Skip to main content

Better Healthcare Closer to Home Strategy

Volume 492: debated on Wednesday 20 May 2009

Eleven days ago, a special health day was held in my constituency. I persuaded my local primary care trust to hold it on the grounds of the Wilson hospital in Mitcham. The PCT seemed quite sceptical about it and, as my hon. Friend the Minister knows, it was not easy to persuade the PCT of how much interest there would be from local residents.

The health day was a chance for local people to find out about the NHS’s plan to improve services and open new hospitals locally. There were stalls giving health advice and information, the most popular of which featured a bicycle that powered a fruit blender. After a couple of minutes spent cycling, people were given a free smoothie, although whether they were in a position to drink it depended on their level of fitness. There were also dance classes and football tuition for children. I arranged for small groups of general practitioners to offer quick and simple health advice, and hundreds of people queued from 10 am until nearly 4 o’clock to see them.

We estimate that about 700 or 800 people came to the health day—I do not think that my local NHS ever imagined there would be so many people. I asked the local NHS to hold question and answer sessions to let people know about the NHS’s plans for the future. It set aside one room for about 50 people and planned to hold just two sessions. In the end, we had seven or eight sessions, all of which were packed to over-capacity. The sessions stopped every 30 or 40 minutes to allow the next audience in. I had warned the local NHS that there was a massive interest in the health service, but it would not believe how large it was.

The Wilson hospital is located in the most disadvantaged ward in my constituency and borough: Cricket Green. Life expectancy in Cricket Green is up to 10 years less than that in areas just a few miles away. Many local residents are shift workers, or come from ethnic minorities or groups who find it difficult to access doctors and hospitals. They feel discouraged from visiting a doctor because of surgeries’ limited opening times. Many local residents do not have a GP and, even if they do, they do not believe that the GP practice is open at times that fit in with their lives. MPs know about the existence of such people who are excluded from primary care in the NHS, but we often find it difficult to persuade our NHS managers that that is the case. That is why the Government are extending GP opening hours, although I am afraid that not all surgeries publicise their new hours.

A few months ago, before the health fair, I visited a practice that serves some of my constituents, although it is just outside my constituency. The people at the practice complained about the Government expecting them to open at times that were convenient to patients rather than to themselves. They said that not many patients asked for evening appointments. I was a bit surprised by that, so I asked them whether they told their patients that they were open at that time, to which they said no. Obviously, that needs to be sorted out. I think that all surgeries should contact all those on their practice lists to advertise their longer hours.

As MPs, we know about such blockages in the system, but the local NHS, the surgeries and the administrators often do not. That was why I knew that there would be an incredible demand from people to come to the health fair, but the local NHS did not. However, good has come from all this. My NHS managers are now only too aware of how much interest there is in improving the health service, particularly in disadvantaged areas. They had talked about consultation, communication and contacting hard-to-reach groups, but they had never really managed it. Thanks to the health fair, they did.

Great things are planned in my area to bring health services closer to the people who need them most. The Wilson hospital, where the health fair took place, is a shining example of that. The Wilson was endowed by Sir Isaac Wilson, a local benefactor, back in 1928. He specifically donated it for health purposes. However, not long ago, in the 1990s, there was a Conservative Government. The public campaigned long and hard to keep this much-loved cottage hospital open, but the Tories would not listen and they closed it. I am afraid to say that that was part of a pattern in my area.

In 1996, during the dying days of the Conservative Government, a secret plan was drawn up to close St. Helier, my local general hospital, even though it was an integral part of the St. Helier council estate, which, when it was built in the 1930s, was one of the largest housing estates in Europe. Under that Conservative Government, secret plans were made to move services away from the people with the greatest health needs in my area. Things happen slowly in the NHS, but a process was set in motion and eventually the local NHS proposed moving everything to Belmont in Sutton.

Unfortunately, the NHS is not representative of local people. Of the 18 board members of Sutton and Merton, my local PCT, none are from Mitcham and Morden, even though we are acknowledged to be the area covered by the PCT with the worst health and greatest medical needs. When there was consultation on where to have our local hospital, the results were overwhelming: St. Helier hospital was the favourite and Belmont was the least favourite. However, the NHS voted for Belmont anyway.

Luckily, in 2004, there was a Labour council in Merton, and it called in the NHS’s decision and asked the Secretary of State to decide. The decision to close St. Helier was reconsidered by my right hon. Friend the Member for Leicester, West (Ms Hewitt) and, in late 2005, she agreed with residents and instructed the NHS to rebuild the hospital at St. Helier, because that would help to reduce health inequalities.

Unfortunately, there has been a battle over the matter ever since. For a while, no progress was made. Meetings were even held with Transport for London, during which the NHS made it clear that Belmont was still its preferred option. So, we carried on campaigning and, three years later, it looks like we have finally won. Last year, the local NHS finally agreed its plans for our local NHS. St. Helier not only has been saved, but will be rebuilt and refurbished. There will be new wards with single rooms to cut down on infections and improve patient privacy, a new local care centre and a new 24-hour GP service operating seven days a week. What is more, there will be four care centres, including one at the Wilson—the hospital that had been closed under the Tories and where we held the health fair. Those care centres will have diagnostics and treatments, dentists and GPs, and will be open when people want them to be. The Wilson is not just getting a care centre. It will reopen as a hospital, carrying out minor operations and with more than 50 intermediate care beds for people recuperating from operations or needing care that they cannot get at home.

