[Relevant document: E-petition, entitled Save our NHS. Stop Privatisation. Save Ealing Hospital – publicly funded & provided (109473).]
I beg to move,
That this House has considered services at Ealing Hospital.
It is a great pleasure to have secured this debate and I am delighted to serve under your chairmanship, Mr Stringer. I am grateful to you and to Mr Speaker for providing the opportunity to debate this important matter. I am also delighted to see the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), here in Westminster Hall today.
Last week, on 26 April, I presented in the main Chamber a petition organised by a local group in my constituency and signed by more than 100,000 people, which said:
“The petitioners therefore request the House of Commons urges the Government to reconsider the impact of the Shaping a Healthier Future programme on Ealing Hospital, Ealing and the surrounding boroughs that rely on Ealing Hospital to deliver high quality emergency care 24 hours a day.”—[Official Report, 26 April 2016; Vol. 608, c. 1404.]
I have outside the room quite a few organisers and other constituents who are visiting from Ealing and hope to see some outcome from the debate today.
The London Borough of Ealing is one of the fastest-growing areas in the city of London. West London is experiencing fantastic population growth, as people flock to join our vibrant multicultural business hub. Ealing, and Ealing hospital, are at the heart of that growth. London is a demanding city—we know that from living here—but it is not just demanding regarding lifestyle and culture, it makes demands on health and the population demands a lot from its healthcare providers. Across the west of the city, in particular, we have a high level of young people, but the area also suffers from one of the highest levels of lifestyle-led premature death. It is a scandal that we in this great city preside over such a high rate of child poverty, while London drives the British economy.
In 2011, in what I can only assume was a well-meant but ill-founded attempt to improve the situation, the “Shaping a healthier future” programme was implemented across Ealing and the surrounding boroughs. “Shaping a healthier future” looked to combine services in certain hospitals to make savings and to improve 24-hour care, but the reconfiguration and rationalisation were often little more than cover for closing services. For the past few years, local people—the Minister can see that many of them are here today—including people from different walks of life and different political backgrounds and beliefs, west London MPs, Ealing Council members and Dr Onkar Sahota, the Labour spokesperson on health in the London Assembly and chair of its health committee, have repeatedly spoken out against what is being done to Ealing hospital.
We were threatened with the loss of four of our local 24/7 blue-light A&E units. Ealing hospital is expected to lose its full A&E service and have it replaced by a service that is not fit for purpose and cannot guarantee the safety of Ealing residents. Despite the increasing birth rate across our area of London, we lost our maternity unit last summer. That loss means that no more children will be born in the London Borough of Ealing. I must declare my interest in Ealing hospital. Two of my three grandchildren, Aatish and Riah, were born there, and I can vouch for the quality services provided. The paediatric unit is scheduled to lose in-patient services this summer. The iniquity of cuts that threaten the health and wellbeing of our youngest is a betrayal of every Ealing resident.
Shirlyn, a single working mother in my constituency, wrote to me last week to ask me to
“do [my] best to fight this”.
She cannot believe that vulnerable children are being put at risk by cuts. Shirlyn is worried, just as every parent across Ealing must be, that in the case of an emergency the increased travelling time risks increasing the danger children are in. The loss of that key community asset means that the most vulnerable families, those that have children with serious long-term medical conditions, will spend longer travelling, which will threaten their ability to both work and see their sick child. What kind of society can stand by and make someone choose between putting food on the table and seeing their sick child? As Shirlyn says, we in Ealing have paid our taxes and we have not been listened to.
As each successive round of downgrades and closures is announced, public trust in the London North West Healthcare NHS Trust falls further. Public confidence is so low, and people so frustrated at being ignored, that many are worried the hospital will be completely closed and sold for housing. That creates an unsafe situation for the people of west London, and for my constituents in Ealing, Southall.
Accompanying investments were supposed to balance the situation, but as costs have spiralled to more than £1 billion, promised investments have been threatened with withdrawal. Part of the deal for Ealing hospital had been that a new, fit-for-purpose, community style hospital would be built, providing high-quality services in a modern, clean and safe environment. In 2014, Ealing Council, along with others served by the London North West Healthcare NHS Trust, established a commission headed by Michael Mansfield, QC. The independent commission almost universally condemned the results of “Shaping a healthier future”. It found that cuts were affecting the poorest in society most acutely, and that the public had not been properly consulted. Plans had been drawn up that just could not deliver for Ealing. There was no sustainable business plan and the reconfiguration did not offer value for money, and was not affordable or deliverable.
The most important adjustment that can be made now is that the Secretary of State step in and halt the current programme, which is risking lives. The experiment is failing my constituents in Ealing, Southall. Michael Mansfield, QC and his independent commission recommended that a full A&E service be reintroduced at Ealing hospital, and that the maternity unit be reopened. The report also noted that local GP and out-of-hospital services were overwhelmed. Investment in public health is the only way we can end this shame, and give back to Ealing residents the healthcare they deserve. By helping young people and those who are mentally ill, and not allowing thousands more to slip into homelessness—as the Mayor has across all of London—we can help the health of everyone.
