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Unsustainable Provider Regime (NHS)

Volume 554: debated on Wednesday 28 November 2012

Motion made, and Question proposed, That this House do now adjourn.—(Joseph Johnson.)

I am delighted that Mr Speaker has seen fit to grant me this opportunity to raise a matter of considerable importance—in fact, the dominant issue—for my constituency and a large part of south-east London at the moment. The title on the Order Paper is “Unsustainable provider regime and special administration in the NHS”; and I will refer to all the special administrators appointed in the past, as there is only the one.

Last Saturday, along with thousands of other people, I was marching through the centre of Lewisham in the rain with my parliamentary colleagues, my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham East (Heidi Alexander)—they would have liked to be here this evening, but are attending other events relating to the same issue—to Ladywell fields just behind Lewisham hospital.

My experience of marches goes back quite a long way—I have been on a fair number of them in my time—but three factors made this march strikingly different from the usual ones. First, the majority of the marchers were ordinary residents and their families. Secondly, the motorists who were being held up by the march were, more often than not, tooting their horns to show their support for it. Thirdly—I had rarely seen this before—people were joining the march along the way, some of them with young children.

That march took place under the auspices of the Save Lewisham Hospital campaign. The reason for it was that, last July, the then Secretary of State appointed a trust special administrator—to whom I shall refer from now on as the TSA—for the South London Healthcare NHS Trust, under the unsustainable provider regime provided for by the National Health Service Act 2006. The three principal hospitals in the trust are Queen Elizabeth hospital in Woolwich, Princess Royal University hospital in Farnborough, and Queen Mary’s hospital in Sidcup. You will have noted, Madam Deputy Speaker, that Lewisham hospital is not part of the trust for which the TSA was appointed. However, far the most damaging proposals are those that affect that hospital.

The proposals are to close the accident and emergency department, which currently sees more than 120,000 attendances a year, to remove the maternity unit altogether—last year there were 4,500 births there, and the number has been projected to rise to 5,000 in the coming year—and to remove all the medical beds. If these plans were to see the light of day, there would be only one fully functioning accident and emergency unit to serve the three quarters of a million people who live in Bexley, Greenwich and Lewisham. Although there is scope for Lewisham to merge with Queen Elizabeth at Woolwich, it should not be necessary to pay such an extortionate price in terms of services for the people of Lewisham. It is rather as if the administrator for Comet—who, sadly, is having to do his work at the moment—were to decide that the best thing to do for Comet was to shut Currys down. The problem does not lie in Lewisham; it lies in the South London Healthcare NHS Trust.

It is not just the proposals themselves that are making people so angry; it is also the devious and underhand way in which they are being enacted. The last Secretary of State made a written statement last July, when he appointed the TSA. Before that, however, one of the first acts that he had undertaken as Secretary of State, just after the general election in May 2010, was to stop changes that were already taking place for the revitalisation of the South London Healthcare NHS Trust. He had put them on hold, without offering any alternative to a plan that had already been in place for a number of years; the last time the Government reviewed the services was four years ago. Having stopped those changes in their tracks, he then had the temerity to say, when he came to appoint the TSA, that not enough progress was being made to rebalance the trust’s finances.

In his written statement in July, the then Secretary of State said:

“The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration.”—[Official Report, 12 July 2012; Vol. 548, c. 48WS.]

However, that is exactly how it feels and looks in south-east London. There is a widespread feeling, backed by legal opinions, that the TSA does not have the power under the 2006 Act—and the current Secretary of State confirmed during Health questions yesterday that that was the legislation involved—to enforce his recommendations. Yet a “chief executive designate”, whatever one of those might be, is already working for the putative but non-existent joint Queen Elizabeth and Lewisham hospital trust.

The ultimate agreement of the Secretary of State seems to have been taken for granted—unless, of course, his authority is so ill-regarded that it does not matter what he thinks. However, the problem is not with the link between the University Hospital in Lewisham and Queen Elizabeth in Woolwich; rather, it is the intolerable price that the people of Lewisham are being expected to pay in terms of poorer, less accessible and more inconvenient services.

Let us contrast how Lewisham is being treated with how the other hospitals in the group are being treated. The TSA has suggested Queen Mary’s Sidcup should do a deal with Oxleas NHS Foundation Trust, and that is apparently going through without any great problem. The TSA also recommends that King’s College Hospital NHS Foundation Trust should take over the Princess Royal in Farnborough, even though no details whatever have been seen on how King’s would manage the Princess Royal. The arrangements for Lewisham are, however, prescriptive and take up much of the TSA report—and we must, of course, bear in mind that Lewisham hospital is not even part of the same trust.

