Lamb and Kramer on Health Care in London

• [Mar 09] . . Susan Kramer : I PARTICULARLY appreciate this opportunity to speak in the debate in defence of my local hospital, Kingston hospital. I am joined in my campaign by my hon. Friend Mr. Davey. We first learned of the risk to the hospital's A&E and maternity departments towards the end of last year. We told NHS officials that we thought the plans were outrageous. Kingston's maternity department deals with nearly 6,000 births a year, and the A and E unit treats more than 100,000 patients a year. It is therefore busier than almost any other hospital that has been mentioned. We agreed that we would hold back from going public with our campaign until the documents had been published. However, we were told in January that the documents would be withheld until after the general election, so we went public with our campaign anyway.

[Mar 09] Norman Lamb (North Norfolk, Liberal Democrat): The Liberal Democrats welcome this debate on an incredibly important issue for the people of London. However, it is fair to say that the Conservative motion does not really achieve very much, because all it calls for, in effect, is a delay in the reconfiguration process until there has been more effective public consultation. [Interruption.] Well, that is exactly what the motion says. We have not even got to the point where the public consultation is built into the process, because we are told that that is due to take place this autumn. Our criticism of the process is much more fundamental than that.

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Andrew Pelling (Croydon Central, Independent)

Will the hon. Gentleman give way?

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Norman Lamb : Not quite yet. I am only 30 seconds into my speech.

Our criticism is of the way in which the NHS makes decisions and the fact that they are taken by bodies that are completely unaccountable to the people they serve. The Minister made two assertions in his speech. The first was that these decisions are local decisions. Who are these local decisions taken by? They are taken by people who have no legitimacy; they have been appointed nationally, so there is no accountability to the communities-

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Clive Efford (Eltham, Labour): Will the hon. Gentleman give way?

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Norman Lamb : I shall in a moment, but let me finish my point. There is no accountability to the communities that they serve.

The Minister's second assertion was that the whole process is clinically driven, but we know that that simply is not the case. I wish to refer to an anonymous e-mail that I received from someone who describes himself as

"a (traditionally Labour voting) commissioner working in the sector"

in north-west London. He refers to the fact that the clinicians have been

"either left in the dark or openly hostile".

This is a process that is "clinically led", but very much the opposite is in fact the case. The process almost seems designed to alienate the public and the clinicians who are desperately trying to provide services. My hon. Friend Mr. Davey has referred to conversations that he has had with local clinicians who are deeply frustrated by what is going on. They may have been involved in the process, but they do not want it and they are not leading it in any sense of that word.

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Andrew Pelling (Croydon Central, Independent)

I want to congratulate the hon. Gentleman and his colleagues on opening up the debate by having the courage to talk about this matter publicly. Is it not right that such a debate should take place during a general election, and not be postponed by the Conservative party or Labour party until afterwards, when patients' influence will be minimised?

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Norman Lamb : The hon. Gentleman makes absolutely the right point. It would be scandalous if any of the related papers were kept secret until after the general election. There almost seems to be a conspiracy of silence to prevent the public from knowing the real facts until after the general election.

The process seems designed to destroy confidence and to engender suspicion about motives. We know that the real pressure comes from the financial crisis faced by the NHS, which is in large part due to the way in which money has been spent by this Government within the NHS. I shall come on to one of the particular reasons for that-PFI, which was mentioned a while ago by an hon. Member on the Conservative Back-Benches.

An opinion piece in The Guardian on 3 March stated that

"proper discussion about the future of vital public services is being stifled because profound changes-in London and beyond-are accompanied by secrecy, obfuscation, double-speak and concealment by the NHS at almost every turn."

There is a culture of fear-people fear the consequences of speaking out. That Labour-voting commissioner from north-west London writes that he wants his e-mail kept anonymous. He does not give his name, because he fears that his job would be threatened

"were I to be linked to sending you this material".

