Motion made, and Question proposed, That this House do now adjourn.—[Chris Mole.]
Bexley borough is a great place in which to live and to work. It has many good and positive attributes, including its location, the many open spaces and places of interest, excellent schools and facilities and a good Conservative council led by Councillor Teresa O’Neill. However, there are a number of local concerns, and among the major concerns is the issue of health care in the borough. I am therefore grateful for the opportunity to raise some of the concerns about health care in Bexley in the debate.
I am delighted that my hon. Friend the Member for Bromley and Chislehurst (Robert Neill)—my long-term personal friend as well as my neighbour and colleague—is in his place this evening. I am also grateful that the hon. Member for Erith and Thamesmead (John Austin), a fellow MP for Bexley borough, is with us for this important debate. Thirdly, I am delighted that my hon. Friend the Member for Hornchurch (James Brokenshire), who is the Conservative parliamentary candidate for the constituency of Old Bexley and Sidcup, is here to listen to the debate, too.
My hon. Friend the Member for Hornchurch has already been very active in our area on this and other issues. His positive contributions to the debate locally have been welcome, in marked contrast to those of some of the Labour parliamentary candidates, who still seem to be rather wedded to spin and inaccuracy and do not seem to take on board the concerns and views of the people of the borough—particularly the views of constituents in Bexleyheath and Crayford and in Old Bexley and Sidcup.
The Minister is a fair and reasonable man, and I hope that he will take on board the concerns felt across my borough. We do not feel that the Government are taking seriously residents’ views, wants and needs about health care at this time.
We accept that there has been increased taxation and increased spending on health. There has been some considerable local improvement, as we know, across London. The Government are to be commended for what has been achieved. However, Bexley residents are concerned that there is a regrettable planned programme of downgrades and cuts to our local NHS. I hope that the Minister will listen to our heartfelt pleas and will take on board the concerns, and I hope that he will go back to the Department and act accordingly.
It is, of course, particularly opportune that we are holding this debate on a day when the Healthcare Commission report is published showing that in London service quality has declined. Is it any wonder that Bexley residents are concerned about their health care?
I turn, first, to Queen Mary’s hospital, Sidcup, in the south of our borough and the proposals made under “A Picture of Health”. Over the past year, residents from Bexley and the surrounding boroughs have been campaigning vigorously against the closure of the accident and emergency, maternity and children’s departments at Queen Mary’s hospital, Sidcup. The campaign has been ably led by Bexley councillors Sharon Massey and David Hurt. Those of us who live in the area and represent the local community believe that those services are vital to local people. There has been considerable concern about the hospital’s future should the proposed changes go ahead. There is a real fear that if the changes are implemented, the long-term prognosis for Queen Mary’s Sidcup will be decline.
The hon. Gentleman has referred to accident and emergency departments, but he will know that the plans under “A Picture of Health” provide for a 24-hour urgent care centre to cover all but the major emergency, blue-light casualty services. In the unfortunate event that he were to suffer a stroke or have a cardiac arrest, would he rather go to the hospital that is nearest, or to the one with the full diagnostic facilities that might save his life?
The hon. Gentleman will have to wait and listen to the rest of my speech, but the most important point is that Queen Mary’s hospital has a fully active accident and emergency department. Of course we accept that people would want to get the best treatment that the major hospitals specialising in treatment for heart and stroke problems offer, but we are talking about something in between, and the present services are greater than what would be provided if the proposals go ahead. That is the crucial point and, although I have a lot of respect for him, the hon. Gentleman is trying to be rather too clever by half on this matter.
The board of “A Picture of Health” was set up to review services in south-east London. It has decided that the Queen Elizabeth hospital in Woolwich, the Princess Royal hospital in Farnborough and Lewisham hospital should retain their accident and emergency services, while Queen Mary’s hospital should lose them. Many residents are concerned that closure of those services at Queen Mary’s would mean that some patients would have to travel much further to obtain treatment.
Transport is a very important issue in our area. Accessibility for treatment, consultation and visitors is all important, and we all know that transport links in south-east London are not good. It is unacceptable to say that the alternatives are only 5 or 7 miles away, as the impact would be felt more by those in our community who are already disadvantaged—the elderly, mothers with young children and people without cars. Those are the key issues.
