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New Clause 6 — Secretary of State’s response to a section 65 regulator’s report on an NHS foundation trust

Part of Oral Answers to Questions — Treasury – in the House of Commons at 3:30 pm on 11th March 2014.

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Photo of Jim Dowd Jim Dowd Labour, Lewisham West and Penge 3:30 pm, 11th March 2014

The hon. Gentleman is right. We have discussed the impact of this on our constituents many times.

I will try to shed some light on why Lewisham was put in the firing line, and why such administrative vehicles are so dangerous and antithetical to good health care. On 24 July 2012, the then Secretary of State invited the Members for Bexley, Bromley and Greenwich to a meeting in his office. That is entirely logical, because South London Healthcare Trust covers Bexley, Bromley and Greenwich. Strangely, he also invited the Members for Lewisham. My right hon. Friend Dame Joan Ruddock was unfortunately unable to attend, but my hon. Friend Heidi Alexander and I did attend.

I thought this was rather strange because if they were looking at the south-east London NHS, why not invite the hon. Members who represent Southwark and Lambeth, the other two boroughs that comprise south-east London? I think the answer is that the services provided principally in Southwark and Lambeth are provided by foundation trusts in the shape of King’s, and Guy’s and St Thomas’. Various people were there, including my right hon. Friend Mr Raynsford, my hon. Friend Clive Efford and the hon. Members for Beckenham (Bob Stewart) and for Old Bexley and Sidcup (James Brokenshire); there were probably some others as well. There were various NHS officials including David Flory, who at the time—I do not know where he is now—was a deputy chief executive, and a woman whom I later discovered to be Hannah Farrar, who played a considerable role in the work of Mr Kershaw as the administrator and came to be roundly despised right across Lewisham for her efforts.

I remember them saying repeatedly—almost as if it were some kind of religious incantation—that “the solutions to the problems of South London Healthcare NHS Trust cannot be found solely within South London

Healthcare NHS Trust.” I woke up at that moment to the notion that they were after Lewisham again and that that was the only reason we had been invited. At the margins of every constituency, people can be treated in a neighbouring health area rather than the one they are currently in, so there would be some impact there. They were signalling the fact that it was going to be a backdoor reconfiguration, although the Secretary of State, in announcing the original order, said that it was not a backdoor reconfiguration. In football parlance, that is the same as getting your retaliation in first. By saying that it was not going to be a backdoor reconfiguration, that is exactly what it was going to be without any of the four so-called tests that the Government have much trumpeted but never used.

The key element of the four tests is the consent of local commissioners. The summer reshuffle gave us a different Secretary of State but he accepted with alacrity and enthusiasm the task that his predecessor had set out. As my right hon. Friend Andy Burnham mentioned, just four or five years previously Lewisham had been through a clinically led process of reconfiguration, called “A Picture of Health.” It found that there was an incontrovertible case for Lewisham to remain as a fully functioning district general hospital and for the formation of the South London Healthcare NHS Trust with the three hospitals that I have mentioned. That report was independently vetted by Professor Sir George Alberti, professor of surgery at King’s College, London, and was found to be sustainable and reliable. The decision on how health care is provided in this country should be made by a clinically led process assessed by a clinician.

For some reason, NHS London, as it once was, always had the idea that there should be only four A and Es in south-east London; St Thomas’ over the river, King’s, the Princess Royal in Orpington and the Queen Elizabeth in Woolwich. It did not want Lewisham; I do not know why it has been obsessed with that for years. It obviously saw the opportunity to dust off that idea—despite the fact that Lewisham had only recently been through a clinical reappraisal—and tried to achieve its goal.

It set out a timetable which, as Jeremy Lefroy will agree, was pretty brisk to put it mildly for setting up the TSA South London healthcare. There were 75 working days between 16 July and 29 October 2012 for the provision of draft reports. Consultation was to run between 2 November and 13 December 2012 and the final report was to be presented by 7 January last year, with the Secretary of State making a decision prior to 1 February. He actually made the decision on 30 or 31 January. The whole thing from beginning to end was to take five or six months.

I will describe briefly how the TSA process works because, let us not forget, if this clause goes through, this could be coming to a community near you. They—and I say “they” because they come mob-handed, bringing all their own clinical advisers—are almost like the Moonies: they have a mission, a task, to bring understanding to those who are less well endowed with it than themselves. All the advisers are imported and paid for, and, together with the consultants—who, as was pointed out by my right hon. Friend the Member for Leigh, are management consultants, not clinical consultants—they set about their task.

One thing that amazed me was the astounding rate at which they were able to get through public money. It was absolutely phenomenal. The consultants—as we were told by my right hon. Friend Frank Dobson, they were mainly from KPMG and PricewaterhouseCoopers—consumed over £2 million of the £5 million cost of the TSA process. The people to whom they were least likely to listen were the local clinicians, whether GPs or hospital doctors, and the local residents and patients. Those people were invited to the consultation groups—although not to the public meetings—but they were then told what they could and could not discuss. If they tried to discuss anything that was not on the facilitators’ list, they were threatened with expulsion. If that is the consultants’ idea of public engagement, it does not commend itself much to the public.