24 Mar 2016 : Column 647WH

Westminster Hall

Thursday 24 March 2016

[Mr Andrew Turner in the Chair]

NHS in London

1.30 pm

Dr Rupa Huq (Ealing Central and Acton) (Lab): I beg to move,

That this House has considered the NHS in London.

I thank the Backbench Business Committee for granting this debate, and I thank the London Members from three different parties who supported my application.

Our consideration today of the NHS in London is timely because there are reorganisations—or reconfigurations, as they are called—going on all over the city. I will address on the situation in north-west London in particular. In Ealing, the NHS was the main issue in the election campaign, and it continues to be a preoccupation, as I can see in my inbox and postbag. I shall talk today about matters such as the junior doctors contract negotiations we hear so much about; A&E closures; changes in maternity and paediatrics, which affect us in Ealing; community pharmacies and some of the other allied services, such as optical services; and staff morale. I have several specific cases from my surgery, including those of whistleblowers. I have a constituent who was sacked and has been effectively blacklisted from NHS employment ever since exposing bribe taking at Ealing hospital. I have raised her case three times on the Floor of the House, but nothing practical seems to be forthcoming for her.

There have been two important reports relating to the health service in north-west London. Most recently, the Independent Healthcare Commission for North West London, chaired by Michael Mansfield QC, was set up in response to the NHS’s “Shaping a Healthier Future” programme to reshape hospital and out-of-hospital health and care services in north-west London. The proposals in “Shaping a Healthier Future” are euphemistically called changes, but they are actually cuts—we know what they really are—and they include nearly halving the number of hospitals in our local area with a proper 24-hour A&E service. There were nine, but that is going down to five.

The London Borough of Ealing is around the same size as cities such as Leeds, but it will have no properly functioning A&E services at a hospital. The nearest four hospitals to my constituency—Central Middlesex, Hammersmith, Ealing and Charing Cross—are set to be downgraded to minor hospitals with no A&E. Instead, there will be urgent care centres.

Ruth Cadbury (Brentford and Isleworth) (Lab): I congratulate my hon. Friend on securing this debate. She is obviously concerned about the loss of services in her constituency, as are other colleagues about theirs. Is it not true that many people, including my constituents, are concerned about the pressure on the remaining hospitals, such as West Middlesex University hospital, when all the surrounding hospital services are closing?

24 Mar 2016 : Column 648WH

There is no guarantee that the remaining hospitals will have either the capital or the revenue funding they will need to cope with the inevitable increase in demand when services such as those at my hon. Friend’s hospital close.

Dr Huq rose

Mr Andrew Turner (in the Chair): Order. Before we continue, let me say that Members must abbreviate interventions.

Dr Huq: My hon. Friend makes an excellent point that I believe deserved to be made at length. She anticipates a point I will come on to about to the business case and the capacity problem. There is a problem with the way these things are organised. The north-west London area does not include West Middlesex hospital, which she mentioned, but that is more proximate to some parts of my constituency than Northwick Park hospital, to which my constituents are being diverted even though it is miles away. That just shows that people do not think in terms of these boundaries.

Dawn Butler (Brent Central) (Lab): I congratulate my hon. Friend on securing this debate. My local A&E at Central Middlesex hospital, which was classified as good, was closed, and now the people from the poorest part of my constituency have to travel to the A&E at Northwick Park hospital, which was ill equipped and ill prepared for the closure of the Central Middlesex services and is often rated below par.

Dr Huq: My hon. Friend puts it very well. Ealing has also been hit by the closure. I have no hospitals within my constituency boundary, but Central Middlesex was one of the nearest. It was performing well and had had lots of investment—it was a brand new shiny thing. I used to be a hospital radio DJ there in the ’80s. We were not allowed to play certain songs, including “My Way” by Frank Sinatra, because it is too much about the end for terminally ill people to listen to. Anyway, the hospital is now completely different from what it was like in the ’80s. It is tragic that the A&E there is being downgraded in favour of Northwick Park.

I saw the Minister’s brow furrow when I mentioned the boundaries. The hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), is in south-west London. Perhaps we can think more creatively about crossing boundaries, because an ambulance will not usually take someone there even if it is nearer than Northwick Park. That was the point I was trying to make.

Tom Brake (Carshalton and Wallington) (LD): On the subject of thinking imaginatively, does she agree that it is important the Government recognise that if more joint working is to take place between, for example, the Epsom and St Helier University Hospitals Trust and the Royal Marsden NHS Foundation Trust—a proposal that I understand is being considered—capital funding might be needed to facilitate the process?

Dr Huq: Yes, I certainly do. I do not know the St Helier hospital well, but I believe it is renowned as a teaching hospital. The business plans must account for such things; there is often too much short-termism.

24 Mar 2016 : Column 649WH

The implementation of the closures listed is well under way. The A&E departments at Central Middlesex and Hammersmith shut their doors in September 2014, despite assurances from the Conservative party during the 2010 general election campaign that that would not happen. The closures have negatively affected waiting times at Northwick Park hospital in Harrow. That hospital is a considerable distance away from a lot of my constituents; as the crow flies, it is pretty far from East Acton to Harrow. I do not like to churn out loads of statistics, but Northwick Park does have the dubious distinction of the worst A&E waiting times on record in England—

Bob Blackman (Harrow East) (Con): Will the hon. Lady give way?

Dr Huq: May I just finish this sentence? The partial sentence might not make as much sense as if I am allowed to complete it. In six out of the 15 weeks that immediately followed the closure, Northwick Park had the worst record in the country. There were anecdotal stories of ambulances backing up at that hospital.

Bob Blackman: I congratulate the hon. Lady on securing this debate, but we must get to the facts of the matter, particularly when we refer to specific hospitals, their standards of performance and what they are achieving. It is true that before the opening of the new A&E at Northwick Park hospital it had the worst record in London and one of the worst in the country, but since the new A&E opened in November 2014, it has had the best record in London and one of the best in the country.

Dr Huq: There is a target of 95% of patients being seen within four hours. Immediately following the closure, at that hospital the proportion was 53%. We should not just brush that away.

Bob Blackman: Will the hon. Lady give way?

Dr Huq: I have already given way to the hon. Gentleman once. I want to finish because a lot of Members want to speak, so I shall crack on for the moment. We should not just brush these things under the carpet and say that they did not happen.

The Independent Healthcare Commission for North West London was set up because of the public distrust of the “Shaping a Healthier Future” programme, known among locals as “Shafting a Healthier Future” because it does not do what it says on the tin. One reason why it was further discredited by the Mansfield commission is that it was based on demographic forecasts from 2012 that massively underestimated the population in north-west London, which has increased at a much faster rate than was foreseen. Perhaps the Minister can clarify this, but there has been no clear indication that the programme has been adjusted to take account of those demographic changes.

Reforms have to make sense economically as well as clinically. Last week, we heard in the Budget about the continuing drive to control expenditure, but this ill-advised reorganisation seems to have been given a blank cheque. The Mansfield report states:

“There is no completed, up-to-date business plan in place that sets out the case for delivering the Shaping a Healthier Future…programme”.

24 Mar 2016 : Column 650WH

There is nothing that demonstrates that the programme is affordable or deliverable, so serious question marks remain regarding its value for money. We are told that we are living in a time when every pound of taxpayers’ money spent has to be justified. Initially, the programme was supposed to deliver £1 billion of savings and cost £235 million, but the costs are ballooning. So far, there has been £1.3 billion of capital investment. Lots of that money has gone to external consultants such as McKinsey and on people’s jollies to America to see how it works there—quite a scary idea. The independent commission concluded that the likely return on the investment is insufficient, based on the strength of the existing evidence.

On the subject of finance, The Independent reported last year that London North West Healthcare NHS Trust warned its staff to limit their use of stationery and stamps, as it is aiming for a £88.3 million deficit this year, and it might miss even that target. Some 95% of NHS acute trusts, which run hospitals, were in deficit in the second quarter of this financial year. The hospital sector is heading for an overall £2.2 billion deficit this year. My hon. Friend the Member for Lewisham East (Heidi Alexander) has warned that the £3.8 billion of extra funding for the NHS next year that was promised in the spending review is going to get lost in the black hole that has emerged in NHS finances; it will be swallowed up in all that debt.

I am a new MP, but since my election I have seen the maternity unit at Ealing hospital join the list of closed departments. That was one of the “Shaping a Healthier Future” recommendations.

James Berry (Kingston and Surbiton) (Con) rose

Tulip Siddiq (Hampstead and Kilburn) (Lab) rose

Dr Huq: Who is first? I give way to my hon. Friend; there are two of her.

Tulip Siddiq: I congratulate my hon. Friend on securing this debate. I apologise, because I have to run off in half an hour for an appointment at the Royal Free hospital’s maternity unit. The birth rate is the highest since the 1970s, yet maternity wards in London have been closing left, right and centre. Elizabeth Duff from the National Childbirth Trust has pointed out how disruptive that is to women’s pregnancy and labour. Will my hon. Friend share her experience of the closure of the maternity unit in her constituency?

Dr Huq: I thank my hon. Friend for that excellent intervention, which is very pertinent to where she is going after this debate. As a mother who has been through these services, I know that it is massively disrupting if the goalposts are suddenly moved, causing people to travel for longer to get to their appointments. The closure of Ealing hospital’s maternity unit was called a consolidation. It was meant to be part of the centralisation of services, but it has had really adverse effects.

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Obviously I will respond to the debate at the end. The hon. Lady is making a wide-ranging speech, but when she talks about adverse consequences, particularly in the context of maternity services, I urge her to give examples and to be careful about her language. We do not want to alarm people—particularly those who are accessing healthcare in her area—for the sake

24 Mar 2016 : Column 651WH

of a rhetorical device. Particularly on Ealing’s maternity unit, where there is now 24-hour consultant coverage, I urge her to be cautious in expressing herself.

Dr Huq: I thought interventions were not allowed to be lengthy.

Dawn Butler: On my hon. Friend’s behalf, I thank the Minister for that intervention. The Government’s language over the past few months, saying that we do not have a seven-day NHS, has been alarming and destabilising for a number of people, who have failed to attend services. Perhaps the Minister should take her own medicine.

Dr Huq: My hon. Friend puts it excellently. I have some figures that illustrate the adverse consequences. Ealing mums were promised access to 24/7 consultant cover—168 hours per week—for a better, safer service. That has not materialised. Eight months after the closure, the only hospital to come close to that figure is West Middlesex, in the constituency of my hon. Friend the Member for Brentford and Isleworth—it is not even in north-west London. St Mary’s has fallen short at 98 hours. Queen Charlotte’s—the hospital where I was born, although it was somewhere else in those days—offers 116 hours, Chelsea and Westminster 115 hours, Northwick Park 108 hours and Hillingdon 112 hours. They all missed. There has been nothing concrete. Only on a wing and a prayer will they reach that nirvana any time soon. So much for a better service.

Paediatrics is next for the chop. On 30 June, there will be no children’s wing at Ealing hospital. I have a lot of figures, but people are often numbed by statistics, and other Members want to speak. According to the Office for National Statistics’ 2014 population estimates, Ealing is a very young borough—23.5% of the population is under the age of 18—so we need a children’s wing.

It is worrying. People can be treated quickly and effectively for accident and emergency cases at Ealing hospital at the moment, but the consequence of the changes will be that ambulances will have to take people to Hillingdon and other places miles away. It is unclear who is going to fund that. A lot of those who are admitted to the children’s wing are not taken in an ambulance; they come on their own steam. Will a nurse or a doctor accompany everyone who uses patient transport service, to ensure child safety? There are a lot of question marks.

Jake Berry (Rossendale and Darwen) (Con): The hon. Lady is familiar with Kingston from having worked there. She knows that it is an excellent hospital with excellent community healthcare service provided by Your Healthcare. She is talking about additional funding for hospitals and acute trusts. Does she agree that, although the Government have provided £10 billion of additional funding for the NHS, it is important that money is not taken out of community services to prop up acute services, because community services are meant to keep people out of hospital?