In January last year, I asked the Prime Minister to consider implementing Labour’s plan to employ a further 8,000 GPs to ease the workload for the most stretched services. Despite agreeing that GP care is fundamental to providing proper healthcare, he dismissed the plan and we are now seeing the results of his complacency.
London does not just have younger people putting pressure on healthcare services. The population at the other end of the spectrum is growing, and by 2031 there will have been a 40% increase in the over-80s population. That means that London, and Ealing, have to be better than many other parts of the country. We have to face the challenges not as problems but as solutions to the significant health inequalities that exist in our city. In 2013, the Mayor of London launched the London Health Commission, which published its report near the end of 2014. Although it suggested many important changes to NHS services, and outlined many noble intentions, the picture for London is only worsening.
That is why the Government have to step in. I ask the Government, on behalf of the more than 100,000 people who signed the petition and the many more who could not sign it but are worried about the services, that the current programme of rationalisation be halted. Services that are not adequately supported must be supported and reopened. Patient safety has to be the ultimate litmus test, and currently that cannot be guaranteed. As my constituent said:
“Every child is important and this move is putting the lives of these children at risk. Children need A&E.”
The people of the London borough of Ealing and surrounding areas need fully resourced and supported hospitals that provide a full service. Those hospitals need to be supported by the Government for the benefit of the local community.
Order. Before I call Dr Rupa Huq, I would like to explain the timetable for this hour-long debate. I would like to call the Opposition spokesperson at approximately 2.15 pm, and I expect him to take five minutes. Then the Minister can respond, leaving a minute or so for the proposer of the debate to reply. We seem to have plenty of time.
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend and parliamentary neighbour, the Member for Ealing, Southall (Mr Sharma), on securing this important debate. It was the consolation prize for a petition that had more than 100,000 signatures. Initially, that petition went to the Petitions Committee. The number of signatures demonstrates how the Ealing hospital issue has gone beyond being a little local difficulty. It is now a national scandal.
Mr Stringer, I do not know what it says in your diary for 18 May. For MPs from all parts of the House, it says, “State opening of Parliament”. Despite the legislative programme coming our way, it is usually a joyous occasion. It has pomp and circumstance, and we may get a sighting of Her Majesty the Queen. It is also, however, the day when the Ealing clinical commissioning group will take the decision to shut the door on children’s services at Ealing hospital. For people in Ealing, it will be a sad day.
It is not yet a year that I have been a Member of Parliament, but some of the subjects that come up in relation to Ealing hospital seem depressingly familiar, even to me as a newbie. We seem to have this common situation when the Government just will not budge. Their intransigence makes it all seem a bit like groundhog day. I was a Labour candidate for 18 months before I was elected, and the NHS was the No. 1 issue on the doorstep. We were told that we were fearmongering. I remember we had a big march—a demonstration—from Ealing hospital to Ealing common, which is a number of miles on the map. We warned that the A&Es at Hammersmith and Central Middlesex would be closed, and we were told that we were fearmongering. They have both gone now, closed in September 2014. That was euphemistically called “changes”. Everyone had a leaflet through the door talking about “changes” when it meant “closures”.
In the run-up to the election, I did several hustings where I warned that maternity was next for the chop at Ealing hospital. Again we were told that we were scaring people and that it was a scare story, but on the other side of my election that closure sadly came to pass. One of the first things I did as an MP was table an early-day motion about it, which my hon. Friend the Member for Ealing, Southall signed. I think my right hon. Friend the Member for Islington North (Jeremy Corbyn) was the first non-Ealing MP to sign that early-day motion, which asked for the Government to think again and condemned the closure.
As my hon. Friend the Member for Ealing, Southall pointed out, Ealing is a young borough. It needs maternity services. Those services closed at Ealing hospital in June, and paediatrics is next, because we cannot have a children’s ward without maternity services, and maternity is gone. There is a fear that there is a domino effect—that these things consequently happen one after another. It creates a climate of fear and uncertainty among the staff and the patients. Many of the mums who had births in the middle of last year were uncertain as to whether the maternity services would be there. The closures are demoralising and out of step with the needs of the wider west London area.
As an academic by trade, I believe in evidence-based policy, and the evidence is that Ealing borough has a population of 360,000 people and rising. That is as big as a city like Leeds. The borough needs accident and emergency services, maternity and a children’s ward. There was a meeting at Richmond House, which I think my hon. Friends the Members for Ealing, Southall and for Hammersmith (Andy Slaughter) attended, along with the Minister. It was a good meeting on the whole, but the PowerPoint we were shown confirmed that Charing Cross and Ealing will be downgraded to minor hospitals. The House of Commons Library confirmed to me this morning that the population of London as a whole is projected to rise to 10 million, so surely we need more capacity, not less.
