I am grateful both to you, Mr Betts, and to the Minister for agreeing to my proposition that I speak for 10 minutes and my hon. Friend the Member for Lewisham East (Heidi Alexander), who is equally concerned about these matters, may speak for five minutes; the Minister will have the prerogative of the usual arrangements for ministerial responses.
The reason I have raised this matter is that in south-east London generally and in Lewisham in particular we have been around this course before, and know exactly where it wound up then. I will be candid from the off: I am deeply suspicious of the whole process currently being embarked upon by Monitor and of the involvement of the Princess Royal university hospital at Orpington and King’s College hospital trust. I hope the Minister will be able to provide me with some assurances that will assuage my fears about this matter.
I will explain why. On Tuesday 24 July 2012—hardly a day that will live in infamy, but one that certainly remains clear in my mind—we had a meeting at the Department of Health with the then Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley). My hon. Friend the Member for Lewisham East was there, as were Members for constituencies in the boroughs of Greenwich and Bromley, including the hon. and gallant Member for Beckenham (Bob Stewart). I see that the hon. Member for Bromley and Chislehurst (Robert Neill) is in his place today; I cannot remember whether he was also at the meeting, but other Members certainly were. The meeting concerned the future of the South London Healthcare NHS Trust, which then consisted effectively of the Queen Elizabeth hospital in Woolwich, the Princess Royal university hospital in Orpington, which I chose as the title for the debate today, and Queen Mary’s hospital in Sidcup.
Members for constituencies in the boroughs of Bexley, Bromley and Greenwich were quite rightly invited to that meeting. As I said, my hon. Friend the Member for Lewisham East and I were both invited, even though Lewisham hospital was not part of the South London Healthcare trust. No one else from south-east London—no Members for constituencies in Lambeth or Southwark—was invited or present, although, strangely enough, they were included in the later stages of the discussions by the current Secretary of State for Health after Mr Matthew Kershaw, the trust’s special administrator, had made an initial report. His report essentially looked at the considerable downgrading—some would say the destruction—of Lewisham hospital as the answer to the problems at the Princess Royal, Queen Elizabeth and Queen Mary’s hospitals.
Sitting suspended for a Division in the House.
I was talking about the fabled meeting in July 2012—two and a half years ago. When the Secretary of State and the trust special administrator said that the answers to the problems of the then South London Healthcare NHS Trust did not lie within its own boundaries, I knew that what they had in mind was effectively the evisceration of Lewisham hospital. For reasons that have eluded me for decades and more—I used to be on the health authority of Lambeth, Southwark and Lewisham, and the district health authority for Lewisham and north Southwark—various elements of NHS London have always had Lewisham hospital in their sights. There was once a plan for there to be only four accident and emergency and general hospitals in south-east London: St Thomas’, King’s, PRUH and Queen Elizabeth; there was no room for Lewisham. I do not know why the various NHS powers think Lewisham is such an encumbrance. The service it provides to its residents and the pressure it relieves from the other hospitals around south-east London are proof positive of its value.
The morning of 5 March dawned—I was quite delighted about that, because it was my birthday. At 9.25 am, I received an e-mail from Monitor, explaining that,
“Monitor is opening an investigation at King’s College Hospital NHS Foundation Trust to find a lasting solution to long-standing problems at the Princess Royal University Hospital…The regulator is concerned that some patients are waiting too long for A&E treatment”—
nothing unusual there. Not one of the hospitals in south-east London—not St Thomas’, over the river, not PRUH, not Queen Elizabeth, not Lewisham, not King’s—is currently meeting the 95% targets for seeing attendances at A and E, so that is not surprising. The e-mail went on to say,
“and routine operations…the trust is predicting a deficit of more than £40m this financial year. This deterioration in its operational and financial performance follows the unexpected costs of making urgent improvements to the quality of care at the PRUH.”
Well, Princess Royal was taken over by King’s College hospital as a consequence of the trust special administrator’s recommendations, and that is the problem it has run into.
When the trust special administrator was appointed, the Secretary of State said in a statement to the House:
“The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS.”—[Official Report, 29 October 2012; Vol. 552, c. 3WS.]
The difference between the £1 million a week then and the predicted £40 million a year at PRUH alone now clearly demonstrates that the trust’s special administration process did not address the right problems. Clearly, the problem was predominantly at Princess Royal.