What an indictment it is of the NHS under this Government that people fear for their jobs if they speak out and reveal to the public what is going on behind closed doors. He says in that e-mail that there has been produced in north-west London

"a long list of fantastical figures about the number of outpatient appointments, emergency admissions and diagnostics to be moved out of hospital and into 'polysystems' in the community. The idea is to move 55 per cent. of everything, even though the infrastructure and ability of the NHS outside the hospital to cope is not credible."

He goes on to talk about how the acute commissioning vehicle has emasculated the primary care trusts-the bodies that are supposed to be there under this Government to determine health care for their local communities. They have been emasculated by this new body that is imposing its decisions on the local area. Clinicians have been kept in the dark and feel completely excluded from the process in many cases.

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Andrew Slaughter (Ealing, Acton & Shepherd's Bush, Labour): The picture that the hon. Gentleman is painting comes from tittle-tattle and innuendo. I represent a seat that is covered by the north-west London sector, and the picture that he paints bears no resemblance to the truth on the ground. All that people have seen for the past five years has been an improvement in the quality of their health services, whether at a polyclinic level, a tertiary level or in the three hospitals that make up the Imperial College Healthcare NHS Trust. He ought to pay some tribute to the work that is going on in the health service in those areas instead of simply spreading despondency on the basis of rumour.

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Norman Lamb : The hon. Gentleman refers to the views of a commissioner from north-west London as tittle-tattle and innuendo. I shall tell him a bit more of what that commissioner says:

"The result is ever increasing centralisation, and clandestine plans for the complete closure/downgrading of sites such as Ealing Hospital, West Middlesex Hospital and others."

The acute commissioning vehicle

"are telling us that there will be only 2 major hospital sites left in NW London, with threats to move all specialist services from others such as C&W Hospital, Central Middlesex, Charing Cross, Mount Vernon, Hammersmith, Hillingdon and possibly Royal Brompton and Royal Marsden."

That is the view on the ground from a commissioner working in the NHS in north-west London. The hon. Gentleman might not have received the leak, but that is the view the commissioner has expressed from the coal face.

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Clive Efford (Eltham, Labour): The hon. Gentleman surely cannot base his argument entirely on one anonymous e-mail that he claims to be a leak. We have all had concerns about the proposals in south-east London, but they were put forward in the autumn of 2007 as a result of a conference held by clinicians-doctors, nurses and midwives. They came up with them and it was on that basis that NHS London decided to move forward on the proposals, which were also reviewed by Professor Alberti on a clinical basis. On what does the hon. Gentleman base his argument that the proposals have nothing to do with local practitioners or local decision making?

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Norman Lamb : I have expressed the view from north-west London, but we have heard other stories from north-east and south-west London, and I shall come to those in due course.

The origin of all this was a report that NHS London commissioned from McKinsey's, which has remained a secret to this day. Surely there can be absolutely no justification for that. The Minister has said that this process should be more open, so will he commit to publishing that report? I give him the opportunity to intervene. Will he publish it today? That is what people want.

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Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour): I am grateful to the hon. Gentleman for that invitation, but I have not seen the McKinsey report to which he refers. It has not landed on my desk and I have not got-

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Norman Lamb : Do you think it should be published?

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Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour): Well, no; it is not mine to publish. I cannot commit to publishing-

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Norman Lamb : But do you think it should be published?

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Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour): Madam Deputy Speaker, I am being heckled from a sedentary position by the hon. Gentleman who has allowed me to intervene on him. Perhaps if I give the floor back to him, he can heckle me a little more.

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Norman Lamb : I do not know what to take from that. I do not know whether the Minister believes that the report should be published. It might not be his to publish, but he could at least indicate to NHS London that the Minister with responsibility for this sphere believes that it should publish the report. That would be very helpful. Is he willing to do that?

