Extract from House of Commons Hansard    Debates for 31^st Jan 2007

Health Services (North-East London)

Mr. Neil Gerrard (Walthamstow) (Lab): I say at the outset that I support what has been said by my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) and the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith). I shall try not to repeat too much of it, but there will inevitably be some repetition because the key points are the same for us all.

The first issue to mention is the wider context. Professor Ara Darzi is just starting the London-wide review. I spoke to him recently and he said that he would be examining the clinical context of what is happening across London and that he wanted to speak, among others, to Members of Parliament who might be affected. He obviously regards his work as just starting. How there can be major changes going on in one sector of London in advance of the London-wide review is beyond me.

We are being told by NHS London that it will not let the review go ahead unless it is confident that it fits in with the general pattern of where it wants to go. That suggests one of two things: either it has already made its mind up about the general pattern or, more likely, it has already made its mind up about what it wants to do in north-east London and it does not really matter what comes out of the general review.

The area covered by the review is quite artificial. When one considers patterns of travel and where hospitals are in north and east London, the lines that have been drawn are an artificial boundary. For people in my constituency, Queen’s is a long way away, or they would regard it as such. It might not look very far on the map, but it is when people are trying to get there. Compared with going to Newham, North Middlesex or Homerton, Queen’s is not on the radar for where people would want to go if there were changes at Whipps Cross.

We have asked questions about what will happen to the other hospitals such as North Middlesex, Newham and Homerton, and whether they will have extra capacity. We have been sent copies of the letters from the fit for the future review team to the hospitals. We have also been sent the replies, although I do not see how the hospitals can reply in any sensible way when they do not know what will happen to them in the London-wide review. For instance, a decision that affected Chase Farm hospital in Enfield—we know that there have been discussions about what might happen there—would have an enormous impact on North Middlesex hospital. That, in turn, would affect what North Middlesex could do for areas such as Waltham Forest.

The review is starting with certain givens. One is that Queen’s hospital will remain as a major acute hospital, irrespective of anything else. Of course, that is because it is a new private finance initiative project. The second given is that the independent-sector treatment centre on the King George hospital site is guaranteed a certain number of routine operations every year. We are then told that there is over-capacity in the hospital system, but I do not remember ever being asked whether I wanted an independent treatment centre at King George, and nor does anybody else locally. We therefore face the possibility that established hospitals will be run down, while we are lumbered with an independent treatment centre for which nobody asked and which nobody wants. However, that centre will cream off work from Whipps Cross and King George.

Mike Gapes (Ilford, South) (Lab/Co-op): My hon. Friend should be aware that the contract for that independent-sector treatment centre on the King George hospital site is for only five years. Therefore, if elective work is removed from King George, as proposed under fit for the future option 4, there is no guarantee that any operations will be carried out overnight at that site in five years.

Mr. Gerrard: That is absolutely right. As has been said, a lot of what is going on is the result of very short-term thinking. We do not know whether the independent treatment centre will be there in 10 years, but we do know that there will be significant population growth in the area over 10 years as a result of work on the Thames Gateway and the Olympics. A significant amount of accommodation will be built as part of the Olympics, and the Olympic village will stay there after the games, but the people who live there permanently will need health care.

My hon. Friend the Member for Leyton and Wanstead mentioned the promises of capital investment at Whipps Cross, and there has been significant capital investment
over the past few years. We have a state-of-the-art eye surgery unit, a brand-new high-class endoscopy unit and walk-in centres, and A and E has been refurbished. There is no question but that that investment has led to significant improvements in the quality of care at the hospital. That is reflected in the Healthcare Commission’s comments and in the fact that significantly fewer people get in touch with me to complain about the quality of the care that they have received at the hospital than was the case a few years ago.

What is happening now as regards capital investment? It appears that the fit for the future review started from the assumption that there will be no capital investment at Whipps Cross. If so, it will produce very different answers from those that it would have produced had it assumed that there would be capital investment. Whenever I have met members of the review team and asked them about the assumptions that they have or have not made about capital investment, I simply have not got a straight answer. My suspicion is that the starting assumption was that there would be no major capital investment at Whipps Cross in the next few years. That, in turn, will drive the direction in which the various options go.

The five options that have been looked at have been scored under a system of assessment. The methodology behind the scores is presented as if it were almost a scientific process and allowed us to look at the factors involved. There are several criteria, such as

“improving the quality of health services...ease of access... providing a...flexible physical capacity...supporting a developing and motivated workforce”.

