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Hospitals: West London

Volume 785: debated on Wednesday 18 October 2017

Question for Short Debate

Asked by

To ask Her Majesty’s Government what are their plans for the future of hospitals in West London, particularly in relation to their proposals to sell off much of the site of the existing Charing Cross hospital.

My Lords, when the local London elections took place in 2014 everybody was surprised that Hammersmith and Fulham went to Labour—everyone except those of us who were knocking on doors like mad to try to win the council for Labour, which was of course the outcome. It was clear from knocking on those doors that the issue of Charing Cross Hospital was very much in people’s minds. After Labour won the Conservatives, who lost, complained that the health service was not directly a local government issue, to which the answer was that the outgoing Conservative council campaigned to support the closure of Charing Cross Hospital so it was not surprising that it became an issue. The Minister shakes his head but they certainly did; I was there. I understand that the NHS is under serious financial pressure. If it were not, the argument about the future of Charing Cross Hospital and other hospitals in north and west London would not apply.

I want to make three arguments. First, it is wrong in principle to close and demolish Charing Cross Hospital; secondly, the method of doing so was less straightforward than it should have been; and thirdly, public opinion is very much on the side of keeping the hospital. Public opinion was ably led by Andy Slaughter, the local MP and Councillor Stephen Cowan, the leader of Hammersmith and Fulham Council.

In 2013, we had the “Shaping a Healthier Future” policy. The NHS agreed plans to close A&E departments and acute care beds in four hospitals in north-west London. These plans continue to be implemented. The Government’s reconfiguration of those services is ironically entitled the “Shaping a Healthier Future” plan for north-west London. It was signed off by the Secretary of State, Jeremy Hunt. It showed that the plan was to demolish the current Charing Cross Hospital; sell off most of the Charing Cross Hospital site, leaving just 13%; replace the current hospital with a series of clinics on a site no more than 13% of the size of the current hospital; rebrand the clinics as a local hospital; replace the current A&E with an urgent care clinic; rebrand the urgent care clinic as a class 3 A&E; lose more than 300, possibly all, of the acute care beds; halt all complex and emergency surgery; and close the renowned stroke unit, which was possibly the best in London.

Since September 2014, the A&E departments at Hammersmith Hospital and Central Middlesex Hospital have been closed as part of the overall plan for the area. This had an immediate impact on waiting times at other A&E departments across north-west London. The figures are quite dramatic. Before September 2014 hospitals across north-west London were hitting their target of seeing 95% of patients within four hours. After the closures of the A&E departments at Hammersmith Hospital and Central Middlesex Hospital, the figure in December 2014 was 90% and by February 2017 it had reached 87%. As recently as September—last month—the combined figure for Charing Cross Hospital and St Mary’s Hospital had fallen to 69.7%, suggesting that there was a great deal of pressure on A&E services which would only get worse if the plans for Charing Cross were proceeded with. I should add that, among other hospital closures, in July 2015 the maternity unit at Ealing Hospital was closed.

Five London boroughs—Brent, Ealing, Hammersmith and Fulham, Harrow and Hounslow—got together to set up an independent healthcare commission, commonly called the Mansfield commission. The commission spent a year gathering evidence and published its findings and recommendations in December 2015. It said:

“There is still no completed, up to date business plan in place that sets out the case for delivering the Shaping a Healthier Future programme, demonstrating that the programme is affordable and deliverable … There was limited and inadequate public consultation on the original SaHF proposals and the proposals themselves did not provide an accurate view of the final costs and risks to the people affected … The escalating costs of the programme does not represent value for money”,

and were a waste of precious public resources. It said that NHS facilities delivering important public healthcare services had been closed without adequate alternative provision having been put in place, and that,

“the original business case seriously underestimated the increases in population being experienced in West London”,

and failed to address the increasing need for services. The main recommendation by the Mansfield commission was that the “Shaping a Healthier Future” programme itself should be halted.

The implications of the programme for protected groups were disturbing. The commission noted that the hospitals targeted for closure were those located in areas with high concentrations of deprived black and minority ethnic communities while the hospitals favoured for expansion were located in more affluent areas of north-west London. Significantly, the population of Hammersmith and Fulham is expected to increase by almost 12,000 between the 2011 and 2021 censuses. There is also a projected target of 22,000 new homes to be built in the borough by 2035.