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Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour): I am grateful to the hon. Gentleman for again inviting me to respond. I do not know what is in the report in the sense that I have not read it. I do not have a copy, so this is a matter for NHS London to deal with, but I am sure that Ruth Carnall, the chief executive, will have heard his comments. I am not going to order her to publish it, no, but I shall ask her about it.

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Norman Lamb : I am pleased that the Minister will at least ask her about the report, because, as he said earlier, this process should be open, but it is certainly far from that. These are our local health services and our taxes that are being spent, so we deserve to know what is being planned behind closed doors. We demand disclosure.

We presume that the Conservatives know about the report because one of their parliamentary candidates works in McKinsey's health team, so they are presumably party to it. Meanwhile, the public and clinicians are kept in the dark. I ask the Government to commit to bringing into the public domain, before the general election, the processes that are taking place around the country, in every strategic health authority, so that people can cast their vote in the full knowledge of what is being planned behind the scenes.

Those who reveal plans to the public are accused of scaremongering. My hon. Friends the Members for Kingston and Surbiton and for Richmond Park (Susan Kramer) rightly decided to inform the public of what they have been told and about draft reports that they have seen regarding threats to their local hospital, but the Conservative shadow Minister, Mike Penning, accused them, in an Adjournment debate, of scaring the public. The Conservative view seems to be that these issues are best kept secret and that they should not be revealed to the public until after the general election, which is outrageous. I applaud my hon. Friends for having had the guts to put that information into the public domain so that the public can know what threats exist.

The threat is real. I have a copy of a draft report entitled "Presentation to NHS Kingston Joint Board and PEC meeting", which confirms that one in three of its 18 options would involve the closure of Kingston hospital's maternity unit, accident and emergency unit and paediatric in-patient department. Sixteen of the 18 options would see Kingston lose a significant service from that hospital. My hon. Friends deserve an apology from members of the Conservative Front-Bench team and local Conservative campaigners. They have been accused of scaremongering, when the matter is in black and white.

Interestingly, the report ends with a note saying that it should be sent to NHS London but not published. My hon. Friends have got it into the public domain, and they made the right judgment in doing so. These are decisions of which the public should be fully aware.

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Mike O'Brien (Minister of State (Health Services), Department of Health; North Warwickshire, Labour): I am a little confused by the point that the hon. Gentleman is making. He referred to Mr. Davey, who was busily telling us about these changes on his website on 5 October. Having talked about how good it was that public meetings were being held, he concluded by saying:

"For my part, I'm excited about what I've heard. I've been critical of the local NHS in the past, but this time the ideas look good."

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Norman Lamb : rose-

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Edward Davey: Will my hon. Friend give way?

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Norman Lamb : I am very happy to.

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Edward Davey: I am very grateful to my hon. Friend, as I want to explain to the Minister what I was talking about on the website. I was talking about proposals for polysystems, and about the fact that Kingston NHS was building a polyclinic at Surbiton hospital. My support for that polyclinic remains, and I also supported the changes to stroke and cardiac services that came from NHS London. What we oppose are these secret changes, with one option in three proposing that our local hospital should lose its A and E, maternity and in-patient paediatric services. The fact that the Minister does not understand that does him no favours.

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Sylvia Heal (Deputy Speaker)

Order. A great many people wish to contribute to the debate, so I would ask that interventions please be as they should be-brief.

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Norman Lamb : Thank you very much, Madam Deputy Speaker, and I am grateful to my hon. Friend for that explanation.

I was referring to the proposals for north-east London, which emerged only because my hon. Friend Lynne Featherstone received a leaked letter from a clinician in the system. Again, the letter demonstrated what was going on but was kept from the public. It set out options, including the potential loss of A and E and maternity services at the Whittington hospital. The hospital is much loved and needed, and it serves one of the poorest communities in the country. The area has one of the lowest rates of car ownership in the country, yet it is proposed that those services should be lost. Again, my hon. Friend was right to get the matter into the public domain so that people can make their own judgments on the proposals.