I congratulate my hon. Friend on securing this debate on a very important issue. May I add my support to his observations on behalf of those residents in that part of my constituency of Bromley that adjoins his area, as they also use the services at Queen Mary’s hospital? He may be aware that I carried out a survey of 9,000 of my constituents who are affected and there was not a single response in support of the proposals, not least because not one of the four options included keeping A and E on the Queen Mary’s site. That stokes up real concerns that the part of the site not covered by private finance arrangements may eventually be disposed of.
My hon. Friend makes a very telling point, and his findings are replicated in my borough.
In March this year, more than 1,500 people attended a march against the proposals that was organised by local Conservatives. I presented a representative of the “A Picture of Health” board with a petition containing more than 8,500 signatures, including those of children, parents, doctors, nurses and other professionals from the health service. I believe that that demonstrates the strength of feeling among local people about the “A Picture of Health” plans, and their desire to retain vital services at Queen Mary’s hospital. As my hon. Friend the Member for Bromley and Chislehurst said, residents of Greenwich and Bromley joined Greenwich residents in the rally.
We were supported by the Mayor of London, Boris Johnson, who has offered his support throughout the campaign. In his letter to us, he stated:
“It would be devastating for local people, if Queen Mary’s Hospital in Sidcup is downgraded to a borough hospital, and it loses its emergency services, including A&E, children’s and maternity department, under A Picture of Health proposals…I am deeply disappointed by these proposals and will do everything I can to help the residents of Bexley in their battle to keep the important services provided by Queen Mary’s. I have already stated that I will give evidence if the Government refers the case to the independent reconfiguration panel.”
That is tremendous support from our Mayor of London. I also have an email from the Bexley local medical committee, an elected body representing GPs. It states:
“The consultation was confusing with A Picture of Health and Healthcare for London running concurrently. In our opinion the views of the public were not taken into consideration and the outcome seemed predetermined.”
That shows that professionals, politicians and all sorts of people in the community are very concerned about the proposals.
My hon. Friend is making some powerful points. I was at Queen Mary’s hospital yesterday and I was impressed by the professionalism of the staff and the real care, focus and attention that was given to patients. There were some very high standards.
My hon. Friend has mentioned his concern about pre-determination and the fact that the views of local residents were not properly taken into account. Does he share my concern and that of other residents that the decisions appear to have been made on the grounds of finance and the existence of PFI hospitals in the vicinity rather than what is best for health care in the borough and in the interests of local residents?
I endorse what my hon. Friend says, and I am very concerned about it. It is perceived that finance is the bottom line.
My concern is whether the other hospitals will be able to meet the need if we close A and E at Queen Mary’s. In December last year the Princess Royal hospital in Farnborough had to turn away patients as it was unable to cope with the high demand. Three ambulances were diverted to Queen Mary’s for three hours because of the influx of patients on 18 December 2007.
There was an increase of about 32 per cent. in the number of A and E attendances at Queen Elizabeth hospital in Woolwich between 2001-02 and 2007-08. So I seriously believe that neither hospital could cope with the additional attendees that the closure of QM at Sidcup would cause.
In 1988 I campaigned vigorously for part of my then constituency of Erith and Crayford to be included in the maternity services catchment area of Queen Mary’s hospital because constituents were having to travel a long way for the services that they needed. We were fortunate in that campaign. The Government and the health authority listened, and the campaign was successful. Residents of Crayford were included in that catchment area. I fear that we are now looking at a retrograde step of closing maternity services at Queen Mary’s, and other areas of Bexley will experience the same problems as my constituents had in the 1980s.
Many constituents from Bexley and Sidcup have contacted my office to praise maternity services at the hospital, which are provided by hard-working doctors and nurses and other staff. The unit has an extremely good record. Again, capacity at other hospitals in south-east London is a concern. While more home births are being promoted—which is good for those who want it—there will be issues for those who prefer hospital care and delivery. I understand that nationally in 2007, 42 per cent. of NHS trusts providing maternity services had to turn away women in labour because they were full. This is a worry that we will have in our area too.
I know that the Princess Royal hospital had to divert patients from its maternity unit in March due to high activity and capacity issues. These are real concerns. I hope that the Minister will appreciate that we are closing facilities in Queen Mary’s hospital in Sidcup when other hospitals are not able to cope. Yet the experts say that those hospitals could cope.
I have received representations from GPs. They say:
“The plans for Maternity services in both Primary and Secondary care do not seem robust. Bexley will be left with a midwife-led birthing unit at QMH with no Consultant backup on the premises.