Queen Elizabeth is now part of a very successful partnership with University hospital Lewisham, and it is doing quite well. It is not without difficulties, but that is the case for any organisations that come together under difficult circumstances. However, it is making progress in clinical and financial affairs, and is well on the way to building a solid and reliable NHS entity in our part of south-east London. That demonstrates that the entire TSA process was substantially illegal, because as we know, the High Court—and subsequently the Court of Appeal—found the trust special administrator’s recommendation with regard to Lewisham hospital, and the current Secretary of State’s stubborn refusal to accept anything other than those proposals, to be illegal. The Secretary of State did not have the powers he assumed he had and could not reorganise in the way that was suggested. He even had the hubris to try and test it at the Court of Appeal, which found similarly that that was the case. Thankfully, sense prevailed at that stage and he left it there, deciding not to waste any more taxpayers’ money by going to the Supreme Court.
However, the Government introduced an amendment to the Bill that became the Care Act 2014, giving them the power that they thought they originally had to do whatever they liked by appointing a trust special administrator. This is where we come to the key worry about the future of Princess Royal and King’s. It is not just about the services that are provided there, which are critically important to all the constituents of Members here today, but about the fear that Monitor, using the powers that the Government put into that Act, will try to engineer another back-door reorganisation involving Lewisham hospital. As I say, that was originally declared illegal, but Lewisham could be dragged into it by other means, so the Government can achieve what they originally meant to achieve and were stopped from so doing.
I understand the hon. Gentleman’s point. Do I gather that his principal concern is the impact on Lewisham, and not the fact that Monitor is looking at accepted issues at the Princess Royal and King’s? From his point of view, it is the Lewisham dimension, rather than what it is necessary to do at the Princess Royal. Am I right in that?
I totally agree with everything that the hon. Gentleman has said. My worry is that the Secretary of State negated the bill. It was wiped clean, and £44 million is a huge amount of money in the very short time that King’s has apparently been mismanaging the PRUH.
I understand the hon. Gentleman’s point. I do not think that would be King’s view. I hold no particular brief for King’s college hospital, other than the fact that I had a heart bypass there a few years ago, so I owe them my life. However, beyond that, I have no particular indebtedness to them. I know that there is a strong feeling that it was misled about what taking on the PRUH would actually mean, and the operational and financial consequences.
That is very gracious—characteristically so—of the hon. Gentleman. I have four points to make briefly: three are questions, and I would also like an assurance from the Minister.
First, I would like an indication about the time scale. How long will Monitor take to report and what is the process following the report? Who will get to review it and how will it be taken beyond that? Secondly, what are the requirements/benefits and the consequences of what Monitor and the letter I received from King’s later that day—5 March—say, which is that the legal powers that Monitor possesses are needed to underpin the changes that are necessary to King’s foundation trust and the PRUH? Thirdly, how much consultation will there be with other providers and commissioners across south-east London outside King’s College Hospital NHS Foundation Trust? Finally, I want an absolute guarantee that University hospital Lewisham and Queen Elizabeth hospital Woolwich, now the Lewisham and Greenwich trust, will not be adversely affected by any decisions that Monitor makes.
I am very grateful for the opportunity to make a short contribution today, and I congratulate my hon. Friend the Member for Lewisham West and Penge (Jim Dowd) on securing the debate. I also thank him for sharing his time with me so that I can put on record my concerns about the challenges facing the Princess Royal and other hospitals in south-east London.
When I first learnt about the Monitor investigation into the PRUH a few weeks ago, I was worried, like my hon. Friend, that we might be witnessing the start of another process that would end up with Ministers or NHS officials wanting to close Lewisham’s full A and E. I was worried because, as he has said, we have been here before. Problems in a neighbouring hospital trust, of which the PRUH was then a part, resulted in NHS bureaucrats casting around, on the look-out for ways to save money.
It is understandable that my constituents might be suspicious about the latest investigation, given their experience a few years ago with the trust special administration process, which, as we all know, had at its heart an ill-judged and illegal attempt by the Government to close services at Lewisham in order to sort out problems at the PRUH and the Queen Elizabeth hospital.
The Minister may tell us today that this process is entirely different, but it would be helpful if she could set out exactly what the process is limited to, the time scale of the process and what change could come about as a result of the investigation. Is it about giving King’s and the PRUH more money to adequately provide the services that are needed? Is it about changing leadership at the hospital or providing specific types of support? When the investigation is concluded, how will local people know what has been proposed? Will we, as local Members of Parliament, get a copy of Monitor’s full report? Could another trust special administration process be triggered?
