17 March 2010
Mike Penning winds up a debate on London hospitals on behalf of the Conservatives and makes the case for all reviews to be clinician-led and not directed by Treasury officials at the top.
Mike Penning (Hemel Hempstead) (Con): As other Members have said, it is a pleasure to take part in a third debate on the future of NHS London. I reiterate the comments commending the hon. Member for Hornsey and Wood Green (Lynne Featherstone) for securing the debate. I also commend her for the tone in which she made her speech on behalf of her constituents, which was eminently sensible.
Like many of the discussions we have had on the subject, this debate is about trust and whether people can trust us as politicians and the Government to produce for them the health service that they deserve in the 21st century. The NHS has £110 billion of taxpayers' money, but can people feel safe that the NHS around them is free at the point of delivery and that their needs and those of GPs will be understood?
The Minister has said today and on several other occasions that the reviews are being clinically led. He said that because the public trust clinicians a lot more than politicians. That is eminently sensible. However, the truth is that the process is not being led by clinicians.
The debate started with Lord Darzi's earlier report on his vision for the future of the NHS in London. I spoke with him before he became a peer when he was an adviser to the Health Committee, of which I had the honour of being a member. He is a highly intelligent and highly skilled surgeon, but when I pushed him on his report bits of it started to flake off, because it was a vision. When he gave evidence to the Committee on the report we asked him how much of the estate in London would go under his vision, but he gave no answer, even though I pushed him extensively.
We have not spoken about the fact that 15 per cent. of the NHS estate in London is currently sitting empty. That is where some of the savings could be made tomorrow morning and where some income could come in straight away. I know the economic climate out there is difficult, but instead of leaving the estate to become even more decrepit and for some developer to come along, let us be forward-thinking about it.
I am afraid that the clinician argument is fundamentally flawed, which is shown on page 3 of NHS London's document "Delivering Healthcare for London", the whole premise of which is the shortfall in funding. Several assumptions are made in that document, the final one being that there will be a shortfall of between £1.5 billion and £1.7 billon in 2016-17. I have no confidence in the document, because when one reads it one finds that it is not only fundamentally flawed in its assumptions, but flawed simply in its maths. It assumes funding growth of 2.3 per cent., but that figure is actually a cut of 2.3 per cent., because the minus sign has been left out. That does not give my constituents, or any others, much faith.
I mention my constituents because we have always come into London for specialist services. With the demise of some of the hospitals in my area, it is obvious that more and more of those services will be required in London.
The hon. Member for Islington, North (Jeremy Corbyn) and others raised concerns about the consultation and about whether the public are being duped. Are we being asked to take part in a consultation on something that has already been decided? That is happening in my constituency, where 82 per cent. of my constituents said no to the closure of the A and E, but it went ahead. As several Members have said, if one loses the A and E, one loses the hospital. Let us have no illusions about that, because the hospital loses its intensive care, its high-dependency unit, its beds and its theatres. Those will all go if the A and E goes, because that is the back-up a hospital requires for an A and E.
My hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett) alluded to the worries in south-east London. He has every right to be concerned, because if those sorts of cuts are made to the front of A and E, the services behind it will go immediately.
Jeremy Corbyn: Does the hon. Gentleman acknowledge that often plans are drawn up for health service changes from which clinicians themselves feel excluded? The changes seem to have some motor of their own that pushes them along until they eventually reach the light of day without support from anyone, and yet somehow they end up becoming fact.
Mike Penning: The hon. Gentleman has touched on an important point. Clinicians are not only often excluded, but gagged and not allowed to tell the people they serve about their concerns. If they do, their careers are put at risk. That has happened in my constituency and it is happening today. Some of the clinicians who have been speaking to me have been leaking documents to me that the Minister says he has not seen. If he indicates that he would like me to supply them to him I will be happy to do so. I have all of them but one, for the whole of London. I would have hoped that he would have seen them, because the Government cannot exclude themselves from a report from NHS London that is based on deficits in the funding supplied by the Government and the assumptions based on that, which mean cuts proposed for London.
Mr. Pelling: Will the hon. Gentleman give way?
Mike Penning: I will not give way because I want to give the Minister sufficient time to respond. When we go further into the document, we find the assumption that hospitals can only stop-it is stop-people going to an A and E and get them to go elsewhere by physically closing the A and E, because when one is open people will invariably go to it. Some of the assumptions are dramatic, such as the one that polyclinics in the primary care sector could take up to 60 per cent. of A and E attendances. Funding models have been based on that assumption.