Community midwives are being taken away from individual GP surgeries and grouped into clusters. This will cause great inconvenience to patients at large who will have to travel further for their care. The midwives will be unable to access patients medical records which are a necessary requirement.”
I note that in other parts of the country smaller maternity units are being maintained, so why not in Bexley? My hon. Friend the Member for Bromley and Chislehurst has alluded to the finance, and I will not go over that in view of the shortage of time. Many people believe that the building is safe, but what about the services? The hospital is being downgraded and services cut for financial reasons.
I should like to ask the Minister a couple of questions. We know that a joint health overview and scrutiny committee referred the decision of the “A Picture of Health” board to the Secretary of State in the summer. I should like to know when the decision is going to be made. Does the Secretary of State intend to refer the decision to the independent reconfiguration panel to ensure that there is independent scrutiny? We would like to know that independent people have looked at the decision and made a judgment. All of us who are campaigning against the downgrades and closures feel that to date that has not been done. As my hon. Friend said, it looks as if there was a done deal and the consultation was a sham. I hope that the Minister will be able to answer these important issues and that he will tell me positively that the case will go to the IRP.
The hospital is not the only local health care issue. We have real concerns about the regrettable cuts made by the Bexley Care Trust, whose headquarters is in my constituency. Those cuts affect quality of life. Pensioners, for example, are disadvantaged by cuts to the chiropody service. Many of them now have to pay for the service and travel to clinics rather than have a free service in their home.
Two years ago, I raised concerns with the Minister’s predecessor about plans to redirect family planning services to GPs and about changes to speech and language therapy services. More recently, we have been concerned locally about the lack of NHS dentistry services. Those are quality of life issues.
When my hon. Friend the Member for Hemel Hempstead (Mike Penning) spoke at the end of the previous debate, he made some important points about polyclinics. Many local pensioners are concerned about how polyclinics will affect them. The closing of GP surgeries in favour of polyclinics could have a considerable effect on early diagnosis rates. We are also concerned that the relationship between pensioners and their doctor will be breached because they will not always see the same doctor.
Those are the concerns that are being raised locally. The fear is that Queen Mary’s hospital may eventually end up as simply a super-polyclinic. That is a real worry to pensioners who rely on their doctor. People get to know their doctor, which makes them feel confident. Elderly people in particular value that relationship.
I am pleased to have been able to raise these issues with the Minister. Will he give us some reassurance that there is no done deal on Queen Mary’s and that there will be independent consideration? South-east London is different from other parts of London; we have particular issues and problems, whether transport or the location of hospitals. We deserve better health care for all the people in Bexley.
I congratulate the hon. Member for Bexleyheath and Crayford (Mr. Evennett) on securing the debate and I pay tribute to NHS staff in Bexleyheath and Crayford, as well as across the NHS as a whole, for their hard work and dedication, which are delivering a better quality health service than ever, benefiting, not least, the hon. Gentleman’s constituents.
As I am sure the hon. Gentleman will acknowledge, the NHS in south-east London has faced significant historical challenges, many of which are shared across London, as we can see from today’s annual Healthcare Commission report. Incidentally, he is not quite correct to say that the commission’s annual health check said that health care in London had declined. In fact, it has improved, but more slowly than in the rest of the country. However, he is right that there have for some time been particular challenges in south-east London.
I hope that the hon. Gentleman will acknowledge, too, that the health service can never stand still; it has to change. Lifestyles, society, medicine and technology are all constantly advancing, which means, for example, that many conditions that used to require admission to hospital can now be treated in the community, by GPs or even in someone’s home. For those who require admission to hospital, the average length of stay is just a fraction of what it was even only five years ago.
Although many services can now be delivered outside a hospital setting, closer to where people live, some more specialist and complex treatments require such a level of expertise, with round-the-clock teams of doctors and nurses, that they are best delivered in a smaller number of major centres. That is the context against which the proposed reorganisation of health care in south-east London is taking place.
The other thing I need to make clear is that decisions on how local services are organised are no longer made by Ministers in Whitehall, but by autonomous NHS professionals on the ground. I take this opportunity to commend the collaborative approach that has been taken by the four primary care trusts involved in the south-east London reorganisation—Bexley, Lewisham, Greenwich and Bromley—and the four acute hospital trusts involved, Queen Mary’s Sidcup, Bromley Hospitals, Queen Elizabeth and University Hospital Lewisham. It is no mean feat that they have managed to come up with a set of proposals that they believe will ensure safe and high-quality services for the people of their boroughs and an NHS for south-east London that will at long last be put on a stable financial footing.
