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Acute NHS Care: South-west Hertfordshire

Volume 656: debated on Wednesday 13 March 2019

I beg to move,

That this House has considered acute NHS care in South West Herts.

It is a pleasure to serve under your chairmanship once again, Sir David. I start by saying that none of my comments about the health provision that allegedly looks after my constituents or about the West Hertfordshire Hospitals NHS Trust are, in any shape or form, about the frontline staff. The doctors, the nurses, the porters and the cleaners are fantastic. However, as I said the other day in a letter to Mr Stevens, the chief executive of NHS England, frankly we have absolutely no confidence in the management of the clinical commissioning group for West Hertfordshire Hospitals NHS Trust.

That lack of confidence that we are being represented and looked after in the best possible way has united the community over many years. It is not new. We have been let down time and again. Unlike a certain other subject that is occupying a lot of our time at the moment, there is no political or community division in west Hertfordshire about what we need from hospital acute provision in our part of the world. I will not go on about the other problems we have with health provision, but I have called the debate today—indeed, I was asked to do so by the community—to discuss how we can trust what is going on in our area.

A package is being put together that is convenient for West Hertfordshire Hospitals NHS Trust and it appears that the CCG and, I am sad to say, NHS Improvement and NHS England are going along with it. To put it in context for the Minister, we used to have acute hospitals in St Albans, in Hemel Hempstead and in Watford. Years ago, there was an evaluation and the decision was taken to close the acute facilities at St Albans. We were told not to worry, as Hemel was very close and would continue to have its acute provision, and there was a minor injuries-type facility in St Albans for elective surgery. After another consultation called “Investing In Your Health”, all the promises that had been made went out of the window and the acute services in Hemel were closed. As a sop, we were given a 24-hour urgent treatment centre.

Guess what? The urgent treatment centre is now not open for 24 hours a day and has a completely different name. Is it open at night? No, it is not. Where does everybody have to go? Even though Hemel is the largest town in Hertfordshire, we go to Watford. Watford General Hospital is a Victorian building next to the football stadium, in the heart of Watford, which is very densely populated. Promises were made about how quickly the ambulances could get there and how good it would be. They have completely gone out of the window, particularly when Watford football club is playing at home. Even though I am not a Watford supporter, I do not want to criticise the football club in any way. Watford football club is there, and has been for a long time.

Now we are looking to the future, not so much for my generation but for the younger generation in this massively growing area of the country. What is the future of the acute provision and hospital provision in my constituency? Historically, West Hertfordshire Hospitals NHS Trust is a small trust that has not been well managed. I have lost count of the number of chief executives it has had during the time I have been MP for Hemel Hempstead. They come and go repeatedly. What always happens—every time—is that the trust gets into deficit, and it is then bailed out in some way. That happened when there were primary care trusts, and now it is being done with the clinical commissioning groups. The trust is in deficit and failing. I do not know how it managed to get something positive into the newspaper the other day, when yet again it is failing in four out of five categories.

That means my constituents are at risk. We rely on the CCG and the trust. I will come on to our involvement in that process in a second, but it appears that as an elected Member of Parliament I have absolutely no influence at all on the CCG’s decisions, West Hertfordshire Hospitals NHS Trust decisions or decisions about any other NHS provision in my area. Joe Public does not understand that there are a myriad pillars and silos inside the NHS. The public just sees the NHS, which people are rightly massively proud of; we all are, including me, and it is fantastic that we are putting more money into it. However, we have got more managers, finance directors and heads of nursing. Why on earth have we got all these people divided up inside the NHS? That is an important point I will come on to.

Part of the appraisals and discussions for the strategic outline case—the Minister will know what I mean by a SOC—was about making decisions on what acute hospital provision should be provided in my constituency. I went with constituents to see Mr Mackey, the head of NHS Improvement. I said to him, “What are the criteria here? Tell me, face to face, what are the criteria for the decision that the West Herts hospital trust is going to make about the future?” He said, quite categorically, that fundamentally different options must be put to us. I asked, “Including a greenfield site?” We have greenfield sites available. He said yes. I received a letter of confirmation that that was a requirement of any SOC that was put forward.

Moving forward to where we are now, we apparently cannot have a new greenfield hospital. Why? That is the question that every one of my constituents asks. It would not necessarily be in the middle of Hemel, St Albans or Watford, but somewhere where there is decent access and transport links for the whole community. We cannot have that. Why not? We are not allowed to borrow more than our income. Because we are a very small trust, the income happens to be £350 million. We cannot borrow more than that. Why? Why do my constituents suffer because we have a small, inefficient, badly managed acute trust?