Weighted scores have been attached to those criteria, and we are presented with a table of scores, as if we were dealing with a scientific, rather than a pseudo-scientific, assessment. That, however, is what is going to the seven trust boards in the next month, and I wonder what will happen if they disagree. What will a board do when faced with a paper that says that serious cuts will be made at the trust for which it is responsible? If the board disagrees, who will decide which option is taken? Who will decide what is or is not viable?

We are clearly told that the status quo is not viable and that that option is virtually ruled out. Some of us believe, however, that it is viable, and that is certainly true when it comes to keeping the current pattern of hospitals. When I say that the status quo is viable, I am certainly not suggesting—I do not think that any of us is suggesting—that there should never be any change. I have no problem with seeking greater efficiencies and, for example, improving the length of stay at Whipps Cross after routine operations, because the hospital’s performance on that has not been terribly good and does not compare tremendously well with the national average. We can, therefore, achieve greater efficiencies, and no one has any problem with that.

Nor do I have any problem with the concept that a lot more can be done. GPs can perform operations that have traditionally been performed in hospitals, and community nurses and practice nurses can do more.

Jon Cruddas (Dagenham) (Lab): The assumption in all the analysis is that primary care is confident that it can take the strain. However, the London borough of Barking and Dagenham has had three top-slices to its primary care budget allocations over the past 12 months.  Does that give confidence to those who assume that the primary care sphere will take the strain as the area’s general capacity is run down?

Mr. Gerrard: Absolutely not, and I am about to come on to what is happening in primary care. I know that in 20 years hospitals will look different from how they look now, in the same way that hospitals now do not look exactly like they did 30 or 40 years ago. The buildings may look the same, but what is happening in them is quite different. However, whether the community and GP facilities are there is another matter.

Let me quote what some local GPs have told me in recent weeks, because they address the point that my hon. Friend has just made. One GP said that the number of community nurses

“is not only inadequate, but is actually falling...this is an unsustainable situation in the long-run... If this situation is not urgently addressed...we will reach a crisis situation especially if services are suddenly shifted from secondary to primary care”.

Another GP said:

“The number of Community Nurses currently employed by the PCT is insufficient for current needs rather than capable of taking on extra workload in the community.”

In another letter, I was told:

“Community Nurses are already over burdened and my colleagues at our surgery feel that if more and more services are moved into the community without adequate resources...this would not be to the benefit of our patients.”

That is the stated view that we hear again and again when we talk to the people who do the work on the ground.

We cannot expect a hospital to function when all the elective work has been taken away, as is proposed under one option. The consultants tell us that if that happens, they will leave, because the better consultants will not want to work there if they do not have the full range of work. That will affect all the training and teaching that is done at the hospital. In the longer term, it will lead to the hospital gradually declining and running down.

Throughout the process, there has been real resentment about the involvement of local Members of Parliament among some of those who have conducted the review and who will be involved in making some of the recommendations. They do not like our being involved. They do not want to talk to us. When we question what will happen to services that affect every one of our constituents, they seem to resent it.

Mr. Duncan Smith: Can I provoke the hon. Gentleman into relating the story from 15 December, when he asked about consultation, and what was said to him about the reason for embarking on consultation and how little was needed? Will he relate it, so that Mr. Cook can understand?

Mr. Gerrard: I will be provoked. When I asked about the consultation process and where it was going—there was the feeling of resentment about us asking the questions, as I have described—a comment was made to me: “We need not have involved you in the first place. We didn’t have to talk to you at all.” That is what came out, and I felt that the view that it is possible not to involve constituency representatives in the process is totally unacceptable. Well, we are involved, and we will stay involved.

We know, and everyone in the area knows, how local people have reacted. Thousands of people in Redbridge and Waltham Forest are deeply unhappy about what is proposed. I share the attitude of other hon. Members who have spoken and who still wish to speak, in that, although I have spoken mainly about Whipps Cross, because it is the hospital in Waltham Forest, I do not mean to say, “Forget about the King George; I don’t care if it is run down instead.”

What happens in the whole area matters, because if either hospital is run down that will inevitably rebound badly on the other, and affect everyone. We are all supporting our constituents in the aim of having local services of good quality that will not disintegrate, but that is where fit for the future is in danger of leading us.

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