NHS: North-West London — [Sir Christopher Chope in the Chair]

– in Westminster Hall at 4:00 pm on 24th April 2019.

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[Sir Christopher Chope in the Chair]

Photo of Andrew Slaughter Andrew Slaughter Labour, Hammersmith 4:30 pm, 24th April 2019

I beg to move,

That this House
has considered the NHS in north west London.

It is a pleasure to serve under your chairmanship, Sir Christopher, and to see so many of my Labour colleagues from north-west London here to support this debate. It will be a relatively short debate on a rather lengthy subject, so I will try to keep my remarks concise, or at least as well ordered and structured as I can. To that end, I will touch on two subjects, and perhaps mention one or two other issues. The first subject is the collapse or withdrawal of the “Shaping a healthier future” programme, which was principally around the reorganisation of acute care; the second is the commercial Babylon GP at Hand service, which is distorting the primary care market, and not just in Hammersmith and Fulham, or indeed in north-west London.

I will begin by reflecting on how we got to where we are. In 2012, “Shaping a healthier future” was heralded as the biggest hospital reorganisation programme in the history of the NHS, but was quickly called the biggest closure programme in its history. It was a scheme for closing four of the nine type 1 A&Es across north-west London, and completely restructuring, demolishing and—in common parlance—closing two of its major hospitals, Ealing and Charing Cross, which is in my constituency. When the scheme was announced, it was unambiguous that it was about saving money. It was part of a programme to save about £1 billion, and we were told that if it did not happen, the NHS in that area would go bankrupt. Those were literally the words that were used. Much water has flowed under the bridge over the past seven years, until almost exactly a month ago, when the scheme was withdrawn wholesale in a rather hole-in-the-corner way.

This is something of a bittersweet debate. I do not know anybody in north-west London who is not delighted that the scheme for hospital closures has been withdrawn, yet because of the way those seven years have been wasted and how the scheme has been dealt with over that time, we are left with as many questions as have been answered. I do not have time to go through the whole history of those seven years. Suffice it to say that Charing Cross Hospital is the second-largest hospital of the nine in its sub-region; it has 360 beds, almost all acute. It was to be demolished. It was to lose more than 300 of those beds—more than 90%. It was to lose all of its major emergency services and its A&E, and effectively be replaced by what was called a local hospital, with primary care and treatment facilities. In other words, it would have been a very radical shake-up.

Throughout the process, there was a frustrating lack of honesty; there was no admission of what the scheme was, certainly not at a political level. If someone drilled down into the business plan or clinical strategy, it was clear what was being advocated. We were told that in some way, the increase in community services and primary care that was also part of the “Shaping a healthier future” scheme would make up for the loss of those hundreds of acute beds and those A&E facilities. It is now commonly accepted that this was always an entirely misconceived plan, as the King’s Fund—to give just one example—has said. Given the rise in demand, the best that could be hoped for was that, if the increases in primary and other care services took place, we would be able to cope with the current amount of acute capacity.

The idea that we could dramatically reduce capacity was entirely misconceived. That is not conjecture; it was proven in 2014, when stage 1 of “Shaping a healthier future” went ahead, with the closure of the A&Es at Hammersmith Hospital and Central Middlesex Hospital. We were told that as those were not two of the main A&E departments, those closures would easily be coped with. However, demand at St Mary’s, Northwick Park and Charing Cross went up to such an extent that they had some of the worst waiting time figures of anywhere in the country. Since then, those figures have come down only slowly and gradually.

I hope that the Government and the health service will learn lessons from this scheme—that is probably the best gloss I can put on this. It has taken a huge amount of time and effort, and a huge amount of money wasted by the health service, to get to where we are today, which is effectively back to where we were seven years ago. In 2012, it looked as though the situation was hopeless, and I have to praise Ealing Council, which was then Labour-controlled. At that stage, Hammersmith and Fulham Council was under Conservative control, and from 2013 onwards it fully backed the closure strategy. Ealing Council stood absolutely solid and firm; it mounted a judicial review, and opposed those proposals from day one.

When there was a change of political control in 2014, that council was joined by Hammersmith and Fulham Council, which, together with surrounding Labour councils, set up the Mansfield commission under Michael Mansfield. That independent commission looked at the “Shaping a healthier future” proposals, and when it reported, it said that those proposals would be a health disaster for the area. By that stage, the sustainability and transformation plans had been introduced. In a way, it is regrettable—although it was the right thing to do—that both Hammersmith and Ealing councils refused to participate, because they knew how damaging “Shaping a healthier future” and the hospital closures would be for the area.