We then had the Naylor review, which showed that, due to increasing demand on health services as a result of an ageing and expanding population, the Nuffield Trust estimates that an additional 22 hospitals of 800 beds will be needed over the next 10 years—not in London, but more widely. The review accepted that, even if new models of care are successful, this expansion and ageing of the population will require the same level of hospital capacity as at present. Most of the sustainability and transfer plan is pretty good; it is desirable to keep people out of hospital and to enable them to leave hospital when they are medically fit to leave so they do not block beds, and it is important that there are joined-up social care and health services.

I turn to urgent care centres. The UCC at St Mary’s was rated inadequate by the CQC and placed into special measures. I understand that there is now a bid from the private sector to buy it. What assurances do we have, if the Charing Cross proposals were proceeded with, and I hope to heaven they are not, that its UCC would not be privatised if the main proposal went ahead? We do not want this just to be a back door for achieving more privatisation.

Both Hammersmith and Fulham and Ealing councils have refused to sign up to the proposal regarding Charing Cross and Ealing hospitals. The reason they did not sign up to the whole proposal is the threat to those two hospitals; otherwise they would have signed up. The councils have said that the sustainability and transfer plan has good elements in it, but they will not sign up to it simply because it endorses the plan to close those two hospitals.

There are key questions that need to be answered so that local residents know what is going on. What is the timetable for service closures at Charing Cross Hospital? I understand that the original plan has been dropped and it is now to be in at least 2021. The problem is that a long period of uncertainty over the future of the hospital is very demoralising; it affects staff and the ability of the hospital to get staff, and it is unhealthy for the local community. Of course, the important thing is that the closure should not go ahead at all but, if it does, there should at least be a sensible timetable.

When will part two of the “Shaping a Healthier Future” strategic outline case be published? We need to know that to see what will happen. We need an assurance that those part 2 plans will be subject to widespread consultation.

Finally, and very importantly, I have mentioned the likely population figures. My question is: what population projections and modelling data are being used to estimate future patient demand for acute hospital services across north-west London generally, and in Hammersmith and Fulham specifically? We need answers to those questions.

I appreciate that this is a very party-political issue, but it is party political because local people want the hospital to remain. They do not want it to close. Many of us have used the services of the hospital and we do not want it to go. If it does, there will be no local hospital. There will be a clinic and one or two minor services, with most of the beds going, and all the good features of Charing Cross Hospital will simply disappear. I hope that will not happen.

I start by thanking my noble friend Lord Dubs, who has spoken on this topic. I have learned a great deal sitting here. I have some thoughts that I would like to share with you.

From the off, let me put on record that I have always supported cross-party collaboration on the future of the NHS. I honestly do not believe that any mainstream party seeks to undermine the future of our health service, and I have argued that it is overpoliticised and underanalysed, especially by leading spokespeople. I have supported increasing technocracy in NHS management for some time. Such enormous organisations require experts in the technicalities, not transient Governments or Ministers, whose jobs and term of office change regularly.

That is not to disparage any current or former Ministers, of course, but it must be a basic principle across government that day-to-day control of huge public services should be done by the most qualified. Oversight, yes, but not overcomplication. I note that the current principal Opposition spokesman on health has backed sustainability and transformation plans in the past, and that the Labour manifesto contained a commitment to decisions on NHS care being made locally. So did the Conservative one. In that cross-party spirit, then, let us proceed.

I am well familiar with the standards and provision of care across the north-west London region. It is not out of selfishness that I support the proposed changes to Charing Cross, but out of necessity. Increased care and support for the frailty service is of paramount importance in an ageing area of London. The cuts to the size of the hospital and provision of services are indeed wide-ranging, but they are necessary. The future of healthcare provision is in dedicated clusters. These serve best to concentrate talent and spur innovation.

In London alone, I encourage noble Lords to visit the splendid Royal National Orthopaedic Hospital or the National Hospital for Neurology and Neurosurgery. These dedicated units provide a higher standard of care, are less bureaucratic due to their specialised care, and bring down the differences between regions by aggregating treatment. Moving Charing Cross’s wide-ranging functions to those units will result in better outcomes, which I think all of us here want.

I have not said anything on funding. If additional funds are required due to the move, or to rehire or relocate professionals, I have no quibble. It is an investment and, I think, a sound one.

On another point, I feel it is necessary to widen the argument on the sale of these sites. The Government own a great deal of land in places with an intense housing shortage. I would want to consider whether the sale of more sites, especially in London, could help to alleviate the housing crisis.

Often I drive past Wormwood Scrubs. That area of land is very much prime, and a similar facility could be built closer to the edges of London. The MoD has been a trailblazer in this regard, and I think that this is one of the easier tools in the policy kit to hand if this Government really are serious about tackling the housing crisis and increasing their own funds to reinvest in core services.