The bill for the “Shaping a healthier future” reconfiguration programme keeps rising. I think it is £235 million at present. Some £35 million has been spent on management consultants, such as McKinsey and all those people. It does not look like good value for the taxpayer. We are living in an age where every pound of public money spent has to be justified, and the end result of this programme will be fewer acute beds and fewer hospitals, with A&Es in west London decimated. It is a bad deal all round. There is other evidence of that. I am not someone who likes to trot out loads of statistics, but waiting times are massively up at Northwick Park, which is seven miles away from bits of Acton in my constituency. In the immediate aftermath of the closure, it had the worst recorded A&E waiting times in England for six out of 15 months.
My hon. Friend the Member for Ealing, Southall has alluded to the Independent Healthcare Commission for North West London headed by Michael Mansfield, who is a respected QC and who has expressed concerns about the business case. Forget all the emotional stuff; he is looking at whether it is a good deal for the taxpayer, and he has called the business case “deeply flawed”. I pay tribute to the tireless work of Eve Turner and Oliver New, as well as to my constituents Arthur and Judy Breens, who have formed an organisation—it keeps changing names: it was Save Our Hospitals, then it was Save Ealing Hospital.
The petition, which was batted back by the Petitions Committee, talks about
“a peaceful occupation at the Maternity Wing Area”.
That is how bad things have got. It also states:
“Protests are growing and the anger is reaching boiling point amongst thousands of members of the community.”
These people were not political before this issue came up. It has politicised the chattering classes of Ealing behind their net curtains, not that I am dismissing people with net curtains. They are a completely valid form of internal decoration and I love them dearly. The issue has managed to inflame people who are not usually inflamed and who have never been on a demonstration.
I am sorry to intervene when my hon. Friend is in full flow, but it is important to make the point that the campaign is non-partisan. All the political parties on Ealing Council unanimously support it and more than 100,000 people signed the petition. Many hundreds of people actively went around their areas asking for signatures. It is important to understand that the campaign is not led by any political party.
My hon. Friend puts it very well. I completely accept his point. The strength of feeling about this issue is palpable. It is a non-partisan thing; they are people who have never been on a protest march before.
Talking of protest marches, a couple of weeks ago I joined the junior doctors on the picket line outside Ealing hospital. Some of those people are in the Public Gallery today. We were last together on that day, so we have been reunited. Quite aside from imposing a contract on junior doctors—a contract is not a contract unless there is offer, acceptance and agreement—there are so many other issues with the junior doctors’ strike that should be raised here, such as the fact that they are patronisingly called junior doctors, as if they are the work experience person who makes the tea. They are very experienced people with years and years of clinical experience. Calling them junior doctors is almost a way of belittling them.
I raised the plight of those highly experienced, yet technically junior, doctors with the Prime Minister at Prime Minister’s questions recently. The Government’s equality impact assessment of the new contract shows that it discriminates disproportionately against women because childcare costs more at the weekend, and if weekend hours are counted as normal hours, women will have to pay. Again, the issue was batted back and just shoed away, which is disappointing because the Government’s own advice tells them about the costs. It feels as though junior doctors are being stretched ever thinner, and if something is stretched ever thinner, it can snap.
I wanted to be brief today because I have spoken many times on Ealing hospital both here and in the main Chamber. This morning I asked the Library staff whether they had a briefing pack on the 1.30 debate on Ealing hospital and they said, “Again? You’re always speaking on this. You had three hours on this subject on 24 March,” for which they did prepare a briefing. One would think that after umpteen debates, I would have said all I have to say on this subject, but the tale gets worse and worse.
I have mentioned before the cases of constituents facing long waits: for example, the Khorsandi and Anand families. The last time I faced the Minister in this Chamber, I mentioned my constituent Bree Robbins’s three-year wait for breast reconstruction. She was disappointed she did not get an answer last time, but maybe we can try again today. People have legitimate concerns.
Like my hon. Friend the Member for Ealing, Southall, for me Ealing hospital is personal. It is where I would have been born, but I was born in 1972 and it did not exist then. However, I remember that hospital going up with so much hope attached to it, and now I see it constantly being downgraded. As my hon. Friend says, the suspicion is that it is on the way out. I have been to the acute medical unit in the basement with my mum; I have been to the hospital as a mum; it is where in September 2014 my father breathed his last. So this hospital is not a hypothetical thing on a spreadsheet; it is something that I and family members use.
Recently, 11 north-west London Labour MPs, led by my hon. Friend the Member for Harrow West (Mr Thomas), signed a letter calling for the National Audit Office to investigate. There is a question of economics. We want the Minister to think again, consider the business case and halt the closure programme. The case simply does not add up.