Dr Huq: The hon. Gentleman makes an interesting point, and I would include community pharmacies among those community services. There is a lot of worry among pharmacists in my constituency.

Tom Brake: I wanted to make that point, too. It looks like up to one in four community pharmacies in my borough—a total of 11 pharmacies—are going to close.

24 Mar 2016 : Column 652WH

That is a bizarre policy, given that the Government have rightly been pressing Members of Parliament to encourage our constituents to go to community pharmacies. Now they propose to close a large number of them.

Dr Huq: I completely agree with the right hon. Gentleman.

Clive Efford (Eltham) (Lab): On the issue of community services, to which the hon. Member for Kingston and Surbiton (James Berry) referred, my local clinical commissioning group is facing a 20% cut in its funding. It has to make savings of £20 million—a fifth of its income—so services that are meant to prevent people from going into tertiary healthcare are being depleted. The Minister said that we should not alarm people, but how do we hold the Government to account if not by bringing these issues to this House for debate?

Dr Huq: I completely agree with my hon. Friend. We are trying to have a serious debate, but we are pooh-poohed at every turn. When my hon. Friend the Member for Hammersmith (Andy Slaughter) asked a question about the Mansfield report, he was told that he was living in a bygone age. I cannot recall the exact remark, but it was something like, “You’re an old soldier fighting a war that’s concluded.” Dismissing people in that way does not inspire confidence.

Andy Slaughter (Hammersmith) (Lab): I always do what I am told by my hon. Friend—the dismissive comment was that the Mansfield report was commissioned by five Labour councils. I have actually had a slightly more considered response, but it was still dismissive. It was a very serious independent report, and I am sure my hon. Friend will agree that the Minister should take it a bit more seriously.

Dr Huq: My hon. Friend puts it very well. People’s concerns are serious and should not simply be dismissed.

I also agree with my hon. Friend the Member for Eltham (Clive Efford) that the community pharmacy network is a vital component of our country’s health and care system. Suddenly, the Government seem to be imposing arbitrary cuts in a high-value, easily accessed, community-based facility, which relies on private investment as well—pharmacists are small businesspeople. Hiten Patel of the Mattock Lane pharmacy opened my eyes when I spent a bit of time shadowing him there. I saw how the burden on the NHS and GPs is reduced by people having such pharmacies at the end of their street. For most people they are much nearer than a hospital or even a GP service.

Hiten Patel and his staff help people to make lifestyle choices. They provide a range of services and information to promote health, wellbeing and self-care. They are a useful check on prescribing errors and are dedicated and trusted people. We have such pharmacies all over the country, and they form obvious back-up and support at a time of crisis for GP recruitment and retention. We should value those people, not make life more and more difficult for them.

Last Sunday, I collected my elderly mum’s meds from Harbs pharmacy in South Ealing Road. That pharmacist is open out of hours. I recall that one year he was open even on 25 December—I did not go past this year,

24 Mar 2016 : Column 653WH

but he was probably open then as well. That releases the Ealing Park surgery practice next door for more acute and specialist care, but the Government seem to do short-termism. The long-term impact of eroding the network will have a disastrous effect.

Another troubleshooting service that is located at the heart of the community and has hidden value is opticians. They, too, have a valuable role of social contact, with networks and support mechanisms, and they can contribute to signposting and safeguarding the vulnerable. As the right hon. Member for Carshalton and Wallington (Tom Brake) pointed out in connection with community pharmacists, opticians can also catch things early.

I visited the Hynes opticians in Northfield Avenue, where staff are worried about the continuity of their supply chain. Joint strategic needs assessments enable clinical commissioning groups and local authorities to work in tandem, and the Ealing Council assessment mentions effective eye services and sight loss, but the NHS Ealing CCG does not use the JSNA in its commissioning decisions. Will there be some guidance from the Minister about how to integrate CCGs and local authorities better?

I could go into mental health services, which are chronically underfunded and a huge cause for concern. The Prime Minister made a speech about them last month, but I would like to see more action. Labour has a shadow mental health services Minister. The chief executive of Central and North West London Foundation Trust, Claire Murdoch, has claimed in an interview that mental health can be an “easy target” at times of belt tightening, saying that

“during recessions mental health tends to be hit first and hardest and recover most slowly…There is an absolute anxiety that people are depressed and really are suffering as a result of some of the economic reforms. What we don’t know yet is the extent to which some of the welfare reforms are driving people to real, serious illness.”

I have the sense of morale taking a nosedive locally. My constituent Michael Mars, who is now retired but was a senior consultant at Great Ormond Street hospital, said:

“The essential problem is the feeling of impotence experienced by those at the coal face

because of an

“overwhelming management culture where clinical knowledge and experience is secondary to management.”

Such words echo, because we hear them from a lot of other public service professions such as teachers and the police. They all say that they are doing all the paperwork and are not allowed to do what they are supposed to do. Michael Mars talked about survival in the culture of management and worries that we might be in danger of forgetting what clinical consultants are appointed to do.

At the other end of the career scale are junior doctors, on whom there was a debate in this Chamber on Monday. I have had numerous representations from constituents who are junior doctors. The latest NHS staff survey showed that the percentage of junior doctors suffering from work-related stress has gone from 20% in 2010 to 34% in 2015.

24 Mar 2016 : Column 654WH

Tulip Siddiq: As my hon. Friend is aware, junior doctors are poised to withdraw emergency cover for 48 hours in April. Does she agree that the Health Secretary’s comments, such as those about the British Medical Association being

“brilliantly clever at winding everyone up on social media”,

show his total disregard for medical professionals who are quite capable of knowing a bad deal when they see it?

Dr Huq: My hon. Friend makes an excellent point. The Health Secretary is the one who is winding everyone up. It cannot be advisable to make staff feel undervalued and overworked. The health service cannot run on good will alone, nor can pharmacists and other such professions. The imposition of a new contract that is overwhelmingly opposed by the vast majority of junior doctors is part of a pattern. The majority of NHS staff have faced pay freezes or real-terms cuts in recent years. The Government should accept that they cannot keep asking everyone to do more and more for less and less.

With such a vast topic, there is never time to cover everything. As I said, I did not want to make this speech a blizzard of statistics, so I will briefly highlight one constituent’s case, then I will make some concluding remarks. Bree Robbins, from Ealing Common, actually ended up not coming to my surgery because she was in too much pain to make it in person, so we took up her case on the phone. Her issue is access to breast reconstruction surgery, and there is a question for the Minister here. My constituent was diagnosed with breast cancer in 2013. She underwent a mastectomy and then suffered an infection, which meant that the reconstruction was delayed. Eventually, she underwent partial reconstruction in January at Charing Cross hospital. She now needs that to be completed, but she is experiencing continued delays, even though she is in pain.

The response from Imperial College Healthcare NHS Trust explained that the delay was due to an increase in urgent cancer cases in the plastic and reconstruction department. That is highly unsatisfactory for my constituent and prompts the question, what are the Government doing to ensure that those awaiting breast reconstruction surgery will undergo it in a timely manner, without having to face delays of three years, as my constituents do?

Ealing has an expanding population. Today, the House of Commons Library confirmed that, paradoxically, the number and percentage of the population aged under 18 and aged over 65 are increasing. Those are the two demographics that need NHS services most. The young and old populations seem to be getting bigger—I feel that I am “the squeezed middle”, to coin a phrase, as I am a mother and a daughter who has to run off to NHS services for offspring and parents.

No one doubts the need for comprehensive weekend care and for efficiencies to be made, but too often such plans amount to cutting corners. We heard in the Budget statement about the need for devolution, but the centralisation that we have discussed today is at odds with that. Pharmacists in my constituency fear that, ultimately, they will be merged with GP surgeries—or co-located or whatever it is called—contrary to popular need. People like to have such services at the end of their street.

Cuts are being targeted at the most deprived communities. There is a lot of distrust about the public consultation, “Shaping a Healthier Future”, because it was so flawed.

24 Mar 2016 : Column 655WH

We have mentioned the escalating costs, and the changes are not good value for taxpayers; they are a waste of precious public resources and involve no business plan.

I have not gone into the Government’s long-standing ambition to integrate NHS health services with council-run care services for the elderly. Ealing is not one of the pilot boroughs, so I will leave that subject to my colleagues. Nor are we a pilot borough for the health devolution deal, announced at the end of last year by Simon Stevens, but I will end with his words at the launch. He said:

“In London’s NHS, we’ve got some of the best health services anywhere on the planet, but also some of the most pressurised. London is the world’s most dynamic and diverse city—why shouldn’t it be the healthiest?”

I am sure that both Opposition and Government Members agree, and I am interested to hear other contributions to the debate.

1.59 pm

Bob Blackman (Harrow East) (Con): It is an honour to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate on London’s NHS. The subject is vital to people not just in London but nationally and internationally because we provide a health service for not just people resident in London but those who work in London and those who come to London for specialist treatment. I apologise that I may not be here for the winding-up speeches; I must attend the debate in the Chamber where I am the lead speaker. My apologies if I have to scuttle off before other contributions.

I want to speak about three issues in my contribution: primary care; the position at Northwick Park hospital; and the Royal National Orthopaedic hospital. In terms of primary care, without doubt, one problem we experience in London is that people have difficulty getting on to a list for a GP and then getting appointments when they are ill. As a result, when a person is ill, they immediately say, “Well, if I can’t get an appointment with my GP, I will go to A&E or the urgent care centre or whatever facilities are around.” That means that people turn up at A&E and at urgent care centres who should be seen by GPs or even by nurses at GP surgeries—they do not necessarily need to be seen by doctors.

We all have anecdotes we can share, but at the health centre to which I go the GP appointments system is now such that people can only register for appointments 48 hours in advance—it is always quite difficult to know whether one will be ill in 48 hours—or walk in and wait; however, how long will it take to be seen after all the appointments? That leads to a challenge. Immediately, people say, “I’m not going to do that, because I can turn up at A&E or the urgent care centre and make sure I am seen.” Therefore, the all-party parliamentary group on primary care and public health, which I co-chair, has pointed to the need for better signposting in the national health service to point patients to the right place and to ensure that primary care in particular can provide care for those who need it.

I will move on to Northwick Park hospital. As I said in my intervention on the hon. Member for Ealing Central and Acton, who led the debate, its A&E performance was truly dreadful. I can speak from personal experience: I waited in A&E for some eight hours before I was seen on an urgent care basis and received medical intervention.

24 Mar 2016 : Column 656WH

It was a disgrace. People were waiting for far too long and never, ever were the targets achieved. However, in November 2014, the Government invested in the new A&E at Northwick Park hospital and since then there has been a complete transformation.

One of the problems we had with Central Middlesex hospital having an A&E was that its brilliant doctors and nurses were sitting around, waiting for patients to arrive; patients would go to the A&E at Northwick Park because it was nearer and more convenient. The consequence of the A&E at Central Middlesex closing and those doctors and nurses transferring to Northwick Park was that performance transformed overnight.

I have the latest figures. When we talk about stats, we should talk about what is going on now in reality, not what happened in the past. At Northwick Park, in January, 89% of patients were seen within four hours and—[Interruption.] I accept that the target has not been reached, but the key issue is that that is far from the dramatic underperformance that the hon. Lady described. The reality is that 90.3% of patients were waiting less than 18 weeks to start treatment at the end of January, and we all accept that January is probably the hardest month for the NHS because of difficulty with the cold weather.

Cancer waiting times are a vital aspect, and Northwick Park hospital meets the targets: 94.1% of patients with suspected cancer were seen by a specialist within two weeks. I would much rather see that figure at 100%, but that is above the target of 93%. Of patients diagnosed with cancer, 99.2% began treatment within 31 days—the target is 96%, so that is an outstanding performance. Finally, 86% of patients began cancer treatment within 62 days of an urgent GP referral; the target is 85%. It is therefore fair to say that Northwick Park hospital—it is not in my constituency but virtually all of my constituents use it—has transformed itself under this Conservative Administration. It is important to get the facts on the record so that people can congratulate the health providers, who are delivering an excellent service. Of course, there are always challenges. We know there is a deficit, but the key is that Northwick Park hospital’s funding from the CCG will see a 6.01% increase this year. That is a good performance; we can see that money is being invested.

