Motion made, and Question proposed, That this House do now adjourn.—(Helen Jones.)
I am very pleased to have secured this Adjournment debate on the Whittington hospital. All my parliamentary neighbours—my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), my hon. Friend the Member for Islington, South and Finsbury (Emily Thornberry) and the hon. Member for Hornsey and Wood Green (Lynne Featherstone)—wish either to intervene on my speech or to contribute to the debate. Like me, they all very much value our local hospital and want it to succeed and to continue in its present form. We all want to lift what I believe to be the threat that is hanging over it at the present time.
I have represented Islington, North since 1983, and have had numerous dealings with the hospital. I have been a patient there, as have my children, and I have been to the hospital many times, either to visit people or to have regular discussions with its successive chairs and chief executives about how it is run. It is a very successful local hospital. It treats a large number of patients, serving roughly 250,000 people in the boroughs of Islington and Haringey and in parts of Camden and Barnet. It has been the beneficiary of a very large amount of investment over the past few years, with £30 million being invested in a new wing. That wing is now open and is very successful. It is very well run and of a very high standard, and the hospital has been free from MRSA for a very long time. It is a successful hospital of which we can all be proud, and that is the message that we want to get across.
The hospital employs 2,000 staff and has 400 beds. Last year, it treated 20,000 in-patients, 16,000 day cases and 233,000 out-patients. It delivered 3,683 babies and, crucially, it treated 80,000 people in its accident and emergency department. It also has a very successful and well run maternity and labour unit. The hospital has a neonatal intensive care unit, and we are rightly proud of its new A and E department, which deals particularly with children. This is a hospital that serves its local community and we want it to continue to do so. That is the point of tonight’s debate.
The health service is undergoing one of its sporadic bouts of internal planning and reconfiguration, which is where the concerns come from. We are part of the north central planning area, which includes Camden, Islington, Haringey, Barnet and Enfield—all densely populated, all with rapidly rising populations, all busy areas and all surrounded by major railways, roads and facilities. For example, a short distance away from the Whittington is the Arsenal stadium, which hosts 60,000 people every fortnight, and there are obviously major roads such as the north circular and the A1, which runs virtually in front of the hospital.
The concerns arose on 19 November, when a story appeared in the local paper, the Islington Gazette, that
“in a massive reorganisation of London’s NHS, every hospital in the boroughs of Islington, Camden, Haringey, Enfield and Barnet will be categorised either as a ‘local’, ‘major acute’ or ‘specialist’. The Whittington will almost definitely be downgraded to a ‘local’ hospital.”
An internal letter then also appeared from NHS Islington, which seemed to say that there was a question mark over the future of the hospital’s A and E department and the intensive care unit. I believe that some of my parliamentary colleagues intend to refer to that when they speak a little later in this short but very important debate.
Since the story came out, I have had numerous contacts with the hospital. I have spoken at some length with the primary care trust for Islington, which is also involved in the commissioning authority for the north central area. The more discussions I have with more people, the more concerned and alarmed I become. I also discovered during those discussions that a company called Participate has been retained by the NHS to undertake a consultation exercise, which, unfortunately, has so far taken place as an internal private focus group of some sort, as I understand it. I certainly was not invited to attend it. I have checked with the local authority and parliamentary neighbours, and I am not quite sure who was invited, but it certainly was not any of us. That has caused understandable concern.
If the hospital’s future is in any doubt, I want to know what attitude the Government will take, what pressure they will put on NHS London and what they see as the future configuration of health care facilities in London, and I say that for two reasons. An accident and emergency unit is the heart of a hospital. Obviously, with an A and E unit and an intensive therapy unit, anyone who suffers any kind of accident, injury or whatever else can be treated very quickly. Major surgery can take place in other parts of the hospital because there is an A and E unit as a back-up facility. That is very important: clearly, if the back-up facility is lost, the possibilities of major elective surgery are removed from the hospital, and we begin to see a downgrading and, ultimately, the hospital’s closure.
At the risk of sounding terminally boring, I would remind the House that I was first elected here in 1983. The first letter that I received from a Minister—I was really chuffed to get one from a Minister—was from the former Health Minister, Brian Mawhinney, who wrote to me to say that previous assurances given to my predecessor that the closure of the casualty unit, as it was then called, at the Royal Northern hospital would not lead to the hospital’s closure were hereby withdrawn. Indeed, the hospital was duly closed. Those who have long memories see what is happening as part of a trajectory that will end with the Whittington hospital’s closure.
