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House of Commons Hansard
01 November 2017
Volume 630

    [Andrew Rosindell in the Chair]

  • I beg to move,

    That this House has considered the future of Charing Cross Hospital.

    It is a pleasure to see you slide effortlessly into the Chair at the beginning of this debate, Mr Rosindell. I am grateful for this opportunity to raise what is perhaps the central issue for my constituents: the future of the major hospital in my constituency, although it also contains the world-class Hammersmith Hospital. This issue matters not only to me but to many people across west London, and I am very grateful that my hon. Friends the Members for Brentford and Isleworth (Ruth Cadbury), and for Ealing Central and Acton (Dr Huq), are here.

    Next year is the 200th anniversary of Charing Cross Hospital and the rather more recent 45th anniversary of the building on the current site, although there has been a hospital—Fulham Hospital and its predecessors—on the site since 1884. It has a long and prestigious history. It is one of London’s major teaching hospitals and is part of the Imperial College Healthcare NHS Trust. It does not rest on its laurels, and has an unprecedented, and growing, level of demand.

    I will spend just two minutes on what one might call the history, simply to set the scene. I deliberately titled this debate “the future of Charing Cross Hospital”, and I have been in contact with the Minister’s office to indicate how I would like to move forward on an issue that is a long-standing sore for the local community, if not entirely this afternoon—that might be asking slightly too much—then certainly over the next weeks and months.

    This is not just about history, but about a devastating series of decisions. They are not new decisions. The first plans to downgrade the hospital substantially were made back in the 1990s. I remember being involved in campaigns led by the former Member of Parliament for Brentford and Isleworth, Ann Keen. When she later became a Health Minister, I knew that the hospital was in safe hands. I hope it will be in safe hands with this Minister.

    The current events were, to begin with, a great surprise—it may surprise the Minister that I say that—because the plans for the changes at Charing Cross were made largely in secret over two years between 2010 and 2012. When they were announced in 2012, the plan was for a full-scale clearing of all Imperial College Healthcare NHS Trust buildings from the site, and for a new clinic to be built on 3% of it. It was modified in 2013, partly because of the pressure and partly to give some cover to the Conservative-controlled local authority and others, so that they could get behind the changes. The new proposal was for what was described as a new hospital but is in fact—I say this advisedly—a collection of primary care and treatment services with an urgent care centre. It is going to be called a local accident and emergency unit and a local hospital, but let us not get hung up on the terminology. It is very clear what actual services will be provided on the site if the proposals go ahead. They will be on 13% of the floor area of the existing hospital. That is what has caused these problems and difficulties.

  • I congratulate my hon. Friend and constituency neighbour on securing this debate, and on his leadership in the campaign on the future of Charing Cross. The great fear among my residents—particularly in the eastern half of my constituency—and among people from a far wider area is about the loss of the full-scale accident and emergency service at Charing Cross, which would potentially mean downgrading many in-patient and out-patient services linked to it.

  • I am grateful for the clarity that my hon. Friend brings on that point. What is proposed is the loss of all consultant-led emergency services—type 1 A&E services. The site will therefore lose blue-light ambulances, emergency surgery and emergency consultant services. That is a very substantial change to the health facilities available.

    The change came under the heading, “Shaping a healthier future”, which I am afraid my constituents regarded as a rather Orwellian title. That programme has now been subsumed within the sustainability and transformation partnership proposals, which are now nationwide, but essentially the meat of the proposal has not changed over that time. I do not deny—I look for points of agreement if I can—that some of the objectives are perfectly laudable, such as specialisation and the bringing together of expertise on a particular site, as has happened with stroke services, major trauma, renal services and so on, even within the three hospitals in the Imperial trust. That is to be commended. No one objects to improvement to primary, social and community care, which may in time lead to less pressure on acute services. If the consequence is not just better health outcomes but a saving for the public finances, we do not object. The problem, and the reason why there has been a breakdown of trust, is that the changes are being advanced before we know the consequences.

