Motion made, and Question proposed, That the sitting be now adjourned.—(Michael Fabricant)
I want to raise the issue of the Care Quality Commission report on the Barking, Havering and Redbridge University Hospitals NHS Trust in north-east London, the related independent reconfiguration panel report and the recent decision by the Secretary of State for Health to endorse the recommendations in the panel’s report and, as a result, significantly to downgrade services at King George hospital in Ilford. It is not the first time that the problems in north-east London health services and hospital provision have been debated in Westminster Hall or the House. Indeed, I introduced debates in 2006, 2009 and 2010, and my right hon. Friend the Member for Barking (Margaret Hodge) introduced a debate in June about maternity services.
Members of Parliament throughout north-east London have been very concerned, and there has been cross-party consensus, in very unusual circumstances, involving eight Members of Parliament: myself, my right hon. Friend the Member for Barking, my hon. Friends the Members for Leyton and Wanstead (John Cryer) and for Dagenham and Rainham (Jon Cruddas), the hon. Members for Ilford North (Mr Scott), for Hornchurch and Upminster (Angela Watkinson), and for Romford (Andrew Rosindell), and the Secretary of State for Work and Pensions. We have had massive support in the community. Decisions have been made by local authority health overview and scrutiny committees and there is wide public concern, with huge petitions and public meetings, about proposals that were initiated in 2006 to downgrade services at King George hospital, the smaller of the two hospitals in the trust.
That trust, in the words of the first paragraph of the Care Quality Commission’s summary,
“had a history of poor performance under the previous regulatory framework. It has long-standing and escalating debts (in 2005/06 this was just under £16m; by 2009/10 it was close to £117m). There have been numerous changes at executive level.”
Queen’s hospital, Romford is the newer of the two hospitals, having opened towards the end of 2006. It cost a huge amount of money and is run under a private finance initiative arrangement, which has led to certain difficulties. There was high-profile publicity, particularly about deaths in maternity services, and the CQC began a series of investigations, as a result of which it decided to carry out a full investigation of the trust as a whole, encompassing both hospitals and all services. That investigation went on throughout this summer, and its report was published at 10 am on 27 October.
At the same time, there have been proposals from the NHS London region bureaucracy, driven by the people within it, who have a vision of reducing the number of hospitals in north-east London from six to five, transferring services to large hospitals and reducing facilities in the Redbridge and Barking and Dagenham areas. We have ended up with a series of proposals that, when they were initially put forward, were deemed by Professor George Alberti to be clinically unsound. Later, they were revamped, tweaked and remodelled, and they became known as the health for north-east London proposals.
Those proposals envisaged principally getting rid of the accident and emergency department at King George hospital, Ilford. There has been an accident and emergency department in the district general hospital there since 1931, when the population was 85,000. Now it is 264,000 in the London borough of Redbridge, and the hospital also serves Barking and Dagenham, with a population approaching 200,000. The proposals also included getting rid of King George hospital’s maternity services, which serve young mothers in an area with a growing, diverse, predominantly ethnic minority population. Many of those young mothers have come recently to the United Kingdom, or at least have recently moved to Ilford. At the same time, it is proposed to increase the number of births taking place at Queen’s hospital in Romford—the one about which there were particular concerns—to make it what some people have called a baby factory. Those words were used in the reports by the CQC and the independent reconfiguration panel.
In March 2010, following concern and a campaign against the proposals, the then Secretary of State for Health referred the matter to the independent reconfiguration panel. The IRP then decided not to carry out an investigation, but to allow the consultation process to continue. That process led to final proposals, which were published towards the end of 2010, and then went through the so-called consultation and decision-making process, based on the primary care trusts. The joint committee of primary care trusts rubber-stamped the proposals despite overwhelming public opposition: aside from the tens of thousands of people who signed petitions against the proposals, within the committee’s own limited, and rigged, consultation procedure the public were opposed by a two-to-one majority—and an eight or nine-to-one majority in areas that were directly affected—to what was put forward.
We were told, however, that there was clinical support. There was no ballot of GPs, or system to ascertain what ordinary GPs thought.
My hon. Friend says that there was no ballot of GPs, but does he accept that I undertook a survey of GPs in Barking and Dagenham, and there was unanimous support for retaining the two A and E departments, at both King George hospital and Queen’s?
Yes, I should have said that there was no official ballot of GPs, because, of course, the view of the NHS bureaucracy was that the clinical leadership and the practices should make the decision; therefore, there was a strange kind of managed democracy and consultation.
I suspect that that may be the case. A number of others were also on the payroll in one way or another—including many who were the lead GPs in the consortia that endorsed the proposals.
It is important to get the chronology right. Following the decision of the joint primary care trust meeting in December to endorse the proposals, all the councillors from all the parties in the London borough of Redbridge made a unanimous referral to the Secretary of State. The joint overview and scrutiny committee for all the boroughs in outer north-east London also made a referral to the Secretary of State. The Secretary of State then decided—the Minister will recall a previous debate in the main Chamber, in which we had an interesting exchange on the matter—to refer the case to a new independent reconfiguration panel investigation.
The IRP spent a lot of time talking to Members of Parliament and councillors, and it worked hard; I have no criticism of the consultation process. In its analysis, although it tended to group us all into one paragraph called, “Save King George Hospital” campaign, which covers many interviews and consultations, the community’s opposition was reflected. The view was expressed, if tucked away, that the local community was overwhelmingly against the proposals.
The IRP published its report internally, but not publicly, and put it on the desk of the Secretary of State on 22 July, and there it sat. Two or three weeks after that, the CQC decided to carry out a full, no-holds-barred look at Barking, Havering and Redbridge trust. Understandably, I guess, the Secretary of State decided to hold back until he had received the CQC report before he published the IRP report and gave his official response; Members of Parliament expected something like that to happen.
Then, interestingly, everything went quiet. We originally thought that we were going to get an announcement in September, but September came and went. Then we thought that we would get an announcement in early October, but that did not happen. Eventually, three hours after the CQC report was made public, the Secretary of State published his response.
There is a little bit of history here. As a local Member of Parliament—I know that other MPs feel the same—I was not appropriately informed about the matters. BBC London news on television at 6.30 pm on Wednesday evening ran a story saying that the Secretary of State was going to announce at 12 o’clock the following day the closure of A and E and maternity services at King George hospital. I raised a point of order in the Chamber that evening with Madam Deputy Speaker, who had no knowledge of the matter—there was no statement or announcement to come.