If we amalgamated with another trust, the income stream would probably be about £500 million, or we could amalgamate with another acute trust and double the income to £700 million. All of a sudden, we get somewhere near the fictitious figure of £750 million, which keeps coming up for how much it would cost to build a new acute hospital. The figure of £750 million is why the trust is ruling out new build at the moment. I am not aware of any new hospitals in this country—leaving aside private finance initiative problems that we had in the past under the previous Administration—that cost £750 million. Interestingly, one of my constituents recently emailed me about the new hospital in Birmingham, which was being built by Carillion—we all know about that problem—that is costing £300 to £350 million. The new hospital in Liverpool is costing about £350 million. These are brand new hospitals, which is exactly what I am asking for and certainly what my constituents are united in wanting.

Where has the figure of £750 million come from? It is being used as part of a narrative to block any new acute hospital in my constituency, which would also look after people in St Albans and Watford. In my area, we seem to be fixated on the idea that the only way to use that £350 million is, believe it or not, to plough it into the Victorian hospital in middle of Watford. There are supposed to be evaluation panels, with the community engaged.

The community evaluation panel sat, and some of the members said, “Could we not have on the list a new hospital on a greenfield site?” There was no request for a show of hands, or vote. It just went forward; but it appears it has been completely ignored. The boards of both the West Hertfordshire hospitals trust and the CCG have disregarded it. It is all too expensive. We know, however, that it is not too expensive. Other parts of the country have an open mind, not a closed mind. They are not the same people who closed our hospitals in the past, making the same decisions on the future of Watford hospital.

I have concerns for the people of Watford—the patients of Watford hospital—and the staff. I am concerned about stripping out and fundamentally refurbishing what is a predominantly Victorian hospital, which was massively refurbished in the 1960s and 1970s. How can a full acute hospital continue to operate while that is going on—with all the risks? I have recently written—my old ministerial role was in the relevant Department—to the head of the Health and Safety Executive, because we know there is asbestos in the building. It is fundamentally dangerous, and it is not just because of asbestos, although that is the most prominent issue, and something that can have a massive effect. A tiny fibre in the lung is a death sentence. We know it is there, but we do not understand why the figure of £750 million has been used, and why the figure of £350 million is trapping my constituents in a certain quality of care, simply because we happen to be small and badly managed—not just by the present management but over many years.

Why are we being penalised? That is how we feel, as a community, across political divides—across everything. Labour were massively involved with the problem long before we took over in Government. Why does not NHS England say: “This trust is failing again. It is not big enough. It cannot cope. Let us sort it, management-wise, and bring trusts together.” Then we would go over the £350 million income stream figure, up into the £500 millions. Strangely, £500 million was the figure for what has just been built in Leeds. It seems strange that for Hertfordshire’s largest town, and one of its most historic towns, St Albans, which have massively growing populations, Watford is the option. I do not want to take anything away from Watford until there is a new build. I do not want to take anything from it that will undermine what it has—unlike what happened to us. However, perhaps the Minister would like to come to Watford when Watford football club is playing at home—or even just during the rush hour. He will have a very different experience coming from Hemel or St Albans from the one he would have coming from any other part of Hertfordshire. It is chock-a-block.

I want to touch on a final thing before I hand over to the Minister, because I want him to have time to respond. I have already asked him not just to read out what has come from the trust. I know, having been a Minister, exactly what happens. An MP asks for a debate, the Department writes to the CCG, the CCG speaks to West Herts, and the speech is halfway written before the Minister has even got to Westminster. I ask him please to listen. We are passionate people and are not going to give up. Some people in the campaign group for the new hospital have been working on it year after year. I want to pay tribute to Zena Bullimore, who sadly passed away, and who was chairman of the hospital campaign, and to Edie and Ron Glatter—Professor Glatter. Even though they have been retired for some time, they are a driving force behind the campaign that I was part of long before I was elected. That is how far we go back.