Over all that time, I do not think a week went by in which I did not deal with this issue, both here and in the constituency. There was a sustained campaign of what I can only call disinformation. A lot of money—£72 million is a conservative estimate—was spent on consultants, preparing for the “Shaping a healthier future” programme. All of that money was wasted. Despite the fact that we relied entirely on internal health service documents to prove what was being planned, I was constantly told by everyone from the then Prime Minister down that we were scaremongering, and that the proposals were sensible and helpful.

It is curious that when the Health Secretary announced the withdrawal of “Shaping a healthier future” a month ago, the Government withdrew support from the scheme, as if somebody else had thought it up. Until that point, we had been told every day and every week for seven years that it was a sensible scheme that would only improve resources and services within the health service. It is to be regretted that the Government did not sit down with politicians, campaigners, local residents and the local health service to talk through where we were and where we were going. Instead, in a rather hole-in-the-corner way, they used the contrived trick of using a planted question from a Conservative Back Bencher to announce withdrawing from the scheme. That does not bode well for the future.

Although we are extremely pleased that the programme has been cancelled and that both Ealing Hospital and Charing Cross Hospital will stay open, where do we go now? First, Charing Cross Hospital has the largest maintenance backlog—£300 million—of any hospital in the country. That was clearly not under consideration, because it was intended that the structure would be demolished. In actual fact, the capital moneys are simply not there to have done that in any event.

The other hospitals in the area, including West Middlesex, Chelsea and Westminster and St Mary’s, were promised that they would benefit from the closures, and that there would be substantial investment. My question to the Minister is: what is the plan going forward? For political expediency, the Government have bailed out of “Shaping a healthier future”, and we are grateful for that, but where do we go now? Certainly the clinicians and the managers in west London cannot answer those questions. This thing has been entirely derived and supported by the Conservative party and this Government. It is for them to answer that question, rather than simply leaving our local health service to stew in that way.

Before I move on, I want to say that some of the staunchest campaigners have turned up to listen to this debate. I last saw them at the victory party at Hammersmith town hall a couple of weeks ago. Without their contribution, we would not be here. They countered well funded, well resourced and entirely disingenuous statements about what would happen to the health service. Every week, rain or shine, they were out talking to and converting the local population. One could say that the local population might not need much conversion to preserve a much-loved, major local hospital that has just celebrated its 200th anniversary, but the reality is that that needed to be done, because millions were being spent on spinning the yarn that the changes would be good for local health services. The campaign was not based simply on sentiment or popular feeling. It was well researched, and well supported with independent clinical evidence. The campaign was based on the day-to-day, week-to-week, absolute dedication of people who worked for nothing, and had nothing in common other than their love of the national health service and their feeling that Government at all levels had got it wrong.

With that, I will move to another topic, GP at Hand, which the Minister probably does know something about. We have become increasingly alarmed at its trajectory. For those who do not know, GP at Hand is a digital app provided by a private company called Babylon Health. The service has raised an enormous amount of concern at different levels; I will narrow that to four points.

The first and most obvious concern is how GP at Hand works. It attaches itself to a particular bricks-and-mortar GP practice—in this case, a particular surgery in Fulham. It was an orthodox GP surgery with a list of around 4,000 patients before that association began. As of today, it is approaching 50,000 patients, and is one of the largest GP practices in the country. That distortion has a cost implication for the clinical commissioning group, initially in Hammersmith and Fulham. It is estimated that over the two years from 2018 to 2020, that distortion alone will cost the CCG about £26 million. There is no provision for that at the moment, and that has to be addressed. I would like to hear from the Minister that there is a scheme for addressing that, and that there will be full reimbursement of those costs.

For those who are not aware of how the system works, it is very straightforward. When patients sign up to a GP practice, the money effectively goes with them. What is not anticipated is that there will suddenly be a tenfold increase in a patient list over one or two years. Why is that money not simply redirected? It has been, to some extent, to the CCGs in west and north-west London, but the money is not provided to the much wider catchment area—GP at Hand now serves not only Greater London and a wider travel area, but has expanded to Birmingham—because those other CCGs are saying, “Hang on.” A digital app of this kind attracts a certain type of patient: younger, fitter patients—effectively those without complex medical conditions or co-morbidities. They do not take up a lot of the GP’s time, as their issues are relatively simple and straightforward to deal with. Often they do not contact the GP at all for long periods.