The most damaging recommendation is that the A and E department at Lewisham should close, followed closely by the proposal to close all maternity services. A little booklet that the trust special administrator has put out says:

“Clearly this recommendation proposes change for University Hospital Lewisham. However, this is less than some may initially think. Based on analysis done by the Trust, it is expected that nearly 80% of patients who currently visit University Hospital Lewisham’s A&E would still be treated at the urgent care centre there in the future. This recommendation is not about ‘closing’ an A&E department but rather making changes to it.”

That is not what happened just over the river at Guy’s when its A and E was closed a few years ago, and it is certainly not what happened when the A and E at Queen Mary’s Sidcup was closed four years ago.

It is also certainly not what the emergency department doctors at Lewisham had to say. Their submission to the trust special administrator states in respect of the

“assumption that 77% of our ED patients can still be seen in the UCC”—

urgent care centre—

“in future: patients in the UHL UCC are seen by combination of”

practice nurses

“GPs and ED doctors between 0800 and 2400hrs…This means patients are seen in our UCC department with problems far greater than those that can be handled in a typical UCC. A standalone UCC will not be able to handle the number or acuity of patient that we presently see…Quite clearly, the 77% figure you have employed is not representative of any realistic future modelling…On review of our case mix, by our estimation at most only 30% of the total attendances to the present-day combined ED and UCC could be safely managed in a standalone UCC.”

That is the view of professional doctors. The TSA’s view is that of a civil servant. We do not need to be terribly perceptive to work out which we should place the greater store by.

The conclusion of the emergency doctors’ statement encapsulates the issue. They state that the TSA suggests that 30% of current presentations will, by some completely magical and invisible formula, be treated in the community, but that has not been achieved anywhere else in the UK and there is no evidence to support the assertion. The TSA is not so foolish as to try to adduce any. Nothing in the report or any of its appendices show how this 30% figure, which represents almost 40,000 people presenting at Lewisham A and E, will be dealt with. Their conclusion is:

“Feedback from our patients, the public and colleagues such as the London Ambulance Service (LAS) tells us that this ED”—

emergency department—

“is incredibly well regarded, and that the public and LAS choose to come here. We believe the implications of this proposal are extremely serious and will detrimentally affect the care and service that is offered to our local community. Concerns over how our patients will be able to access acute services at QEH, and the inevitable impact on an overstretched LAS, have also not been adequately addressed.

It is our opinion that as the draft report has been based on demonstrably incorrect figures and assumptions, its findings cannot be relied upon. An issue as important as the acute care of patients in South-East London cannot be determined by a hasty and flawed process, which was never designed to be used to reconfigure NHS services.

We have no objections to change, and strongly support all moves that propose the safe and effective care of patients. Thus we strongly urge that the proposed merged trusts (QEH and UHL), the local GPs and the wider public be left to decide at a local level how our services should be reconfigured. This would not only be safer and more considered, but would also be in line with the Government’s ethos of greater local control with a patient-centred approach to healthcare.”

That is signed by the four emergency department consultants, including the clinical lead, the two emergency department matrons and the emergency department nurse consultant. Hon. Members would have to agree that that is a damning indictment of what the TSA has been proposing.

As I have just demonstrated, the report’s assumptions, such as they are, are inaccurate, and the figures—even the financial figures—are completely unreliable. The TSA suggests that there is a £1.7 million saving to the Beckenham Beacon, the former Beckenham hospital which is now an urgent care centre predominantly occupied by GPs, but with the support of secondary and ancillary services. The TSA states that £1.7 million can be saved on what the South London Healthcare NHS Trust currently rents at Beckenham Beacon. This is right on the boundary of my constituency and that of the hon. and gallant Member for Beckenham (Bob Stewart); his constituency is on one side of the Croydon road and mine is on the other. People in the area were clearly concerned about the effect on services, so I went to see the putative clinical commissioning group, which takes over next year. It said that it is determined to continue to provide a comparable range of services—it will not be exactly the same as what is there at the moment—that that £1.7 million was only provided to South London Healthcare NHS Trust by the primary care trust previously for commissioning services there and that the CCG will continue commissioning services there. I have asked for exactly what the services will be to be put in writing, but I was told that broadly the CCG will be spending the same. So there is no saving to be had.