I have some anecdotal evidence to show how wrong it is even to contemplate going further with Watford, instead of getting a hospital out of Watford in a suitable place. One of my constituents had a heart attack and the ambulance arrived in good time. The paramedics did a wonderful job and she was taken to Watford. The ambulance was turned away by the police from the fastest route to accident and emergency. The police had a cordon up so that the fans could use the streets, so it had to go another way, at which stage the non-local ambulance driver got lost. I went to see the officer in charge of the football match and said, “Did you turn the blue light ambulance away?” He said, “I can’t quite—”. I said, “Let’s do another one. Would you have turned away the blue light ambulance that was trying to get to the A&E because you had a cordon up?” He said, “Yes, I would.” I said to him, “If one of your officers had been assaulted and stabbed, would you have let the blue light ambulance in to pick him up?” “Yes, of course I would.” What is the difference between my constituents and the police? I want the police protected, and he would have been absolutely right to let the blue light in. However, the Department and NHS England seem to have tunnel vision about the situation.

I had a response in the last couple of days to a letter I sent to NHS Improvement—to Mr Stevens, actually—saying, “Would you please analyse this very in-depth document that goes into five pages, and give us your opinions?” I got, apart from the signature, one piece of A4 back, which in my opinion was written by the West Hertfordshire hospital trust. If it did not write it, it contains all the same language—probably the same language that is in the Minister’s notes. We have to open up to the fact that there must be accountability in the NHS. It is right that Ministers do not these days make decisions in the way they used to, but things have gone too far. There are people running CCGs who are not qualified to do so. I do not think that a GP is highly qualified to chair and run such a trust.

My acute trust has to make a fundamentally important decision, based on fact, but it is ignoring fact—not just public opinion or “This is the best place for it”, but fact. They keep going on about “You can’t afford it. It will be over £350 million. It will cost £750 million.” Frankly that is a pack of lies and we need to wake up. As I said the other day among colleagues, “Wake up and smell the coffee.” The public will not put up with a second-rate management system in the NHS. It is affecting my constituents—and I class myself as a member of the public. I live in the middle of the town. I am not going to put up with a second-rate system of management, and incompetence in running a trust.

I shall probably ask to intervene on the Minister during his speech.

It is a pleasure to serve under your chairmanship, Sir David, and to respond to my right hon. Friend. I want to say at the outset that one thing we absolutely agree on is what he said in his opening remarks. He expressed, in bringing forward this important matter for debate on behalf of his constituents, recognition of and admiration for the frontline staff. Even though I do not know the frontline staff in his area, I know from my visits in my short time as Minister and from my constituency experience that the professional care they deliver is admirable and extraordinary. We should never forget the effort they put in, and my right hon. Friend is right to acknowledge that.

Before I address specifics, and before what I suspect will be an iterative debate, I want to deal with two fundamental points, which I know my right hon. Friend knows, but are worth putting on the record. First, any service change in the NHS must clearly be based on clear evidence. Secondly, before any substantive change is made, patients and the public should be consulted. My right hon. Friend raised two interesting subjects on which we could have a debate of an hour and a half, or probably even three hours. One was local accountability in the NHS, in its wider sense and form, and how he is accountable as the Member of Parliament. The other was funding criteria.

My right hon. Friend has, I think, addressed two other Ministers on his passion for the longstanding need to improve the quality of hospital infrastructure in west Hertfordshire. That has been a stated aim of the Hertfordshire and West Essex sustainability and transformation plan since its inception. I know it is engaging in the process of looking at how a redevelopment and redesign of the hospital provision in west Hertfordshire can be achieved, working alongside NHS England and NHS Improvement.

I recognise that my right hon. Friend has real concerns and real scepticism about the work of the CCG. I hope he will recognise the work that the sustainability and transformation partnership is involved in in the hospital development process, and the fact that the director of strategy took part in a process and evaluation meeting in February 2019, at which a shortlist of our options was discussed. The STP is also due to take part in the next evaluation event.

I understand what my right hon. Friend says about the capital. I hear his criticism and scepticism of the West Hertfordshire hospitals trust, but it has been taking the lead in developing the strategic outline case for change. I understand that it and NHS Improvement had dialogue, and feedback was provided on the strategic outline case for the acute hospital redesign submitted by the trust. I also understand, as he will, that the feedback made two key points: it was clear, first, about the need for funding, and secondly, that the overall public money for hospital redevelopment is relatively limited.

My right hon. Friend has raised the issue of the £350 million; he knows that the turnover figure is a key criterion and a key threshold for capital investment, and that any options that significantly exceed the £350 million capital cost have been excluded from the current shortlist. He is obviously aware of a £750 million figure being used locally, but I must confess I am not aware of that figure. I would be delighted to offer him a chance to sit down and try to work out with me where that figure came in—recognising, as he rightly points out, that it will not be a Minister who makes any decision. If it is helpful to him, I am happy to have that discussion.