The belief, certainly in north-east London, is that the proposals are not evidence- based, and that wrong assumptions have been made about the potential impact of the loss of an A and E department at the Whittington hospital. People believe that conclusions are being drawn that do not stand up to analysis.

I turn now to the private finance initiative, which has imposed an enormous burden on the NHS in London.

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Iain Duncan Smith (Chingford & Woodford Green, Conservative): The hon. Gentleman is talking about north-east London, but a year and a half or two years ago Professor Alberti was called in to have a look at the process whereby the various PCTs in the area were going about the business of change. He was highly critical of the secrecy involved, and of the trusts' failure to tell the public exactly what was going on. The idea that the problems were driven by clinicians is absolutely not true.

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Norman Lamb : I am very grateful to the right hon. Gentleman for that intervention. It appears that the PCTs have learned nothing from George Alberti's intervention a year ago, as the same secrecy continues to pervade the entire process.

As I was saying, I shall deal now with PFI. There have been 20 PFI schemes providing new facilities in London at a cost of £2.6 billion, but the repayments over the lifetime of those facilities will come to a staggering total of £16.7 billion. Those repayments have not been properly budgeted for, but they will bankrupt the NHS and in a sense drive the changes that we are debating today.

This year, PFI payments will amount to £250 million in London alone. By 2014, that will have risen to £400 million per year. That is forcing up overhead costs on trusts and squeezing the resources of other health services. It is also, as James Brokenshire said, distorting decision making about service changes.

The proposals appear not to have taken sufficiently into account the pressure of rising case loads in London. Many London hospitals find that acute bed occupancy rates are approaching 100 per cent. In other words, throughout the year they are virtually entirely full. The BMA says that the 3.7 million attendances at accident and emergency departments reflect high levels of mobility and temporary residents often unregistered with GPs, who choose to go to their local A and E department because they have nowhere else to go. As the proposals are put forward, there is nothing else in place to reassure the public. It is dangerous to make assumptions about the ability to cut numbers going to hospital before new arrangements and facilities are put in place.

There should be a recognition that the process is flawed. Consultation, despite the Conservatives' apparent faith in it, will not satisfy the public of London because all too often, as Mr. Duncan Smith suggested, consultation is seen-rightly, in many cases-to be a fait accompli, a rubber-stamping exercise. As the report from south-west London confirms in one of the charts that it contains, the final stage is consultation and implementation, as if consultation is a box that must be ticked before implementation of the changes that have already been determined.

We have surely tested to destruction the model that seeks to impose change decided by unaccountable bodies. We have the bizarre spectacle now of Labour Ministers leading protest marches against closures in their own local area. Instead, let us start by achieving savings in the NHS by slimming down the central bureaucracy, which has become overblown and entirely out of control under this Government, with 25,000 people working for NHS quangos at a cost of £1.2 billion a year. Let us reform the way that money is used in the NHS to manage those with chronic conditions much more effectively than we do at present, avoiding the crisis admissions to hospital which are so costly to the NHS and so disruptive to patients and their care.

Let us provide better incentives to prevent ill health in the first place. Critically, let us make primary care trusts democratically accountable to the people they serve. These are services that we all use, and those bodies that make decisions should be accountable to us. It is instructive that two former Secretaries of State from the present Government now support the case for democratic accountability in the decisions relating to the commissioning of health services. Decisions about local services should be reached in as open a way as possible by democratically accountable bodies.

Chris Ham, who will take over as head of the King's Fund, has cited the process in Sweden, where there are democratically accountable bodies responsible for health care. In Sweden they go about decisions in a collaborative way, involving the public not after the decisions have been taken, but at the start of the process, so that everybody understands the financial constraints that we all accept are there, involving the clinicians and reaching decisions together, rather than imposing them from on high.

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Jeremy Corbyn (Islington North, Labour): Will the hon. Gentleman give way?

