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South London Healthcare NHS Trust

Volume 556: debated on Tuesday 8 January 2013

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the trust special administrator’s report on South London Healthcare NHS Trust and the NHS in south-east London.

I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to make a decision by 1 February on how best to secure a sustainable future for services provided by the trust.

The trust special administrator began his appointment on 16 July. He published his draft report on 29 October and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the consultation and sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.

I understand the concerns of hon. Members and, indeed, the people living in areas affected by the proposals, especially in Lewisham. They have a right to expect the highest quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view on the report’s recommendations only one day after receiving it.  To do so would be pre-emptive and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.

However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), with respect to any major reconfigurations: the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.

The challenges facing South London Healthcare NHS Trust are complex and long standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust can secure a sustainable future for its services within its existing configuration and organisational form. In appointing a special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services, and I will consider the special administrator’s report with that objective in mind.

I thank the Secretary of State for his reply. Neither I nor my hon. Friends the Members for Lewisham East (Heidi Alexander) and for Lewisham West and Penge (Jim Dowd) are opposed to change or to greater efficiencies, but we are opposed to the destruction of Lewisham hospital, which is a solvent, well-regarded trust that meets all its performance and financial standards.

There is a fundamental question at stake. My right hon. Friend the Member for Leigh (Andy Burnham) has made it clear that the powers associated with the failure regime under which the TSA acts were not intended to be used to encompass the services of other hospitals. Yet in order to tackle the huge financial deficit sustained by South London Healthcare Trust, the TSA proposes to close Lewisham hospital’s accident and emergency services, including the acclaimed children’s A and E, to end all medical and surgical emergency care and to demolish maternity services. He then proposes to sell off half the hospital’s land. That cannot be justified. Each year around 120,000 people use Lewisham A and E, more than 30,000 children use the children’s A and E and more than 4,000 babies are born in the hospital. There is no current capacity at any of the other hospitals in the area to provide for those patients.

These proposals amount to a major reconfiguration by the back door, and they are opposed by virtually all the health professionals in the area and by the people of Lewisham. Does the Secretary of State believe that a reconfiguration of services in south-east London is necessary? If he does, he needs to propose one with the relevant consideration for patient safety and health care standards and that meets his four tests. These proposals do none of that and must be rejected.

First, I want to recognise the right hon. Lady’s real concerns about the proposals that have been made. I also recognise that they reflect the concerns of many of her constituents and, indeed, many people in Lewisham. Her point about scope is one I replied to in my letter to the right hon. Member for Leigh (Andy Burnham) before Christmas. I have taken legal advice on that and been told that under the unsustainable provider regime, which the previous Government put into law, an administrator must initially look at a trust’s defined area, but if they conclude that the defined area is not in itself financially sustainable—they have a duty to come back with a financially sustainable solution—and if it is necessary and consequential, they need to look at a broader area. Of course there is interrelation between different parts of the south-east London health care economy. However, I will be getting fresh legal advice on that point, because I recognise that it is extremely important.

I welcome the fact that the right hon. Lady recognises that changes need to be made. I also hope that she understands that I have a duty to address this issue, which has affected hospitals in the South London Healthcare Trust area for many years. The deficit of the trust amounts to £207 million in the period since it was set up, and that is money that must be taken away from other parts of the NHS. I have a clear duty to address that issue. I will not comment on specific proposals today, but I will be very happy to meet her and her colleagues from Lewisham in order to hear from them directly about their concerns. Indeed, I will be meeting the trust special administrator on 10 January so that I can ask him any questions about his proposals before I make my decision, which must be within 20 working days.

I remind my right hon. Friend that the Beckenham Beacon is not only modern, but extremely central. I stress the incredible value it could have in south London. I very much hope that the services currently provided there will increase, rather than decrease, at the end of this consultation.

I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.

I apologise for missing the start of proceedings on this urgent question.

It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.

However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that

“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”

In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?

As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.

Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.

People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.

We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.

Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.

I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.

The report mentions an increase in elective surgery in Darent Valley hospital—my local hospital, which is just over the Kent border with south London. Although the hospital has enjoyed extra funding from the Government, it still has capacity issues. Will the Secretary of State ensure that the knock-on issues are taken into account before he makes any decision?

My hon. Friend makes a very important point. One of the most important things that I have to consider in the next 20 days is what he describes as the knock-on impact of all the proposed changes. I have a duty to find a solution that is financially and clinically sustainable for the South London Healthcare NHS Trust area. However, I need to consider the knock-on effects everywhere else, including in Lewisham and my hon. Friend’s constituency.