Arguments have been put that the casualty units are all very close together, so a closure is okay; it does not matter. Well, it does matter. It matters because of the safety of the people who live around that area, the safety of the community and the ability of the NHS, which we are all very proud of, to provide services free at the point of use for people who desperately need them.
I am sure my hon. Friend would agree that all the investment in the Whittington has been intended to upgrade it. What appears to be proposed now is to downgrade it. In relation to the threat to the 80,000 accident and emergency patients, will he confirm that the alternatives are the Royal Free, which has 80,000 accident and emergency patients, and University College hospital in my constituency, which has 130,000 accident and emergency patients and is already saying that the number of emergency cases is leading to delays in elective surgery, so as far as that hospital is concerned, it is getting too many emergency cases already, but if the Whittington A and E department closes, it will clearly get many more?
My right hon. Friend is right: 80,000 patients are treated there. A friend of mine had a very serious heart attack in August. The ambulance did not have time to get to UCH because it would have taken five to 10 minutes more. It was very late at night and the roads were clear, so he was rushed to the Whittington, which was the nearest hospital. He was treated superbly and has made a recovery. That is one example in which somebody, had they had to go somewhere else, might not have survived. I want the House to understand that if we close casualty units it might look efficient on paper, but there are 80,000 people who use that casualty unit and I want them to be able to continue to do so.
I shall be brief. Tomorrow evening Islington council is to receive a motion moved by the leader of the council and seconded by the leader of the opposition, expressing its concern at the threat to the accident and emergency service at the Whittington under the plans put forward, and asking that the council express its view that the accident and emergency department at the Whittington should remain open. I am sure that that motion will be carried by the council, and that equivalent motions will be carried on a cross-party basis in the neighbouring local authorities.
Everyone in the area is aware that the huge amounts of investment to which my right hon. Friend referred, some of which he was instrumental in pursuing when he was Secretary of State, have paid off. We have good services, good treatment and a good hospital, and we want it to carry on that way. If we allow the proposal to go ahead and if we lose the A and E department, everything else is at risk, entailing a huge waste of public money and resources.
I conclude by quoting Dr. Wendy Savage, a leading gynaecologist and co-chair of Keep Our NHS Public, who said:
“We are gravely concerned about the implications of these changes.”
She said that they would
“involve the loss of key services, including emergency surgery, paediatrics and maternity”
if the full A and E services were lost.
The consultations make me suspicious. If there are plans to close the Whittington A and E, come out with it in the open and let the public express their views. Do not allow the whole thing to be built up as some kind of financial case which becomes unanswerable, with the result that we lose those facilities. I am determined to defend my local hospital. We are all determined to defend our local hospital. I hope the Minister will understand the passion that is felt about that locally and that he will be able to say tonight that he is prepared to put pressure on to ensure that we keep that A and E and the hospital, and that the people of that very crowded part of London can rely on the NHS to provide them with the emergency services and all the other services that they need.
I congratulate my hon. Friend the Member for Islington, North (Jeremy Corbyn) on securing the debate. The issue is extremely important. The local Labour group of councillors has an online petition. I will not go through all the comments on that petition, but they are extremely moving and show how much loved the Whittington hospital is.
I had my life saved by the Whittington hospital. I remember arriving at A and E, standing at a desk and weeping on the woman at the desk. I had gone yellow, my eyes had gone strange and I was having problems breathing. I had, it seems, gallstones that were messing up my liver and my pancreas. If I had left it any longer, I would not be here today. I love the Whittington and there is a strong reason for that.
If there is any chance that anyone is seriously thinking about closing the Whittington A and E, they will have a fight on their hands, certainly from my hon. Friend and myself and the huge amount of support that we are already garnering in Islington and, I strongly suspect, across other boroughs that use the Whittington. I was speaking earlier today to the Minister for Higher Education and Intellectual Property, my right hon. Friend the Member for Tottenham (Mr. Lammy). There was some confusion about when the debate would begin, but he was intending to sit on the Back Benches and look like thunder. I know that he feels as strongly as I do.
I congratulate the hon. Member for Islington, North (Jeremy Corbyn) on securing this vital, urgent and timely debate. He put his case—our case—exceptionally well, because what is true in Islington, North is true in Haringey and in Hornsey and Wood Green.