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Norman Lamb : No.

We want to be able to hold those organisations to account. Until that happens, we will oppose cuts in local services imposed on local communities by people who have no democratic accountability.

• . . Susan Kramer : I particularly appreciate this opportunity to speak in the debate in defence of my local hospital, Kingston hospital. I am joined in my campaign by my hon. Friend Mr. Davey. We first learned of the risk to the hospital's accident and emergency and maternity departments towards the end of last year. We told NHS officials that we thought the plans were outrageous. Kingston's maternity department deals with nearly 6,000 births a year, and the A and E unit treats more than 100,000 patients a year. It is therefore busier than almost any other hospital that has been mentioned. We agreed that we would hold back from going public with our campaign until the documents had been published. However, we were told in January that the documents would be withheld until after the general election, so we went public with our campaign anyway.

I have heard about cross-party campaigns in every corner of London, but I am incredibly sad to say that south-west London is the exception, and accusations of scaremongering have been levelled against my hon. Friend and me today. Those who did so are well aware, however, that, on 8 February, we put into the public arena the document that was leaked to us confirming everything that we had said about the threats to Kingston hospital. That document-the "South-West London Strategic Plan: private and confidential: final draft"-is now on our website. It lists the 18 options under consideration, nearly all of which, unfortunately, involve the loss of services at Kingston hospital.

Those hon. Members will also be entirely aware that, on 24 February, Kingston's health overview panel held a five-hour scrutiny meeting, at which NHS representatives were questioned for almost the entire time. I will read the local newspaper's report of that meeting. It said:

"NHS bosses have bowed to public and media pressure and confirmed the closure of Kingston Hospital's accident and emergency and maternity units is being considered as part of a review of services in the area."

That is from our very reliable Richmond and Twickenham Times. We have also put into the public arena today, through our website, the presentation to NHS Kingston's joint board and professional executive committee meeting, dated 15 January. That document unfortunately shows the situation to be even worse, involving a greater loss of elective surgery than we had feared. I am expecting a sincere-and, I hope, written-apology from those on the other Benches.

More than anything, however, I am here to ask for the disclosure of information. My local residents want to be part of this conversation in detail. They want to understand all the facts and issues now, when they can be part of the fundamental discussion, and not when they have been told that they can find out about them. At that point, three final options will be presented to them, and there will be a 12-week formal consultation, which can have an impact only at the edges.

We have put freedom of information requests in place, but the response to all of them was, "You are asking for too much information." But there is no such thing as too much information for the public, who need to be able to participate and make decisions. Although I intend to pursue those FOIs, let me show how bad things are by reading from the front of the leaked document, now on the website:

"The document contains extensive material that is exempt from disclosure under the Freedom of Information Act 2000. It should not be released under the Act without prior consultation with the NHS in South West London."

Even FOIs will not obtain the full range of information.

I am incredibly sad to say that the Conservatives do not join us in the wish for full information. Mike Penning declared in the debate of 8 February that he would not have put into the arena the information that we have, which I find shocking. On 24 February, after five hours of questioning the NHS, Liberal Democrat councillors at Kingston council moved a resolution. It said that since the panel was now aware of the first of the documents, the south-west London strategic plan, it called

"upon NHS London to publish this document immediately."

Every Conservative councillor present voted against that resolution. I am afraid that we are in a battle for information by ourselves.

The House will be interested to know that my Conservative opponent joined in a letter with my Labour opponent and the Green, all saying that our campaign had been invented and amounted to scaremongering. I envy the many others who have cross-party co-operation because that is what people in our area deserve and should have. I turn to the Government and ask them to provide the information so that our local people can be fully engaged and involved in absolutely key and critical decisions at a time when decisions should be flexible and are formulated. I also turn to the Conservatives and ask why they are singling out south-west London as place for which they do not demand information and why they will not join in the defence of the hospital, because it is time that they did, for the sake of all our constituents.