I am keen to get answers to those questions. Although we successfully fought the Government’s proposals for Lewisham hospital last time around, the Government have since changed the law. They can now use a rushed and chaotic process to force service closures at any hospital in the country as long as they deem the neighbouring hospital trust to be failing. Given that cynical move by the Government, it is little wonder that among my constituents there is considerable anxiety that the proposals to take services away from Lewisham will rear their head again.
I tell the Minister, for the sake of clarity if nothing else, that the people of Lewisham are adamant: no matter what the problems in neighbouring hospitals are, our full accident and emergency and maternity departments are essential local services that we cannot do without. I am not saying that everything is perfect, but when there are such huge pressures on the system, such as those we saw in the winter, my constituents are right when they say to me, “Just think how much worse it would have been if they had closed Lewisham.”
There are enormous pressures on London hospitals, and the situation is getting worse. At the PRUH, according to the chief executive’s January board report, one in four people who attended the A and E there in December were not seen within four hours. The latest weekly figures for both the PRUH and Lewisham hospital show a much lower percentage of patients seen within four hours than this time three years ago. We know that the PRUH is heavily reliant on nursing agency staff because of recruitment difficulties. That has resulted in an overspend on its staffing budget. I could list other problems, but time is short.
Suffice it to say, the system is under increasing pressure, and that has happened on this Government’s watch. When I first stood to be a Member of Parliament five years ago, the NHS hardly ever came up on the doorstep. It now comes up time and again. When I get an e-mail from a constituent telling me about their elderly neighbour being left waiting hours for an ambulance to turn up, waiting hours on a trolley to be seen in A and E and then waiting hours to be given a bed, I know that something is seriously wrong with our health service.
Will the Minister give us her honest assessment of the state of hospital services in south-east London? Will she set out exactly what her Government are doing to resolve the problems and give us categorical reassurance that the latest investigation into the Princess Royal hospital is not just another attempt to come after services in Lewisham?
I say now to colleagues who understandably are concerned about local health services and have rightly raised concerns on behalf of their constituents that if I cannot cover some of their questions in the next 12 minutes, I will undertake to write to them in the remaining days of this Parliament, or to ask someone else to write to them, so that we can try to give them some reassurance.
I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and the hon. Member for Lewisham East (Heidi Alexander) on raising her concerns. Taking my cue from what was said previously, I start by paying tribute to all those working in London’s NHS—in those hon. Members’ constituencies, in mine and right across London—for their dedication and commitment to providing first-class services to those in their care at a time when we know that the system is, in places, under pressure.
As we have heard, after consulting with the trust, its commissioners and the London strategic health authority, the then Secretary of State instituted the special administration process at South London Healthcare NHS Trust in July 2012. He was guided in making that very difficult decision on the basis of the clinical interests of local patients, with advice from the NHS medical director, Sir Bruce Keogh. The decision was also based on the fact that there was no clear option for restoring the trust’s finances while maintaining the quality of services to patients. It was clear at the time that doing nothing was not an option. Not resolving the issues at the trust would have carried a high degree of risk. It would have meant that the trust would not meet the London-wide clinical quality standards and that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit.
The trust special administrator looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but no one was able to come forward with a proposal that would solve the problem within the existing footprint of the trust. Indeed, there were no proposals that would not have involved neighbouring health care economies.
The long-standing clinical, operational and financial problems at South London Healthcare NHS Trust led the trust special administrator to recommend that Princess Royal university hospital be acquired by King’s College Hospital NHS Foundation Trust. The associated hospital sites in Bromley—Beckenham Beacon and Orpington hospital—were part of that transaction. I must say for the record that the transaction agreement was signed by all parties and no information was withheld from any organisation.
At the time, South London Healthcare NHS Trust was the most financially challenged in the country, with a deficit of £65 million per annum. Repeated local attempts to resolve the financial crisis at the trust had failed. Millions of pounds were spent on paying for debt rather than improving patient care for the local community in south-east London. The trust special administrator was clear that long-standing problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. That is why, after careful consideration, the Secretary of State accepted his recommendations, including that the PRUH be transferred to King’s.
The new expanded trust is one of London’s largest and busiest teaching hospitals and plays a key role in the education and training of the next generation of medical, nursing and dental students. King’s has acknowledged that it has been facing a number of pressures that have had a bearing on its performance. The challenge of integrating and transforming the performance of the PRUH, combined with a significant increase in emergency in-patient activity, has, as the hon. Member for Lewisham West and Penge described, adversely affected the trust’s operational and financial performance. A key aim of the trust’s five-year strategy is to restore its traditional high levels of performance, in particular by returning to achieving its emergency department and referral to treatment waiting time targets.
