Earlier today (Monday 10th July 2017) Mike Gapes MP (Ilford South) spoke during end of day adjournment debate in the House of Commons yesterday on the future of the A&E department at King George Hospital.
A transcript of the debate is provided below:
Mike Gapes (Labour/Co-operative, Ilford South): It is a pleasure to be called before 10 o’clock. I wish to begin by saying that, earlier this evening, I was at a celebration function organised by the Barking, Havering and Redbridge University Hospitals NHS Trust celebrating the fact that, in March, after three years, it came out of special measures. That event was a very good occasion, because it enabled me to get even more up-to-date information before this debate. The trust has published 10 tips on how to climb out of special measures. I am sure that other NHS trusts will find that valuable. It is has also published the booklet “The Only Way is Up”, which is original, and it details the strenuous efforts made by all the staff and the management and various people with whom they were engaged in order to achieve that great progress.
I must say that, in my 25 years in this House, I have often had to bring to the attention of the House and the Government problems in the NHS in my area. It is not the first time that I have talked about the future of King George Hospital. Although the hospital, which is one of the two—with Queen’s Hospital, Romford—in our trust, is now improving and is under the best management that it has had in 25 years, there are still clouds on the horizon. First, there is, inexplicably, a delay in an announcement about the future of the North East London NHS Treatment Centre where I understand there is some difference of opinion between local clinical commissioning groups. I must declare an interest here: I had an operation on my nose in that facility a few years ago and found it to be very good. There is a very strong argument that that facility could be brought in-house within the NHS, and no longer provided by Care UK. That would allow greater flexibility onsite for longer planning of what might happen at King George Hospital.
Secondly—I referred to clouds on the horizon—there is the ongoing social care crisis, which has impacted very much in my local authority and neighbouring local authorities, linked to the 40% cuts in funding for Redbridge local authority, an ageing population on the one hand and the ongoing social care crisis poses major difficulties. We all know that private care homes are struggling and that there is an issue of quality. It seems to me that one advantage of the King George Hospital site is that it is co-located next door to the facilities of the North East London NHS Foundation Trust’s Goodmayes Hospital and various other facilities that provide support for people with learning difficulties and people with acute, severe and less severe mental health problems. It would seem logical, if we are to have joined-up NHS treatment, to have alongside a hospital facilities for those who need short-term, temporary or longer-term care in transition to or from the NHS facilities next door. The site is big enough to do that and, with imagination, could be a model to be followed.
We also have a third cloud on the horizon, which is the north-east London draft sustainability and transformation plan. The Minister will recall that he and I had a very useful meeting in February, along with his then colleague, Mr David Mowat. We had a useful discussion about the implications of the huge deficit in north-east London—£586 million—the potential huge cuts in the budget over the next four years, and the implications they might have. I raised the issue in detail in a debate on 16 December 2016 and that was why I had the meeting with Ministers.
I am very concerned that the funding gap, even if we have predicted regular savings of about £220 million or £240 million in the NHS, would still be £336 million by 2021. One of the most worrying points about the plan—I understand it is still a draft and has not been signed off—is that I went to a meeting last week when the people involved in the organisation considering the plan were discussing it and senior figures in the London NHS referred to it, saying, “You have to work within the basis of the plan.” It has not been signed off or approved, but the people in the NHS health economy in London are thinking ahead as though it will be.
The plan points out that the population of the north-east London boroughs will increase by 18% over the next 15 years, equivalent to a new city. Normally that level of population increase would require a new hospital, but there is no provision, no funding and no expectation of a new hospital. Instead, the proposal is to downgrade King George Hospital in my constituency and take away its accident and emergency department. That is still in the plan, and it is not a new proposal. In fact, I have been campaigning to save the A&E in my constituency for more than 10 years. But the formal decision was taken by the former Health Secretary, Andrew Lansley, only in 2011. That decision, which was linked at the time to a suggestion of closing maternity services at King George Hospital, provided that those two things would happen in around two years. That was in October 2011.
The reality is that maternity services went to Queen’s Hospital in early 2013—I do not question that there have been improvements—but the A&E could not close as there was no capacity at other hospitals in the region. In addition, it was quite clear that it required huge capital investment, which was not forthcoming. The decision was made in 2011, but in 2013 there was no action and the issue was deferred. The trust then went into special measures three years ago because of a variety of issues, which I have already mentioned.
As the trust comes out of special measures, the question becomes whether it will go ahead with the plans to close the A&E. Practically, it is impossible for that closure to happen soon, but the sustainability and transformation plan still states that the intention is to close the A&E in 2019. The original suggestion was that it would stop the 24-hour service, getting rid of the overnight A&E from September this year. That plan was dropped in January, and I welcome that, but the reality is that it is still in the plan and is still proposed. That cloud still hangs over the trust and all its excellent staff, who have done so much to bring our hospital out of special measures.