  • Does my hon. Friend agree that the plans may be transformational, but they are certainly not sustainable, given that London is heading to a population of 10 million before long? It is projected that there will be 12,000 more people in his borough, Hammersmith and Fulham, between the last census and the next one in 2021. We were both at a meeting on Monday night, and he pointed out that the borough has a target of 20,000 new homes by 2035. Where are all those people meant to get treatment, given that we have lost A&E at Charing Cross and Hammersmith, and maternity and paediatrics at Ealing? Demographically, that is illiterate.

  • My hon. Friend puts it very forensically. The difficulty is that however much the aspiration may be to relieve acute services, most independent analysis—whether from the King’s Fund or the Mansfield review, which specifically looked at west London—shows that that is not likely to happen in the foreseeable future. The precious little additional investment in primary and social care is barely keeping up with the pressure on those services. That is where the lack of confidence comes from. However pious and laudable the aspirations, what is hoped for is simply not happening in fact.

    I welcome the announcement that nothing will happen in the current sustainability and transformation partnership period, which runs to 2020. That is an admission by the Government that the pressure on services is so great that one could not possibly think about the proposed downgradings at the moment, but that is simply to put off a wrong decision. It means that nothing can happen physically to the Charing Cross site, other than maintenance, until 2021. I have been told privately that it probably means a number of years beyond that, because the eastern part of north-west London, which includes the three Imperial hospitals, has now been put in the slow lane behind what is happening in the western half, so it is unlikely that any changes will happen before 2025. That is 13 years after the first proposals were put forward; that is a very long time in politics, but it is a very long time in the NHS as well.

    I am looking for something of more substance from the Government. We have had virtually nothing in writing, or in terms of consultation or engagement with the public, since those announcements back in 2013. Substantial expertise in the community has sprung up in the vacuum that has been created by the health service simply not engaging—expertise through the hospitals movement, trade unions and local people generally. An independent survey conducted by a polling organisation recently showed that 90% of people in the west London area opposed the proposals—that has been borne out in every other survey that I have seen—and 82% think that they have not been involved properly in the decisions. I urge the Minister to listen to that, to turn over a page and to engage with the community on these matters.

    Going back to the point made by my hon. Friend the Member for Ealing Central and Acton, last month the four-hour waiting time target was achieved only in 70% of cases for the two hospitals in Imperial. Figures are not disaggregated, so I cannot give them exactly for Charing Cross—only for St Mary’s and Charing Cross combined. That has been a regular pattern over the previous months and years, in particular since the closure of the A&E departments at the Central Middlesex and Hammersmith Hospitals.

    The population is growing hugely—as are the health demands, because the area’s population is not only ageing, but mobile and diverse, and those are not on the whole people who do not need acute care. For many years Charing Cross has had good practice: people who arrive at that hospital and have something that can be dealt with by a nurse, a GP or an urgent care centre—in some way other than through consultant care—are simply filtered off, because all those services are available on site. This is not a case of unsuitable use; this is a case of growing demand, and lack of resources to deal with that demand.

    I will sit down in a moment, because I want to give the Minister a proper opportunity to respond. I urge him not to read out the brief again because, with respect, I have heard it a number of times over the past five years. I genuinely wish to engage in reassessing what has happened. I welcomed the debate in the other place on 18 October, which was called by my friend Lord Dubs, a Hammersmith resident. More eloquently than I could, he too led a debate specifically on Charing Cross, in which a number of peers took part. The Minister there responded:

    “there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved”.—[Official Report, House of Lords, 18 October 2017; Vol. 785, c. 659.]

    Those are very welcome words to have put on the record. I am sure that the Minister here will not resile from that today, but will there therefore be an assessment of whether the changes are likely to happen in the foreseeable future? If they are not going to happen for another four, eight or 12 years, or however long, I put it to him that the Government cannot persist in saying simply, “We will do this when the time is right.” That creates uncertainty, demoralisation among staff, and a motivation for management not to maintain or keep up services because they are in effect throwing good money into a building that they believe will not be there in the foreseeable future.