All the TSA is saying is that as South London Healthcare NHS Trust will cease to exist, it cannot pay any bills—so far, so bloody obvious. I would have thought it was not worth making the effort, but including this in the financial calculations demonstrates just how unreliable this report is. It is all smoke and mirrors. Given that it was carried out in such a short time and given that this system—the unsustainable provider regime—is not designed to deal with this degree of complexity, it is hardly surprising that it is such a shoddy and unreliable piece of work.

Why then be so prescriptive about what happens at Lewisham, given that in the case of the Princess Royal and Queen Mary’s an altogether more relaxed view is to be taken? The answer can be found on page 41 of the report. I will not wave it at you, Madam Deputy Speaker, but take my word for it. It contains a map of the Lewisham hospital site and it shows that the TSA wants to sell more than two thirds of the whole site. That would leave one building for hospital purposes and one building currently used by South London and Maudsley NHS Foundation Trust, which deals with mental health, so that the rest of the site can be sold off. Doing that will only raise between £17 million and £20 million, but it will close off the options. Once that has been done, Lewisham hospital can never be resuscitated, resurrected or whatever other language we might care to use. To enable the rest of the site, which includes a £12 million redevelopment of accident and emergency and maternity services that was only completed in 2010, to be cleared the TSA suggests that an additional £55 million will need to be spent on extending the riverside block.

The whole riverside block to which the TSA refers was only built six years ago under the private finance initiative and is working pretty well. The whole building only cost £70 million, and the TSA is proposing that £55 million should be spent so that the rest of the site can be cleared and sold for less than £20 million. That is almost unbelievable—it does not make any sense whatsoever. I do not know what will come back from the consultation that is under way.

Right across south-east London there are huge issues with acute services. I know that colleagues raised the matter in Health questions yesterday. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) mentioned the concern about Guy’s and St Thomas’, King’s, South London and Maudsley and King’s college, London—that is the university college, not the hospital—joining together to construct one of the largest trusts in the country. There is deep concern in Southwark and Lambeth about the impact that that could have on services. There is further concern, as I mentioned, in Lewisham, Bexley, Bromley and Greenwich about what else is going on.

I suggest that the Secretary of State parks the consultation. He should note what it says but launch a proper and legal clinical review of services across south-east London, as was conducted just four short years ago, when it was decided that Lewisham could stand on its own and provide decent services for the people of that area. I am not against improving services in Greenwich, Bexley or Bromley. Indeed, I represent the north-west part of Bromley, which sees Lewisham as its local hospital. However, what I cannot see—the TSA cannot convince me of this—is how degrading the services for people in Lewisham benefits anybody. It will not improve the services in Greenwich, Bexley or Bromley, so what is the point?

On 31 October, my hon. Friend the Member for Lewisham East asked the Prime Minister to recall that in 2007 he said that he would be prepared to get into a “bare-knuckle fight” over 29 assorted hospitals, one of which was Lewisham, to protect their A and E. I can tell the Prime Minister that he is in a bare-knuckle fight now over the future of A and E at Lewisham. The fight for Lewisham goes on.

Lewisham hospital has been threatened before, but the people of Lewisham have always fought to save it and they always have. They will again. In his reply to my hon. Friend, the Prime Minister said—this gives me some hope—that

“there will be no changes to NHS configurations unless they have the support of local GPs, unless they have strong public and patient engagement, unless they are backed by sound clinical evidence and unless they provide support for patient choice.”—[Official Report, 31 October 2012; Vol. 552, c. 230.]

I am confident that Lewisham will survive this, because none of those factors is in place at the moment, nor does this process have any legitimacy.

I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and on speaking with such eloquence and passion. That is what one would expect from a Member of this place; we would expect Members to bring to Parliament the concerns and the anger of those whom they represent so that Ministers can hear all that is to be said. In this case, perhaps most importantly, even if the trust special administrator and his team did not hear the hon. Gentleman’s speech they will certainly read it and take it on board.

These matters are always difficult and, as I have mentioned, they make people angry. I hope that the hon. Gentleman’s speech will be reported in his local media and that my remarks might also be reported.

