Unsustainable Provider Regime (NHS): 28th November 2012

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and on speaking with such eloquence and passion. That is what one would expect from a Member of this place; we would expect Members to bring to Parliament the concerns and the anger of those whom they represent so that Ministers can hear all that is to be said. In this case, perhaps most importantly, even if the trust special administrator and his team did not hear the hon. Gentleman’s speech they will certainly read it and take it on board.

These matters are always difficult and, as I have mentioned, they make people angry. I hope that the ​hon. Gentleman’s speech will be reported in his local media and that my remarks might also be reported.

It is important to make it clear—and I hope that the hon. Gentleman will take this back to Lewisham and the people he represents—that this is not a question of cuts. Anyone on a march bearing a banner saying, “Stop the Government cuts” does not represent the situation fairly, and does their cause no great service. It is about how to make sure that people receive the finest health care that can be provided, and that that service is sustainable. As the hon. Gentleman said, it stems from a profound problem at South London Healthcare NHS Trust.

When changes to an NHS service are mooted, people become anxious and feelings run high. This is the first time that the trust special administration regime has been used, so people are anxious, and that has a knock-on effect on patients, staff and members of the public. This may sound like weasel words, but it is important. It would be wrong to comment on specific recommendations of the trust’s special administrator, because the matter is out for public consultation, which closes on 13 December. As the hon. Gentleman explained, the matter will go to the Secretary of State, who will consider the recommendations and the full report. He will make his decision at the beginning of February. At this stage, it is not for Ministers to comment. Our minds must remain completely open.

I want to explain the process. The previous Government created the trust special administration regime in the Health Act 2009. The regime creates a transparent, time-limited process to deal with trusts in failure. We have alluded to that timetable, and have given details of it. A trust special administrator appointed to an NHS trust must make recommendations to the Secretary of State about the future of the organisation and its services. Significantly, they must set out how high-quality services can be provided in a financially and clinically sustainable way. Before making final recommendations to the Secretary of State, the administrator must consult publicly on draft recommendations, and that process has been undertaken. A summary of all consultation responses must be included in the final report to the Secretary of State. I am sure that the hon. Gentleman will ensure that his response and the responses of other MPs representing Lewisham are included in that report.

South London Healthcare NHS Trust was formed in 2009, and it was the product of a merger of three trusts, each with long-standing financial issues. When the Secretary of State appointed the special administrator to the trust in July, it was losing over £1 million a week. Last year, the trust had a deficit of £65million—the largest in the country—which is £65 million a year being taken away from well-run trusts to subsidise one that is clearly failing. There are two private finance initiatives with which the trust is struggling. They are incredibly burdensome, with a cost of £60 million a year.

To be blunt, the situation cannot go on indefinitely. The NHS simply cannot afford to spend huge sums on keeping non-viable organisations afloat. Even if we had all the money in the world, it would not be right to have such a deficit and loss. In my opinion, the Government are to be commended on having the courage to tackle the long-running challenges facing South London Healthcare NHS Trust. Sometimes, tough decisions ​have to be made to make sure that NHS services are improved and are put on a clinically and financially sustainable footing.

I fully accept that the hon. Gentleman is concerned about the administrator’s recommendations in the draft report that impact on Lewisham Healthcare NHS Trust. The remit of the trust special administrator is to develop recommendations for the Secretary of State on the action that should be taken in relation to South London Healthcare NHS Trust. The aim is to secure the sustainable provision of health services which meet patients’ needs and deliver value for money. For those recommendations to be viable and credible, the trust special administrator must consider all relevant factors, including the intentions of NHS commissioners and the consequential impact on the local health system. This has required him to consider implications for other health care providers that are part of the local health care system. That is why his remit is so large and so broad.

As we all know, an NHS trust does not exist in a vacuum. All trusts are part of a complex, integrated health care system. In making recommendations about South London Healthcare NHS Trust, the trust special administrator must consider the consequences of those recommendations on neighbouring trusts, such as Lewisham, and patients in those neighbouring areas. I am aware that in developing his draft recommendations the trust special administrator has had continuing dialogue with patients and the public, staff, clinicians, local authorities ​and other partners, and so he should. That is continuing through his public consultation, which is now under way.

In addressing the long-standing challenges facing South London Healthcare NHS Trust, the administrator’s recommendations must take into account the objective of delivering safe, high quality, sustainable health care for the people of south-east London. That, of course, includes Lewisham. To ensure that this happens, he must have regard to the Secretary of State’s four tests for NHS service change when developing his recommendations. Perhaps this may give some comfort to the hon. Gentleman. Those four tests are: support from GP commissioners; the strength of public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Those are four very important principles.

The hon. Gentleman touched on many of those principles. He spoke with passion and some anger. Much of that anger is understandable in all the circumstances. The draft report is out to the public, as I said. I hope that everybody will now engage and make sure that their voice is heard, as individuals or through their elected representatives. The recommendations will go to the Secretary of State, who will consider all of them. He will then make his decision.