I had that discussion with the Secretary of State, a couple of days after he was appointed. It is not just Ministers that I pick on—Secretaries of State get it in the ear as well. There are two points I would like to touch on. First, how can it be fair to a community that, if it is just based on the turnover of a trust and that trust happens to be a very small one, the provision we get locally is second class? We cannot even go to that territory. Secondly, on the £750 million, I will ask the Minister to step in, because that is the figure being used locally to rule out the greenfield site. There was an evaluation panel, and members of the panel asked for the greenfield site to be put in, and fundamentally, it appears to me, they have been completely ignored.

I made the point a moment ago that, because the cost of that greenfield site exceeds the £350 million threshold, it has currently been dropped from the shortlist of options. My right hon. Friend repeats a point that he made during his speech, questioning the criteria; he will know that I have heard what he has said. As he has just informed me, he has made a representation to the Secretary of State about that figure, and I have offered to have a meeting with him so that we can both explore it.

I do not think that, in the relatively short time available, I should get into the debate about the loan criteria, as I said at the beginning. We can have that debate at some other stage if my right hon. Friend wishes to put it forward, but he knows that at the moment the key threshold for capital investment would be the turnover, and therefore options that significantly exceed a £350 million capital cost have been excluded. As part of the option appraisal process, senior leaders and clinicians, as well as expert analysts, were involved in information gathering to put together the option evaluation. He will know that that included demand and capacity analysis based on population, hospital activity and operational planning.

With regard to reviewing that process, my right hon. Friend, as he said, wrote to both NHS England and NHS Improvement concerning the approval process. As he referenced in his speech, he forwarded to them an email from Professor Ron Glatter of the New Hospital Campaign. I understand that in that email, the professor requested a full statement of the outcomes of NHS Improvement’s review of the trust’s acute transformation strategic outline case.

In its answer, NHS Improvement has so far said that it has not started its formal review because the Treasury and the Department have not yet decided whether the proposal represents a scheme that can in principle be supported by central Government. I recognise the strength and effort of the campaigning for the new hospital option and I acknowledge the expert views that have been sought. While it is obviously not right for me to prejudge the answer from NHS Improvement, I know my right hon. Friend will recognise that I and the Department must take a wider view and that decisions made on capital funding must be the same for everyone across the country.

There has clearly been a huge amount of public engagement throughout the process, and I understand that further public engagement is planned for this month. Notwithstanding my right hon. Friend’s scepticism, I understand that the results of those consultations, in terms of the preferred way forward, will be taken to the trust board and the CCG in June 2019.

I recognise my right hon. Friend’s commitment to improving services; I assure him that the information provided by the New Hospital Campaign is being considered and will be considered as part of the review. As I said, it is not appropriate for Ministers to comment on specific decisions but, as he knows, the Government are determined to encourage innovation and to ensure that all patients have access to high-quality services. The updated proposal will clearly help to inform both the Department and the Treasury about capital allocations in the next spending review. I will not rehearse the arguments about the extra £33.9 billion of cash to support the NHS, or the additional capital and the bid we are putting forward in the comprehensive spending review.

If we accept that the rules at the moment are that any bid cannot be over the revenue income, which is the £350 million, can the Minister explain to me why, in Birmingham, the new build for 750,000 people cost between £300 million and £350 million, which we know because of the Carillion contract that collapsed, and the Royal Liverpool cost £335 million, yet we have been ruled out of having any new build on land that is actually owned by us—one of the sites is on Crown Estate land, public land—because it would exceed £350 million? I know he probably will not have the ability to answer that this second, but a letter in the next few weeks would be very helpful.

As my right hon. Friend knows, all Ministers can make an attempt at an answer, but I am sure he would prefer a detailed answer. Therefore, I will make that detailed response to him, as he has asked, in a letter. I also know that he would like me to commit to the spending now, but he will know that I am unable to do so at this stage. I have listened carefully to his points about what might be the cost of the redevelopment that he believes should happen, and he will know that I have heard that. He will also know that I have heard the differences that he has pointed out between the supposed or quoted cost and the cost of build in other areas. He knows that I will have taken that on board.

At this stage, with just 30 seconds to go, I thank my right hon. Friend for bringing this matter to the Chamber and for making the case yet again for his constituents. He should know that the Minister and the Department have listened, and I will respond to him and have that meeting with him.

Order; I do not think we have time, Sir Mike. There is no right to sum up in a half-hour debate.

Question put and agreed to.

Sitting suspended.