The following morning, telephone calls to the private and press offices of the Department of Health ascertained that, yes, the news was true: there was going to be an announcement. To be fair, I was phoned back eventually, at 11.15 am, and told that the announcement would be made at 1 pm, and that I would be told in advance of it. That is true: I received an e-mail at, I think, 12.46 pm. Attached was a letter from the Secretary of State with a link to the IRP report, but the report was not available on that link; the link did not work until 1.10 pm. Other people had a similar problem, by which time the announcement was already up and running. Therefore, we knew what the decision was—to endorse the report—but we did not know the content of the report. That is a matter of concern.
Nevertheless, the essence of the proposal is that Barking, Havering and Redbridge trust will be completely reorganised, because the IRP recommended going ahead with the downgrading of services at King George hospital, despite public opposition and deep concerns.
I have a question. The CQC report was published at 10 o’clock. Is the CQC report consistent with the IRP report and the Secretary of State’s decision? The Secretary of State, having read the CQC report, should have thought hard about whether to endorse the IRP report. The CQC report is absolutely damning about services at Queen’s hospital. It contains some criticisms of King George, principally because that hospital is in the same trust as Queen’s, with the same management, which the report is also strongly critical of. However, of the 73 recommendations in the CQC report, concerning maternity, A and E, children’s services, dealing with complaints from MPs, quality of care, cleanliness and all kinds of other issues, the vast majority relate to the new, five-year-old, private finance initiative-built Queen’s hospital in Romford. The report explicitly says on occasion that the recommendations do not apply to King George and that at King George, there is a different case. We have a series of absolutely damning recommendations relating to the larger hospital in the trust.
I do not wish to go through the report in great detail, as it is a long document. If people are looking for horror reading at Christmas, I recommend taking the report away and reading it. Apart from criticising poor management, it says that some staff, particularly in the maternity services at Queen’s, have very poor attitudes to the patients whom they are treating. It also confirms that attempts to cut the deficit at Barking, Havering and Redbridge trust over the years have led to reductions in the quality of care.
The IRP report also flags up concerns, saying that if the trust drove on with the deficit reduction programme and reduced the number of staff and beds, there could be an issue with quality. Damningly, the report makes it clear that although services at King George were reduced over the years, it has not led to efficiency savings. All it has done is reduce the quality of care in a hospital that serves my constituents and those of a number of other MPs. The cost of doing that has not led to improvements in efficiency; on the contrary, it has contributed to the ongoing deficit problems in the dysfunctional trust.
There we have it. The Secretary of State receives a report from the IRP recommending the endorsement of NHS London’s vision to downgrade services at King George hospital in Ilford. He then receives a report saying that there are two hospitals in the trust, covering 750,000 people in the community in the three boroughs, one of which is doing badly and there are criticisms of the other. He therefore endorses the recommendations to cut the services at the hospital that is doing better, on the aspiration, but with no evidence, that it will lead to a miraculous Stakhanovite improvement in the services at the bigger, supposedly better and more expensive hospital in the long term. You really could not make it up.
The Secretary of State could have delayed his decision on the IRP report. He could have said, “I am concerned about the CQC report and the damning indictment of what is going on at Queen’s hospital. I have waited three months with the report sitting on my desk, and I will wait another year to see whether I am satisfied that the improvements at Queen’s hospital are happening and have happened, that the quality of services provided is sufficient and that there has been an improvement in primary care services, which is also called for in the IRP report.” He could have waited, or he could have said, “I have made an announcement. I am minded to support the recommendations unless there is a significant improvement at Queen’s hospital and other services.”
I am grateful to the hon. Gentleman for giving way, and I hope this reassures him. As he will know from the decision, nothing to do with the IRP proposals will come into effect until the problems highlighted in the CQC report have been remedied, and the time scale for that in many ways fits in with the hon. Gentleman’s point.
I am sorry, but that is not good enough. The Minister gives the impression that the Secretary of State has somehow not “fully supported”—to use his own words—the recommendations. The letter that I have from Heather Mullin of the Health for north east London programme states that the Secretary of State fully supports the recommendations of the IRP.
The hon. Gentleman is making a fallacious point. I have never said that at all. It is quite clear from the letter that my right hon. Friend the Secretary of State sent to him and to other hon. Members that he does. The point that I was making in my intervention is that he said that the IRP proposals should not come into effect until the problems have been sorted out at the two hospitals. I am saying that it has already been accepted that those improvements have to be made prior to the IRP proposals coming into effect, which is what I understood that the hon. Gentleman was saying should happen.
I am saying something different; I am saying that the Secretary of State could have delayed his decision or that he could have said that he was minded to—the words that I used—support the proposals, but would not make a final decision until he was satisfied.
I spoke to people within the Health for north east London programme last week. I asked them what the timetable for the implementation of the proposals was, and they could not tell me. I asked them whether babies will be born at King George hospital, Ilford, in five years’ time, and I was told, “Almost certainly not.” I therefore asked whether babies would be born there in two years’ time, and I was told, “They may be. We have not yet worked out the detail of these proposals. There is still a lot of work to do.”
Perhaps the Minister will be able to help us in his reply, but my understanding is that the business plan put forward by NHS Outer North East London at the end of the summer suggested that, for the finances to stack up, the proposals will have to be implemented by April 2012. If that has been superseded, that is welcome news, but the local information is that the NHS ONEL business plan suggests the closure of the A and E and maternity services by April 2012.
To respond to the hon. Gentleman and the right hon. Member for Barking (Margaret Hodge), I will repeat what I said before, which is that it is of paramount importance that the recommendations and demands of CQC are met before anything happens with the IRP recommendations, because patient safety is paramount. As far as can be assessed, it will probably be two years to get patient safety to the required levels and to address all the problems highlighted in the CQC report. Whatever the hon. Gentleman or the right hon. Lady may have heard from other people, we estimate that the time scale will probably be about two years, because the CQC’s requirements are paramount.