It is important to make it clear—and I hope that the hon. Gentleman will take this back to Lewisham and the people he represents—that this is not a question of cuts. Anyone on a march bearing a banner saying, “Stop the Government cuts” does not represent the situation fairly, and does their cause no great service. It is about how to make sure that people receive the finest health care that can be provided, and that that service is sustainable. As the hon. Gentleman said, it stems from a profound problem at South London Healthcare NHS Trust.

When changes to an NHS service are mooted, people become anxious and feelings run high. This is the first time that the trust special administration regime has been used, so people are anxious, and that has a knock-on effect on patients, staff and members of the public. This may sound like weasel words, but it is important. It would be wrong to comment on specific recommendations of the trust’s special administrator, because the matter is out for public consultation, which closes on 13 December. As the hon. Gentleman explained, the matter will go to the Secretary of State, who will consider the recommendations and the full report. He will make his decision at the beginning of February. At this stage, it is not for Ministers to comment. Our minds must remain completely open.

I want to explain the process. The previous Government created the trust special administration regime in the Health Act 2009. The regime creates a transparent, time-limited process to deal with trusts in failure. We have alluded to that timetable, and have given details of it. A trust special administrator appointed to an NHS trust must make recommendations to the Secretary of State about the future of the organisation and its services. Significantly, they must set out how high-quality services can be provided in a financially and clinically sustainable way. Before making final recommendations to the Secretary of State, the administrator must consult publicly on draft recommendations, and that process has been undertaken. A summary of all consultation responses must be included in the final report to the Secretary of State. I am sure that the hon. Gentleman will ensure that his response and the responses of other MPs representing Lewisham are included in that report.

South London Healthcare NHS Trust was formed in 2009, and it was the product of a merger of three trusts, each with long-standing financial issues. When the Secretary of State appointed the special administrator to the trust in July, it was losing over £1 million a week. Last year, the trust had a deficit of £65million—the largest in the country—which is £65 million a year being taken away from well-run trusts to subsidise one that is clearly failing. There are two private finance initiatives with which the trust is struggling. They are incredibly burdensome, with a cost of £60 million a year.

To be blunt, the situation cannot go on indefinitely. The NHS simply cannot afford to spend huge sums on keeping non-viable organisations afloat. Even if we had all the money in the world, it would not be right to have such a deficit and loss. In my opinion, the Government are to be commended on having the courage to tackle the long-running challenges facing South London Healthcare NHS Trust. Sometimes, tough decisions have to be made to make sure that NHS services are improved and are put on a clinically and financially sustainable footing.

I fully accept that the hon. Gentleman is concerned about the administrator’s recommendations in the draft report that impact on Lewisham Healthcare NHS Trust. The remit of the trust special administrator is to develop recommendations for the Secretary of State on the action that should be taken in relation to South London Healthcare NHS Trust. The aim is to secure the sustainable provision of health services which meet patients’ needs and deliver value for money. For those recommendations to be viable and credible, the trust special administrator must consider all relevant factors, including the intentions of NHS commissioners and the consequential impact on the local health system. This has required him to consider implications for other health care providers that are part of the local health care system. That is why his remit is so large and so broad.

As we all know, an NHS trust does not exist in a vacuum. All trusts are part of a complex, integrated health care system. In making recommendations about South London Healthcare NHS Trust, the trust special administrator must consider the consequences of those recommendations on neighbouring trusts, such as Lewisham, and patients in those neighbouring areas. I am aware that in developing his draft recommendations the trust special administrator has had continuing dialogue with patients and the public, staff, clinicians, local authorities and other partners, and so he should. That is continuing through his public consultation, which is now under way.

In addressing the long-standing challenges facing South London Healthcare NHS Trust, the administrator’s recommendations must take into account the objective of delivering safe, high quality, sustainable health care for the people of south-east London. That, of course, includes Lewisham. To ensure that this happens, he must have regard to the Secretary of State’s four tests for NHS service change when developing his recommendations. Perhaps this may give some comfort to the hon. Gentleman. Those four tests are: support from GP commissioners; the strength of public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Those are four very important principles.

The hon. Gentleman touched on many of those principles. He spoke with passion and some anger. Much of that anger is understandable in all the circumstances. The draft report is out to the public, as I said. I hope that everybody will now engage and make sure that their voice is heard, as individuals or through their elected representatives. The recommendations will go to the Secretary of State, who will consider all of them. He will then make his decision.

Question put and agreed to.

House adjourned.