Just before the 2010 election, when I was elected for the first time, under the previous Labour Government, there was a review of accident and emergency services in north-west London. We heard not a squeak from Labour MPs about the fact that as part of that review they wanted to close down five of the A&Es in north-west London. [Interruption.] Oh yes. The incoming Health Secretary said, “We are going to stop that review in its tracks, and any review of A&E services will be clinically led, not driven by particular elements or arguments.” The reality is that this is nothing new; this is being driven by the NHS and the NHS bureaucracy. That is what I want to move on to finally.

Andy Slaughter: The hon. Gentleman needs to substantiate both elements of what he just said. To go back 10 years to try to defend the current crisis in the NHS in his constituency is a bit unnecessary. The fact is that promises were made by his party about specific hospitals as well as about A&E generally and it has gone back on almost every single one of those. A little less hubris from him would be appropriate.

24 Mar 2016 : Column 657WH

Bob Blackman: I am going back not 10 years but to 2009 when a report was produced under the previous Labour Administration that would have decimated us in north-west London in terms of A&E. The incoming Health Secretary froze that and said, “No, we’re not going to implement this. We want a clinically led review of what provision should be provided.” In certain instances, it is clear that some of those areas have been led in that way. I am going to talk about Northwick Park hospital because through better investment and better provision it has been transformed and it treats people better.

Dr Huq: Will the hon. Gentleman give way?

Bob Blackman: I will give way briefly to the hon. Lady, who made a very long oration.

Dr Huq: The hon. Gentleman will know that the most recent Care Quality Commission report on Northwick Park hospital says that it requires improvement. Several shortcomings were found. Does he appreciate why Northwick Park strikes fear into the hearts of many of my constituents?

Bob Blackman: I will come on to a CQC report on the Royal National Orthopaedic hospital in my constituency in a minute. The reality is we can pick and choose from CQC reports, but I want to ensure that the brilliant doctors, nurses and support staff who work in Northwick Park hospital are recognised for the work they do and not the fear, uncertainty and doubt created by Opposition Members about the performance of an outstanding hospital.

I will move on to the Royal National Orthopaedic hospital in my constituency. The Minister knows about this subject extremely well. The reality is shown in the most recent CQC report, which I will quote directly. It said that the hospital has

“Outstanding clinical outcomes for patients”

in premises that were—and are—

“not fit for purpose—it does not provide an adequate environment to care and treat patients.”

I could not have put it better myself. The reality is that, over the past 30 years, under Governments of all persuasions, we have heard promises to rebuild the Royal National Orthopaedic hospital. The medical and support staff there do a brilliant job; if I took you to that hospital, Mr Turner, you would see for yourself. They are treating patients in Nissen huts created during the second world war. It is an absolute disgrace that staff have to operate in such dreadful facilities. They do brilliant work to rehabilitate patients who come in crippled and leave much better able to live a decent-quality life.

That is why I am concerned about national health service bureaucracy. Previous Governments have committed to funding. The Chancellor stood up at the Dispatch Box during the emergency Budget in June 2010 and agreed and confirmed funding to rebuild the hospital. None the less, we still drag on. It is nothing to do with the Government; it is NHS bureaucracy. I will not go through all the details of everything we and the board have had to do to get to the point where the hospital can be rebuilt.

We have a plan. The hospital will be completely rebuilt. We will have a private hospital alongside the NHS hospital so that consultants and medical staff will

24 Mar 2016 : Column 658WH

not have to leave the site to do their excellent work. We will sell off part of the land for much-needed housing. Instead of selling it off as a job lot, we will sell it off in tranches to ensure that we get the best value for money, and then the money can be reinvested in the national health service, in the hospital itself.

One would think that, if someone came up with a plan like that, the NHS bureaucracy would be leaping to say, “Yes, let’s get on with it.” Instead, we have had report after report, and business case after business case. I will not, as I did once in the Chamber, describe the 11 stages of the business case that a hospital must go through to get approval for finance. More money is spent on management consultants producing reports than on hospital consultants delivering health services.

Heidi Alexander (Lewisham East) (Lab): I think I agree with the hon. Gentleman on that last point. In last week’s Budget, the Government shifted more than £1 billion within the NHS from the capital budget to the revenue budget. How does he think that helps deliver the kinds of building that we need in order to provide health services in the 21st century?

Bob Blackman: Clearly, the Government must balance the capital and revenue budgets and ensure that they and the national health service are fit for purpose. I believe passionately that it is wrong to expect our medical professionals and brilliant staff across the health service to operate out of substandard buildings. The more that we do to improve them, the better.

As the Minister will know, I have been agitating on this issue for the past six years. I will not stop until we get what we deserve—a rebuilt hospital of which we can all be proud. The reality is that the NHS Trust Development Authority, which seems to dictate finances within the national health service, is holding up this prestigious project. The hospital now has planning permission, and we are ready to go. Immediately on approval by the TDA, demolition of the existing buildings will start, and work will begin on the new hospital in June or July this year. However, the TDA has yet to approve. We now have a further eight-week delay while the TDA looks again at the business case to see whether it is justified. The staff, patients and everyone connected with the hospital are growing frustrated as a result of what has happened over not just the past six years but the 30-odd years before it as well.

We seek assurances from the Minister that the prevaricating TDA will be leaned on to give a decision, which will be to the benefit of the hospital, the patients and the health service in London and nationally, so that we can ensure that this brilliant hospital continues with its great work. I apologise that I will not necessarily be here to hear the Minister confirm the good news that she will do all that she can to make that happen, but I will sit down—

The Parliamentary Under-Secretary of State for Health (Jane Ellison): On that specific point, as I am conscious that my hon. Friend might not be back, my noble Friend Lord Prior in the other place took a debate on this topic this week and undertook to set up a meeting with the NHS Institute for Innovation and Improvement and interested Peers should there be any slippage in the timetable set out today by NHSI for approval of this

24 Mar 2016 : Column 659WH

important project. I know that that invitation will be extended to my hon. Friend as well, to give him a little assurance on that.

Mr Andrew Turner (in the Chair): I call the Minister—no, Mr Blackman.

Bob Blackman: Mr Turner, if I were the Minister, I would be ensuring that it was delivered, but that is another issue. I welcome the Minister’s remarks. Clearly, people will be watching and waiting. As she said, there was a debate in the other place only last week, and we had a good, positive answer during oral questions this week, assuring us that it is a key project for the health service. All those who are waiting with their pens poised could give us an Easter present of which we can all be proud on Maundy Thursday by signing off the business case, letting us get on with the project and ensuring that it is delivered for the benefit of all.

2.16 pm

Andy Slaughter (Hammersmith) (Lab): It is a pleasure to be here under your chairmanship, Mr Turner, and to be called early in the debate. I thank the Backbench Business Committee for giving us this long and generous slot on the last day before the recess. Given that it is the last day, there is a good turnout from London Labour Members, and one or two London Conservative Members. Indeed, we had the whole of the Liberal Democrat representation for London, but he has gone now.

I particularly thank my neighbour and hon. Friend the hon. Member for Ealing Central and Acton (Dr Huq) for introducing this debate in a comprehensive manner, which permits me to make my contribution shorter than it otherwise would have been, because I am going to deal with some of the same issues. I preface my remarks by saying that London Members deal with a great many health service issues—on the whole successfully—through their clinical commissioning groups, hospital trusts and the other myriad health service bodies that the Government inflicted on us in the last top-down reorganisation.

We have heard about primary care, mental health and community pharmacies. The reason why we—particularly the 11 Labour MPs for north and west London—keep returning again and again to the issue of acute hospitals and the “Shaping a Healthier Future” programme is not only that it is such a major reorganisation of services but that it has become very politicised. Of course, all these issues are political—money spent on the health service is always political—but we feel that we are either not being given information or being given the wrong information.

I must disagree with the hon. Member for Harrow East (Bob Blackman). My memory goes back a long way. I was part of the campaign against the closure of Charing Cross hospital in the early 1990s. It was successful, obviously, but it was a long and hard-fought campaign, and again, the grounds for closure were entirely spurious. I remember the former Member for Brentford and Isleworth, who was a Health Minister, leading that campaign when she was the head of nursing there.

Dawn Butler: I remember leading a campaign in 2006 to save Central Middlesex hospital’s A&E, which was successful. Unfortunately, it then closed when I was not an MP in, I think, 2011.

24 Mar 2016 : Column 660WH

Andy Slaughter: We all bear these scars. I am grateful for all the efforts that Members have made to protect their local health services.

The next time that Charing Cross hospital came up, it was in the context of the 2005 election campaign, when a Conservative candidate, now the right hon. Member for Chelsea and Fulham (Greg Hands), shamelessly said that it was going to close, with no evidence whatever; there were no plans to close it. The candidate running against me in 2010 did exactly the same in relation to the hospital in my constituency. The difference was that immediately after the 2010 election, plans began to be drawn up—we did not see them until 2012—by McKinsey and others. The reference to consultants was well made by the hon. Member for Harrow East, because the spend on consultants on “Shaping a Healthier Future” alone is running at something like £20 million per annum at the moment.

I did not recognise, in what the hon. Gentleman said, what has actually happened. The brief history is as follows. Those plans were presented. They were kept under wraps and took us all by surprise with the dramatic changes they contained—the downgrading of the four A&Es and what was going to happen to Ealing and Charing Cross hospitals. However, that was a long time ago now, in the summer of 2012. The only revision to those published proposals was at the end of the so-called consultation process in February 2013. Apart from references in board papers and other statements, we have not had a formal upgrade to the process since then. That is more than three years ago, yet the proposals affect about 2 million people across the whole of west and north-west London.

I accept that there can be faults on all sides and that in the run-up to elections, people get quite emotional and political about these issues, but that is partly because they matter so much to our constituents. At the 2015 election, at least we were getting emotional and political about something that was actually proposed, rather than something that was invented. Since the election last year we have attempted—certainly I have, and I think this goes for a number of my colleagues—to engage in the process with Ministers and officials, partly to find out what is going on and partly to try to influence the outcome. The Minister met a group of MPs last summer and said that there would be a great deal of engagement and transparency. I have not given up on that, but it has not happened so far.

The key document in the “Shaping a Healthier Future” programme—the implementation business plan—is still under wraps. We have been asking for it for the best part of three years, formally, informally or through freedom of information requests. Different reasons have been given at different times—“It’s a work in progress,” or “It’s commercially confidential”; all the usual reasons. It becomes a bit ridiculous after a while. I am not sure it is very helpful to the Government or the NHS, because in the end we have to rely on what information we can scrape together.

Of course, the world has changed a lot in those three years. Let me give some examples. The London head of NHS England, Anne Rainsberry, came to brief Labour London Members earlier this week and gave us some quite interesting information. First, “Shaping a Healthier Future” alone will not deal with the financial problems, which have got substantially worse. My trust, Imperial College Healthcare NHS Trust, last reported that it was

24 Mar 2016 : Column 661WH

running a £25 million deficit, but I know that other trusts, including London North West Healthcare Trust, have higher deficits than that.

The position has got markedly worse. I know the Government say there is a clinical basis for “Shaping a Healthier Future”, but it is interesting that there has been a concession that there is a financial basis to it; it is about saving money. Opposition Members would say that it is mainly about saving money, but the Government might say that that is an ancillary purpose. We are now being told that even if “Shaping a Healthier Future” were implemented, it would not save enough money given the deteriorating situation.

The shadow Secretary of State, my hon. Friend the Member for Lewisham East (Heidi Alexander), mentioned the shift from capital to revenue, partly as a bail-out. That may be a crisis move to offset the immediate financial crisis, but it has implications, particularly for a grandiloquent project such as “Shaping a Healthier Future”, which is about a major redesign of hospital sites—particularly the Charing Cross and St Mary’s sites, which are taking the bulk of the money.