The local NHS has called those plans Better Healthcare Closer to Home. The programme shows the stark contrast between Conservative and Labour Governments—hospitals closed under the Conservatives, but are reopening under Labour. However, at times, it has seemed as though our achievements have been in spite of the local NHS, and I still have great concerns. It takes a very long time to persuade NHS managers about anything. At the health fair, I showed them that there was huge demand for extra and better health care, and that it needed to be delivered in ways that were convenient to patients rather than to the establishment. The local NHS met more people in one day than it probably meets in a whole year of doing things its way, including hundreds of people from hard-to-reach groups with whom it has never had a conversation in the past.

My constituents are delighted that health centres are opening. They are over the moon that the Wilson is going to reopen as a hospital and they are cock-a-hoop that St. Helier has been saved and will be rebuilt and modernised. However, they are a little astonished that it is going to take quite so much time—[Interruption.]

I congratulate the hon. Lady on her health initiative and encouraging such a number of people to come out on that day. Like me, I am sure that she is pleased with the endorsement that the Better Healthcare Closer to Home project has received from the Health Secretary, who said:

“It is the type of project that we want to succeed”—[Official Report, 12 May 2009; Vol. 492, c. 678.]

However, through her, may I ask the Minister to give us some reassurance that the BHCH project remains a top priority for NHS London?

I completely agree with the hon. Gentleman. I am absolutely fine after falling over before his intervention; I did not knock any sense out—there is probably only stuff to go in.

Our new care centres and hospitals will take a long time to set up. It could take two years to get approval from the Department of Health and to plan, prepare, design and procure the care centre at the Wilson. It could take three years before building can start at St. Helier. A time scale of two or three years with nothing built at all is baffling to my constituents. It will then take a further two years to build the Wilson and four years to build St. Helier. I am sure the Minister can well understand that, as far as many of my constituents are concerned, 2016 might as well be the middle of the next millennium.

I am talking about an astonishing improvement to the local health service. Yes, the programme is complex and will cost hundreds of millions of pounds. Of course we do not want the buildings to fall down, but we are talking about a major capital project at a time when our local and national economies need a shot in the arm.

I do not ask the Minister to act recklessly. However, the Better Healthcare Closer to Home plans have been going back and forth for five or six years. After such a long time, local people know what they want and are impatient for things to happen. We all believe that the plans will put patients more in control of their treatment, particularly those in hard-to-reach groups with poor health who live in less well-off areas. I am asking the Minister to do all that he can to accelerate the programme.

There is still a lot of mistrust in our NHS, and there is also a great deal of fear that future Governments might be just as hostile to our NHS as the Government in the early 1990s. If we can speed up the process and get building under way more quickly, it will reassure my constituents that things really will happen.

I should praise my neighbouring MPs, the hon. Members for Sutton and Cheam (Mr. Burstow) and for Carshalton and Wallington (Tom Brake), who have supported the plans to rebuild St. Helier. They, too, will get new local care centres in Wallington and at St. Helier. They also have neighbourhoods where people’s health is not so good, and where the local NHS seems remote.

Our communities will be reassured if people can see with their own eyes that work is beginning. While plans make their slow, steady way through the hands of the mandarins and the bureaucrats, there is nothing tangible to see. At this point, I hope that the Government will be decisive and insistent. We all want this to happen—let us get started.

I congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on securing this debate and on her tireless work on behalf of her constituents, not least when it comes to health issues. I commend the health fair that she helped to organise in her constituency at Wilson hospital and I am glad that it was a success.

My hon. Friend is absolutely right about the importance of letting the general public know about the improved general practitioner services that are now available around the country, including in her constituency. There are extended opening hours in the evenings and at weekends, and new health centres are popping up in every primary care trust area. She might not be aware that we have asked every PCT to ensure that every household in its area gets a leaflet—it is called “Your Guide”—explaining what is happening in the area, including details of GPs’ extended opening to ensure that the public are aware of such information, even if GPs do not communicate it directly to them.

During the past 60 years, we have seen dramatic changes in the way in which health care is delivered. Today, patients with more and more conditions can be treated and cared for in their own homes or in their local community. For many procedures that still require hospital admission, the length of stay needed has reduced dramatically.

As medical science has advanced, NHS staff have become ever more capable of amazing feats of clinical care. For some complex procedures or operations, it is important to have well equipped and well staffed specialist centres where round-the-clock consultant and specialist nurse expertise can be assured, and where technology, which is sometimes very expensive, can be concentrated. At the same time, there is a great deal of travel in the other direction, as my hon. Friend said. More and more care and procedures no longer need to be delivered in hospitals, but can be delivered in health centres that are closer to where people live, or in people’s homes.