I first learned about the possible closure because I broke my toe—these things happen—and went to the Whittington hospital, as one does. A letter was leaked to me, and that letter was very explicit about all four options for the hospital’s future. It was sent by Rachel Tyndall from the north central London sector to all the chief executive officers and medical directors of the relevant hospitals, and all four options showed that the Whittington would have no emergency take in future. That is how it was. As soon as the letter went public, however, it was retracted—to an extent—and became a proposal for local hospital designation, which would mean a reduction in services. There certainly would not be 24-hour care; there certainly would not be emergency care; and the hospital certainly would not retain the intensive therapy units, although urgent care of some sort might be provided.
The proposals have become mushed up with merger talks and service rationalisation, which I accept can be sensible. If the Royal Free hospital and the Whittington hospital both undertake kidney and liver treatment, one could do kidneys and one could do livers. That treatment is not urgent, however, and it does not need to be dealt with in seconds, as accident and emergency cases do.
The Liberal Democrat and Labour parties on Haringey council have passed a motion to keep the Whittington open. Other services may be dealt with separately, but this issue is all mixed up with the Darzi plan and the proposals on specialist trauma centres throughout London. Interestingly, the plan says that local hospital designation, which is the designation outlined in the second letter, means that one can retain 24-hour accident and emergency care. We should make no mistake: the issue is about budget cuts.
Local people have responded, and I had more than 1,000 signatures to the petition in the first 48 hours, which was an extraordinary response. They want their local A and E service, and it is absolutely vital that it is retained. Although is not like any other service provided by the hospital, it is important, as the hon. Gentleman said, that its other services are not diminished, because otherwise, the Whittington will wither on the vine. It cannot have escaped people’s notice that the land on which it sits is worth a fortune. I do not want to take up any more time, so without adding anything further I thank the hon. Gentleman for letting me speak in his debate.
I congratulate my hon. Friend the Member for Islington, North (Jeremy Corbyn) on securing this debate about what is clearly a very important subject for his constituents and for the national health service in north central London.
I recognise the good work of NHS staff, not just at the Whittington hospital but throughout Islington and north central London. They are constantly striving to deliver better quality health care, benefiting the constituents of my hon. Friend and other hon. Members. Sometimes, it is worth recognising in this place the commitment and dedication of those staff.
This Government remain committed to supporting health service staff to provide good-quality health services throughout London. We have consistently emphasised the value of strong clinical and local leadership, so that doctors, nurses and other clinicians—those who understand best what their patients need—are at the forefront of the programme to shape the health service locally, in the best interest of patients.
However, the challenge for the local NHS is to explain to patients, the public and their representatives, including Members of Parliament, where any change might be needed, and to put forward clear proposals for that change. The aim should be to ensure safer, high-quality health care for everyone. However, I understand that there are no formal proposals for north central London at the moment. I do not quite know why managers have decided to start a process of consultation, and they will have to justify the cost of a consultation when there are no clear proposals in place. If there are no clear proposals, and that is what I am led to believe, the concern is why managers have decided to busy themselves consulting on proposals that do not at the moment really exist.
My hon. Friend’s idea is that proposals are being discussed between managers, and that may well be the case—that they are having some discussions. Some of that may have been leaked, but NHS managers must be sure of the issues on which they are going to consult the public. Vague proposals that have no clarity about them and are then put out to consultation on the basis of saying, “Well, let’s all talk about what we could do”, serve little purpose other than to raise a lot of public concern. Something as woolly and vague as that is a recipe for considerable concern for Members of Parliament and other public representatives, particularly if they are not being properly consulted and need to have these things explained to them. That is a recipe for ending up with confusion. Managers now need to explain very clearly what they are proposing. If they have recruited this organisation, Participate, it is up to them to justify the cost, particularly if local NHS money is being spent on a company that appears to be consulting without including political representatives in the appropriate way.
Local organisations have the budgets, and they have to justify how they choose to spend them. The local organisation of health care services is not dictated by Ministers or civil servants in Whitehall; it should be led by local health care professionals on the ground, clinically driven, focused on the best outcome for patients and, of course, meeting the highest levels of patient safety.
The hon. Member for Hornsey and Wood Green (Lynne Featherstone) expressed concern that the NHS across London faces cuts, as she put it. I have made it very clear to managers in the NHS that there should be no slash-and-burn cuts and no predicting of the Chancellor’s settlements or the outcomes of general elections or any other elections, and I will name and shame those who try to do that. We have said that we want good-quality health services to be delivered, and that should be clinically driven. These decisions should be for those who make the judgments about what is the best care for their patients, not for managers simply deciding what they are going to do with their budgets. It has been the clear view of the Darzi review that the driving force of any change in the health service must be improving the quality of care that patients get.