We know—the NHS is now being slightly more candid about this—that the Treasury is getting cold feet about the programme, and the date is being pushed back and back. That is good in a way, because originally we were told that Charing Cross was going to be demolished in 2016-17, and now we are talking about 2020 at the earliest. I am delighted by that, because the longer it is pushed back, the less likely it is to happen, but it reflects serious concerns in the Treasury, and possibly in the Department of Health, about where the programme is going.

Dawn Butler: My hon. Friend is being generous with his time. Is he concerned, as I am, by the letter from Clare Parker, the senior responsible officer for “Shaping a Healthier Future”? Brent has been trying to get hold of the latest version of the implementation business case. She notes the request, but states:

“Unfortunately this document is in draft form and not currently suitable to be shared.”

Does he wonder, as Brent and I do, when we will be able to have sight of that document?

Andy Slaughter: That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will

24 Mar 2016 : Column 662WH

have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in

24 Mar 2016 : Column 663WH

population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.

Ruth Cadbury: Skiing injuries.

Andy Slaughter: Well, perhaps. The situation does not give us a lot of confidence in the plans that are being made.

I hope I have given a flavour of what is happening. I cannot do much more than that, because I do not have the information available. This is the No. 1 issue for my constituents, yet when I look back to see how often I have raised it—I have made one speech on it since the election and asked a few questions to Ministers—I am sorry to see that on the whole, I get pretty dismissive answers. I do not think that is how this Minister would wish to behave.

I ask that sooner or later—sooner, preferably—we get the business plan so that we can see what changes are being proposed and what the timetable is. I also ask for a realistic reassessment of the need for acute hospital services, because I do not believe that “Shaping a Healthier Future”—2010 or 2012—will be the appropriate mechanism for doing that. If the Government are prepared to do that, I am sure that all Members, irrespective of party or of the proposals for their local hospital, will be prepared to sit down and negotiate.

2.34 pm

Paul Scully (Sutton and Cheam) (Con): It is a pleasure to serve under your chairmanship, Mr Turner. I start by congratulating the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate. I was delighted to support her bid to the Backbench Business Committee to have the opportunity to debate this incredibly important subject. The NHS is source of great pride. Londoners are particularly protective of healthcare in their area, and none more so than the people of Sutton. I shall speak about my local area, but I think the story and the issues are the same throughout London.

For many years, people in Sutton have talked about St Helier hospital as the focal point of the community and of local healthcare. I serve as a volunteer at the hospital—I go regularly to feed people on the stroke ward—and I try to continue doing that even now I have been elected to Parliament, as it gives me a great opportunity to go in and see people on the front line. My family have also used the hospital. Before the last election, the right hon. Member for Doncaster North (Edward Miliband) weaponised the NHS. I tend to weaponise my mum’s use of the NHS. She has been brought in from sheltered accommodation, having taken a couple of falls, and when she injured her hand and fractured her hip, St Helier treated her really well. The hospital has a particularly good hip fracture unit that is renowned across London and indeed, across the country.

24 Mar 2016 : Column 664WH

Epsom and St Helier University Hospitals NHS Trust is predicted to run a deficit this year, despite hard work to try and break even, as it did last year. Opposition Members may use that as a brickbat to throw at the Government in respect of funding, but they fail to look at some of the symptoms behind what is happening in St Helier hospital in particular. The building has been crumbling for many years and is getting beyond use. For as long as I have lived in Sutton, which is about 26 or 27 years, there has been a political campaign, primarily by the Liberal Democrats in my area but involving other parties too, trying to “Save St Helier”—scaring people into believing that the hospital is to close imminently. Using the hospital as a political football has resulted in a failure to get some sort of consensus or agreement on how we can protect healthcare and build a really effective healthcare system in Sutton.

The trust has that deficit and the chief executive will need to tackle it without compromising quality.

Clive Efford: On the threatened closure of St Helier hospital, perhaps I have been in this place for longer than I should have been—[Hon. Members: “No!”] Thanks, I was hoping to get that response. I seem to remember that a Minister resigned in order to fight the campaign to defend St Helier hospital. He should have known what he was talking about, because he was a Health Minister at that time.

Paul Scully: Obviously he did not, which is why I won the election against him[Interruption.] It is funny. I think the tale was that he resigned, but I do not know a lot of Ministers who would resign to save a hospital when they were one of the Ministers in charge. Others have reported that he was sacked. I do not know the truth, and I am not sure we will ever know.

Stephen Hammond (Wimbledon) (Con): For the sake of clarity, I am in the next-door seat to my hon. Friend and many of my constituents look to St Helier hospital. An outrageous campaign was run by the Labour party in 2014, completely without foundation, about the hospital closing. It was at the time of the local government elections, when the Government, all the management of St Helier and all the board papers showed that there was no plan to close the hospital. It was exactly as my hon. Friend says: a scare story.

Paul Scully: I am grateful to my hon. Friend for making that point, and he is absolutely correct. It is why we need some degree of certainty. For many years now, we have had such things as “Better Healthcare Closer to Home” and “Better Services Better Value”—an alphabet soup of NHS changes, with no degree of certainty for residents or staff in that hospital. A lot of the BSBV review was clinician-led, but it was based on the premise that they wanted to concentrate consultants in certain places—in my case, at St George’s hospital in Tooting—because they did not have enough consultants in each of the different hospitals seeing enough of the more unusual cases; they wanted to concentrate expertise.

Imagine a whole load of politicians in Sutton telling residents time and again that the hospital is about to close, as my hon. Friend just said. Where would a newly qualified consultant want to go and practise? Would they want to go to a hospital that they are being told is

24 Mar 2016 : Column 665WH

about to close down, or would they go just up the road to one that receives all the plaudits and which has all the concentration of expertise? I know what I would do. If people talk down their local hospital and healthcare, it may become a self-fulfilling prophecy. They may be in danger of getting a result that is exactly the opposite of what they seek.

Ruth Cadbury: The hon. Gentleman is making a point, but some services have moved or closed without political problems because the people who used them and valued them realised that change was necessary. I suggest that the change in stroke and trauma services in recent years was right—fewer, larger, better. I also suggest that the opposition to changes the hon. Gentleman describes is caused by genuine worry that the solutions will not provide the adequate future service that we all want for London. In addition, in recent years we have seen a significant rise in population in London. We do not oppose that per se, but the health service in all its facets should be seen to be growing to accommodate that rising population.

Paul Scully: The hon. Lady makes some interesting points. There have been changes and closures in Sutton. The stroke service was one, and it made sense to provide immediate treatment at St George’s although it was further away, because those first few hours are crucial. Several smaller hospitals also closed over many years. However, I return to the changes and closures of A&E and maternity services to concentrate them at St George’s. Although it is only a few miles away, in rush hour traffic it takes those without the ambulance service’s blues and twos a long time to get to St George’s. If politicians were concerned, I would have thought they would do a more effective job than just trying to get tens of thousands of signatures on a petition aimed at the primary care trust. It took so long that the petition was still being presented two and a half years after PCTs were abolished in favour of CCGs. Effectively it was a data-harvesting exercise to extract a whole lot of email addresses that could be used in a political campaign and as a political football. The NHS is inherently political, but sometimes we must take the party politics out of it and focus on healthcare and what we have to do to best treat patients in a local area.

As I was saying, the St Helier building is fast becoming not fit for purpose, with 43% of the space having been deemed functionally unsuitable. That is no way to provide 21st century healthcare. The hospital predates the NHS by some time. The huge white building on a hill was used by German fighters to line up as they were coming to London on their bombing raids.

I look forward to plans being produced, using any capital funding we can attract from the Government in a cost effective way, so that it is not too onerous for the Treasury, to make use of all the component parts of the Epsom, St Helier and Sutton hospital sites. Businesses, the Royal Marsden hospital and the Institute of Cancer Research are sited there and the NHS is planning an exciting project—a London cancer hub—to attract even more world-class research. The Institute of Cancer Research and the Royal Marsden have a world-class reputation and it would be fantastic to expand it, but the Royal Marsden needs acute facilities to support

24 Mar 2016 : Column 666WH

treatment there. If we can use that huge space for healthcare for the borough as well specialist healthcare, that would be brilliant.

The “Save St Helier” campaign is great in theory, but there are some holes in the plans and there may be unintended consequences resulting in the opposite of what we want. With the “Better Services Better Value” campaign, the fact that St Helier sits between Kingston hospital, St George’s hospital, Croydon University hospital and Epsom hospital means it is always at threat because of the way the catchment area is designed. The trust is acutely aware of that. We want St Helier to be meshed into the London cancer hub with an integrated approach.

We have heard that the NHS can be somewhat bureaucratic. A few years back, I was at a hospital that closed—Queen Mary’s hospital for children. It was eventually sold for a secondary school and housing in Sutton, but it took two years and £1 million in legal fees for two public bodies, the local authority and the NHS to agree terms. The lawyers got the money and children were not educated there for another two years at a time when there was a shortage of school places. Cutting through that bureaucracy and making sure we get the healthcare we want without having to go through the 11 tiers to which my hon. Friend the Member for Harrow East (Bob Blackman) referred would be fantastic.

We have heard a little about the difficulties of getting GP appointments and how infrastructure in London does not always keep up with planning and the need for housing. Sutton is no different. Worcester Park is one of the densest wards on the border with Kingston and has two vets but no GPs. I am not sure what that tells us about Worcester Park, but there is certainly a lack of planning somewhere.

I live in Carshalton and the one Liberal Democrat MP who was here is my MP. There is a health centre and it is a good example of how we might roll things up across Sutton and other areas. Two practices have come together in a purpose-built building with a shared practice so it is slightly easier to get an appointment, although it may be not with one’s named doctor, but with one of their colleagues. People can wait to see their named doctor, or they can get a reasonably quick appointment if it is an emergency; they can have blood tests, antenatal care and vaccinations. I recently had a rabies vaccination there—for a trip to Burma, not because of the prospect of facing hostile Opposition Members. The range of facilities helps to keep people away from A&E.

I have visited several pharmacies in my local area. They are concerned about closures, but the Minister has talked about putting in extra funding and integrating the pharmacy service as an alternative first port of call.

Dr Huq: I understand that the block grant that pharmacists receive for things such as driving around delivering medicines is being cut by 6%.

Paul Scully: My understanding is that that may vary from pharmacy to pharmacy. It is important that, however the block grant is carved up, we can offer the range of services in any area. I was at a pharmacy last week that had a needle exchange programme, but another just round the corner does not offer that. It is important to have a range of services in a given area.

24 Mar 2016 : Column 667WH

Heidi Alexander: The hon. Gentleman is referring to community pharmacies. One of the latest estimates of the Government’s proposals is that up to 3,000 community pharmacies could close. What impact does he believe that would have on his constituents?

Paul Scully: The pharmacists raised that with me last week, and I am meeting a delegation of them next week as well. Rather than an estimate, I want to see more detail on that to work out how we can give pharmacies more information, data and space to use their consulting rooms in order to make them the true first port of call. It occurs to me that people tend to look to their GP when they are ill, whereas pharmacists—especially the ones that deliver and go into people’s homes—can see people in their homes and get indicators that may predict other illnesses. Any preventive measures that can be taken through community pharmacists would be very useful.

In conclusion, I come back to the fact that I really do not want to see hospitals and healthcare used as a political football in Sutton or across London. I want to ensure that we have excellent healthcare in St Helier but this is not about saving St Helier per se. It is about saving and protecting local healthcare so that every one of the 190,000-odd residents in the London Borough of Sutton can get easy access to a GP, a community pharmacy, A&E, maternity services, children’s services, daycare and the whole range of services in their local area. I want to ensure that they can do that not in a building that is making them feel worse by its very nature, design and crumbling fabric, but in a building that is designed to help them get better.

Sutton has made one innovation particularly well. It is one of two trusts in London that is running a vanguard scheme in nursing homes. That kind of innovation is really interesting: a group of nursing homes have got together in Sutton with the hospital trust; there are ward rounds in the nursing homes so that the patients do not have to go into hospital. Although hospital is the best place to get treatment, it is not usually the best place to recuperate. The more we can work effectively out in the field—in people’s homes and in care homes—the better. I want that collection of innovations to develop over the next few years for excellent healthcare in Sutton.