I would like to move on to what the CQC actually said, because it has made several criticisms and expressed deep concern. It will prove difficult for the management of the trust and the present configuration of Queen’s hospital to meet the required improvements within a two-year timetable. My right hon. Friend the Member for Barking and I have visited the hospital, and there are, for example, bottlenecks where people are on trolleys around the corner where they cannot be seen, which is pointed out in the report. There are design faults, and it is a bit like Eros at Piccadilly circus with trolleys suddenly coming from both directions. This newly designed hospital has a level of chaos. Whoever was responsible for signing off the design must have decided that it was an airport rather than a hospital, because the design has big issues—
Before the Minister intervenes, I am criticising the previous Government, the private finance initiative and the people in the consultancies and the private sector who run the PFI and make a huge amount of money from it, for designing a hospital that does not work well. The reports state that. They criticise the bad signage, the design and the way that wards are structured. Queen’s hospital has, for example, areas where children cannot be seen and areas where people wait for more than an hour before being attended to by a nurse or doctor. There is a whole litany of things that relate partly to design, partly to management, partly to staff shortages and partly to other issues at the hospital.
I do not believe that Queen’s hospital can be turned around in the suggested time scale, and that raises wider questions. The CQC wrote to me after I asked for an update following the publication of its report, and I received it yesterday. The update confirms the reasons why it had to intervene, which included the poor performance of the trust in the past and the fact that long-term problems prevented offering care that consistently meets CQC’s essential standards. To be fair, the CQC refers to both hospitals. It continues by saying that they have taken action to mitigate the risk of immediate harm in the short term, which includes reducing births at both Queen’s hospital and King George hospital and transferring caesareans out of the area. When they will be transferred back is an interesting question, which we can perhaps come to later. The update also states that the CQC met many staff and patients and that their concerns were made known, but the nub of the issue is that if improvements are not forthcoming, the CQC is prepared to restrict access to or close services that appear to be basically unsustainable. It then states that the CQC is not responsible for service reconfiguration.
The CQC, therefore, is not yet convinced that the 74 improvements that it has requested will be met. The final paragraph in the letter to me states that the CQC has set out 16 key recommendations that must be fulfilled by the trust and that it will monitor their implementation, but it admits that the trust needs help from organisations in the local health economy such as NHS London and commissioners and that the necessary significant changes are likely to challenge both clinical flows and trust finances.
There it is. We have problems with capacity and money, and we have a decision from the IRP and the Secretary of State to downgrade King George hospital, but serious concerns remain about Queen’s hospital. Are we confident that within two years those problems will have been addressed sufficiently well, at a time when there are financial problems; that Queen’s hospital will suddenly have been turned around, so that it is such a fantastic place that my constituents and the constituents of my neighbouring MPs—my right hon. Friend the Member for Barking and my hon. Friend the Member for Dagenham and Rainham—will feel happy to go into it to give birth to their children? I already have constituents expressing concerns because of the media reports and other things that are going on.
The CQC report points out that in the past there were more than 2,000 births a year in the King George hospital; at one time, there were 2,500 births a year. However, those numbers were deliberately run down by the trust to around 1,300 births a year. Then, a few months ago, the trust began to push the numbers up again, because Queen’s hospital could not cope. Within two years of now, the capacity for births at King George hospital—a capacity of around 2,000 births a year—will go. We are told that some of that capacity will go to a midwife-led birthing unit on the Barking hospital site, where there are currently about 10 births a week, or about 500 births a year. I am told that that figure is the maximum for that unit, although I do not know whether that is accurate. There is no proposal to have a similar unit on the King George site. That idea was floated in the consultation, but it was ruled out.
We have had a maternity hospital in Ilford since 1926; children have been born in that hospital since 1926. But from 2013 there will be no children born in that hospital, even though we have a young population. People in Ilford will be forced to go to the Queen’s hospital, where there is capacity for 9,000 or 10,000 births a year. It will be one of the largest maternity units in the country and it has been described as a “baby factory” in one of the documents that I have referred to this morning. Alternatively, they can go to Newham hospital or Whipps Cross hospital. Apparently, the facilities for babies to be born at Newham hospital or Whipps Cross hospital will be increased, although the cost of doing that is undefined. That will happen, while the perfectly good maternity service that exists in Ilford at King George hospital is being run down. My constituents will have to travel to Havering or to Whipps Cross. It is not easy to get to Whipps Cross from Ilford lane; the route is complicated and there are sometimes lots of traffic problems. There will be concerns about that.
Interestingly, Havering has the oldest population of any London borough; that is pointed out in the IRP report. The boroughs with the youngest populations in London are Barking and Dagenham, and Redbridge. So we have this huge increase in young people in north-east London, but their hospital will not be in the communities where they live. I could understand it if we had had a hospital at Queen’s hospital that provided long-term care for people suffering from long-term illnesses, mental health problems and so on, and if we had our maternity hospital in the area where most of the births were taking place. But oh no—the IRP, Health for north east London and the Government do it the other way round. We pointed that out in the consultation and the local MPs and councillors kept making these points, but we have been ignored.
Mr Brady, I am conscious of the time and that other Members wish to speak, so I simply want to get back to the CQC. I have been told that the CQC will review in March 2012 whether or not the Barking, Havering and Redbridge University Hospitals NHS Trust is delivering improvements. The CQC says:
“If we do not see improvements, we are prepared to take further action to restrict and ultimately close services that do not deliver care that meets our essential standards of safety and quality, and that present risks to people using services.”
That review is due to take place in March 2012, which is not very far away. It is not two years away; it is just a few months away.
I hope that the quality of care at Queen’s hospital improves sufficiently; I hope that services at King George hospital are not run down by surreptitious salami-slicing cuts in preparation for the implementation of Health for north east London’s plans, as they have been for several years now; and I hope that quality of patient care and treatment for my constituents is put ahead of the bean-counting desire to reduce the deficit at the Barking, Havering and Redbridge University Hospitals NHS Trust.
However, I am not confident that those things will happen. I am extremely angry at the betrayal of my constituents by the bureaucracy in Health for north east London; by the Minister, who said before the general election last year that there would be no top-down reorganisation; and by others, who said that they would keep district general hospitals open and that those hospitals should not close. The Prime Minister said that in 2007. In 2009, he promised “a bare-knuckle fight”. That was in the context of Chase Farm hospital, but the principles involved are the same. I feel that we have been betrayed and that our services are going to be reduced, and I fear the consequences of that for my constituents.
It may be helpful for right hon. and hon. Members to know that I anticipate taking Front-Bench contributions from 10.40 am. Colleagues can work out for themselves that we may be able to get everyone in to speak if speeches are reasonably short.
I am grateful for the opportunity to speak in this debate.