Those patients effectively subsidise older and sicker patients. There is a perfectly understandable resistance from local GPs and CCGs to allowing those patients to escape, leaving them only with the most demanding and least cost-effective patients. If the issue is not addressed, the problem that results for my CCG is an annually increasing bill, going from £10 million to £16 million and who knows what beyond that, with no provision for that in any way.

The second concern, which has been expressed by clinicians and those who have simply tested out the app, is whether the app—like other apps, it is based on algorithms and diagnostic tools—is accurate and good enough. Has it been sufficiently tested? It is growing logarithmically across the country. It is not a question of it perhaps being tested in a small area and got absolutely right before it moves on. It could be in your constituency tomorrow, Sir Christopher, and it could be across the entire country in a year or two.

The third issue is that GP at Hand is driven entirely by a single commercial provider. It is a way of doing digitisation, but it is the way of the wild west to simply allow one particular firm to start from one location and expand across the country at a rate that it determines, controlled only by its advertising budget and its ability to attract customers. In my submission, there is no thought behind how that is done. The NHS is jumping to the tune that is being played by GP at Hand. One might suggest that it should be the other way around.

The fourth and perhaps most contentious issue is the fact that this particular private provider has had the support of the Secretary of State for Health from the beginning. He is a subscriber and has written about it in glowing terms. Whenever the matter is raised in the House and he is responding, at Health questions or wherever else, he has only praise to give it, but he is parti pris to this. Not only is that of concern in itself, but it means that when one is talking to local, regional and even national organisations within the NHS—this is now a national issue—they are looking over their shoulder, because their boss or their boss’s boss is saying, “This is the future and this is what is going to happen.”

With the support of a number of colleagues, I have written today to the Chair of the Health and Social Care Committee, asking the Committee to undertake an investigation into GP at Hand. I know that she shares a lot of my concerns, so I am hopeful that that investigation will follow. I ask the Minister to give what assurances she can on those four points that I have raised.

Sir Christopher, I can see you are looking at the clock, and my colleagues are looking at me with daggers drawn, so I will speak for one more minute and then sit down. That means that I cannot go into detail about the other local health service issues, which will have to wait for another day. Suffice it to say—I will give a lightning portrait—that in Hammersmith and Fulham, we have a number of failing GP practices that are either suspended or require improvement. We have planned substantial cuts to our CCGs of £30 million. We have cuts planned to palliative care, community care and the hospital sector, including a proposal to close the hydrotherapy pool at Charing Cross Hospital. Everybody who has been involved in that has told me that it provides an invaluable service.

The overall picture is one of declining and reducing services. Only yesterday, a letter informed us that the “Beyond places of safety” scheme, which is very good, has been suspended because the funding is not there. There is no pretence anymore that we are restructuring services, or reducing such things as management costs—that has all been done. What is being cut now are basic and essential services from the community, primary and indeed acute sectors.

I will conclude, as colleagues want to contribute to the debate. I hope that the Minister appreciates the seriousness, complexity and universality of the cuts that are happening across the health service. I hope that she will be more magnanimous than some of her colleagues in admitting the mistake that was made over “Shaping a healthier future”. We can turn the page and move on. We all want to work together for improved health, but first, some of these issues have to be addressed.

Several hon. Members:

rose—

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

Order. The wind-ups will start at quarter past 5, and five Members wish to catch my eye. I believe in self-regulation; you can do the maths for yourselves. I call Mr Virendra Sharma.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall 4:51 pm, 24th April 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend Andy Slaughter and congratulate him on securing this important debate.

North-west London has been a guinea pig—unloved and uncared for in the testing of a failed experiment. It has taken our local NHS trust and the Secretary of State all this time to recognise what we have been saying for years. When I say “us”, I mean not just Members of this House, but doctors, nurses, clinicians and, most importantly, patients and the local community. The “Shaping a healthier future” programme was not fit for purpose. It did not work, and it did not deliver for those who needed it most.

