments—if that person has a family of three children—a 73% marginal tax rate. That then falls to 42%; then it goes up again if people earn more than £100,000, because of the personal allowance withdrawal. Then it goes down again. The progressive tax system, which everyone in this country believed in, has been completely distorted by a process in which benefits, personal allowances and so forth have been withdrawn in response to a financial crisis. That has left a distorted tax system that goes against something the coalition is strongly in favour of—the aspiration to support people who want to support themselves. It is difficult to see how a tax system that now has so many distortions is doing the job it is meant to do, of supporting such people.

The Treasury faces a huge job in dealing with the deficit, but in due course it will need to think carefully about how to make the tax system fairer, with a progressive element rather than the present slightly distorting effect. There are opportunities to change it. Universal credit will deal with many anomalies at the lower end of the income spectrum, but we must recognise our responsibility to see the tax system for what it is—a failing system whose distortions run counter to the work ethic. The counter-productive element of the tax system is reflected in the fall in the 40% tax rate threshold. The fact that it will hit people on an income of £34,000 from April is counterbalanced by an increase in the personal allowance, but we must be aware that people in fairly modest positions in society are now being expected to pay a higher rate of tax, something that previous generations would not have anticipated. We have a responsibility to deal with that issue. The important thing for the Government is to try to provide circumstances that will support people in work.

The Northern Ireland situation has been discussed, and it is similar to that in Wales. We need to congratulate the Government on the fact that the tax payments of a person on the minimum wage, for example, have been halved as a result of changes to the personal allowance. There is a question whether it is justifiable to call something a minimum wage while still expecting someone to pay tax on it. However, I want to sound a note of caution about the living wage. I support the aspiration, but I question the affordability of it. I specifically question the fact that local authorities in Wales are saying they will pay all their staff a living wage. Is that a reasonable way to deal with the issue? In effect, it is using money raised in taxes from people who are often not particularly well paid to provide a benefit for people in the public sector, who may have better benefits than other workers. I question that: by bringing in a living wage for some workers, the public sector in some local authorities reinforces the view that people who work for the public sector somehow deserve better pay than those who work in the private sector. I am hugely concerned about it.