2.52 pm

Kate Osamor (Edmonton) (Lab/Co-op): It is a pleasure to serve under your chairmanship for the first time, Mr Turner. I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for her lovely contribution. It was very colourful, as per usual. As well as the subject being serious, I appreciate her opening speech.

I will talk about the crisis in A&E and access to primary care in my constituency. North Middlesex University hospital A&E has recently become the subject of national attention. In December 2015, a patient died in A&E and, at the end of January, the A&E department subsequently received a notification of a risk summit. Waiting times reached crisis point on Friday 19 February, when patients were reported to have been left for up to seven hours on hospital trolleys. Medics came under such extreme pressure that they were forced, at 11 pm, to put a message over the tannoy advising patients to go home unless they were dying. The crisis at the hospital

24 Mar 2016 : Column 668WH

did not go unnoticed. It was widely reported in the media, including in my local paper and many major national newspapers such as


Daily Telegraph, Daily Mail





Earlier, the Minister accused my hon. Friend the Member for Ealing Central and Acton of being alarmist. I would like the Minister really to listen to me and appreciate where I am coming from. My constituents were those people in that hospital and the reality for them is very difficult, so I would like her to reflect on what she said.

The incident was not isolated. Separate reports reveal that, over the previous week, paramedics were forced to wait for hours in A&E because there was a shortage of trolleys. One of my constituents phoned my office from the A&E complaining about the unacceptably long waiting hours. She was so worried about her loved ones that she did not know whether to leave her mother there or to take her home. My staff had to talk her through that and told her to stay because that is where the doctors were so it was the safest place for her to stay with her mother.

I believe that the staff in North Middlesex University hospital are under enormous pressure and are doing a fantastic job despite that. The unfolding events are clearly symptomatic of a wider crisis in the NHS locally. A Care Quality Commission report in 2014 failed the department, saying there is an overreliance from people living in the community. That overreliance is understandable given the December 2013 closure of Chase Farm hospital A&E, which is in the west of Enfield, the borough in which Edmonton resides. That has put North Middlesex University hospital under enormous pressure. It is clear that the overreliance on the A&E service results not only from the closure of Chase Farm A&E, but from the pressures on local GP services.

Research published in 2015 by the National Audit Office, entitled, “Investigating the impact of out-of-hours GP services on A&E attendance rates: multilevel regression analysis” found that satisfaction with overall GP services is significantly associated with the level of attendance at A&E both overall and during out of hours. A 1% increase in patients satisfied with their GP practice’s opening hours is also associated with the reduction in A&E attendance. The latest report from the NAO, “Stocktake of access to general practice in England”, shows that patient satisfaction continues to decline. A fifth of those surveyed reported that GP opening hours were inconvenient.

Enfield, in general, has a problem with unhealthy living, which has contributed to the problem in my constituency. We have a prevalence—unfortunately, the ninth highest rate in London—of coronary heart disease. Strokes are prevalent; we have the eighth highest rate in London. Enfield also has the seventh highest rate of diabetes in London. As hon. Members can see, my constituents are very sick and poorly. We need GP services that people can attend at a convenient time, and where they can get an appointment that will ensure they get a referral to hospital so that they do not present themselves at A&E.

With the exception of one ward, Bush Hill Park, Edmonton is, socially and economically, a deprived constituency. Of the seven wards in my constituency, three—Upper Edmonton, Ponders End and Jubilee—are among the five wards in Enfield with the lowest life

24 Mar 2016 : Column 669WH

expectancy. Healthwatch Enfield found, through a survey in the summer, that the vast majority of those not registered with a GP in Enfield are in Lower Edmonton, which is in my constituency. However, when the Government replace public health funding by local business rates, as suggested in the 2015 spending review, it will be challenging for an economically deprived borough such as Enfield adequately to fund public health activities to monitor and sustain the current pace of improvement of the health of Enfield’s population.

I wrote to a Health Minister raising my concerns and requesting a meeting about these matters more than a month ago, and I received a response to one of my questions about half an hour ago. I thank the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) for that—[Interruption.] She has done well. I did ask a few days ago, but I thank her for responding. I was going to say that I received no response but I will not say that because I did. However, I would like to have a meeting, if possible, to talk about the seriousness of the crisis in my constituency and the effect it is having.

Jane Ellison: I would be happy to do that.

Kate Osamor: I thank the Minister very much for that, and I will end there.

[Ms Karen Buck in the Chair]

2.59 pm

Wes Streeting (Ilford North) (Lab): It is a pleasure to serve under your chairmanship, Ms Buck, and a pleasure to follow so many contributions from hon. Members from across London. I congratulate my hon. Friend the Member for Ealing Central and Acton (Dr Huq) on securing the debate. I thank the Backbench Business Committee for granting us this opportunity to talk about the NHS across London.

The context is challenging across London, with a swiftly growing population, huge health pressures arising from demographic change and from London lifestyles, and a national health service that across the city is struggling to cope with those myriad pressures. We have seen that across the capital since the 2010 general election. A&E waiting times in hospitals throughout London, referral-to-treatment times and cancer waits have worsened throughout the period. As we have heard, Members from every corner of our capital city are reporting local pressures that reinforce that picture of national health service provision across London.

We feel that pressure acutely in Redbridge. Both the NHS trusts that cover our borough are in special measures: Barts Health NHS Trust, which covers the west of my constituency; and Barking, Havering and Redbridge University Hospitals NHS Trust, which serves patients throughout my constituency. Primary care is an issue, with patients increasingly struggling to get a GP appointment and finding new barriers put in their way, such as telephone consultations before a GP practice will even grant an appointment. There are also service reconfigurations.

We have already heard about service closures across the rest of London, and in Redbridge we remember the Conservative party’s commitment before the 2010 general

24 Mar 2016 : Column 670WH

election that there would be no enforced closures of accident and emergency or maternity units. Well, we lost the maternity unit at King George hospital, and the decision to close the accident and emergency department was taken in 2011 by Andrew Lansley when he was Secretary of State for Health. That decision still stands, albeit it has not yet been implemented because the NHS is in such a state of crisis locally. Our local A&E waiting times for the last six months show that we have failed at any point to hit the target of 95% of patients being seen within four hours. The worst rate in the last six months was 76.8%, in December, and the best was 92.6%, in February. People living in my constituency will not find that satisfactory. In the last couple of weeks, the chief executive of the Barking, Havering and Redbridge trust has had to apologise to the 1,015 patients who have waited more than a year for routine treatment such as knee operations, which is simply unacceptable.

There are some positives. I have mentioned the chief executive of the Barking, Havering and Redbridge trust. I have confidence in the trust’s leadership. Since they came on board, they have approached the task energetically. They inherited an absolute mess that developed over a number of years, and there are some improvements but, as recent events have shown, there is still a long way to go.

I welcome the work that the clinical commissioning group and GPs are leading on primary care transformation to try to improve primary care services locally, but we are yet to see the fruits of their labour. I also welcome the extent to which the local authority, which is now Labour-led, has been leading the way on integration to help partners across the local health economy. I am pleased to see that my borough is taking part in piloting the accountable care organisation initiative, which I hope will bring real benefits to patients through greater integration between healthcare providers and our local authority. In that context, the cuts to local government spending and, in particular, to public health budgets are a real concern.

I should probably declare that I am still a serving councillor in the London Borough of Redbridge, albeit an unpaid one, so I am excellent value for money for my constituents.

Andy Slaughter: They should be the judge of that.

Wes Streeting: They may well be the judge, but I am standing down as a councillor in 2018. I was elected to Parliament while serving as a councillor, which is a good indication.

Seriously, the London Borough of Redbridge has the fourth lowest public health grant in London. Given the diversity of our population, and the pressures that that brings, it is a cause for concern. In that context, I was even more disappointed to find that the Government have cut our public health grant in-year. As a former cabinet member for health and wellbeing in Redbridge, and as the former chair of our health and wellbeing board, I know that we were already struggling to meet our statutory duties on public health, not least the new responsibilities we have been given, such as for health visiting, for which the allocation received from Government was not sufficient. We managed to squeeze some extra funding out of the Government, but we are still struggling.

24 Mar 2016 : Column 671WH

The reduction is disappointing, particularly in the context of London, where people’s healthcare needs and lifestyles are placing pressures on the NHS. Public health investment is an upfront investment in people’s lifestyles that will reduce NHS costs in the longer term, as well as improving people’s health and wellbeing. I cannot understand why, in that context, preventive budgets such as public health budgets are bearing the brunt of cuts. I hope Redbridge’s public health allocation in particular is something that the Department of Health will revisit.

I have talked about the financial challenge for local authorities, and I will now address the financial challenge facing the NHS and our local health economy. I was concerned, as everyone else was, to read David Laws’s revelation at the weekend that, far from the £8 billion that keeps being mentioned as the hole in the NHS budget, Simon Stevens actually identified a £30 billion hole, of which he said £15 billion could be found through efficiencies and improvements. My maths makes that a £15 billion hole in the NHS budget, and it is a source of concern that the £8 billion promised by the Conservatives at the last election is still not there. We have seen the Chancellor having to shuffle money around. Earlier, my hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, talked about the reallocation from capital to revenue in terms of the health budget.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): The Public Accounts Committee recently considered the health budget following a National Audit Office report. There is a £22 billion gap, and one of the key drivers of that is the 4% efficiency savings year on year. Simon Stevens has himself acknowledged that that is too high and that 2% would be more reasonable. The head of NHS Improvement also acknowledged that it is a cause of acute hospitals’ deficits at the moment.

Wes Streeting: I am grateful to the Chair of the Public Accounts Committee for giving us that insight, which gives me even greater cause for concern about our local situation in Redbridge. The overall gap in funding for the NHS should be a concern to the whole country.

In my borough in particular, I am concerned by a report produced for NHS England by McKinsey & Company in, I believe, July 2014. The report has just been released by NHS England following a freedom of information request, and it identifies a Barking, Havering and Redbridge system gap of £128 million for commissioners and £260 million for providers. I am concerned by several things. One is that one way in which McKinsey identified that the BHR system will be able to address that gap is through acute reconfiguration of King George hospital, where the accident and emergency department is threatened with closure. I am deeply disappointed that, at a recent meeting of the Ilford North Conservatives attended by the hon. Member for Richmond Park (Zac Goldsmith) for his London mayoral campaign, the Conservatives once again stood up and said, “People should not worry about the accident and emergency department, because we always say it’s going to close and it never does.” The only reason why the accident and emergency department at King George hospital is still there is not because of a positive decision

24 Mar 2016 : Column 672WH

to keep it but because the NHS trust and the local health economy are in such a mess that it would not be clinically safe to close it at this time; the accident and emergency department is still very much at risk.

Mike Gapes (Ilford South) (Lab/Co-op): The national health service bureaucracy has been trying to close the A&E at King George hospital since 2006. We are coming up to the 10th anniversary of the misnamed “Fit for the Future” document. My hon. Friend’s predecessor, Lee Scott, and I fought a vigorous campaign to stop the closure at the time, and the closure decision was deemed to be clinically unsound. Now, the Trust Development Authority is in charge, and the A&E cannot be closed because the trust is not out of special measures. My hon. Friend has mentioned the trust’s chief executive, Matthew Hopkins, who was hoping to get out of special measures by the end of the year, but that has not happened. We are still in a period of great uncertainty.

Wes Streeting: I agree with my hon. Friend and I welcome him back to Parliament this week after his break. [Laughter.] I know that he has gone to extraordinary lengths to test the resilience of the NHS in London and that he will talk about that shortly. We look forward to it.

In all seriousness, the A&E department is still at risk and many of my constituents worry that it is the financial drivers that are pressing ahead with the closure, rather than the clinical drivers. As my hon. Friend the Member for Ilford South (Mike Gapes) has said, given the length of time since the original case for closure was prepared and since the decision to close was made, it is not unreasonable to ask the Minister to commit to reopening that closure decision, and to look at the issue with a fresh pair of eyes, testing whether the evidence base is still there, testing the assumptions that were made when the original closure proposal was put forward and giving people the assurance that it is clinical factors and the healthcare of our residents, rather than financial factors, that are driving this process.