However, attendances at A and E increased last year, even in areas where polyclinics are open. In areas of London represented by Members who are not here today, but which I have visited in recent weeks-such as areas of north-west London-A and E attendances went up by 15 per cent. last year alone, even though some of those hospitals have bolted on GP-led triage at the front so that they can get some of the people who we would all accept should not be going to A and E to another triage point.
The point is that the public trust an A and E. They will go to an A and E. We can sometimes address the problems of access to GPs, which can be why people go to A and Es, but to assume that we can get 60 per cent. of the public who need services to decide not to go to an A and E is beyond belief.
One document that has not been withheld is the Government's own report, "Primary Care and Emergency Departments", which they commissioned from David Carson, Henry Clay and Rick Stern. Their assumptions are astonishing, because they actually agree with what our constituents are saying:
That is just one excerpt from the press release for that report. In it, the experts and clinicians state that proposals to try to close A and E departments and get people into primary care fundamentally will not work. The Government want to bury that conclusion. They did not want it to come out or to have the debates we have had for the past three weeks.
Should the policy go ahead? No, it must be stopped in its tracks because the whole premise is fundamentally flawed, as shown in the Government's own documentation. As the shadow Health Minister and the shadow Secretary of State have told NHS London, we have promised a real-terms growth in NHS funding. The Government are not reinvesting money elsewhere in the NHS, which is what the Minister has said they will do. They assume that there will be cuts in NHS funding, and that is stated on page 3, right at the start of the document "Delivering Healthcare for London". It is imperative that the Minister does not shirk his responsibilities.
The hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, said that Ministers cannot tell NHS London to publish those documents, but they can and they should because they are paid to take responsibility. They should tell NHS London to publish the documents so that we know what the proposals are and can debate them. We could then robustly refute most of the assumptions and look at what is best for the constituents of London, from the bottom up, from GPs and patients, rather than from the top down.
It is not a case of scaring people. I have visited many hospitals in the past few weeks and I know that NHS staff are really worried. They do a fantastic job, but at the moment their morale is low and they are genuinely worried that they will be unable to deliver the sort of care London deserves. We must not scare people, and I am afraid that I have to reiterate the point that the Liberal Democrats have been scaring people in Kingston, which is fundamentally wrong. We should have a proper debate so that the clinicians feel comfortable to tell us publicly what London needs. We should listen to them, rather than to the top-down Treasury officials who are trying to cut money from the NHS, which is what the Government want to do.
3.48 pm
| Hansard
Mike Penning (Hemel Hempstead) (Con): As other Members have said, it is a pleasure to take part in a third debate on the future of NHS London. I reiterate the comments commending the hon. Member for Hornsey and Wood Green (Lynne Featherstone) for securing the debate. I also commend her for the tone in which she made her speech on behalf of her constituents, which was eminently sensible.
Like many of the discussions we have had on the subject, this debate is about trust and whether people can trust us as politicians and the Government to produce for them the health service that they deserve in the 21st century. The NHS has £110 billion of taxpayers' money, but can people feel safe that the NHS around them is free at the point of delivery and that their needs and those of GPs will be understood?
The Minister has said today and on several other occasions that the reviews are being clinically led. He said that because the public trust clinicians a lot more than politicians. That is eminently sensible. However, the truth is that the process is not being led by clinicians.
The debate started with Lord Darzi's earlier report on his vision for the future of the NHS in London. I spoke with him before he became a peer when he was an adviser to the Health Committee, of which I had the honour of being a member. He is a highly intelligent and highly skilled surgeon, but when I pushed him on his report bits of it started to flake off, because it was a vision. When he gave evidence to the Committee on the report we asked him how much of the estate in London would go under his vision, but he gave no answer, even though I pushed him extensively.
We have not spoken about the fact that 15 per cent. of the NHS estate in London is currently sitting empty. That is where some of the savings could be made tomorrow morning and where some income could come in straight away. I know the economic climate out there is difficult, but instead of leaving the estate to become even more decrepit and for some developer to come along, let us be forward-thinking about it.
I am afraid that the clinician argument is fundamentally flawed, which is shown on page 3 of NHS London's document "Delivering Healthcare for London", the whole premise of which is the shortfall in funding. Several assumptions are made in that document, the final one being that there will be a shortfall of between £1.5 billion and £1.7 billon in 2016-17. I have no confidence in the document, because when one reads it one finds that it is not only fundamentally flawed in its assumptions, but flawed simply in its maths. It assumes funding growth of 2.3 per cent., but that figure is actually a cut of 2.3 per cent., because the minus sign has been left out. That does not give my constituents, or any others, much faith.
I mention my constituents because we have always come into London for specialist services. With the demise of some of the hospitals in my area, it is obvious that more and more of those services will be required in London.