The process of drawing up the proposals—called, as we know, “A Picture of Health”—has been led by doctors and other health care professionals and has involved, as the hon. Gentleman knows because he has taken part in it, extensive public consultation. The clear view of the clinicians involved has been that while many services can be devolved further out into local communities, there are others that, because of their speciality, urgency or complexity, need to be concentrated on three rather than four sites to make the most of the available expertise.
In his speech, the hon. Member for Bexleyheath and Crayford (Mr. Evennett) often used the word “downgrading.” Does my hon. Friend share my view that there is a powerful and arguable case for the separation of elective care from trauma services? Is he aware that the proposals for Queen Mary’s Sidcup mean that it will become a centre of excellence for elective care, including cancer services, not just for the borough of Bexley but for Greenwich, Lewisham and Bromley as well? Does he consider it correct to describe that as downgrading?
No, I do not. I have been trying to improve understanding of how health care is organised. There are many services, and many in the case of this reorganisation, that are being delivered and devolved out into the communities; I will come on to the extra services that these proposals are intended to provide at St. Mary’s Sidcup in a moment.
Queen Mary’s; I beg the hon. Gentleman’s pardon.
There are other services that, because of their nature, require, for the sake of patient safety and lives saved, to be concentrated in more specialist centres.
The independent national clinical advisory team, under the respected doctor Professor Sir George Alberti, reviewed the proposed changes in south-east London. Its report said:
“It is obvious that no change is not an option. This has been stressed particularly by hospital clinicians. We support the view of concentrating acute services on fewer sites as soon as possible.”
As I am sure that the hon. Gentleman knows, in July a joint committee of the primary care trusts involved agreed to recommend a variation of a number of the options that had been considered during the public consultation. Its recommendation is for two fully admitting hospitals, Queen Elizabeth in Woolwich and Princess Royal in Orpington, and a medically admitting hospital at University Hospital Lewisham and a borough hospital at Queen Mary’s Sidcup. The local NHS has said that it believes that that solution would deliver the most clinical and non-clinical benefits to local people.
Under the proposals, as my hon. Friend the Member for Erith and Thamesmead (John Austin) has just mentioned, Queen Mary’s Sidcup would lose its full A and E department and maternity services, but its urgent care centre would be expanded to provide 24-hour cover, routine surgery would also be expanded to cover not only Bexley but all of Bromley and Greenwich, and there would be an expansion of several community diagnostic and specialist ambulatory services.
The advantages of those proposals, according to the NHS in south-east London, is that they will bring together small teams that currently provide specialist care, such as emergency and trauma care, into larger teams with the capacity and round-the-clock expertise to provide top-quality and safe care, while other services would be provided closer to people’s homes. That will make services easy to access and help to reduce health inequalities and differences in access to care in the area.
As the hon. Member for Bexleyheath and Crayford is aware, the overview and scrutiny committee of Bexley council, which has the role of monitoring NHS decisions in his area, has formally referred the proposals to the Secretary of State for review. The joint overview and scrutiny committee, comprising six interested boroughs and Kent county council, has indicated its intention to refer at least some of the proposals to the Secretary of State, and I understand that it is meeting shortly to agree the precise terms of any referral. I can assure the hon. Gentleman that in any event the referral by Bexley means, under the independent system set up by the Government, that the national independent review panel will look again at the proposals. As for the process, I suspect that the panel will not wish to consider the referral formally until it hears from the joint overview and scrutiny committee, because it will need to be clear about the exact reasons for the referral, and what its terms are.
As the hon. Gentleman acknowledged, the panel is genuinely independent—for example, it recently rejected proposed NHS reorganisations affecting East Sussex and Oxfordshire. Anyone, including the hon. Gentleman, and the hon. Members for Hornchurch (James Brokenshire) and for Bromley and Chislehurst (Robert Neill), who are sitting behind him, and my hon. Friend the Member for Erith and Thamesmead, may make representations to the panel. I hope that that has gone some way to reassure the hon. Member for Bexleyheath and Crayford that the decisions that are being taken on health in his local area are being led by the local NHS and clinicians, and are aimed at trying to provide his constituents and the rest of the public in south-east London with the modern, safe and high-quality health services which I hope we all agree they deserve.
Question put and agreed to.
Adjourned accordingly at twenty-five minutes past Six o’clock.