Before I talk about anything to do with the hospitals that we are discussing today, we should praise the doctors, the nurses and the back-up staff at Barking, Havering and Redbridge University Hospitals NHS Trust. After everything that has happened in these last few weeks, particularly the reports on the trust, morale must be pretty low. I do not believe that those staff are to blame for the problems at the trust. I believe that criticisms of staff can be made and that there are things that need to be learned, but I also believe that the fault for the problems lies much more with the previous senior management at the trust than with the doctors, nurses, back-up staff and front-line staff. Of course, recommendations for improvements have been made, but those staff took their orders from others and we should try to build morale rather than knock it down. That is what I genuinely feel.
I, along with other right hon. and hon. Members in our local area, thought that the Care Quality Commission report was going to be bad, but I did not think for one moment that it would be quite as bad as it turned out to be. It was damning of just about everything. It was probably easier to see what was right than what was wrong, because the good points were fewer than the bad ones.
I will talk about the CQC report in depth, and at this point I want to mention that I am talking on my own behalf and that of my hon. Friend the Member for Hornchurch and Upminster (Angela Watkinson), who is a Government Whip and therefore is unable to speak in this debate. If she disagrees with anything I say, I am sorry but that is too bad. The damning report by the CQC was ostensibly of Queen’s hospital, but it also points the finger at King George hospital. As with the independent reconfiguration panel report, I was disappointed, upset and angry that the decision that was made had been taken.
I will begin with accident and emergency. In my own constituency of Ilford, North, I believe that a large additional burden will be placed on Whipps Cross hospital. My guess is that in an emergency, people from wards such as Woodford Bridge, Fairlop and Fullwell will go to that hospital, rather than cross the A12 right the way through to Queen’s hospital, so there will be a major problem at Whipps Cross.
The CQC report and the letters that I have received say that, that owing to the pressure of our one-paragraph “Save King George Hospital” campaign, the urgent care centre will now be manned by doctors, nurses and some specialists 24/7, 365 days a year. I acknowledge that, and I am grateful for it. However, in his response to the debate, will the Minister say whether we can look at taking the next step and going a bit further to make that urgent care centre an A and E department.
Regarding maternity services, during the consultation I had a meeting at Barking, Havering and Redbridge University Hospitals NHS Trust, and I believe that the hon. Member for Ilford South (Mike Gapes) had a similar meeting, although we were not allowed to have meetings together, for whatever reason. It was hinted—quite strongly—that a birthing unit would remain, in some shape or form, at King George hospital. I do not know what happened to that idea, but I would like it to be considered, because it came through loud and clear at the meeting that I attended.
I recall the conversation that I had very well. I was told that the local trust wanted to have the birthing unit, but that they had to get the approval of NHS London and that, as usual with regard to services in Ilford, NHS London’s bureaucracy was less inclined to go along with it.
I thank the hon. Gentleman for that intervention.
I want to praise the hospital’s new management. Averil Dongworth is doing a good job with her staff. She inherited a difficult situation, with a £117 million deficit and low morale, and she should be praised for doing her utmost to turn things around. The CQC report stated that things had improved over the past months.
The hon. Gentleman said that there are 265,000 people in the London borough of Redbridge alone and, given the amount of new build that has outline or detailed planning permission, the population is going to grow considerably. I understand that the situation is similar in Barking and Dagenham, and it is estimated that the area could grow by about 50,000 people in the next five years or so. When I met with the independent reconfiguration panel and the CQC, I mentioned that issue in relation to my own constituency, and I am sure that colleagues have also done so.
On the ballot of GPs that did not take place, GPs were consulted and the report says that they gave their blessing to what was happening. However, that seems to contradict what I heard from a number of GPs who contacted me in private, as they made it clear that although they did not feel confident enough to make their views public they had grave concerns. I know that that is anecdotal, but I want to put it on the record. It certainly happened with me; I know not whether it happened with other Members, but I would be surprised if it had not.
I think that it is fair to say that the private finance initiative at Queen’s hospital has been a failure. It was badly negotiated—the hon. Gentleman acknowledged that that was done by the previous Government and not the current one—it was a bad deal; it was badly set out and there are grave concerns. I understand that the planning applications for the new units that would need to be built at Queen’s have not even gone in, and are unlikely to do so before the new year. The time scale for the build ties in with the two years the Minister mentioned earlier, so that would obviously be a constraint.
In a letter to the hon. Gentleman, we heard that the CQC would undertake a re-evaluation in March 2012. I urge it to make a full report before any changes are made—in two years’ time or whenever—to say, “Yes, we are satisfied that our 73 points of concern have been rectified.”
As my hon. Friend will appreciate, the CQC is independent of the Department of Health, because it is a regulatory body that is concerned with standards of quality. Knowing how it works, however, I have no doubt that on an ongoing basis it will look closely at ensuring that its recommendations are implemented and the required standards for people in that community are reached.
I thank the Minister. I am sure that the CQC will take note of what the Minister, other colleagues and I say in this debate. I have presented petitions signed by a total of 39,000 people, and other Members have presented petitions directly to Downing street; via our local Ilford Recorder, to which I pay tribute for its continued campaign; and in other ways. I am sure that it is an underestimate to say that there must have been a total of 50,000-plus signatures.
My arithmetic shows why I will probably never be in the Treasury. None the less, a huge number of people have signed petitions.
I ask the Minister to take on board the fact that there is cross-party support for keeping the services that our constituents need at King George’s, and to consider upgrading the urgent care centre by renaming it an A and E and adding a little to it—I do not ask for a lot in life—and a birthing unit at King George’s.
I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this debate and on giving us the opportunity to comment on something that impacts on all constituents of all hon. Members participating today.
I am really disappointed, because I feel that the Minister and his Secretary of State have reneged on promises that he gave to my constituents before the election. First, he said that he would never close the A and E, and we all know that the closure of such a department means the closure of a hospital over time, because most patients who go through a hospital come in that way. Secondly, he said that there would be more money in real terms for the NHS. Sadly, that is not true either, and it is impacting dreadfully—[Interruption.] The Minister can reply if he wishes. A 0.1% increase in cash terms is not real-terms growth, especially when inflation is running at about 5%. Thirdly, he promised no more top-down reorganisation. In north-east London, we are suffering from his reneging on those three promises. He must listen to that, because it has a terrible impact on the quality of the health service offered to my constituents. I have said to him privately, and will say to him publicly, that that will grow health inequalities in London.