The final thing I will draw upon from the McKinsey report is about meeting the financial pressure within the BHR system. McKinsey observes that to fully close the gap will require further stretch productivity achievement beyond the levels agreed locally, as well as additional private finance initiative support and the closure of the gap to the CCG allocation. The £140 million-odd deficit in 2013-14 was only reached after a £16 million PFI subsidy, and the deficit as a percentage of income is far larger even than it was for Barts at that time.

It is not unreasonable, as part of the wider changes in Redbridge and the work being led by the accountable care organisation, to expect the Government to provide further support in relation to our PFI debt. Many challenges face the local health economy in Redbridge and that debt is like an albatross around our necks. If the Government were to invest now in alleviating that pressure, we may get better outcomes in the long term. I hope that that is an issue the Minister will address when she responds to the debate.

3.12 pm

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate my hon. Friend the Member

24 Mar 2016 : Column 673WH

for Ealing Central and Acton (Dr Huq) on securing the debate, and I thank the Backbench Business Committee for granting it.

I represent the Homerton hospital, which is a foundation trust, and a clinical commissioning group in Hackney that has good, clear clinical outcomes in a very deprived population. The level of deprivation is such that we have underlying population health outcomes that are not good despite the good healthcare available locally.

There is huge pressure on GP surgeries across east London in particular and London in general. Funding for the minimum practice income guarantee is under threat, and recruitment of GPs is very difficult now. Too often, committed but demoralised GPs, many of whom are older, are—in line with national trends—retiring early. We also have a devolution model that is being piloted in Hackney.

Given the time and to give the Minister the chance to respond, I will jump to some of the questions that I want to put to her. I will refer to the McKinsey report that has just seen the light of day today, although it was published in July 2015. It is very worrying. I do not have time to go into the report in detail, but it raises issues about my area that are similar to those raised by my hon. Friend the Member for Ilford North (Wes Streeting). It gives an indication of the gap in the health economy and the funding. We have looked at this type of gap in the Public Accounts Committee, holding three hearings on these issues in recent months. Those hearings have underlined the crisis in recruitment, poor retention of experienced staff and particularly the financial crisis in the NHS.

The PAC, which of course is a cross-party Committee, is not alone in looking into this situation; the National Audit Office has, too. The NAO tells us that in 2014 NHS commissioners and providers overspent for the first time, with a deficit of £471 million. It must have been around that time or before then that McKinsey was commissioned to do its work. We know that the position is deteriorating, despite the efforts of consultancies to come in and save the day—let me make it clear for the Official Report that I am being slightly ironic. The position is deteriorating so much that the total deficit in NHS trusts and foundation trusts is projected to be £2.2 billion.

As I highlighted in my intervention, in a PAC hearing on the subject, Jim Mackey, the head of NHS Improvement —we have also heard from Simon Stevens, the head of NHS England—acknowledged that the 4% efficiency savings target that was established by the Department of Health in 2010-11 was unrealistic. In fact, that target was set by the Chancellor, so I should perhaps absolve the Department of Health a little, as it was clearly set by the Treasury. Both Jim Mackey and Simon Stevens acknowledged that. Simon Stevens has said on the record that he would call delivery of 2% efficiency savings “more reasonable” for trusts. As I have highlighted, we have said in our report that there is not really a convincing plan for closing the £22 billion gap in NHS finances now looming.

I will come back to the McKinsey report as it relates to my own area, referring again to huge financial gaps in the NHS budget locally. However, it also refers to how to deal with those gaps, and that is what really

24 Mar 2016 : Column 674WH

concerns me and it is what I am seeking an answer from the Minister about. The report refers to the engagement that McKinsey had:

“an intensive series of meetings and engagement…with material senior time and…complemented this with numerous sessions with Chairs, CEOs, Clinical Leaders and Finance Directors.”

So McKinsey has been getting people round the table, which is all well and good. However, the report continues:

“This engagement has been focused on building alignment around the case for change”—

so change is looming—

“on forcing the pace of this work and also in scoping future governance changes to sustain more rapid future delivery.”

Will the Minister be clear about what the plans are for “future governance” of health services in my part of London? I am sure that other Members will be interested to hear about their parts of London, as well. I ask her directly: is there a plan to amalgamate CCGs or to establish sub-regional health commissioners in London? We need to know what is happening and what the timescale is for any proposed changes.

Also, while we are considering the budget and the gaps in the budget, what commitment can the Minister make about NHS land? That has been a constituency concern of mine for some time. The PAC has heard fairly recently that the capital released to balance the budget deficit that we are seeing among trusts factors in some land for homes for health workers. So the full dividend of sale will not be taken and some land will be used to build homes for health workers, but figures were very light on the ground. If the Minister is able to respond today on this issue, I would be very grateful; if not, I would welcome a detailed letter from her on it.

In particular, I would be grateful if the Minister provided more information about the list of NHS sites released under the Government’s land disposals programme. The programme was overseen by the Department for Communities and Local Government and required every Department to come up with a list of sites that could be provided to build new homes. So far, it has been difficult to identify the sale of land and how many homes have actually been built. Again, that may not be something that the Minister has answers on today, given that another Department is the lead, but I think her Department should have some figures. Once again, if she cannot tell me about that today, I ask her to write to me about it, because housing for health workers is a key concern.

Heidi Alexander: My hon. Friend is making a very important point. I intervene to put on the record my desire to be copied in to the response that she receives from the Minister.

Meg Hillier: I am sure the Minister will do that, but I am happy to share anything I receive from her. I am sure she will not be writing me secret letters, and even if she told me that she was I would ignore her, so I hope she provides information that is fully public.

There is a real concern about health workers being unable to afford to buy homes. When a group of local MPs met officials from the Barts trust after one of the trust’s more recent crises—it was around the time of, or just before, the general election—we asked them about release of land for health workers. We got the distinct impression that those running the trust at the time—we have had new management in since—did not think that it was their responsibility to provide housing; the process

24 Mar 2016 : Column 675WH

was just about disposing of the land to fill the black hole in the trust’s budget. However, we know that health workers cannot afford to live in London and work locally; that is often true of doctors on good salaries, let alone anyone on a lower salary. There will be a real crisis if we cannot recruit health workers, and I will touch on that issue in a moment.

NHS England is keen to lay the blame for the financial crisis in acute trusts at the door of agency staff costs. The Secretary of State announced a cap on the pay rate in October, but the National Audit Office found that that is not the underlying problem. We also touched on the matter in a Public Accounts Committee hearing. It is the volume of agency working, rather than the rate paid, that is the bigger problem—the vacancy rate, requiring backfilling with agency workers, rather than the amount that they are paid. No doubt there is an problem there and the NHS should begin—I hope it is beginning—to use its purchasing power to tackle that, but the foundation staffing model for hospitals, which is designed to fit the budget allocated by the Department, often has too few staff to deliver the required health outcomes. The NAO has uncovered the fact that 61% of temporary staffing requests in 2014-15 were to cover vacancies, not emergency cover.

Mike Gapes: Is my hon. Friend aware that the NHS employers and London NHS partnership have this week sent out information stating that nursing vacancies in London are running at 17%, which is 10,000 nurses? The NHS and local trusts are going all over the world to recruit, but the Home Office is bringing in a requirement for people to earn £35,000 before letting them in. Does not that contradict what the NHS is trying to do?

Meg Hillier: My hon. Friend anticipates what I was going to say—or perhaps it is just that we are all dealing with the same problems. Will the Minister outline what conversations her Department and NHS England have been having with the Home Office about the issue? We have seen many changes in the immigration rules, and they affect what happens. We should be recruiting and training British citizens and enabling them to earning a living, although I have no problem with other people working in the NHS. When we have problems with recruitment, of course it is right to look overseas, and many of our hospitals are well staffed by people from all round the world; but if those people cannot meet the threshold, they will not be allowed in, and that will cause a problem. I know that it is also causing concern to NHS England. No doubt the Minister is being lobbied; perhaps she can advise us. The cost to hospital trusts of the agency staff who fill in the gaps—they could be full-time workers from overseas or from the UK—has risen from £2.2 billion in 2009-10 to £3.3 billion in 2014-15.

I do not have much time to discuss GPs, but we know that that is a big issue, given the demand on the health service at primary care level in particular. On national figures, recruitment of new GPs is slow and early retirement is a looming crisis. If the Minister has not been alerted to that problem, I hope she will look into it. It is not a new phenomenon, but it is getting worse. Between 2005 and 2014 the proportion of GPs aged between 55 and 64 who left approximately doubled. In addition there is an increasing proportion of unfilled training places—the figure was 12% in 2014-15—and an increasing number of younger GPs are leaving because the job is becoming

24 Mar 2016 : Column 676WH

untenable, with 12-hour days typical. Many GPs just do not want to do that. We need good access and support in primary care to make it work.

The Public Accounts Committee has recently looked at another issue that is worth highlighting, which is the management and supply of NHS clinical staff. We would acknowledge, although our report is not yet out, that in an organisation the size of the national health service, getting things exactly right will always be complex. The figures and the available data about who is needed, together with the problems that I have mentioned to do with GPs and recruitment of hospital and other health workers, could have been predicted. That is something on which I want the Minister to respond: surely, if there is a prediction, there is a need to be able to react quickly, so that training places are available and people are encouraged to take them up. That way, we would ensure that there were enough health workers.

To return to the issue of housing, it is at crisis point in my constituency. Someone on quite a good income cannot afford to buy or to rent in the private sector and will not have a hope of getting social housing, so we have a vast turnover of people. Young people come and live like students, but when they want a home of their own, a spare bedroom for a child, or just a lifestyle that they think befits their status and age, they move out. We have a crisis across the board, but particularly for the NHS. I hope that the Minister will answer some of my questions about how housing can become a key concern for her Department as well as the Department for Communities and Local Government, which delivers housing. My worry is that if the Minister and her colleagues do not lobby hard, the problem will be forgotten in the overall housing crisis and will become a major crisis for public health and health and wellbeing in London.

3.24 pm

Mike Gapes (Ilford South) (Lab/Co-op): I am particularly pleased that you are in the Chair today, Ms Buck, because I am going to refer to St. Mary’s hospital and the Imperial College Healthcare NHS trust, which saved my life. You know it very well. This is my first speech or question in the House—apart from my earlier interventions —since November. My neighbour, the hon. Member for Ilford North (Wes Streeting) referred to my extended break. It was not voluntary or by choice.

I had been at a concert at the Royal Albert Hall—in fact, Jools Holland saved my life, because if I had not gone to the concert I would not have had friends with me during the events of that November evening. I was rushed by ambulance initially to Chelsea and Westminster hospital, where I collapsed. They scanned me and decided that I had such a serious ruptured thoracic aneurysm that they had to transfer me by ambulance to St Mary’s hospital in Paddington. I came to in the ambulance and I have a vivid memory of going down the ramp out of the ambulance into A&E at St Mary’s, where about 10 people were waiting. They ran me in the trolley straight into the operating theatre, where the consultant said, “I hope you don’t mind. We have injected you with the anaesthetic, but do you mind if we cut the shirt off your back, because we have got to start straight away? The anaesthetic will take a moment to work.” Then I heard a female voice saying, “I know this is hurting, but I’m sorry, I’ve got to do this.” Then I was unconscious.

24 Mar 2016 : Column 677WH

I had a total of eight weeks in St Mary’s hospital, with five and a half weeks in the intensive care unit, for nearly three of which I was in an induced coma. I had a series of operations on my heart and a tracheostomy, which is an interesting experience whereby a tube is permanently inserted—or it seems as it if is permanent; fortunately it is not there any more. I had other operations while I was there, as well, so I am a bit bionic. I have not yet flown anywhere, and I am waiting to see what will happen to the metal detectors at the airport, because I have some stents that might cause some complications.