As well as legal advice, I will be seeking clinical advice and want to make sure that my officials agree with the financial considerations made in the report. I will consider all that advice in enormous detail before I come to any decisions.

I am grateful to the Secretary of State for agreeing to meet Members with Lewisham constituencies about this matter. Representatives of the Save Lewisham Hospital campaign, which is made up of local GPs, local hospital doctors and the public, are also very keen to meet the Secretary of State to put our case directly to him about why it is important to retain a full, admitting A and E and full maternity service at Lewisham. Will he agree to meet them?

I want to meet colleagues from the House but, as I am sure the hon. Lady will understand, I want to be careful not to restart the whole consultation process that has been happening in what I believe is a very thorough way in the past few months. However, one of the things that I will be considering very carefully—and I will listen to any points that the hon. Lady makes when I meet her—is whether the consultation has been done properly, as it needs to be done and as was intended by the legislation. I will not accept any changes unless I am satisfied on that point.

I welcome the Secretary of State’s apparently open-minded approach to the proposals, which have caused enormous clinical alarm in our hospitals as well as local concern.

Two particular issues affect my constituents and those of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) in relation to King’s College hospital. I ask the Secretary of State to take them seriously. First, should the proposed closures at Lewisham hospital go ahead, that will impact on the King’s College hospital paediatric A and E, which is already overstretched; the staff have enormous concern about their ability to meet any additional demand.

Secondly, will the Secretary of State agree that discussions currently under way to merge the managements of King’s College hospital with those of Guy’s and St Thomas’s should be suspended while the extensive reorganisation threatens the stability of a number of hospitals? If they were to go ahead in parallel, that would risk engulfing our hospitals with preoccupations about reorganisation rather than there being a focus from our world-class hospital staff in south London on treating the patients that we represent.

The right hon. Lady makes two important points. As she knows, I visited King’s College hospital just before Christmas and was incredibly impressed by what I saw. I visited the geriatric ward and was really impressed, and I am sure that the paediatric service is outstanding as well. It came across to me as an extremely well run hospital. I will, of course, make sure that I consider the impact of the changes proposed by the trust special administrator on King’s, just as I will consider the impact on all surrounding hospitals.

With respect to the merger proposals, because the legislation requires me to come to a decision within 20 working days, the right hon. Lady will find that I have to make and publish my decision quickly enough to ensure that any impact from the changes is properly considered by the people pursuing the possibility of a merger between King’s, Guy’s and Tommy’s.

The Secretary of State will understand that I have not been able to read the entire trust special administrator’s report in the hour or so I have had access to it. However, while I was reading the report, it became clear that a great deal of concern was expressed during the consultation about the implementation of the proposals. Indeed, the report highlights the fact that following previous reorganisations, costs have increased rather than reduced as a result of the very process of reorganisation.

Given those worries, will the Secretary of State agree to meet representatives from other boroughs, who are equally concerned? I remind him that he declined my request for a meeting on the trust special administrator’s draft report; I hope he will not decline to meet now that we have the full report. In particular, will he consider the implications for patient care and services of a major reorganisation, which can be disruptive and fail to deliver the savings envisaged?

I heed absolutely the right hon. Gentleman’s warning that reorganisations are not always the panacea that they are made out to be. We need to be absolutely clear that, if we accept the proposals, they will deliver a sustainable, robust and clinically sound outcome for the right hon. Gentleman’s and neighbouring constituents, as the trust special administrator believes they will. I shall be delighted if the right hon. Gentleman attends the meeting with other MPs affected by the proposal. I shall hear what he has to say further at that meeting.

The Secretary of State has to recognise the serious contradictions between the proposals in the trust special administrator’s report and the Conservative manifesto before the last general election. If he were to accept the proposals, particularly in relation to A and E, that would be a serious betrayal of promises made to the electorate. There are also the changes expected from the “A Picture of Health” proposals for Queen Mary’s hospital in Sidcup in relation to overnight elective surgery. How much is the Secretary of State bound by the specific promises made in the Conservative manifesto before the election when it comes to making a decision on the report?

We were concerned in the run-up to the last election at the pace and scale of many of the reconfigurations pursued by the last Government. That is why when we came into office we paused the reconfigurations and introduced the four tests—an additional safeguard to make sure that reconfigurations were not done without local clinical support.

We wanted to avoid what had happened so often, including in my own constituency—an alliance of Health Ministers and NHS managers riding roughshod over what local people wanted. We wanted to stop that, so we put in place new systems. I hope that the hon. Gentleman will be comforted by the robustness and thoroughness of the processes that we are now going through.