My Lords, it is good that the noble Lord, Lord Dubs, has given us a chance to traverse the well-trodden paths of the future of north-west London’s hospitals. I want to put his concerns into a wider context. First, let me declare my interest as an elderly resident of Barnes with a personal interest in these hospitals. But I have also dabbled in the issues of London’s hospitals both as a Health Minister and subsequently as the chair of a provider agency established by the former strategic health authority for London which attempted to reshape some of the provider services in London.

Let me start with that latter experience. Reforming London’s health services is rather like battling through the Somme mud. Occasionally after a well-thought-out battle plan you make an advance. This happened with the reform of London’s stroke services where the number of stroke centres was cut from 32 to eight which saved lives and money, and produced better recovery outcomes for patients. This change, however, was a whole-London system change driven by the London SHA which was rather cavalierly abolished by the Secretary of State in the coalition Government. More often, the forces of local public and professional conservatism have thwarted change, as has consistently happened with the various attempts of the noble Lord, Lord Darzi, since 2007 to reshape London’s health services to meet today’s needs rather than those of the 1960s.

All the worthwhile attempts to reform the effectiveness of London’s acute hospital services have required a level and consistency of capital investment which has usually not been forthcoming from any Government. That looks to be the case for the proposals put forward in the five London STP plans. They call for a capital investment plan of about £6 billion over four years. This is probably an underestimate, but in any case, is highly unlikely to be forthcoming, unless the Minister has a surprise up his sleeve. Moreover, it is difficult to see whether these five separate STP plans are consistent with the overall needs of London, especially in relation to the consolidation of specialist services. This is where the loss of the London SHA is very telling. Will the Minister enlighten us on who will knit the five STP plans together in the best interests of Londoners?

Let me now turn to the issue of revenue budgets. According to the STPs themselves, the aggregate London “do nothing” revenue funding gap will be £4.1 billion by the end of 2021. This is without any allowance for any likely, and I have to say sizeable, shortfall in adult social care funding. If London was fairly treated on the basis of its weighted capitation population in 2021, this gap would shrink by about a third. So, can the Minister explain why London is being treated so unfairly in its NHS allocations, given the character and nature of its population? All this assumes that the whole NHS estimated deficit in 2021 will be as low as the NHS has calculated on present assumptions, which is a mere £17 billion.

I say all this because, despite the well-intentioned work that has gone into the STPs, those for London may have no more relevance than the latest Harry Potter story. The truth is that there is no credible funded plan for reshaping London’s health services as a whole. The STPs seem likely to suffer the fate of the noble Lord, Lord Darzi. Instead, what we will actually experience is more likely to be a series of actions aimed at trying to balance the books and patching up the services as best they can. That kind of patch-up approach seems to me—let me assure the noble Lord, Lord Dubs—a much more likely outcome for Charing Cross Hospital which, in any case, under the STP plans, is not due to change before 2021. I would be a bit more relaxed about the NHS’s capacity to reshape Charing Cross Hospital that much before the middle of the next decade.

However, it is crucial that as the London STPs evolve—and they will evolve; they are not going to be set in stone as they stand—they need much greater clarity about the future location of specialist services, not just A&E departments. They should also develop a much better definition of the services to be provided in what is starting to be called a “local hospital”—a term almost designed to raise local anxieties, unless you explain much more clearly than has been done what it means.

The NHS in London also needs to explain better than it has so far why it may well need to reduce its secondary care footprint by selling higher value land and buildings to fund the new community facilities that London so badly needs—and, as the noble Lord, Lord Suri, said, to help to contribute to providing land for affordable housing. So we should not get too excited about demolishing some hospital buildings in London to provide alternative facilities for the NHS and other social goods such as affordable housing, where land is very scarce.

I have to say, in conclusion, that the STPs have made a valiant attempt at coming up with a plan, but that plan lacks coherence across the scale of the whole of London and they do not seem to have done that good a job of taking the public with them.

My Lords, I am grateful to my noble friend for bringing to the House’s attention the concerns of residents about the future of Charing Cross Hospital. Although my noble friend has focused on issues in west London, the kind of debate that we are having is reflected up and down the country, as each area develops its sustainability and transformation programmes. My noble friend Lord Warner has outlined some of the issues with STPs. I particularly share his view about the loss of a London-wide SHA in terms of trying to lead change in the metropolis.