The hon. Member for Islington, North (Jeremy Corbyn) and others raised concerns about the consultation and about whether the public are being duped. Are we being asked to take part in a consultation on something that has already been decided? That is happening in my constituency, where 82 per cent. of my constituents said no to the closure of the A and E, but it went ahead. As several Members have said, if one loses the A and E, one loses the hospital. Let us have no illusions about that, because the hospital loses its intensive care, its high-dependency unit, its beds and its theatres. Those will all go if the A and E goes, because that is the back-up a hospital requires for an A and E.
My hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett) alluded to the worries in south-east London. He has every right to be concerned, because if those sorts of cuts are made to the front of A and E, the services behind it will go immediately.
Jeremy Corbyn: Does the hon. Gentleman acknowledge that often plans are drawn up for health service changes from which clinicians themselves feel excluded? The changes seem to have some motor of their own that pushes them along until they eventually reach the light of day without support from anyone, and yet somehow they end up becoming fact.
Mike Penning: The hon. Gentleman has touched on an important point. Clinicians are not only often excluded, but gagged and not allowed to tell the people they serve about their concerns. If they do, their careers are put at risk. That has happened in my constituency and it is happening today. Some of the clinicians who have been speaking to me have been leaking documents to me that the Minister says he has not seen. If he indicates that he would like me to supply them to him I will be happy to do so. I have all of them but one, for the whole of London. I would have hoped that he would have seen them, because the Government cannot exclude themselves from a report from NHS London that is based on deficits in the funding supplied by the Government and the assumptions based on that, which mean cuts proposed for London.
Mr. Pelling: Will the hon. Gentleman give way?
Mike Penning: I will not give way because I want to give the Minister sufficient time to respond. When we go further into the document, we find the assumption that hospitals can only stop-it is stop-people going to an A and E and get them to go elsewhere by physically closing the A and E, because when one is open people will invariably go to it. Some of the assumptions are dramatic, such as the one that polyclinics in the primary care sector could take up to 60 per cent. of A and E attendances. Funding models have been based on that assumption.
However, attendances at A and E increased last year, even in areas where polyclinics are open. In areas of London represented by Members who are not here today, but which I have visited in recent weeks-such as areas of north-west London-A and E attendances went up by 15 per cent. last year alone, even though some of those hospitals have bolted on GP-led triage at the front so that they can get some of the people who we would all accept should not be going to A and E to another triage point.
The point is that the public trust an A and E. They will go to an A and E. We can sometimes address the problems of access to GPs, which can be why people go to A and Es, but to assume that we can get 60 per cent. of the public who need services to decide not to go to an A and E is beyond belief.
One document that has not been withheld is the Government's own report, "Primary Care and Emergency Departments", which they commissioned from David Carson, Henry Clay and Rick Stern. Their assumptions are astonishing, because they actually agree with what our constituents are saying:
"We were surprised to find that there is no evidence that providing primary care in emergency departments could tackle rising costs to help to avoid unnecessary admissions."
That is just one excerpt from the press release for that report. In it, the experts and clinicians state that proposals to try to close A and E departments and get people into primary care fundamentally will not work. The Government want to bury that conclusion. They did not want it to come out or to have the debates we have had for the past three weeks.
Should the policy go ahead? No, it must be stopped in its tracks because the whole premise is fundamentally flawed, as shown in the Government's own documentation. As the shadow Health Minister and the shadow Secretary of State have told NHS London, we have promised a real-terms growth in NHS funding. The Government are not reinvesting money elsewhere in the NHS, which is what the Minister has said they will do. They assume that there will be cuts in NHS funding, and that is stated on page 3, right at the start of the document "Delivering Healthcare for London". It is imperative that the Minister does not shirk his responsibilities.
The hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, said that Ministers cannot tell NHS London to publish those documents, but they can and they should because they are paid to take responsibility. They should tell NHS London to publish the documents so that we know what the proposals are and can debate them. We could then robustly refute most of the assumptions and look at what is best for the constituents of London, from the bottom up, from GPs and patients, rather than from the top down.
It is not a case of scaring people. I have visited many hospitals in the past few weeks and I know that NHS staff are really worried. They do a fantastic job, but at the moment their morale is low and they are genuinely worried that they will be unable to deliver the sort of care London deserves. We must not scare people, and I am afraid that I have to reiterate the point that the Liberal Democrats have been scaring people in Kingston, which is fundamentally wrong. We should have a proper debate so that the clinicians feel comfortable to tell us publicly what London needs. We should listen to them, rather than to the top-down Treasury officials who are trying to cut money from the NHS, which is what the Government want to do.
3.48 pm
| Hansard