As I said, I remember the hospital going up and I remember, as will my hon. Friend the Member for Ealing, Southall, several schools in the Borough of Ealing that were closed in the ’80s when rolls were falling. The place in Greenford—I cannot remember its name—where they send school governors on training courses is a disused school, but now schools in Greenford are having to be opened. The Priory Centre in Acton was a community centre in a disused school. Now it has been razed to the ground and a brand-new primary school built, because numbers are going up. The short-sightedness flies in the face of the evidence and ignores the fact that populations are rising.
I do not have any hospitals in my constituency, although I had several on the edges: Central Middlesex, where the A&E has gone, Hammersmith hospital, where the A&E has gone, and Charing Cross, in the constituency of my hon. Friend the Member for Hammersmith (Andy Slaughter), which is going to be downgraded. Although I do not have hospitals in my constituency, all those ones that were there on the edges are disappearing before our eyes, so I urge the Minister, who I know is a reasonable person and a London MP, to think again.
It is a pleasure to be here this afternoon under your chairmanship, Mr Stringer. Although the debate is difficult, it is a great pleasure to follow my two neighbours from the London Borough of Ealing, and I thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for securing this debate today. As the MP for Ealing hospital, no one has done more than he has to champion the cause of that hospital over the four years that it has been under threat. As we see from the petition that generated this debate—not the first petition of this size—he is admirably and clearly reflecting the view of the vast majority of people not only in Ealing borough but across west London.
Apart from their choice of Member of Parliament, the constituency of my hon. Friend the Member for Ealing Central and Acton (Dr Huq) may be one of the most unlucky in the country. To lose one A&E department may be considered unfortunate; to lose four must be an all-time record. Following the closures of Central Middlesex and Hammersmith and the downgrading of Ealing and Charing Cross to non-type 1 status, her constituents will be in a very difficult position, as will all our constituents.
I am here today for two reasons. I am not an Ealing MP, but I want to support my colleagues and I want to say—I think the Minister will accept this—that the proposals for Ealing hospital are inextricably linked, under the “Shaping a healthier future” programme, to the future of the eight other major hospitals in west and north-west London, four of which, as we have seen, will undergo substantial change and either closure or downgrading of services, or at least movement of services elsewhere.
As my hon. Friend the Member for Ealing Central and Acton said, we have debated this subject many times. I do not think that is surprising. I make no apology for that, given the importance of the issue. In the recent debate in March, which was an across-London debate, “Shaping a healthier future” was raised several times. One of the matters on which I and others pressed the Minister was when we would see the next developments. I was grateful when the Minister said that Members would have the next important document—the draft of the implementation business case—as soon as possible.
Since that debate we have also managed to fix a date, 25 May, for the 11 MPs to meet the health service management across north-west London. Unfortunately, I have been told by my clinical commissioning group that the document will not be available for the meeting, although it will be available later in the summer. The sooner we can see that document and have an update on what the proposals are for Ealing and the other hospitals, the better. I say that because this will be familiar not only to Members here, but to the many people in the Public Gallery. The difficulty we have had over the past four years is a lack of information.
We began with the bombshell proposals in the summer of 2012, which effectively proposed the closure of Ealing and Charing Cross hospitals, leaving just a primary care facility on the site. There was a modification when the final proposals were brought forward in February 2013. Those proposals—which most of us regarded as a fig leaf, albeit a very expensive fig leaf—were for the demolition and disposal of a substantial portion of the site, but with the building of new facilities, primarily for primary care and some other treatment, while still using the majority of emergency and acute services on the site. Since then, nothing. Indeed, we have been waiting a couple of years for the business case. In the place of factual information, rumours tend to spread. As was mentioned previously, nothing has changed.
As for Ealing hospital, the very strong rumour is that, given the poor financial condition of the NHS and the scepticism of the Treasury about the programme, it is likely that the service cuts and reconfigurations will go ahead, but also that the existing buildings will be retained. Those buildings were not designed for the purposes for which they will now be used and will not receive the funding to modernise them that was at least the mitigation in the previous proposals. The sooner we know one way or the other on that, the sooner we can have a proper discussion about it. The news that Imperial will have a £50 million deficit this year—I think the situation for north-west London hospitals is even worse—suggests that the financial imperative is continuing to drive this
Although the health service itself may have been quiet—certainly in what it has told Members and the public—my constituents and those of my hon. Friends have not been quiet over the past few years. As I say, the petition that generated this debate is not the first petition of more than 100,000 signatures that has been lodged. I hope that more attention is paid to this one than has been paid to previous ones. I pay tribute to the thousands of people who have not only signed petitions but been active in the campaign, which is going into its fifth year. The uncertainty is not helping anyone.