If the Minister thinks that STPs are going to get this Government out of trouble on the NHS, he should think again. Essentially, the wording may be different but, actually, when you look at them, they are previous plans dusted down and regurgitated in new language. At heart they are based on the belief that think tanks have had for 30 years that, if you invest in prevention, community and primary care, demand for hospital care will reduce. The evidence for that is very thin indeed. The fact is that there have been any number of attempts to implement those kinds of programmes, but of course the investment has never been of the order required out of the hospital setting, because the programmes almost invariably rely on acute bed closures to fund future investment. That is particularly difficult in current circumstances. Clearly, that is the case in west London.

The STP document really goes back to the 2012 consultation. My noble friend described that; the proposal was to reduce the number of major hospitals in north-west London from nine to five in a programme called “Shaping a Healthier Future”. That was subject to a searching independent review chaired by Michael Mansfield QC. My noble friend explained to the House some of the conclusions of Mr Mansfield’s review.

Despite that, the STP has decided to plough on with the proposals before us tonight. It is clear, reading between the lines, that the STP’s overriding motive is financial. It says that a clinically and financially sustainable system cannot be delivered in west London without reconfiguring acute services. Although it says—and the noble Lord, Lord Warner, is right—that no planned changes are to be made to Charing Cross’s A&E services before 2021, the fact is, because of the decision over the land closure on the Charing Cross site, there is a risk that, once the public and staff become uncertain about the future of the hospital, people will leave, retention and recruitment will become more difficult, patient confidence will be lessened, and the hospital will become blighted. This is the real risk for Charing Cross.

What is happening in west London cannot be divorced from general concerns about capacity in the NHS. We have debated twice in the last week the King’s Fund report, which identified that we have fewer acute beds in this country than any advanced healthcare system. We could of course use them better—we know that we could improve the way that discharge procedures work—but the fact is that it would be very risky indeed to go ahead with further reductions in acute capacity when the number of patients, particularly frail, older people who need the kind of care that hospitals provide, is going to grow. The King’s Fund therefore concluded that further significant reductions in bed numbers are unrealistic, which ties in with the Naylor review that I think my noble friend referred to.

We have not had much opportunity to debate STPs, but I point the Minister to the recent IPPR report, which found a deficiency of leadership within STPs and that funding was the overwhelming pressure on them, to the expense of any other action that they take and, of course, that there are no statutory powers with which to deliver the reform agenda as a result of the fragmentation created by the 2012 Act. The King’s Fund analysis of STPs in February 2017 concluded that, despite all the warm words about new models of care, they are driven by financial imperatives. I remind the Minister that a survey of 172 NHS trust chairs and chief executives, carried out last autumn, found that achieving financial balance was seen as the most important issue in STP land.

It is clear that the north-west London STP is financially driven. The noble Lord, Lord Warner, referred to the London STPs as a whole and the “do nothing” deficit of over £4 billion by 2021. The figure in the north-west London STP puts its funding gap at £1.113 billion. The STP then goes on to make the highly questionable claim that, through a combination of normal savings delivery and the benefits to be realised through the STP proposals, this huge deficit can be turned into a £15 million surplus. I hope that Ministers realise that this is a fantasy. It is a requirement, because the system bullies STPs if they do not come up with financial balance. But I do not know anybody who thinks that this STP could deliver anything like a £15 million surplus by 2021—it is a complete and utter fantasy.

The STP goes on to talk about the need to transform general practice and for,

“a substantial upscaling of the intermediate care services … offering integrated health and social care teams outside of an acute hospital setting”.

Well, every STP says that. The question I put to the Minister is: how on earth is this going to happen? Clearly, it expects general practice to take on greater responsibilities, yet only a few days ago the Secretary of State acknowledged the overload on GPs. Many practices are now closing their lists to new patients, many GPs are choosing to go part-time and others are retiring. I wonder how on earth this STP envisages that by 2021 the GPs in west London will miraculously suddenly develop a new drive and energy to provide the kind of additional services that are required.

What about intermediate or step-down care? Unbelievably, we hear that while these STPs talk about the importance of intermediate or step-down care, they have proposals to close community hospitals. Again, I ask the Minister: where on earth is the confidence that the STP will deliver what it says to bring down the deficit, reduce acute capacity—clearly, that is what it will do—and provide the kind of enhanced service that it talks about?