Wes Streeting (Labour, Ilford North): I congratulate my hon. Friend on securing this important debate. In my capacity as a Labour councillor in the London Borough of Redbridge, I currently chair a cross-party working group on the future of A&E provision in north-east London. One frustrating thing is that all the local health leads in the area are working to a decision made by a previous Secretary of State. That ministerial decision still stands and the leads have to work towards it. They do not believe that is achievable or clinically sound. Yet, they point to the Secretary of State when pressed to abandon the plans. I hope that the Minister might be able to reverse that ministerial decision and remove the sword of Damocles from our A&E department.
Mike Gapes (Labour/Co-operative, Ilford South): I am grateful for that intervention as it saves me from making the same point. During the election campaign, the Secretary of State went to my hon. Friend’s constituency for a private Conservative party function. He was asked by the local paper, the Ilford Recorder, about the plans to close the A&E at King George Hospital. He said that there were no plans to close it in the “foreseeable future”. Now, I do not know how big the crystal ball is. I do not know what kind of telescope the Secretary of State has and which end he is looking through. The fact is that “foreseeable” does not necessarily mean that the A&E will not close in 2019. If it is not going to close in the near future or even in the medium term, why not lift the cloud of uncertainty over the staff and over the planning process? Then we could have a serious look at the draft sustainability and transformation plan for north-east London, which is partly predicated on the closure of A&E at King George Hospital.
In January, the trust wrote a letter saying:
“It is our intention to make the changes by 2019 but please be assured nothing will happen until we are fully satisfied all the necessary resources are in place, including the additional capacity at the neighbouring hospitals, and we have made sure it is safe for our patients. In the meantime, the existing A&E facilities at King George will continue to operate as now.”
The reality is that there is no additional resource in terms of the capital that would be required to provide the beds for 400 patients at King George overall. We face a very uncertain future. If the A&E closed, where would those patients go? There would be a need for capital investment at Queen’s and for big capital investment at Whipps Cross. That would take time and resources, at a time when NHS budgets are seriously pressed. And we still have that huge deficit in our regional health economy.
Why not take that issue off the agenda? Last month, my hon. Friend and I jointly wrote a letter with the leader of Redbridge Council, Councillor Jas Athwal, to the Secretary of State. We requested that he formally reverse the decision taken by his predecessor, to allow certainty and to allow more sensible planning.
Last week, one of our health campaigners, Andy Walker, who put in various questions and freedom of information requests—he is a very persistent campaigner—received a response from the Barking, Havering and Redbridge trust, commenting on this issue. It used the same formulation:
“We have been very clear that no changes will be made until we have the relevant assurances that it is safe to do so and this remains the case.”
That formulation has been used for several years; it is like a stuck record. It is not safe to make the changes. Why not have a new, imaginative approach that says, “Let’s look at social care. Let’s look at the potential for developing the site. Let’s look at collaboration between the mental health services of the North East London NHS Foundation Trust. Let’s look at providing particular forms of housing and support.” This area could be a model for a new way forward.
I know from discussions I have had that people in various NHS organisations are working on such possibilities, but they cannot go any further than possible explorations while this cloud—the threat to close the A&E—still lies on the table. If the Secretary of State would take it off the table, we could have some serious discussions about improvements to health facilities. We could deal with not just the A&E but other issues.
On the King George site at the moment, we also have an urgent care centre. It recently had a Care Quality Commission inspection and was rated as “requires improvement”. That is an indication, again, of the problems we face. I have a lot of inadequate GP facilities in my constituency; I have lots of problems with people coming to me complaining that they cannot get through. Primary care in north-east London faces a crisis of retention, recruitment and standards of services. If we could make imaginative use of the facilities at the King George Hospital site, we could make a big difference to primary care, as well as to the acute services and the mental health services next door.
My plea to the Minister and the Government is this: take the closure of the A&E off the table, and let us then work collaboratively to improve the NHS in north-east London and in my constituency.
Philip Dunne (The Minister of State, Department of Health): It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by Mike Gapes. I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate Wes Streeting on joining us. He obviously has experience of these matters as well, given his role in the local council.
I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.
The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.
The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.
The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.
We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.
Wes Streeting (Labour, Ilford North): Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?
Philip Dunne (The Minister of State, Department of Health): I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.
I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.
There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.
Mike Gapes (Labour/Co-operative, Ilford South): Does the Minister think that the whole process could be completed by 2019?
Philip Dunne (The Minister of State, Department of Health): I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.
In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.
In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.
Wes Streeting (Labour, Ilford North): Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?
Philip Dunne (The Minister of State, Department of Health): The process should be informed by the decisions taken in 2010, but it will be up to today’s STP leadership to decide what to do.