The public, the organised campaigns and the local authorities have acted responsibly. The local authorities commissioned the Mansfield report, a serious document that was not taken seriously enough by the NHS. The level of demoralisation is extremely high, and is combined with issues relating to the junior doctors’ dispute. Places such as the Imperial College school of medicine are centres of excellence for training junior doctors. I have spoken many times to the staff there and their morale is very low. All staff morale is very low because people do not know where they are going to be working or what job they will have. They do not know whether the facilities they are working in will survive, or whether they are going to be run down in the meantime. Consequently, we have a substantial overreliance on agency staff. That is not a good template for the NHS.
I appreciate the fact that there are financial difficulties throughout the country and that the situation in west and north-west London is not unique. Nevertheless, I do not think that any other areas have had to put up with this reorganisation—or whatever we want to call it—for as long as we have.
When my hon. Friend made the point about the loss of four A&E departments, he reminded me of the saying, “Once is unfortunate, twice is a coincidence, but three times is beginning to look like a habit.” I do not believe that any saying even goes up to four. Does he agree that it is unprecedented to lose four A&E departments?
Yes, I do. I anticipate that we are unlikely to get much by way of an answer from the Minister today, although I will be delighted if she does have some news to impart. I hope she will take the debate in the spirit it has been conducted, because there is genuine anxiety. What we are asking for and what will help is transparency. It may be that we do not like what we hear any more than we liked what we heard three or four years ago, but it is getting beyond a joke now.
We talk a lot about hundreds of millions of pounds of money and about people’s love for institutions such as hospitals, but if we are pragmatic about it, at the end of the day the important thing is whether individuals receive a good standard of care. By coincidence, this morning I spent half an hour on the phone to a constituent whose husband’s life was saved two years ago when he had a serious aneurism. They were told by the professor who operated on him that had they taken a few moments longer to reach Charing Cross hospital, which they live very close to, that would have been the end.
The rider to that is that last week the same gentleman was rushed to Charing Cross hospital again with a recurrence of that issue. He spent seven hours there before being transferred to St Mary’s in Paddington, where he again received very good treatment. I hear again and again that the system is beginning to break down and people are not necessarily taken to the right place at the right time or, when they do get there, they are not seen quickly enough. That is not a criticism of the staff, who are working extremely hard against the odds and are highly professional.
We are very lucky to have such world-class hospitals in west London. We do not take that for granted, but I have given just one example of the kind of story I could probably repeat every week. I worry about the future of the health service for my constituents and those of my colleagues if we do not get to grips with the situation quickly. We are drifting in a way that means that the excellent and superb levels of healthcare we have become used to over the years are no longer likely to be maintained.
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this extremely important debate and on the eloquent way he introduced it. He is widely known in this place for championing issues on behalf of his constituents; his contribution today will only further enhance that reputation. He presented a comprehensive picture of his constituency, rightly highlighting the scandal of health inequalities there and his concern about the implications for patient safety of the Government’s proposals. He cited staggering figures for the growth in elderly population in his area—not unique, but by no means to be ignored. He expressed his concern that the most vulnerable and those whose children have long-term conditions will have to travel further to access services, with possible negative implications for their economic situation. It is clear from what he said that he and his constituents have lost confidence in the process.
I draw attention to the contribution from my hon. Friend the Member for Ealing Central and Acton (Dr Huq). She is new to this place but is fast gaining a reputation as a Member who assiduously represents her constituents. She described the Government’s response as intransigent. If that is her experience, I am sure it is no reflection of the effort she has put in. She compared Ealing to the city of Leeds, and it is unthinkable that a city the size of Leeds would not have such fundamental health services as those being discussed today. She described what has been presented to us over the past few years as a bad deal all round. As an academic, she has based her comments on the evidence she has seen, not on opinion. She and my hon. Friend the Member for Ealing, Southall both expressed concern that Ealing hospital is on the way out. Those were not careless comments thrown about for political gain but genuine anxieties born out of what they see and hear.
My hon. Friend the Member for Hammersmith (Andy Slaughter) correctly said that the sooner the business plan for further implementation is available, the better. He identified the lack of information as a factor that has made the situation far more difficult than it could have been. As he says, where there is a vacuum, something will fill it. In this case, the vacuum has been filled by rumours—rumours so strong that two of my hon. Friends have felt compelled to raise them here today. He said that transparency will help; I certainly agree with that. I also agree that our concerns are no reflection on the hard work and valuable contribution that our NHS staff make each and every day.
More than 100,000 people have now signed the petition to express their concern about service downgrades and what they see as a real threat to the future of Ealing hospital. Their concerns relate to the “Shaping a healthier future” programme, which was launched in 2011 by a group of what were then 10 primary care trusts,
“to reshape hospital and out of hospital health and care services in North West London.”
Following the abolition of primary care trusts, the North West London Collaboration of Clinical Commissioning Groups has led the programme. It has proposed a number of extremely significant changes, including the downgrading of accident and emergency services at a number of hospitals.