Monitor has concerns that some patients are waiting too long for A and E treatment and routine operations and that the trust is predicting a deficit of more than £40 million in this financial year. The regulator is undertaking its investigation to find a lasting solution to long-standing problems at the PRUH. Monitor is concerned that the trust’s operational and financial performance issues post the acquisition of the PRUH have not improved in line with expectations. In particular, some long-standing financial and operational performance issues at the hospital have continued post acquisition.
May I say this on behalf of my hon. Friend the Member for Orpington (Joseph Johnson), the Minister of State, Cabinet Office, who cannot be at the debate? He and I would want to put on the record the fact that there have been areas of improvement at the Princess Royal and at Orpington, particularly in terms of patient experience scores, which have picked up considerably. On the point that my hon. Friend the Minister just mentioned, we are especially concerned at the prospect that has been raised that the full financial picture may not become available to King’s until after the acquisition. It is very clear—I hope that the Minister can assure us on this—that the Monitor investigation is intended once and for all to get to the bottom of, the root of, the financial difficulties that this trust suffers. May I also say that I welcome the appointment of the noble Lord Kerslake as chairman of the King’s trust? He will bring considerable credibility and rigour to that process.
I thank my hon. Friend for that intervention. I will say more about Monitor’s role, but it is very much in line with what he said and I hope to give him the assurance that he seeks.
Monitor has been working with King’s, local clinical commissioning groups, the NHS Trust Development Authority and NHS England since the acquisition and has worked more closely with the trust recently to get a better picture of the challenges that it faces. However, Monitor has decided to take the new, formal action because King’s has not been able to tackle its challenges on its own. Monitor considers that continuing to work with the trust through more intensive and formal engagement will help to drive the necessary changes.
I want at this point to highlight the fact that, following a formal investigation into a suspected licence breach at a foundation trust, Monitor does not have the power to direct non-foundation trusts, nor does it have the power to direct neighbouring foundation trusts unless they themselves are in breach of their licence. The range of actions available to the regulator range from informal action—for example, requesting further information—to formal enforcement action, including the imposition of additional licence conditions.
Where appropriate, Monitor seeks to encourage the whole health economy to work together to reach a locally owned, consensual solution, which is very much in line with the NHS “Five Year Forward View”. Monitor has said that it recognises that King’s has been working hard, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has said, to improve the quality of care provided at the PRUH. However, through its close work with the trust, Monitor has discovered that achieving the necessary financial and operational turnaround at the PRUH will be a greater challenge than was initially anticipated. Therefore, the regulator has decided to open a formal investigation as part of the regulatory process, which will enable it to use its legal powers to underpin the changes that the trust needs to make. The investigation will help Monitor to decide what resources and support King’s needs to enable it to deal with its financial problems and reduce waiting times for patients. Monitor will announce in due course the outcome of the investigation and whether it will take any further action. There is no statutory time scale for the investigation, because it depends on the scale of the issues encountered. I am sure that all hon. Members would want those issues to be looked at thoroughly.
I have just made clear for the record what Monitor’s powers are and are not. I hope that that gives Members on both sides of the Chamber greater clarity than they had when we started. Monitor is in the process of concluding its investigation. It will announce in due course the outcome and whether it will take any further action. Key findings and any next steps will be announced by means of a press notice. Colleagues from Monitor are here in the House, and I would like to put them on notice that I expect—I am sure that they also expect this—Monitor to engage fully with local Members. Clearly, we are entering a more tricky period from that point of view, but on the other side of the election I expect there to be full engagement with local Members, particularly as the solution lies, as I think it will in other health economies that are challenged, in the whole local health economy coming together to understand how to work through the problems. That is laid out in NHS England’s “Five Year Forward View”.
If it is acceptable to the hon. Lady, I will write to her to provide some clarity on that. It might be helpful, for example, for Monitor to give examples from other investigations of the sorts of things that it undertook and the changes that it requested through the formal process. I will write to her with some examples to give her a sense of that. I have sought to give a degree of reassurance to Members, and I hope that I have managed to do so.
I detect that the Minister has almost concluded her remarks, and I will not have the opportunity to intervene once she has sat down. I am grateful for what she has said, and I will look at the Official Report most carefully. I would be grateful to be copied in on any information that is sent to other Members.
I would like to make another point, out of courtesy, as much as anything else. The hon. Member for Bromley and Chislehurst welcomed the appointment of the new chair of King’s trust, Lord Kerslake. May I put on record a huge vote of gratitude to Sir George Alberti, who is standing down as the chair of the trust, for the service that he has given to King’s and the health service more generally?
That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.
I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.