I do not want to repeat what others have said about the Care Quality Commission. What I will say is that a lot of emphasis has been placed on confidence in the new management at Queen’s. I am on my fifth chief executive there, and every time a new one arrives, I think, “Perhaps this one will be a little better.” The new chief executive has been in place for six months, and so far I am not sure about that confidence. If one looks at the maternity services, why in September did we suddenly see elective caesareans being transferred from Queen’s to the London hospital? None of us knew why; none of us could understand it; none of us was told the reason, but it was because the CQC went back into the maternity unit because it was so bad and threatened to close the entire unit. The only way for the hospital to maintain the unit was for it to accept that caesareans should be transferred. The teams were not talking to each other; people were not taking responsibility, and no one was putting the patient at the heart of care, but the required cultural change has not occurred. Yes, new midwives are being recruited, but not at the right grade and not to manage the unit. The Minister is putting too much on Averil Dongworth, because she will not be able to turn around those cultural issues. The record so far shows that she does not share information freely, particularly with Members of Parliament, and that she has not done much.
The most recent case that I have had at the unit is an anonymous one—the woman does not want to reveal her name, although the case will be investigated. This mother was left for hours without being checked on, and it was her mother—the grandmother—who had to look after her. She was almost lifeless and delirious, and she was discharged without anyone checking her scar from the cuts she was given or changing her dressing. She was asked to give water samples, but they were left in the bathroom and were still there when she left, which is just not on. Queen’s provides facilities for 7,000 births, and if the proposals go ahead that will increase to 9,000, making it the biggest single maternity unit in the country. Given the quality of care, the problems faced and the population growth, it is sheer madness to go ahead with a proposition that closes a hospital in this area of London.
Perhaps the Minister will give us some words of comfort about the finances. The trust’s finances have been in a mess for ever, since well before the Labour Government came into office. I assure the Minister that when I became a Member of Parliament in 1994 there was already a deficit in the trust. David Varney, a well-respected and talented man with a lot of experience, was chairman of the trust although for a very short time, and I breathed an enormous sigh of relief that at last we had someone there who could sort the trust out. He went to NHS London and said, “Write off the debt, give me a blank sheet of paper and I’ll provide you with a decent health service within budget.” NHS London refused, so David Varney walked away. That was a tragedy for the people of that part of London, and such tragedies will continue to be repeated. The problems will not be sorted out until somebody grasps them properly and says, “Right, we will do something about the finances,” enabling the trust to run a decent service within budget rather than always chasing a deficit.
One thing about the CQC report that has not been raised is that it is about not only maternity but accident and emergency. One of the most shocking things, for me, involves radiology. The results of scans are just sitting around. Some scans show a possibility of cancer, but individuals are seen so late that the cancer has grown. People’s lives are being threatened and death warrants are being written simply because the hospital has no systems to transfer knowledge from a scan to a consultant who can quickly pick up on the symptoms and deal with the patient.
That is awful, as is the fact that people sit in theatre all the time. The fact that A and E is bound to be bad again this winter is awful. The fact that proper records are not kept of who has had cannulas inserted for treatment is awful. The culture throughout the hospital is awful, and it seems to me that it will take a heck of a lot more than Averil Dongworth, whose only record is the closure of Chase Farm hospital, to turn that around.
I am conscious of time. I campaigned for years to reopen a birthing unit at Barking hospital, for all sorts of reasons, including pressure on Queen’s, population growth and the fact that I wanted babies to be born in Barking again. I was grateful when it was finally built. Those hospital beds have been ready for occupation since March this year, but they are still not occupied. When I last asked NHS London what was happening, I was told that the unit would be open by March next year. That is a 12-month wait. If the hospital is kept empty, £1 million in costs for security, electricity, heating and so on will go down the drain each year. Now the deadline has changed from next March to next spring.
That is absolute madness. There is pressure on Queen’s. Queen’s is failing to deliver, so people are being sent to London, while a brand-new facility that could provide for many more births than my hon. Friend the Member for Ilford South has suggested stands empty. Will the Minister give us an assurance that the unit will be open not next spring but by Christmas, so that people in my constituency can have hope?
The decision whether to close the A and E at King George hospital was predicated on the idea that fewer people should go to A and E; I agree. If and when the Minister can demonstrate to me and other Members of Parliament that fewer people are actually going to A and E, maybe we can have a serious conversation about whether that part of north-east London has too many hospital places. The reality is that we have a mobile and transient population, many of whom have not registered with a GP and who, if they want to access health care, go first to A and E.
Another reality is that GP and community services also have issues. Before taking a decision, is the Minister willing to do a comprehensive inspection of GP services in my area to ensure that they can fulfil the demands on them, as the decision to close assumes they can? If GP services prove to be up to scratch, again, I am willing to enter into conversation with him about whether there are too many hospital places. However, at present, he is letting down the people in my borough.
Time and again people say to me, “I rang the GP at 6.30 in the evening. He said to ring back the following morning. I rang at 8 o’clock in the morning, and I couldn’t get through. By that time, I felt that the only way to be seen was to go to A and E.” [Interruption.] The Minister looks at me in amazement. That is the reality on the ground.
Making a political point does not get at what is happening in practice. It is not about the contract; it is about the practice, attitude and culture in the whole NHS economy in our part of north-east London. That is the problem that the Minister must tackle. Making a cheap political point does not help make any advances in the quality of health care in my quarter of London, for which he is responsible.
Finally—I have said this to the Minister privately, and I will say it publicly—there is inequality in health care across London. The teaching hospitals in the heart of London take away necessary resources from outer London, whether north-east or south-east. If Queen’s becomes the only hospital in our part of London, it will have to meet the health needs of 500,000 people, according to the CQC. The catchment area in inner London has a population of about 200,000. It is completely different.
I have spent my whole adult life bringing up my children in north London. The catchment area where I live has four hospitals that I can reach within 10 minutes and that provide excellent health care for me and my family. In north-east London, where I work, if King George hospital closes, it will take those who live on the Thames View estate an hour and a half on three buses to get to Queen’s hospital. People with weekly hospital appointments will not go. With the greatest respect to the Minister, that means that they will die earlier. His Government have said that they want to tackle health inequalities. Our Government tried to tackle them, but did not make much progress. Those health inequalities will grow.