In 2013, Ealing Council’s health overview and scrutiny committee referred the programme to the Secretary of State, who concluded that changes to NHS services in north-west London should proceed. In a statement, the Secretary of State said that five of the nine hospitals—Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster, and St Mary’s—would provide comprehensive, seven-day-a-week acute emergency care. He also stated that A&E departments at Ealing and Charing Cross hospitals would remain open, although with what—as my hon. Friend the Member for Ealing Central and Acton pointed out—he euphemistically called changes to the “shape or size” of services. Those changes have probably not turned out as people hoped. Changes were recommended to replace the A&E services of Hammersmith and Central Middlesex hospitals with urgent care centres, which were subsequently implemented in September 2014.
In 2013, it was decided that maternity services would be consolidated on to six hospital sites and maternity deliveries at Ealing hospital would cease. We have heard from my hon. Friends how significant that has been for their communities. The maternity unit at Ealing hospital was closed in July 2015. It has now been recommended that in-patient paediatric services should also be moved to maintain appropriate staffing levels. These changes have, understandably, caused great public concern, which in 2014 led to Brent, Ealing, Hounslow, and Hammersmith and Fulham Councils establishing an independent commission under Michael Mansfield QC to review the impact of the changes to the north-west London health economy and to assess the impact of planned changes.
On 2 December 2015, the commission published its final report, which was extremely critical of the “Shaping a healthier future” programme, finding that inadequate consultation had been undertaken and that departments had been shut without providing adequate alternative healthcare. Its recommendations included halting the SHF programme and that local authorities should consider a legal challenge. The Government’s response states that they are
“clear that reconfiguration of front line health services is a matter for the local NHS.”
It is clear from answers to parliamentary questions and a Westminster Hall debate on 24 March that both the CCGs and the Government do not accept the review’s findings.
The principle that decisions should be made locally by clinicians is sound, but there seems to be an issue about accountability in this case, as there is a clear feeling among the public and local politicians that their concerns are simply not being heard. Those who gave evidence to the commission were not fly-by-nights. Many were working on the front line of the services under discussion. Indeed, they are the local clinicians the Government say should be making the decisions. What recourse do clinicians, the public and patients have if they disagree so fundamentally with what is being done as we have seen here?
The most successful service reconfigurations are those where consultation is most effectively carried out and where support from clinicians at all levels, local politicians and, of course, members of the public is secured. It is no coincidence that when public concern is at its present level in Ealing and the surrounding communities, we tend not to see successful changes in provision.
Such was the frustration and concern about the changes that four local councils thought it necessary to use local taxpayers’ money to commission an independent report. As my hon. Friend the Member for Hammersmith said, the local authorities involved have behaved responsibly in commissioning this report. I do not believe there is any suggestion that they have behaved irresponsibly, so surely the Minister must acknowledge that taking this extraordinary step means that something must have happened that deserves further examination.
I turn to some of the recommendations in the independent report. Serious concerns have been raised about the consultation in 2012. There has been no significant further consultation since. Given that we are now four years on from that point and that the scheme has undergone considerable changes, as has the demographic make-up of the communities, it seems reasonable to consider a further period of consultation.
Concern was also expressed in the Mansfield commission’s report and here today about transparency, particularly in the business case on which the SHF scheme is based. I would welcome the Minister’s observations on both points, and if, like me, she is not satisfied that there has been sufficient public involvement, will she step in and ensure that that takes place before further downgrades or closures and that it is genuine consultation predicated on release of the full business case? Genuine consultation cannot take place if vital information is withheld. Transparency is the key to meaningful engagement.
The commission was asked to look at deteriorating standards in three local NHS trusts that were consistently failing to meet key targets, including that 95% of patients attending A&E must be seen, treated and admitted or discharged within four hours. The Minister will be aware that after six years of a Conservative Government, February’s figures are the worst on record for A&E waiting times. The most recent figures confirm that all three NHS trusts covering this area are failing to meet their targets.
In major A&E units, London North West Healthcare NHS Trust saw just 76% of patients within four hours and Imperial College Healthcare NHS Trust saw 69.1%. Does the Minister agree with the commission that the closures of Hammersmith and Central Middlesex A&E departments are responsible for these appalling figures, or is the Government’s overall record to blame?
Finally, the other key principle to which all service reconfigurations should adhere is that they should be based on clinical rather than financial need. They must represent what is in the best interests of the patients who access the services and not simply be a tool to balance budgets at any cost. In this case, because the Government have fundamentally lost control of NHS finances with 75% of trusts now in deficit, local people are understandably asking whether the serious financial hardship that the trusts face is forcing the CCGs to consider changes that they otherwise would not. Can the Minister assure us that no decision will be made in this case or any other on the basis of finance alone and that the interests of patients will remain the central focus at all times? It is clear that public confidence has been lost in this case, and it is simply not good enough for the Government to wash their hands of it. We urgently need an acknowledgement of those concerns and concrete plans to address them.