    That is my first request to the Minister: that we have a proper assessment of whether those “Shaping a healthier future” proposals are still fit for purpose, as the Government believed in 2012—although I did not. My second request involves the land on the hospital site, because none of it has been designated as surplus land for redevelopment. I push the Minister to say what exactly is meant by that. In 2012 and 2013 we were told in terms that the land not used for health service purposes would be disposed of privately to subsidise the cost of building on the land that would remain within the health service. Will that not now happen, or is it simply that no formal proposals have yet been brought forward?

    As I said, this has been a hospital site for well over a century, and the hospital has existed for two centuries. It would be a great pity if that were to change on my watch and the Minister’s, particularly when the hospital is needed most by people in my constituency and others who have used it throughout their life and their family’s lives.

  • It is a pleasure to serve under your chairmanship, Mr Rosindell, and to have been left sufficient time to address, I hope, some of the concerns expressed by the hon. Member for Hammersmith (Andy Slaughter). I am grateful to him for engaging with my office in advance to indicate his line of questioning. He has made his points with characteristic skill and calm composure, which is much appreciated.

    I will set the issue of Charing Cross within the context of the wider north-west London sustainability and transformation partnership to which he referred briefly. That is how the NHS is looking at the future of healthcare provision for populations throughout the country. Charing Cross, within the Imperial trust, sits firmly in the north-west London STP, the footprint for which has funding of some £3.7 billion. Between 2015-16 and 2020-21, that funding is expected to rise by more than £600 million—an increase of some 17%.

    The Government’s position, as the hon. Gentleman is aware, is that any potential service change affecting Charing Cross is a matter for the local NHS. It will be determined primarily through the prism of the STP and the leadership of that wider NHS group. In our view it is right that decisions on service configuration are led by local clinicians, who understand better than the national NHS the healthcare needs of their local population, and that those decisions are made in consultation with local people, which was one of his challenges to the process. All proposed service changes will be based on clear evidence that they will deliver better outcomes for patients.

  • Is the Minister familiar with the King’s Fund analysis of the STP plans from February this year, which concluded that despite all the warm words about the new models of care, they are driven more by financial imperatives than by clinicians?

  • I do not agree with that. The analysis at the time was of course of the preliminary drafts of the STP plans, before any assessment by NHS England or the Department of Health. The plans are evolving and becoming partnerships, and they will move at differing speeds in different parts of the country, depending on the quality of the work and the extent to which they meet the four tests for service change, namely that they should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice.

    In addition, NHS England introduced a new test from 1 April this year on the future use of beds, which is pertinent to the Charing Cross case. It requires commissioners to assure NHS England that any proposed reduction in the number of acute hospital beds is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

    The north-west London STP plan was published in November 2016. It confirmed that the “Shaping a healthier future” programme, to which the hon. Member for Hammersmith rightly referred and which was published in 2012, had set out the right plans to reshape health services across north-west London to respond to rapidly changing health and care needs. “Shaping a healthier future” forms a core part of the STP plan and I understand that the STP leadership intends to take that forward. There was a full public consultation in 2012 on the plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites across north-west London to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that Charing Cross would become a growing hub for integrated care in that services network. Following feedback from the public consultation, the proposals were refined to retain a wider range of services than initially proposed on the Charing Cross site.

    In October 2013, the Secretary of State for Health clearly set out, following the full public consultation, that both Charing Cross and Ealing hospitals would retain A&E services, even if in a “different shape or size” from current arrangements, and that proposal remains. No final decisions have been made about the exact nature of services that are planned to continue at Charing Cross Hospital. It is certain that, even if changes are made, there will still be a thriving Charing Cross Hospital. There will be engagement with the public in due course on the detailed design and implementation of services on the site, which will include cancer, outpatients, diagnostics and 24/7 local A&E services.

    As the hon. Member for Hammersmith quite rightly said, the STP is initially focusing on developing new models of care to reduce demand on acute services. I am grateful to him for welcoming the improvement of services in the community, so that it can be established that those services work before acute reconfiguration takes place through the proposal.

  • The Minister is being generous in giving way. He pointed out that no final decisions have been taken, but can he not appreciate that that uncertainty creates a lack of morale among the staff? I had to visit Charing Cross very regularly for my late mother, who we lost during the election campaign, as her specialist Dr Perry was there. Staff morale is sapped: they are demoralised because they do not know what is going on.