Why does the Minister not take a bold move and consider the configuration of teaching hospitals in inner London? For example, the Royal Free hospital is not a good hospital. The physical building is terrible, and it sits on an extremely valuable site that would do a lot to sort out the financial situation faced by the NHS, but some talented and good people with the right culture and attitude work there. Those people ought to be working in areas of health need, such as our bit of north-east London. They should be operating out of the brand-new Queen’s hospital on the Romford site. If he did something radical and sensible like that, it would improve health outcomes for people in my constituency. It would also help him tackle some of the financial problems that he faces, and it would make sense in terms of tackling health inequalities across the capital.
I echo every point made by my right hon. Friend the Member for Barking (Margaret Hodge) in her powerful speech, which I think will resonate with the local community. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this debate and on the extensive speech that he made, as did the hon. Member for Ilford North (Mr Scott). There is total agreement across the aisle on issues of local concern about the provision of health care in north-east London and the sub-region. I will not repeat the points made, but I will emphasise a couple of them, especially about the pressure on Queen’s hospital if the King George closes. Those points are echoed in the report, and I will touch on them.
I welcome the Care Quality Commission’s investigation of Queen’s hospital. I recognise that it must have been a stressful and worrying time for many people involved, but it is definitely a process that we needed to go through. The report has 16 key recommendations for the future, and I, like my colleagues, will support the chief executive and her staff in trying to meet them. I have major concerns, however, about how the two reports will affect each other, specifically in relation to Queen’s hospital. Many of my constituents are extremely worried about the proposals to close the A and E and maternity services at King George hospital, especially when the only alternative for them is to go to Queen’s hospital.
Some figures have not been cited this morning, but they are worth rehearsing. According to page 26 of the independent reconfiguration panel report, planned activity for 2011 for Queen’s hospital is 885,511 people, while for King George hospital it is 284,459. The combined total of 1,169,970 people simply cannot be treated by Queen’s hospital alone. A 24% increase in patient numbers will result in havoc in a hospital that is struggling to cope with its current intake of patients. The estimated increases from 2010 to 2017 of 12.5% in the Barking and Dagenham primary care trust and of 5.7% in Havering PCT demonstrate that the acute sector in the sub-region has a serious structural problem, and closing the services at King George hospital will do nothing to help.
The question of the structural debt has been raised throughout the debate. The trust is clearly suffering from its escalating debts. From 2005-06 to 2009-10, the trust debts rose from £16 million to £117 million. Those levels will only increase and make any future improvements very difficult to sustain. That takes us back to the changes in the staffing of people who were keen to remove some of the structural debts to resolve some of the health problems that we have seen over the past few years, but who have since departed because they did not receive the support that they desperately needed to secure that.
I want to touch on the four general issues in the CQC report. First, capacity at Queen’s hospital is already too high for hospital staff to cope. The report states:
“An independent review of maternity services at the trust was undertaken at the beginning of 2011, which concluded that ‘Capacity at Queen’s is of major concern to the review team’. The recommendations from this review included the need to develop measures to ease the capacity at Queen’s, including ‘an impact assessment of the changes at KGH. It should also include an updated Escalation Plan, with clear indicators relating to capping numbers at Queen’s and temporary closure if required in the interests of patient safety’.”
Nevertheless, the Health Secretary is looking to increasing capacity further. Does the Department not understand what multiple panels are recommending to it?
Secondly, on demographic changes, which have also been mentioned, the IRP’s decision to transfer maternity services to Queen’s hospital seems peculiar, given that the CQC report states that
“King George Hospital is geographically located for the populations of Barking and Dagenham and Redbridge,”
an area with an expanding, multicultural and relatively young population and a high level of teenage pregnancies. Under the IRP’s recommendations, however, provision of maternity services would be predominantly from Queen’s hospital. Moreover, as has been mentioned, a third of the population of Havering is over the age of 65, which means a different health profile and different needs in the sub-region that cannot be catered for solely by Queen’s hospital. With people living longer and the population growing at an ever-increasing rate, the number of patients presenting at Queen’s hospital will increase year on year, and it is very unlikely that it will be able to manage these levels in five, 10 or even 15 years’ time.
Thirdly, on travel, it does not help the fears of local residents that, historically, transport links between the hospitals have been incredibly poor. My right hon. Friend the Member for Barking has mentioned the Thames View estate. It can easily take someone living on the other side of Ilford up to an hour and a half to get to Queen’s hospital, as opposed to 20 minutes or less to get to King George hospital.
I travel to Queen’s hospital by public transport. If people get the train from Ilford to Romford and come out of the station, they will see that two buses on one side of the road go in one direction to Queen’s hospital, and that two buses on the other side go in the other direction. I have been pressing for years for proper signage at Romford station, and, while various chief executives of the trust have said that they will do it, they still have not done so. The links for people who have to rely on public transport to get to Queen’s hospital are appalling.
I agree. The point has been made in Havering, Barking and Dagenham, and Waltham Forest, as well as Redbridge.
The fourth point relates to evidence of no gains from the previous transfer of services in the sub-region. There has already been a long, ongoing transfer of services form King George hospital to Queen’s hospital, but the efficiency gains that were predicted have not occurred, as my hon. Friend has said. What are the guarantees that any future transfer of resources will lead to such efficiency gains? What is the correct move for both hospitals and the wider trust to see a rise in standards and for the faith of local residents to be restored in their local NHS trust? If that is to be achieved, King George hospital’s A and E and maternity services simply cannot close. It would go against all logic suggested by the CQC report and cause no end of damage to the confidence of residents in their local hospitals. I urge the Government to step in and implement the CQC report and hold back the IRP report, until we can re-evaluate after the CQC has been able to see whether its initial recommendations have been met.
My right hon. Friend the Member for Barking has talked about one case that was recently brought to her attention. All local MPs have a series of cases that are equally dramatic and heart-rending. A few hours after the two reports were published on 27 October, I received this e-mail:
“Just wanted to give an example of what could happen if the above A&E is closed.”
The correspondent is referring to King George hospital. They continue:
“Two weeks ago I had to take my eldest daughter to Queens as she thought she was having an early miscarriage. All the spaces in the Early Pregnancy Unit were full, (apparently they even called in the consultants), we had to wait in the A&E department for approximately 7 hours before she was seen by a doctor, she could not have a scan as there were 15 women in the unit which meant it was full, so she was sent away and told that there was no point in returning at 9am as they had a full unit to clear before they could see her. We tried to arrange a private scan but were unable to do so (not that we are awash with money but she was distraught). Homerton agreed to see her and scan her and we are returning there tomorrow, unfortunately we are almost certain that she has lost a much wanted baby.