Of course, Mr Stringer. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Ealing, Southall (Mr Sharma), a fellow London MP, on securing this debate on an issue that is of concern to him, to his constituents, as we can see from the attendance in the Public Gallery, and, of course, to colleagues in neighbouring constituencies, who also contributed to the debate—not for the first time.
Before I address the issues raised, I would like to echo the words of others and pay tribute to those who work in our national health service. Despite the debates that we have in this place about reconfigurations and the like, all of us are united in praise of the dedication of those working on the frontline to provide first-class services to all in their care.
There is of course considerable ongoing interest in the changes in north-west London proposed under the “Shaping a healthier future” reconfiguration programme. It is worth stressing that those are not just changes to acute hospitals, but planned changes to the whole of that health economy. The aim has been to look at how it can best provide in the future for the local population.
Of course I acknowledge the concern expressed among local people and in particular by the Save Ealing Hospital Community Action Group. The hon. Member for Ealing, Southall will know that I responded in January to a petition by the action group, and I will respond in writing in due course to the latest petition that he has presented. But I want to make it clear that proposals and change on so large a scale as that taking place in north-west London are inevitably controversial. Major change is inevitably controversial, but we have always stressed, as did the shadow Front-Bench spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), that the reconfiguration of services is a matter for the local NHS. That is best organised and shaped by those who know the communities best, and with local clinicians right at its heart, rather than being dictated from Whitehall.
Let me deal with the Mansfield Commission report. On Thursday 14 January, the North West London Clinical Board considered the report of the Independent Healthcare Commission for North West London, and the view of the clinicians on the board—local doctors and health workers—is that the current programme, which was designed by doctors and based on significant clinical data, evidence and experience, continues to offer the best outcomes, experience and equality of access to NHS services for all our patients. That is a direct quote from what they said. Having read the Mansfield report, I am not surprised that that was the conclusion of local health leaders. I take issue with a number of things said about that report, not least about its independence, but I want to use some of the time that I have this afternoon to deal with some of the substance of the concerns raised about services for people in Ealing. Some of the language used was very strong, and I want to try to set a few minds at rest by talking about some of the new services.
Before moving on to specifics about Ealing, though, let me deal with the implementation of the programme itself. The hon. Member for Hammersmith (Andy Slaughter), perfectly reasonably, exposed the case why it is important that people have certainty and transparency. Some colleagues referred to the meeting that I chaired last summer to try to reboot this process after the general election—with a degree of success, in terms of the contacts between Members. But on the proposals for capital works for both Ealing and Charing Cross hospitals, I have been assured that local health and social care partners are working together to produce a sustainability and transformation plan by the end of June 2016, and it is anticipated that details for those two sites will be included in that.
I have been honest enough before to say that I share hon. Members’ frustrations about delay. I quite understand why they want more certainty and I fully expect NHS England and the “Shaping a healthier future” programme to keep me abreast of developments as we move towards the summer. I want to hear if there are any problems with hitting that timetable, because Members have a right to expect to get that information, so that they can respond to it, so please rest assured that I will continue to ask those questions.
The hon. Member for Hammersmith also talked about morale, and it is vital that we put on the record some of the ways in which good progress is already being made as part of the “Shaping a healthier future” programme. As I have said, better healthcare is not just about the acute sector, important though that is. For example, good progress has been made in developing primary and community services, and there are examples showing patients benefitting. GP practices across north-west London now offer more than 1 million people in the area extended opening hours on weekdays, from 8 until 8, and weekend access. That is vital for families’ peace of mind, as has been mentioned. GPs in Ealing now provide 19 new services, including anticoagulation services, electrocardiograms and some mental health services. Many more community services are now in place across all eight boroughs, so more patients can be seen closer to home.
Those are just some of the reasons why I do not recognise the description of the plans given by the hon. Member for Ealing, Southall. He used expressions such as “risking lives” and that is not what local doctors want to do or what the plans are about.
I am sorry; I will not, because the hon. Lady made a long speech and I must respond to it.
At the heart of the plans is the fact that local clinicians want to provide more and better services, although delivered differently, it is true, from the way they may sometimes have been delivered in the past. That brings me to the focus on Ealing hospital. Of course I recognise the concerns associated with such significant changes as are proposed, and I take the point entirely that uncertainty, both for Members of Parliament and members of the general public, gives rise to concerns.
Ealing hospital will be redesigned as a 21st century facility for the local community. The hospital will have a local A&E and a 24-hour GP-led urgent care centre, with access to 24-hour specialist care, as well as a range of specialist services designed with the needs of the community in mind, such as a diabetes centre of excellence. The hospital will be a centre of excellence for other areas of care, such as elderly patients, those with long-term conditions and the most vulnerable members of the community, by integrating primary and secondary care with community and social care. It is common ground between all parties that that is how we will help to keep people healthier in the future. So good news for patients is already beginning, in the changes.