As my hon. Friend said, there has been a long and extensive debate about how best to reorganise health services in her part of south-west London. Better Healthcare Closer to Home was launched in 2002. The initial proposal, which based acute services at Sutton hospital, was rejected by the then Secretary of State, in part due to arguments put forward by my hon. Friend. Since then, the strategy has evolved, and, alongside the Local Needs, Local Health review, it now offers the means to improve the quality of local patient care.

There is consensus in the Sutton and Merton area that change is needed. The fabric of the estate at St. Helier hospital is very poor. The trust has inherited a legacy of old buildings, some of which are more than 60 years old, and patients’ dignity is compromised by a lack of privacy and a shortage of facilities.

The NHS in Sutton and Merton is reshaping health care around the needs of local people. For example, it will replace worn-out accommodation with facilities and single-sex areas fit for the delivery of modern health care. It will concentrate acute care at one key hospital while providing more care locally, and it will aim to improve patient outcomes and tackle the all-important issue of health inequalities, which my hon. Friend raised.

We all agree that St. Helier hospital is no longer fit to provide the 21st century health care that its local residents expect and deserve. Spending increasing sums of money on inefficient, inflexible and inadequate facilities does not represent good value for taxpayers’ money. Better Healthcare Closer to Home proposes a number of local care centres supported by a local acute hospital. St. Helier will continue to be the centre for acute health care services for the people of Sutton and Merton, and it will bring benefits to the deprived surrounding area, including my hon. Friend’s constituency. Substantially rebuilding St. Helier at an estimated cost of £155 million will be the first phase of the redevelopment, which is due to finish in 2016.

Sitting suspended for Divisions in the House.

On resuming—

The proposed improvements will include 65 per cent. of beds in new accommodation, with the existing site being modernised to improve patient comfort and satisfaction, and half of all in-patients will be given the privacy of single rooms, which will help to tackle health care-associated infections. By 2013, three local care centres will be built, with a fourth at the St. Helier development, bringing traditional hospital services and primary care closer to people’s homes. Ten per cent. of all intermediate and post-acute care will take place in people’s homes and in a new intermediate care centre. That service, with the Wilson local care centre, will serve my hon. Friend’s constituency at a capital cost of £22 million.

The local NHS believes that the changes will prevent 1,000 unnecessary hospital admissions every year; enable 1,500 patients a year to recover 20 per cent. faster, with more post-hospital care in people’s homes; ensure that 65 per cent. of local people in Sutton and Merton are no more than 10 minutes’ travel time from their nearest out-patient appointment; and reduce travel times by 30 per cent. for people with long-term conditions. Additionally, about £185 million is being invested in the disadvantaged areas covered by the strategy. The lower average travel times will help to reduce inequalities in access to care.

The projects submitted to NHS London have a total capital value of £208 million, and are considerably more complex than most projects on that scale. I am sure that my hon. Friend will agree that the assessment of all the projects must be thorough and the analysis robust. It is therefore taking a little longer than perhaps she and others would wish.

The Minister is doing a good job of setting out the long-term benefits of Better Healthcare Closer to Home. I should like to encourage him, however, to comment on the short term, and perhaps I can obtain an assurance from him that when the business case for the proposals is complete, which is expected to be by the end of this month, he will take personal responsibility for ensuring that the matter is expedited through his Department.

I was coming on to discuss the short-term process, which I think will help to reassure the hon. Gentleman.

NHS London, the PCT and the trust are doing everything in their power to make the soundest case for the success of the Better Healthcare Closer to Home strategy. To that end, the finance director at NHS London is working closely with the PCT to ensure affordability. The PCT and the trust have been asked to provide clarification on a number of issues to ensure that the business cases stand up to the strongest possible scrutiny. Bearing that in mind, the PCT will resubmit the outline business case for Better Healthcare Closer to Home to NHS London before the end of this month. NHS London’s capital management group and capital investment committee will consider the case, and a decision should be made by 7 July. The Department of Health will then be free to report its decision. However, to speed up the whole process, my Department will consider the business case in parallel with NHS London, before the capital investment committee meets in July.

The proposed changes in the strategy are a key service development for the NHS in London and, alongside the changes already being implemented at Barnet and Chase Farm Hospitals NHS Trust and North Middlesex University Hospital NHS Trust, they represent the top funding priorities for NHS London. Indeed, a number of improvements have already been made through the strategy. For example, on the Wilson site, a GP-led health centre is due to open later this year. It is being procured through an open tender process. It will be open from 8 am to 8 pm, seven days a week, 365 days a year, and will be open to everyone, whether they are registered with a local GP or not.

I have had a conversation, as I understand my hon. Friend has too, with the chief executive of the London strategic health authority in the past 24 hours, and she has assured me that everything is being done locally to reach a decision in July and that the redevelopment of St. Helier hospital alongside the development of four local care centres for the residents of Sutton and Merton will be given the go-ahead. I urge my hon. Friend and other hon. Members to continue to work constructively and keep up the pressure on the local NHS and NHS London to ensure that progress is expedited and that the residents of my hon. Friend’s constituency and others in the area are provided with the best NHS services now and in the future.