Accident and Emergency Departments: 7th February 2013

Jim Dowd
No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the ​previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
Will the hon. Gentleman give way?

Jim Dowd
I certainly will; I need the extra minute.

Anna Soubry
Is the hon. Gentleman saying that the trust special administrator was given a brief and did not act independently? Does he recognise that he had two hospitals in PFI agreements that were losing £1 million of taxpayers’ money in those agreements—money that should have been spent on health services?

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.

I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.
Jim Dowd
Will the Minister give way?

Anna Soubry
I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members ​want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

Mr Virendra Sharma

Anna Soubry
I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.​

Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.