On maternity services, some strong language was used in the opening speech about concerns for local mums and their babies. As has been pointed out, maternity services were consolidated in July across north-west London into six maternity units. Women from Ealing now have a choice in maternity services, with 30 antenatal sites across Ealing, including Ealing hospital, and six sites for delivery across north-west London. As a result, there has been a 10% increase in choice of midwifery-led units. I am told that 778 women had their maternity care safely transferred from Ealing to a new maternity unit of their choice with no incidents reported.
What is the benefit to Ealing women from the changes? Before the changes, Ealing hospital was achieving 60 hours of consultant cover—lower than all the neighbouring hospitals. Across north-west London before the transition, the average was 101 hours. North-west London has set out to achieve 123 hours in 2015-16, and it currently has 122 hours of consultant cover. Also, 100 new midwives have been recruited across north-west London as a result of the changes. Antenatal and postnatal care are still available at Ealing hospital, and as I said, the number of community midwives has also increased locally at 30 sites across Ealing. It is clear that a complex service change has been managed safely, with benefits to patients—mothers and their babies. It is telling—Members need not just listen to my words—that Ealing Council’s health and adult social services standing scrutiny meeting on 26 April heard from the Royal College of Midwives. That is not the Government. It endorsed the transition and congratulated the NHS in north-west London on the model of care and the detail in the transition. Again, I do not recognise that service in the words of the hon. Member for Ealing, Southall, although I know that he meant them with due concern for his community.
On paediatric in-patient services, good progress is being made on the implementation of changes. I am informed that that will ensure that children in north-west London will receive consistently high-quality seven-day care, with more paediatric nurses and specialist doctors available. Paediatric in-patient services, which are for children who require emergency treatment or an overnight stay, will move on 30 June from Ealing hospital to five other hospital sites in north-west London. That will significantly expand capacity—more beds, doctors and nurses, seven days a week.
The changes do not mean that all children services are moving from Ealing. Nearly three quarters of existing children’s services will continue on the Ealing hospital site and elsewhere in the borough. Services remaining include routine appointments and treatments that do not require an overnight stay, such as day care unit activity, so most children will be seen in the same place as they are now. Urgent care for minor injuries and out-of-hours GP appointments will also remain at Ealing hospital. The majority of children who are brought to Ealing’s A&E by their family or friends are already treated in the urgent care centre. Services for children with long-term conditions, such as asthma and epilepsy, and child and adolescent mental health services will also remain unchanged.
To reiterate, 75% of existing children’s services will continue to be delivered by the dedicated staff of Ealing hospital, but—this is an important “but”—the sickest children in north-west London will receive better care as a result of the changes. That is what we all care about the most.
It is right that local people have the chance to hear from their parliamentary representatives in such debates, so I welcome the fact that we have had the chance to debate the subject again. I suspect that we will do so again at some point in the future. As the programme moves through its implementation, I encourage those with particular concerns to continue to engage with the local NHS. I thank colleagues for doing so, as they have been, because that is the right way to proceed. I have reiterated to local health leaders the need to share plans in a timely fashion. I only ask of hon. Members that they also share the positive changes that are already visible to people in their communities, as I have illustrated today. I look forward to hearing how the meeting later this month goes—it was referred to earlier—and I will continue to engage positively with colleagues as they handle this important issue, which matters so much, as we can see, to local members of the public.
I thank the Minister, and I thank all my colleagues who have given their points of view on my side and supported what their local constituents want. I do not want to give the impression that we are only talking about hard-hitting, scaremongering practice; I am representing the true feelings at the grassroots—what people think of their services.
I, too, have experienced huge numbers of cuts in services, with a long waiting list, or people not getting appointments in time, or being sent home after hours of waiting, because a service cannot be given. There is a shortage of nursing and other staff members, so hospitals are unable to provide services. Northwick Park hospital, mainly used since Ealing hospital services closed down, has been declared to be the most inefficient hospital in west London. It came the very bottom of the league.
Something is therefore wrong, which is why we are making our points and asking the Minister to reconsider those values and to sympathise with those people who will be receiving the services on offer and with how they suffer the travelling and not knowing the system, which involves long waiting and not getting the services. In addition, there is sometimes a language problem for people from different communities without knowledge and experience of English.
I urge the Minister to reconsider, as my colleagues and I have requested. Again, I thank my colleagues and, in particular, my hon. Friend the Member for Ealing North (Stephen Pound), who unfortunately was unable to attend. He sends his support, of which he has spoken many times before.
Question put and agreed to.
That this House has considered services at Ealing Hospital.