I was at the hospital this morning and they were pleased with my progress, so I am able to be back here in Parliament. I want to say thank you to all the staff —the consultants, the senior and junior doctors, the cleaners, the people who gave me my food, all the nursing staff, and the physiotherapists. They initially got me walking with a Zimmer frame, with oxygen cylinders first at 100% and eventually at 28%; they managed to get me to walk up some stairs, so I could be sent home. I pay tribute to them because it is a bit of a miracle that I am here today—I have been told that by at least two consultants. Most people who go into hospital with what happened to me do not come out, so every day from now on is a bonus.

I went in on a Friday night, in the early hours of Saturday morning—a weekend. We must not let anyone say we do not have a seven-days-a-week NHS. I have seen it. I have been cared for seven days a week, looked after and fed seven days a week, for two months. I have had the most excellent treatment. I have seen the 8 o’clock in the morning shift come on and then the 8 o’clock at night shift—12-hour shifts. I have seen the turnaround. Whether I was in the intensive care unit, the Charles Pannett ward or the Zachary Cope ward, I have seen the dedication and commitment of the staff. They come from all over the world. The nurses who treated me included a man called Riad, a Palestinian from Jordan, who was fascinated to know that I had been in Amman with the Foreign Affairs Committee four days before I went into hospital. There were nurses from Malaysia, the Philippines, Ireland, Ilford and many other places around the world.

The fact is that we in London depend on a pool of staff who have come to our city from all over the world to help us, to save us and to keep us well. We must never forget that. It is why the Home Office needs to understand that London’s success as a global city depends on the workers in London being healthy. As Anne Rainsberry told us in the meeting with London Labour MPs the other day, 20% of the people treated in London do not live in London. London serves the whole community. The vascular facilities at St Mary’s take patients from all over. I was told that even if I had had the heart problem in Ilford, I might still have been transferred to St Mary’s. The unit has patients from Southend, Newport in south Wales and even from Gibraltar.

That indicates to me that we have to retain the staffing levels and level of expertise in our specialist hospitals and in our specialist departments within London hospitals. That is not possible, as my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) pointed out, if people cannot afford to live in London and if most newly trained nurses seek jobs elsewhere

24 Mar 2016 : Column 678WH

within two or three years. It is not because they do not enjoy their work, but because they cannot afford or are fed up with two or three hours of travel every day.

We have to deal with the problem, and it requires the new Mayor of London, all our local authorities and the Government to look at it seriously. It also requires the Home Office, after the European referendum, to think again about the absurd position where we will cut off our nose to spite our face by making it impossible in a shortage period to recruit people to certain occupations because of the £35,000 threshold.

Paul Scully: The hon. Gentleman is making an incredibly powerful speech and I am grateful to hear about his personal experience. On the shortage of nurses, while it is preferable to train people domestically, does the hon. Gentleman agree that where we cannot fill those places, the shortage occupation list—it is devised by the Migration Advisory Committee, which has placed nurses on the list—goes some way to mitigating the £35,000 criteria?

Mike Gapes: The interesting thing is that NHS nurses were not originally on that shortage list. There had to be a lobbying campaign to get them put in because of the stupidity of the people in the Home Office who drew up the list. The fact is that the £35,000 figure will present a problem. Obviously it will not present a problem in recruiting doctors from abroad, but it is a significant problem in recruiting nurses and other people at lower wage levels. We need to raise that issue, because it will be damaging in the long term.

Of course we need to train more nurses, but to do so the Government need a consistent policy. It takes several years to train a nurse. It is not something that can be switched on and switched off. The other issue is retention. Large numbers of nurses leave our NHS and go and work in other countries. Just as we take nurses from other countries, so British nurses go abroad. There is no reason why that should not be the case; it is a global health economy and the reality is that if we do not pay the lower paid staff in the NHS what they need, we will not recruit sufficient numbers of people to do those jobs.

Wes Streeting: In the context of the recruitment and retention challenges for NHS staff, does my hon. Friend share my concern and that of a number of Members from all parts of the House on the plans to charge nurses, midwives and students of allied health subjects full tuition fees and to remove the NHS bursary? Those things will be deeply damaging to recruitment of the very staff that we need to bring into the NHS.

Mike Gapes: Absolutely, I do agree. That is why I signed my hon. Friend’s early-day motion today. I am about to put it in so that my name is added, now that I am back.

In conclusion, it is a great pleasure and a bit of a coincidence that this debate was here today, but I could not miss the opportunity to say thank you to those people who saved my life.

3.34 pm

Barry Gardiner (Brent North) (Lab): It is a great pleasure to serve under your chairmanship, Ms Buck, but it is an even greater pleasure for all of us to see our

24 Mar 2016 : Column 679WH

hon. Friend the Member for Ilford South (Mike Gapes) back in his proper place in the House, doing what he does so well: representing his constituents.

I wish to make two points in this debate, and I am grateful for your indulgence, Ms Buck, in letting me come in at the end of the debate; I had other engagements. First, I wish to mention the case of Dr Chris Day v. NHS and Health Education England, which has exposed a particular lacuna in the protection for whistleblowers in the NHS. HEE oversees the training placement of doctors, and I understand that its role will increase under the new contracts. If a junior doctor blows the whistle, HEE will be able to terminate the doctor’s training as a punishment with absolute impunity. I know that the Minister would not wish to see that and that she is keen to ensure that whistleblowers get appropriate protection. I simply ask that she looks at that issue and takes the necessary action to remedy it.

The main focus of my remarks is the recruitment process for GP surgeries in north-west London. Specifically, I refer to Integrated Health CIC, which is known locally as the Sudbury surgery, and the number of problems that have arisen with that and the commissioning thereof. In 2013, the surgery was given to two doctors, Dr Omodu and Dr Akumabor, until March 2016. In fact, the contract on the surgery expires in precisely seven days’ times. I have been in correspondence with NHS England and Dr Anne Rainsberry, and the local council’s health scrutiny committee has been in correspondence with Monitor, to try to ensure that the concerns of local people are respected in relation to the surgery and the procurement process, and that is what I want to bring to the Minister’s attention.

There has been a lack of clarity in the handling of conflicts of interest in relation to the procurement. According to Brent CCG’s website, in February this year, five of the seven local GPs who have declared interests in relation to their Brent CCG activity have interests in Harness, which is the name of another surgery. They include the chair and vice-chair of the CCG.

It is noted that the practices that have been removed from the commissioning timetable are also associated with Harness, and that in October, Harness Harlesden and Harness Acton Lane surgeries were withdrawn from the timetable. It was reported that they were to “merge and procure a service from either current Harness Harlesden premises or from primary care hub. In March 2016, it was confirmed that Brent GP Access Centre, run by Harness, was also removed from the timetable to align it with the service start of the walk-in service contract, also run by Harness, that is provided on the same site, but is being procured and commissioned by the CCG. This is to reduce the chance of any confusion about accessing the services and to avoid any unnecessary disruption to either service.” It would appear that Harness Locality, representing 21 of the 69 GP practices in Brent, has disproportionate representation on the CCG governing body. It is the belief of members of the scrutiny committee, and a concern of mine and of residents, that there needs to be clarity on commissioner-provider interrelationships to ensure a fair procurement process and the retention of public confidence in that process.

GP practice leaders have expressed misgivings about the ability of local practices to meet the demands of the London key performance indicators. It has been suggested to Members that the London KPI regime is intended to

24 Mar 2016 : Column 680WH

favour larger bidders with the infrastructure to offer economies of scale. If that is the case, it puts NHS England and Brent CCG in direct conflict with residents in my constituency, especially in relation to the Sudbury surgery.

It is the clearly expressed opinion of local residents that the practice has served the community incredibly well, and they are extremely distressed, angry and puzzled by NHS England’s treatment of it. To give an example of just how well regarded the surgery is locally, in the three years that the two doctors have been running it, its list has increased from 3,500 to more than 8,000. That is by word of mouth, and that is success in action. People are rightly concerned about how the surgery has been treated.

On 11 March, I received a letter from Dr Anne Rainsberry of NHS England, in which she confirmed to me that

“in undertaking the decision making processes with the local CCG related to this time limited contract, the NHS England standard operating procedure ‘Managing the end of time limited contracts for primary medical services’…was followed.”

She goes on in her letter to talk about key stages 1 and 2, which she says were

“completed to enable a decision on how the services should be provided after the end of the contract and to implement that decision.”

I refer to stages 1 and 2 and the time standards for that contract. Stage 1 lists four requirements to be carried out a minimum of

“9 to 15 months before contract end (all essential)”.

Those requirements are:

“Needs assessment…Value for money…Impact assessment… Consultation proposal.”

The first contact that NHS England had with the surgery is noted in Dr Rainsberry’s letter, in the fourth paragraph from the bottom of the second page, which states:

“NHS England wrote to the current contractors in September 2015 regarding their contract and the proposal to re-procure the contract when it expired.”

On that page she has outlined the fact that the procedure was not followed within the set time period. Yet on the first page of her letter, she told me that it was followed. That is not good enough.

Procurement does not have the confidence of local people or patients certainly in north-west London. I have enormous respect for the Minister—she is one of the Ministers I respect most across the House. She deals with things in a straightforward, plain-dealing manner. I urge her to look at the process I have outlined, because I do not think it has been done properly. I trust her to get it done right.

3.42 pm

Clive Efford (Eltham) (Lab): May I start by saying what a pleasure it is to serve under your chairmanship, Ms Buck? We have been colleagues here for nearly 20 years, and this is the first time I have spoken in a debate under your chairmanship. It really is a pleasure to see you in the Chair.

I was not going to contribute, but as we have some time before 4.30 pm, I thought I should take a little time to discuss one or two issues relating to my constituency

24 Mar 2016 : Column 681WH

and the situation in London. Most of London’s hospital trusts are facing serious deficits, and this is an extremely worrying time for our National Health Service. When the London group of MPs met Dr Anne Rainsberry the other day, we asked her what the major sources of stress on our hospital trusts’ budgets are. She said that there was a failure in planning for the number of nurses that the NHS was going to require, and that because not enough training places had been made available, not enough nurses were becoming available for employment in our hospital trusts, which in turn meant that the trusts were having to look to agency nurses.

I have spoken to a number of nurses who live in my constituency. They point out that, taking into account the stress they are working under in the NHS and the pressure that they come under from management, it is easier for them to work for an agency. As an agency nurse they can manage their time more effectively, because they are not under direct management and pressure to work extremely long hours, and earn more money, because of the shortages. Meanwhile, our NHS bill for nurses—in some circumstances nurses who were formerly employed in the NHS but have chosen to work as agency nurses—is growing.

As my hon. Friend the Member for Ilford South (Mike Gapes) said, the trusts could not recruit from overseas because nurses were not on the list of people whose professions allow them to come to the UK to work. That exacerbated the shortage and added to the demand for agency staff, and it is a major source of the problem. The lack of foresight and planning has led to this situation. Deficits are growing, and as I pointed out earlier, my local CCG is having to find savings of up to £1 in every £5 of its income to balance its budget. The knock-on effect on partnership working, for example on long-term care in the community, is frightening.

I shall not take much longer, but I want to discuss a couple of local matters. I have been advised by a local councillors that one of my local GP practices was summarily closed over the weekend. There was no notice or advice; the Care Quality Commission went in and literally put a stop notice on the practice. There are 3,800 patients at that practice. I am the locally elected Member of Parliament; can the Minister tell me why no one has been in touch with me to explain what is going on? What on earth is going on? Why do I not know about it? Why has no one from the CCG been in touch with me? Why have I not had an explanation of what will happen to my constituents because the surgery has been closed? I am really angry about this. I accept that the Minister cannot answer me right now, but will she look into the matter? I would like to hear why Members of Parliament are being overlooked in such circumstances, because I am elected to represent my constituents.

The surgery has been closed. We are told that additional resources are being made available to a neighbouring surgery—I will not name it now, but I will talk to the Minister after the debate—but what does that mean? As I understand it, the surgery that has been closed has to turn its service around within six months. How does it do that if it has been closed? What does that mean for the patients? What services are being moved into the neighbouring surgery? There are all sorts of questions.

24 Mar 2016 : Column 682WH

Who is communicating with my constituents? Do I get a copy of any letters so that I know what is going on? The Minister really should look into the situation.