How is Queens going to cope if King Georges is closed as they are not coping now?”
Overall, such reports confirm what all the local MPs have known for years about the standards of care throughout the sub-region. The pressures are growing. Extra capacity is needed and should not be cut.
I welcome you to the Chair, Mr Brady, and congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate on the issues facing his local hospitals. I know that he, my right hon. and hon. Friends, and other Members across the party divide have campaigned extensively for their local health services, and I commend them for it.
The Government are implementing a number of much wider changes in the health service—I will touch on those later—but my hon. Friend must be disappointed with the recent decisions made about the hospitals in his area and the health services used by his constituents. He and others have mentioned the recent Care Quality Commission report on the standard of care received by people under Barking, Havering and Redbridge University Hospitals NHS Trust. The report had immediate concerns in relation to maternity services, identified failings in emergency care and radiology, and demanded widespread improvement.
As Members have mentioned, Queen’s hospital had the most serious concerns, including poor clinical care, verbally abusive and unprofessional behaviour by staff towards patients and colleagues, and a lack of learning from maternal deaths and incidents. The report states:
“Despite some signs of improvement in recent months, patients remain at risk of poor care in this trust”.
It also notes that the trust addresses issues on a short-term basis, under instruction, rather than proactively looking for longer term solutions. The report also states:
“There is past and current evidence of poor leadership from some managers and a culture among some staff of poor attitude and a lack of care for patients, especially in maternity.”
That is of extreme concern, and those views have been reinforced in this debate. The report also confirmed that attempts to cut the financial deficit at Barking, Havering and Redbridge trust led to reductions in the quality of care.
About three hours after the CQC report was published, the Health Secretary made an announcement about King George hospital, which now looks set to lose its A and E and maternity units. We know that the Health Secretary backed the IRP’s proposal for services to be expanded at nearby Queen’s hospital in Romford. That raises the question why, when the report on King George hospital was presented to the Secretary of State on 22 July, it then sat on his desk for more than three months and he chose to release its conclusions and recommendations on the same day, three hours after the CQC report.
From articles in the Ilford Recorder, in the constituency of my hon. Friend the Member for Ilford South, I see that there is a great deal of concern and consternation about that decision. Indeed, my right hon. Friend the Member for Barking (Margaret Hodge) described the decision in the press as “sheer madness”, outlining how Queen’s hospital is already having difficulty dealing with existing pressures—an issue which she raised today. My hon. Friend the Member for Ilford South previously described the decision as a disaster and is quoted in the Ilford Recorder as saying that the decision on King George hospital showed an
“absolutely contemptuous attitude to local people’s wishes and concerns”.
The proposed changes will not take place until the Barking, Havering and Redbridge University Hospitals NHS Trust, which runs both sites, tackles the issues raised by the CQC. The Minister went into a little more detail about that in the debate. However, it is not just the disruption, but the uncertainty of local people, who will no longer have access to A and E and maternity services on their doorstep, that should be of concern to all hon. Members.
Yes, we need to acknowledge that reconfigurations are unpopular. We went through that a few years ago in Greater Manchester. Nevertheless, given public opposition and the views of the overview and scrutiny panel, local MPs and members of the local authorities across party, will the Minister say what account has been taken of the level of local opinion on the local health services by the IRP? My hon. Friend says that it was in its report, but what weight did the IRP and the Secretary of State give to that level of opinion?
May I help the shadow Minister? The consultations—not on the IRP level when it was doing its work, but on the proposals themselves—have, since 20 March 2010, had to fulfil the four conditions for reconfigurations set out by my right hon. Friend the Secretary of State, which include consulting local people within the health economy and local opinion.
Absolutely. We recognise that reconfiguration is sometimes necessary in parts of the country for reasons of financial efficiency, safety and better health outcomes. However, people are rightly disappointed by the way in which the nature of the debate changed in the run-up to the general election. As hon. Members rightly said, the general election was fought with a pledge about hospital closures and reconfigurations that is not being met. Back in 2010, the now Prime Minister clearly promised a moratorium to stop closures. Indeed, in opposition both he and the Secretary of State toured the country making promises to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.
I do not want to stray too far from the subject, but it is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011 the Secretary of State accepted the recommendations of the IRP and approved the downgrading and closure of services at Chase Farm. Similarly, at the Fairfield maternity department near Bury, we were told on a visit by the now Secretary of State that the service would be kept open. We now know that the maternity department at Fairfield general hospital is scheduled to close in March 2012.
My hon. Friend the Member for Ilford South raised concerns about the ability of Queen’s hospital to improve when the NHS faces tough financial challenges in the years ahead. That is fair comment. At the general election, Labour promised to guarantee to maintain NHS front-line funding in real terms. In contrast, the Prime Minister offered real-terms increases. We can debate that another time, but I would suggest that that was just an electoral gimmick. The Treasury figures show that in 2009-10 health spending was £102,751 million in the last year of the Labour Government. In 2010-11, actual health spending was £101,985 million.
Will the hon. Gentleman be kind enough to tell hon. Members that the health spending figures for the financial year 2010-11 were set by his own Government, and that, for the lifetime of this Parliament and thereafter, we are increasing health spending in real terms, albeit a modest increase because of the financial mess we inherited, which needs to be sorted out?
I said that that was the actual health spend for the first year of this Government, which represents a real-terms cut of £766 million, according to Treasury figures. That includes the GDP deflator, which so excited the Minister during the Opposition day debate when my hon. Friend the Member for Leicester West (Liz Kendall) tried to raise this issue. That is the first cut in health spending for 14 years. Indeed, that is the first real-terms cut since the last year of the previous Conservative Government in 1996-97. The Government promised a real-terms increase in health spending; they have delivered a real-terms cut.
There are wider concerns about how the Health and Social Care Bill will impact on local health services. The extensive reorganisation of the NHS was not put forward by either party in government in their manifestos, or in the coalition agreement. Clearly, such a massive reorganisation will make it harder for the NHS to tackle the sorts of problems identified at Barking, Havering and Redbridge University Hospitals NHS Trust, and the wider issue of social care for older people by the CQC. The Prime Minister has clearly gone back on his promise on NHS reorganisation. The coalition agreement could not have been any clearer:
“We will stop the top-down reorganisations of the NHS”.