  • I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.

    It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities, in this case Charing Cross Hospital, have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.

  • The Minister is being generous in giving way. What I said was that I applaud the aims of improving community services. My CCG faces having to make £17 million of further savings—that creates great difficulty for maintaining services, let alone improving them. The Imperial trust has huge deficits and, as far as I can see, most of the sustainability transformation funds for last year have gone to addressing those deficits. That is the difficulty, which is why I asked for a review of where we are going—because hopes are not being fulfilled.

  • It is fair to say that part of the STP’s objective is to help the NHS in a particular area to work more co-operatively, to encourage better public health for the population as a whole, and thereby work within the available budgets that have been allocated by NHS England. We think that creating a coherent plan for the entire area is the most logical way to try to ensure that that happens.

    As I have said, the service change is a matter for the local NHS, which has been clear that there will be no changes at Charing Cross before 2021, as the hon. Gentleman has acknowledged. He did not mention that, in the meantime, NHS England has confirmed its commitment to Charing Cross Hospital and invested £8 million in the hospital in the last year alone. That funding enabled refurbishment of urgent and emergency care wards, theatres, out-patient clinics and lifts, as well as the creation of a patient service centre and the main new facility for north-west London pathology. Further significant investments are also planned, notwithstanding what the hon. Gentleman says about the current financial situation of the Imperial trust.

    It remains the case that the STP is planning, in due course, a phased new build across north-west London rather than refurbishing existing buildings, including on the Charing Cross site, but it is not yet at the point of finalising that plan. I can confirm, as the hon. Gentleman asked me, that no hospital run by Imperial College Healthcare NHS Trust, including Charing Cross, has declared any site surplus land. He asked what commitment that means for the future; clearly, until the plans are completely finalised it would be wrong of me to give any further indication of what that might mean in relation to land, because that will depend on the configuration of the buildings, which have yet to be designed. It would be an unrealistic expectation to be definitive about that today.

    I am glad that the hon. Member for Ealing Central and Acton (Dr Huq) raised the point about the workforce. It is unsurprising that discussions about proposed service change have created some uncertainty for staff, patients and other stakeholders, including local residents. However, there has been a very clear position on the future development of Charing Cross since the STP plan for north-west London was published a year ago. This position has been shared widely with staff and all stakeholders. As I said earlier, I sincerely hope that my remarks can help to reassure staff working at the hospital that there will be no changes to service levels until 2021 at the very earliest, and that the local NHS commitment to Charing Cross Hospital has been reaffirmed.

    In August, the trust leadership undertook a review to more fully understand staff morale at Charing Cross and to develop actions in response. The conclusion was that site-level data do not indicate that Charing Cross is affected by poor morale or that it has more difficulty than other sites in the trust in recruiting and retaining staff. However, there are higher vacancy levels in a few specific staff groups in certain areas, such as elderly care. In response to that review, the trust leadership team has established an action plan, including organising a succession of staff briefings. This week, the trust announced a public meeting for local residents on 27 November to ensure clarity on the future position of Charing Cross and to share information about recent and planned investments on the site. I strongly encourage the hon. Member for Hammersmith to attend that meeting, if he is able to do so, to understand what the trust is saying and to provide reassurance to local residents on the state of the hospital.

    The trust has been in correspondence with the leader of Hammersmith and Fulham Council regarding mailings that the council has sent to residents that do not reflect the evolving position at Charing Cross. As well as raising constituents’ concerns, we have a responsibility to allay fears when discussing this subject. We can best do that by being clear about what is and is not in prospect, and by encouraging constituents to take up the offers of engagement made by local decision makers. I understand that the council has expressed some concern about doing that.

    The Government remain committed to supporting the local NHS in engaging well with its local population and local clinicians, to ensure that decisions about services in north-west London are made in the best interests of patients, now and in the future. I hope that the hon. Gentleman’s constituents, who are paying attention to this debate, will make the most of the opportunities to participate in future public engagement on the design of services in their area, and that as many as possible will attend the meeting at the hospital on 27 November.

    Question put and agreed to.