The Government have established an independent scrutiny and review process for local service change as part of their commitment to place patients and the public at the centre of health services. If MPs and local councillors have any concerns about proposals coming from their local health services, I urge them to engage directly with primary care trusts, who are responsible for developing any proposals for change. I know that there have already been some meetings locally, and PCTs have assured me they would welcome any discussions with MPs. However, if there are significant local concerns, then the health and well-being scrutiny committee can refer proposals for any reconfiguration to the Secretary of State for Health, who in turn may decide to refer the case to the Independent Reconfiguration Panel for consideration and independent advice. Ministers will be prepared to look at any such referral by a health and well-being scrutiny committee or any overview and scrutiny committee of a local council. I want to make that clear; I know that local managers in the health service are clear about it.
Will the Minister confirm that nothing in the plans for the future of the NHS includes the removal of 24-hour accident and emergency services where they are clearly identified as being necessary and vital in an area of rising population with an extremely large day time transient population who obviously need to have access to A and E just like everybody else?
The priority for any reconfiguration must be patient safety. Any reconfiguration or examination of the quality of services, whether they be A and E or any other kind of service, must be on the basis that the clinically led judgment is that the quality of patient care will be improved by the change.
I know I am being slightly oblique, because I do not want to venture into the detail of local decisions that need to be arrived at, but it is clear that if the quality of care for local people will not be better as a result, a reconfiguration should not be proceeded with. If it will improve the quality of patient safety and care, of course it needs to be examined properly.
The north central London sector involves five PCTs—Barnet, Camden, Enfield, Haringey and Islington, serving a combined population of 1.3 million people. Despite the headlines, it is worth noting that the review of the sector is at a very early stage of development. That is why it is surprising that some people are already supposedly carrying out consultations. Managers ought to draw up clear proposals, then put them to the public, have a proper consultation and listen to what is said. It is important that that be a genuine consultation and that people be listened to and their views properly taken into account before any decisions are arrived at. I am told that the local NHS is working closely with clinicians and will engage in due course with the general public on any proposals that might come forward.
With the sort of letters that are going out, the fear is that when the options for consultation finally come forward to the public, which will be in September 2010, there will not be a 24-hour A and E in them and that option will not be on the table for the public to let the authorities know about it. That is why we need to hear public voices now, because there may not be any option that says, “Keep the Whittington A and E open.” The options that will be consulted on will not be the ones that the general public want.
I am slightly confused as to quite what the hon. Lady is suggesting. Is she saying that she wants a consultation when there are no proposals, or that she wants to wait and see what the proposals are so that there is something to consult on? It is not entirely clear.
I was trying to say that if people across Islington and Haringey did not make it known now how passionately they feel about the A and E at the Whittington, they might find that the options that come forward for consultation next September contain nothing that they actually want.
The hon. Lady appears to suggest, then, that a consultation should happen now. That is a matter for her to engage with the PCT on, but it seems to me that it is always better to have something on the table so that people know what they are talking about, rather than to have some vague and general consultation. She appears to think that there should just be general discussion, and that is for her to take up with the PCT.
I understand that the Whittington Hospital NHS Trust and the Royal Free Hampstead NHS Trust have been in discussion about how they can work more closely together in a number of ways. They already have some successful joint working practices in place. For example, some clinicians work across more than one site, and the Whittington, Royal Free and University College hospitals collaborate on matters such as urology. As I understand it, they are holding further discussions with staff as work progresses.
Any changes that the trusts might wish to make should be underpinned by a proper process, so that the public are aware of them and know what is being discussed. An options appraisal, followed by a strategic outline case, would need to be endorsed by the trust boards, the relevant PCTs, the sector chief executive and the strategic health authority. As I understand it, nothing has been put before either board yet.
I entirely agree that the case for the closure of the Whittington hospital A and E department, if such a proposal were ever made, has yet to be made. As I understand it, the situation is that some vague discussions are going on. Local people have expressed their views, as have my hon. Friend and others, and it is now a matter for the PCT to decide how properly to proceed. However, I would tell the PCT to proceed with caution. Local people will have a view and the NHS needs to consult them properly. They ought to know what the ideas and so on are on the table in order to express a clear view about them.
My right hon. and hon. Friends have expressed very clearly their views about these matters and the importance to local people of the Whittington hospital, including its A and E department, and I am sure that those on the PCT will have heard those words very forcibly indeed.
Question put and agreed to.