Ministers tend to hear what they want to hear, as we all do. However, the word on the street, when one talks to any senior person locally who is not in the earshot of one or other of the regulators, is that STPs are a mere flight of fantasy designed to get Ministers off the back of the NHS and give it a little more time until somebody comes up with something new that Ministers will latch on to as the next solution for the NHS. STPs will not work. We all know they are not going to work.

The risk is that Charing Cross Hospital becomes absolutely blighted. I agree with my noble friend Lord Warner, who says that in the light of previous experience, whatever the STP says about Charing Cross, if anyone thinks that all this is going to be done by 2021, they need to think again. The risk is that poor old Charing Cross will be stuck in this awful blighted position, good people will leave and it will become increasingly difficult to manage this hospital. That is why residents are right to be concerned and why we look to the Minister for reassurance tonight.

My Lords, I congratulate the noble Lord, Lord Dubs, on securing this debate and thank him and all noble Lords for their contributions. As ever, I will try to address as many of the points made this evening as possible.

In responding to this debate as a Minister in the Department of Health, I should declare an interest as a resident of west London for the past 11 years. I have counted up the number of hospitals in the STP area that my family have used—often too often. That figure incorporates pretty much all of them one way or another for various services. Therefore, I know from personal experience as a resident, patient, husband and father what we are talking about, and the very strong emotions that can be evoked by the discussions we are having about the future of Charing Cross and other hospitals. I also confirm to the noble Lord, Lord Dubs, that this has been an issue on the doorstep during local and national elections. However, some of the accusations I have heard about what will happen have been wrong, very misguided and, frankly, scaremongering. I see posters up all the time, as I am sure does the noble Lord, saying that hospitals are going to close. Indeed, he talked about hospital closures when, as he well knows if he has looked at the plans, we are not talking about closing hospitals and the sustainability and transformation plans are not talking about closing hospitals.

Noble Lords will know that west London—I think pretty much everyone who has spoken is a resident of west London—is a large area with many clinical commissioning groups, local authorities and providers split across two transformation plans in north-west London and south-west London. The north-west London plan covers about 2 million people. As that is the one that the noble Lord and other noble Lords have highlighted, that is where I shall focus my attention. The area covers a broad range of population and some of the country’s leading hospitals, including world-famous trusts such as Imperial, the Royal Brompton and the Royal Marsden, and cherished district general hospitals such as Ealing and Charing Cross. I note that this year the funding for the North West London Sustainability and Transformation Plan area is £3.7 billion, and that between 2015-16 and 2020-21, funding is expected to rise on current plans by £602.5 million—a cash increase of 17%. I think that answers the question asked by the noble Lord, Lord Warner, about funding. We also know that it is an area with a growing population with changing needs, driven by a relatively high turnover of people, with large-scale, inward migration from the UK and other countries. The changing needs of this population must of course shape the local NHS’s plans for the future.

Many times in this House we have discussed how the healthcare needs of patients in our country are changing. On average, we are becoming older and frailer, but also more mobile and more networked together by technology. Added to this, the science and practice of health is changing. We understand that some services are better centralised into highly specialised facilities—the noble Lord, Lord Warner, talked about stroke care and my noble friend Lord Suri talked about neurology, which are two good examples—while other treatment, such as rehabilitation, is better delivered in the community.

Therefore, because of demographic and professional developments, service change is inevitable. But it is of course always an issue that raises concerns, so it is vital that any proposed changes are looked at with great care. The noble Lord, Lord Warner, talked about it as being like the Somme mud; in slightly more uplifting terms, my noble friend Lord Lawson once said that the NHS is the closest the English get to a religion—and I think hospitals are our churches. That describes how people feel about them. It is therefore incredibly important that I stress that any potential service changes affecting west London hospitals must be driven by local health organisations and, while I am sure local people will follow this debate with interest, the opportunity to shape their future health services is driven by engaging with their own clinical commissioning groups and the STP.

The Government are clear that any health service changes proposed are subject to an agreed set of procedures. Proposed changes stand and fall on their ability to show clear evidence that they will deliver better outcomes for patients, and they must meet the four tests for service change. First, they should have support from GP commissioners; secondly, they should be based on clinical evidence; thirdly, they should demonstrate public and patient engagement; and fourthly, they should consider patient choice.

In addition, in April this year NHS England introduced a new test on the future use of beds, which requires commissioners to assure NHS England that any proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed. This is precisely the point that the noble Lord, Lord Hunt, made about preserving beds, and he will also know that the number of acute beds has been falling over many years under many different Governments. Indeed, the number has stabilised in the last couple of years, which speaks to the point he raised from the King’s Fund research.