We have a right to be kept informed in such circumstances, because we are talking about a public service. Some 3,800 people are affected, most of whom are probably my constituents, and I would really like to be kept informed and know what is going on. I would be grateful if the Minister could tell whoever has failed to keep me informed to keep me informed from now on, and to take that point on board so that in future other Members are kept informed of such serious matters in their constituencies.

We can look at the consequences of the savings that my CCG has to make. I have been in my constituency for many years as a councillor and as an elected Member of Parliament—I am in my 30th year as an elected representative of one type or another in my local community. There is an estate in my constituency on the border with Lewisham. More than 20 years ago, the local district health authority closed the doctors’ surgery on that estate because it was a single practice, and it was moved in with another practice. That left the people there with no direct access to a GP surgery. A lot of the patients affected lived on the border, so they went to GP surgeries in Lewisham.

Later, in partnership with the health authority, a local regeneration programme paid for a nurse-led practice on that estate to provide support to elderly people and families. As part of the cuts, the Source, on the Horn Park estate, now faces closure, which will yet again leave the community with no health services on that estate. That is completely unacceptable. People will have to travel a long distance to the nearest service if the Source is closed.

The CCG says that a number of the patients affected are from Lewisham, but they are not; they are actually from Greenwich, but they are considered Lewisham NHS patients. It is madness that they are to be penalised for living too close to the border with the neighbouring borough. That is just another failure in the planning of our health services. I hope the Minister will take that issue on board.

3.51 pm

Heidi Alexander (Lewisham East) (Lab): It is a pleasure to serve under your chairmanship, Ms Buck. I know that, on another day, you would be participating in this debate yourself. I congratulate my hon. Friend the Member for Ealing Central and Acton (Dr Huq) on securing the debate and for introducing it in an engaging and wide-ranging way. I commend the excellent contributions of my hon. Friends the Members for Hammersmith (Andy Slaughter), for Edmonton (Kate Osamor), for Ilford North (Wes Streeting), for Hackney South and Shoreditch (Meg Hillier), for Ilford South (Mike Gapes), for Brent North (Barry Gardiner) and for Eltham (Clive Efford). They all expressed their concerns about the quality of care that their constituents receive. It is really good to see my hon. Friend the Member for Ilford South back and to hear his reflections on his experience of the seven-day service. I am not medically qualified, but I want to offer him a bit of advice to help his continued recovery: he should limit his time on Twitter.

24 Mar 2016 : Column 683WH

Many of us in this Chamber have discussed the NHS in London previously. I cannot but reflect on the fact that, back in 2010, when I was first elected to this place, the NHS was hardly ever raised with me on the doorstep, but at the previous election it came up on every road that I canvassed. It is clear from the many contributions today that the NHS in London is under real pressure. We heard about the huge financial pressure, crumbling buildings and difficulty accessing GP services—and that was just from the Conservative Members.

As a London MP, I know that some of the health challenges that our city faces are specific to the capital. Others, such as the rising hospital deficits and declining staff morale, are symptomatic of problems that affect the whole country and can be traced back to decisions made by this Government and their coalition predecessor.

Let me start with the issues that are specific to London. London is a fast-growing city. More than 1 million more people are living here in 2016 than in 2006. The birth rate is higher in London than in almost every other major European city. London is a city of huge economic contrasts. Some of the wealthiest parts of the country are here, and also some of the poorest.

The vicious cycle that links poverty and poor health is all too evident in the advice surgeries that London MPs hold weekly or fortnightly. Overcrowded, damp housing and low incomes cause depression and anxiety, which place significant strain on the mental health system and the NHS more broadly. London contains diverse communities with different needs, from City workers dealing with stress to recent migrants from war-torn countries, which means that the NHS in London faces multiple and complicated challenges.

The huge contrast that characterises our city also creates problems in the delivery of health services. The lack of affordable housing, which my hon. Friend the Member for Hackney South and Shoreditch mentioned, and the instability of the rental market makes staff recruitment and retention a particular challenge. The London Health Commission found that NHS staff cited the high cost of living and the lack of affordable housing as two of the biggest barriers to living and working in London.

The sister of a very good friend of mine used to work as a cancer nurse at the Royal Marsden. She lived outside London and commuted into Clapham Junction by train. She then cycled from Clapham Junction because she could not afford the fare to a zone 1 station. Her daily round trip took four hours. It is probably no surprise that she has now moved to a new job in Huddersfield.

Nurses in my constituency rent single rooms in flats so they can live close to the hospitals where they work. Nurses with families are desperate for social housing because private rents are unaffordable and owning a property is a pipe dream for them. We should use the NHS’s large footprint to solve that problem.

Meg Hillier: My hon. Friend underlines my concerns. Is she also concerned about the advent of PropCo? It took land away from Hackney, and we now have no control of it locally. It would do more for health outcomes to turn that hospital land into good-quality housing, rather than luxury flats, which are unfortunately becoming the norm in Hackney.

24 Mar 2016 : Column 684WH

Heidi Alexander: I entirely agree. We need to look at how we can use the NHS estate to provide more affordable housing for key workers and NHS staff, in particular.

A related issue is the quality of the buildings in which healthcare is delivered. London has some state-of-the-art hospitals but, because of the property prices, some of the poorest-quality GP premises. Some of our facilities look like the first-class lounges at international airports, while others look like unloved community centres. According to figures I obtained recently in answer to a parliamentary question, that difference in quality could get worse. Hospitals in London face a £1.2 billion backlog for key maintenance and repairs, including a £150 million bill for high-risk repairs, which the NHS should address as an urgent priority to prevent catastrophic failure. It might sound like that problem should concern only NHS property managers, but that backlog will have a negative impact on the NHS’s ability to provide high-quality, safe and effective care for patients.

A review of Care Quality Commission inspection reports found hospitals in London with A&E equipment that is a year out of date, and heating that had been left broken for 10 months before being repaired. I do not blame hospital bosses for that situation; I blame Ministers for underfunding them. Rather than an investment in the NHS’s infrastructure, last week’s Budget included a £1.1 billion cut to its capital funding to pay for those repairs. The money is being switched to revenue budgets instead. That might plug a short-term gap on the NHS spreadsheets, but it does nothing to improve the quality of care that Londoners experience. As a number of hon. Members said, capital investment is essential when services are being reconfigured.

London’s NHS faces specific problems. At the same time, it also faces the enormous challenges that affect the whole country. How do we improve morale among a workforce that feels stretched to breaking point? How do we provide high-quality care when, despite what Ministers claim, the NHS faces its toughest funding settlement in a generation? How do we ensure that vulnerable older people are treated with dignity and respect when the budgets that pay for their care are being slashed?

A&E performance is often said to be a barometer for how the health service in general is performing. That is because a well-functioning A&E depends on accessible GP services, the availability of social care and adequate numbers of clinical staff. If we look at the latest A&E performance figures for London, however, they show a bleak picture. The number of people attending A&E has barely changed in recent years—perhaps surprisingly—but the number of people waiting longer than four hours in emergency departments has increased fivefold.

To quote the figures, in the third quarter of 2009-10, under the previous Labour Government, 20,000 patients waited longer than four hours to be seen in A&E; fast-forward six years and in the third quarter of 2015-16, the figure was almost 100,000. When we talk about national performance in A&Es, Ministers try to explain that away by claiming that more people go to A&E, but their claim is simply not borne out by the facts in London. The reality is that focusing solely on the number of people going to A&E is missing the point. We must also focus on the type of person going to A&E.

24 Mar 2016 : Column 685WH

It is fair to say that in the past six months I have visited more hospitals in London than in the previous 40 years. From all of those visits, one image sticks in my mind: hospital wards full of disorientated, frail, older people, many of whom should not be in hospital, and would not be had appropriate care been available for them in their home or community. I am clear—we cannot solve the crisis in our NHS until we solve the crisis in our social care system. That is as true of London as it is of anywhere. Furthermore, A&E is not alone in being under pressure; we can see the same problems affecting the ambulance service, primary care and mental health services.

In the 19th century, London led the way in how we responded to some of the major health challenges facing the world. In this century, London has fallen behind, and other cities are taking some of the bold and radical action necessary to improve health services and to help people live healthier lives. With the right leadership and the political will, London has an opportunity to be that world-leading city once more. I look forward to hearing what the Minister, who is also a London MP, has to say.

4.2 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): It is a pleasure to respond to a debate under your chairmanship, Ms Buck, I think for the first time.

The debate has been extraordinarily rich, with many excellent speeches from my fellow London Members of Parliament. We have a reasonable amount of time left, so I will try to respond to as many points as I can, but certainly on some I would prefer to write a response after the debate. In particular, I would not wish to give my friend, the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, anything but the best information, so I will write to her afterwards about some of the details.

I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate with cross-party support. I echo the words of the shadow Secretary of State: it is a great pleasure to see the hon. Member for Ilford South (Mike Gapes) back in this place. He made typically generous remarks about the NHS staff who cared for him, and we, too, thank them, because he is a popular Member in all parts of the House. We are delighted to see him back.

I am a London MP, so the debate is about my constituents as well. Rightly, hon. Members have taken this important opportunity to champion their local populations and their healthcare needs. However, some consistent threads have run through many of the speeches, in particular on the long-term strategic direction given the nature of London and its population. As well as responding to specific points, I want to give Members a sense of the strategic direction that the NHS wants to take in London, and some of the thinking around that.

The NHS in London serves a population of more than 8 million and spent £18 billion last year. As the shadow Secretary of State and others have said, London’s population is younger than the national average and more mobile, and its transient nature often makes continuity of care harder to achieve. In Battersea, I represent the youngest seat in England, and I see that transient, mobile population all the time, whether they are shift

24 Mar 2016 : Column 686WH

workers or young professionals. There are wide variations between and within boroughs in the health of the population, life expectancy and the quality of healthcare.

I will not attempt to respond to all the detailed points that have been made about housing, immigration and some of other wider determinants of health, but I fully acknowledge the interaction of all such important factors when it comes to the health of our constituents, and those factors are rightly at the forefront of the ongoing mayoral election campaign. It is inconceivable that the next Mayor of London, whoever is elected, will not have right at the top of their agenda issues such as housing in London, especially for key workers and the people who keep our important public services going. That is entirely right. I acknowledge that some of issues that have been highlighted are important for the future of London. The population of London is projected to increase to more than 9 million by 2020, with the largest proportional increase expected in the over-65 age group. Members clearly know what that means for the increasing demand for healthcare.

The leaders of the national health and care bodies in England have set out steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service. I accept that there was controversy in the last Parliament, and that the majority of Members present in the Chamber today disagreed with many of the measures enacted. Nevertheless, we have since had a general election and a majority Conservative Government were elected, having stood on the NHS architecture as it is. At the heart of the Conservative manifesto was an acceptance of the NHS in England’s own plan for its future, the five-year forward view. In a fixed-term Parliament, that gives us the opportunity for a stable system, which can look ahead across five years at how it provides sustainable and transformed services.

As in previous years, NHS organisations will be required to produce individual operational plans for the next financial year. Obviously, that work has happened for 2016-17. In addition, every health and care system will be required, for the first time, to work together to produce a sustainability and transformation plan, which is a separate but connected strategic plan covering October 2016 to March 2021. Many Members have highlighted the frustrations felt between the acute sector and CCGs, and some of the other stresses and strains between the different parts of the system. This year will be the first time that the NHS has required all parts of the local health and social care system to sit down together to draw up a five-year plan. That is strategically important in understanding how the system responds.

Those local plans represent an ambitious local blueprint for implementing NHS England’s five-year forward view locally. My hon. Friend the Member for Sutton and Cheam (Paul Scully) and many others talked about the need for long-term planning.

Meg Hillier: I thank the Minister for giving way, because I know she is trying to cover a lot of ground. Long-term planning is sensible, but is she not concerned about a five-year plan when at the same time major transformation is being required of acute hospital trusts through NHS Improvement—again, not a problem in itself, except that it is to be in very short order? Is there not a contradiction between a five-year plan and the short-order demands of the improvement plan for trusts, just to make their books balance?