It is difficult to see how the coalition Government could have said that, when only weeks later they published a White Paper outlining the biggest reorganisation of the NHS since 1948. It is clear that such a change on this scale is the last thing that the NHS needs right now.
Returning to the more specific question about Barking, Havering and Redbridge trust and the future of King George hospital, given the CQC report and what hon. Members have said today, what consideration has the Minister given to the ability of Queen’s hospital to deal with the added pressures on its services when King George hospital closes its A and E and maternity services? On the face of it, no consideration has been given to the local support for keeping A and E and maternity services at King George hospital. If services are to be transferred—the Minister says within two years—does he recognise that people need certainty and that NHS staff need proper expectations to plan and manage those changes? If those time scales are not met, what plans are in place for NHS services in that part of London?
The concerns expressed by Members today are right and need to be addressed by the Minister. Also, the wider changes to the NHS will make it much harder to identify such failures in care in future and to deal with them effectively. That is why we are so against what the Government are doing to our national health service.
It is a pleasure to serve under your chairmanship today, Mr Brady.
I congratulate the hon. Member for Ilford South (Mike Gapes) on securing the debate because, from personal experience in a previous debate and from meetings, I know that he and other right hon. and hon. Members have a tremendous interest in, and concern about, securing the highest-quality health care for their constituents. I share their desire for excellent health services in hospitals and in the community, whether in Barking, Dagenham, Ilford or elsewhere in London and the country. That is why it is so important that the issues raised by the Care Quality Commission’s investigation into Barking, Havering and Redbridge University Hospitals NHS Trust are acted on immediately and that safe services are realised and sustained.
Before I go on, I extend my sympathies to anyone who has experienced poor care at the trust. We can all be united in our concern and, in certain cases, even horror at what the CQC report showed. It is unacceptable in this day and age for services to deteriorate to that level, with such low-quality patient care. The improvement of the quality of care in that area and throughout the NHS is crucial—it is imperative and a priority. I can assure right hon. and hon. Members that the Secretary of State, my ministerial colleagues and I take such issues every bit as seriously as they do.
Although the CQC report identified some risk of poor care throughout the trust, it is the maternity service that requires immediate action and where the biggest risk of poor care was identified. The local NHS has taken immediate action at the trust to ensure that services are safe. NHS London and the Outer North East London PCT cluster have been working in collaboration with the trust to manage capacity and demand, to support its clinical leadership and to address the gaps in capability.
Since the right hon. Lady has specifically mentioned it, I will discuss that now, instead of later as I had intended. There is a plan to move the midwifery-led unit services into Barking hospital; that is a continuing, high priority for the hospital, and currently I believe that capacity is about 50%. [Interruption] She ought to have waited until she had heard the end of my answer. If she wants to intervene again, I point out that I have only been left seven minutes and there is a lot to deal with. However, it is not for me in Whitehall to micro-manage decisions; services and the speed at which services are provided must be a local decision by the local health economy. The only assurance that I can give—it is an assurance—is that the MLU is a priority for the hospital. I am advised that the whole service is expected to be provided at Barking hospital by April 2012, which I think is the date given to the right hon. Lady.
NHS London continues to monitor closely the actions taken in the local NHS, including twice-weekly discussions with all key stakeholders, as well as regular meetings with the PCT cluster, the trust and NHS London’s performance and chief nurse’s teams. Some concrete actions, which I hope reassure right hon. and hon. Members, have already been taken. To ensure safety, NHS London, PCTs and the trust decided to cap the number of deliveries to 20 a day at Queen’s and seven a day at King George from the beginning of October. In collaboration with the South West Essex commissioning cluster, a number of women with Essex postcodes due to give birth at Queen’s or King George will give, and have given, birth in hospitals in Essex instead. Additional, part-time professionals are being brought in—including the well-respected head of midwifery from the Royal Free hospital—to support the maternity unit until substantive leadership can be appointed.
Five supervisors of midwives from surrounding trusts have agreed to support the team at Queen’s. A senior obstetrician has been recruited and will begin working with the trust shortly. Given CQC concerns about the number of vacancies and the skill mix in the maternity work force, NHS London’s chief nurse has set up a midwifery leadership scheme to attract 12 experienced midwives to the trust. For an initial period of eight weeks, Caesarean sections have been transferred from the trust to Homerton university hospital in Hackney. All such actions are having an immediate impact on the ground and protect patients.
In February of this year, the trust gained a new chief executive, Ms Dongworth. The CQC and NHS London have confidence in her and have given her their full support. The CQC reported:
“Almost without exception, staff were positive about the impact the new Chief Executive is having at the Trust. They have embraced the Chief Executive’s inclusive style and believe, for the first time in many years, that there is a real opportunity for positive change.”
It is my belief that such positive leadership can help the trust to move forward from the report and to continue to make the improvements that are so badly needed. A recruitment drive has already brought in an additional 72 midwives, enabling the trust to have one of the best midwife-to-birth ratios anywhere in London, and one of the highest levels of senior doctor cover. There is now regular, independent monitoring of performance every week. The trust has made it absolutely clear that continuing to improve is its top priority. All local NHS partners are committed to making that happen. The Secretary of State will also actively monitor developments.
I now pick up on a point made by my hon. Friend the Member for Ilford North (Mr Scott) which, to be fair, I think was a special plea about his urgent care centre. The urgent care centre at King George’s will see the majority of patients who already attend. I must advise my hon. Friend that few blue-light cases are actually taken to that unit. He might have been hoping that I would do something to upgrade the centre to an accident and emergency unit, but I am afraid that that is not within my remit. However, under the modernisation of the NHS, nothing prevents the clinical commissioning group, when commissioning care for its patients, from looking at the situation if it is so minded. If it wants to commission enhanced care in an urgent care or A and E centre, it has the powers to do so if it wishes. I cannot prejudge what a local CCG might or might not want to commission in the future, but the opportunity is available.
Owing to the shortage of time in the debate, I have not been able to answer all the points made by the hon. Member for Ilford South, or by the right hon. Member for Barking (Margaret Hodge) and the hon. Member for Dagenham and Rainham (Jon Cruddas). I commit to writing to them with the answers to their specific points, made during this interesting and in many ways traumatic debate. I appreciate, as they do as constituency MPs, that it is totally unacceptable to have poor-quality health care for our constituents and for patients within the NHS.