Where local discussions fail to provide resolution, proposed changes may be challenged on a number of grounds—for example, if there has not been proper local consultation or where the local oversight and scrutiny committee concludes that the changes are not in the best interests of the health service. The Independent Reconfiguration Panel exists to arbitrate and provide independent and authoritative advice to the Secretary of State in such instances. That is therefore the policy background against which any plan must be judged.

The North West London Sustainability and Transformation Plan was published in November 2016, and a core component is a programme called Shaping a Healthier Future, plans of which were first published in 2012. The public consultation in 2012 set out plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that the Charing Cross Hospital would become a growing hub for integrated care within this network of services.

Following feedback from the public consultation, the proposals were refined to retain the integrated care approach and, in addition, for the Charing Cross site to house a wider range of services than initially proposed. Following examinations by both the IRP and the Secretary of State, the plans changed further. Since then, as noble Lords may be aware, NHS England invested a further £8 million in the Charing Cross Hospital site last year. This funding enabled refurbishment of urgent and emergency care wards, theatres, outpatient clinics and lifts, as well as the creation of a patient service centre and the main new facility for North West London Pathology.

There is widespread recognition that in north-west London and other areas of the country we need to ensure there are strong primary and community services to keep people well, effective urgent care services to deal with more intensive need, and world-class services to treat the most severe and urgent emergencies. That is why I welcome the sustainability and transformation plan commitment that there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved—and, as the noble Lords, Lord Warner and Lord Hunt, pointed out, it cannot happen before 2021. Furthermore, despite the accusations of local campaigners, there are no plans to close Charing Cross Hospital, and none of the land on the hospital site has been designated as surplus land for redevelopment.

I turn to some of the points raised in the debate. There is of course with any difficult decision such as this the question of whether there is support from the clinical community. Members of the clinical community were clear from the beginning in 2013 that they,

“remain absolutely confident that delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS”.

The noble Lord, Lord Dubs, pointed out that two councils had not signed up to any plan that involved a hospital being closed. I will say two things in response. First, there is no suggestion that any hospital will be closed. Secondly, I suggest that one reason those councils are not engaging is that they won elections on the basis of suggesting that hospitals would be closed and it is not in their political interest to endorse a plan which makes clear that that is not going to happen.

My noble friend Lord Suri was absolutely right about the need for a bipartisan approach and to avoid mud-slinging at local political level. He made a particular suggestion about the potential use of Wormwood Scrubs. It is not one that I personally endorse, but the point is that any suggestion for reconfiguration must emanate from local health organisations and then go through the service-change tests that I outlined.

The noble Lord, Lord Warner, made a very valid point about co-ordination across London. This is something that we are looking at in particular at the moment. I hope that we will be able to say more about it in due course. Clearly, the interaction between services across the five STP areas is incredibly important; people are clearly moving across boundaries for the healthcare that they need and it is important that there is a degree of local co-ordination.

Of course, there is always with our health service a need for more funding. I know that many noble Lords feel that the Government are not giving the funding they should. With the STPs, I have to disagree; the Budget provided £325 million as a first capital instalment towards transformation and we are absolutely supporting the process—which of course was begun and is being led by NHS England—to transform our health service into an integrated process. One way in which that can be delivered, as my right honourable friend the Secretary of State set out in a speech to the Royal College of General Practitioners, is to have more GPs in training so that there can be more community-based care.

The noble Lord, Lord Hunt, called the STPs a “fantasy”. I know that his right honourable friend the shadow Secretary of State for Health said in his party conference speech that he did not support the STPs but did want integrated care. That is a very easy thing to say, but the challenge is how it will be delivered if STPs are not going to get the backing of the Opposition.

In conclusion, I hope that I have been able to reassure noble Lords and local residents on two fronts. First, there are strict rules that govern the reorganisation of NHS services and that put patient outcomes first. Secondly, Charing Cross hospital has a critical role to play in the sustainability and transformation plan for north-west London and will continue to operate A&E and acute services while the demand for them exists.

The Government remain committed to supporting the local NHS to make complex and sometimes challenging decisions about the future configuration of the services on which we all depend. As those discussions take place locally, it is incumbent on all of us to deal with the facts about what is and is not in prospect, and to avoid playing political games with people’s healthcare.

I will close by congratulating all noble Lords on their incisive and, as ever, forthright contributions to the debate, informed by their role both as legislators and local residents—and once again thank the noble Lord, Lord Dubs, for securing it.

House adjourned at 6.44 pm.