Two weeks ago, I attended a party in Ealing—my hon. Friend mentioned that he had one in Hammersmith—celebrating the end of “Shaping a healthier future”. My constituents were ecstatic. I have rarely seen more strongly held convictions than those they had that lives were being put at risk by the scheme. The cancellation of the programme is the greatest gift that we could have been given. It was almost an Easter miracle. Ealing Hospital, Charing Cross Hospital and others in the area can now rise from the dead and continue to serve our constituents.

However, those hospitals remain broken—not yet whole again. Ealing Hospital has lost full A&E services, which we badly need. We have lost our maternity ward and in-patient paediatric care. I remember, only a few years ago, spending time with volunteers in that area helping to raise funds for a publicly paid-for refurbishment of that children’s ward. It now lies empty. The garden we built is un-played in, and the swings are still. Its closure was a slap in the face to hospital users and the patients’ group. Parents felt un-consulted—a theme that runs throughout the “Shaping a healthier future” programme. It always seemed to be a top-down programme: a project put on local people and led by Whitehall that was not what patients needed.

Thankfully, the scheme is now only a failed experiment, not an ongoing disaster, but the clearing and cleaning up still need time and effort. Local residents want to feel listened to. They want to feel that their needs are being placed at the centre of their care, not treated as a peripheral concern. I hope that the Minister can commit to restoring services to all our hospitals in north-west London, but—I would say, selfishly—particularly to Ealing hospital, which is in my constituency.

The London Borough of Ealing has a very high number of young people, but suffers from one of the highest levels of lifestyle-led premature death. The widely reported Mansfield commission into the programme roundly condemned the “Shaping a healthier future” plans, and found that cuts were falling disproportionately on the poorest in society. Minister, please reverse the cuts and give my worst-off constituents a fair chance at healthy and full lives, unblighted by ill health.

Photo of Ruth Cadbury Ruth Cadbury Labour, Brentford and Isleworth 4:56 pm, 24th April 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I, too, congratulate my hon. Friend Andy Slaughter on introducing this timely debate. Before I say any more, I need to declare an interest: my husband is a non-executive director of the Chelsea and Westminster Hospital Trust.

I congratulate the key people who have made this possible: the campaigners. They have worked tirelessly and, as my hon. Friend said, for no money for, I think, seven years now, to wake the community up about the implications of the loss of, initially, four hospitals. We have since lived through the closure of many services, the downgrading of Charing Cross Hospital, and, as my hon. Friend Mr Sharma said, the downgrading and withdrawal of services at Ealing Hospital.

The issue is important to my constituents in a number of ways. First, for the residents of Chiswick, in the east side of my constituency, Charing Cross is their nearest hospital. It is the hospital that they look to for all the basic services, particularly A&E. It is the nearest and easiest to get to. They have rightly been really angry and worried about the loss of that hospital, as have residents in Hammersmith and other parts of west London—the places for which Charing Cross is the nearest and easiest hospital to get to. We have had many campaigners and many campaign days, signing petitions at public meetings and so on, in Chiswick over the last seven years.

The impact of the cuts to services, and the threat of cuts to services, in Charing Cross and Ealing in particular, have affected all residents across my constituency; for many of my constituents, Ealing is their nearest hospital. The other concern surrounds the impact on the general hospital in my constituency, the West Middlesex University Hospital, part of the Chelsea and Westminster Hospital Trust. It has been very difficult for staff there to plan properly, and for patients to know what their future will be in terms of potential services.

The recent announcement on the ending of “Shaping a healthier future” was not entirely a surprise. We have heard nothing for months, if not years—no new information, and no new developments. However, A&E attendance has increased—by 11%, I think, at Charing Cross in recent years. The increasing pressure on Ealing and Charing Cross hospitals is not entirely surprising. Hon. Members for constituencies not only in London but throughout the country have said in debate after debate on the NHS that we are seeing more and more pressure on accident and emergency services as a result of our rising population, the withdrawal of basic primary care, the cutbacks in adult social care and mental health services, as well as a whole host of other issues.

There is no way that the loss of significant accident and emergency services in west London could fail to cause incredible pressure on the remaining services and long journey times, given the levels of congestion in London. Another problem, as I know from many constituents who work at Charing Cross and Ealing hospitals, is the effect on staff morale: will people apply for a job in those hospitals, where they do not know how long their post will be available, or will they try for a vacancy in another hospital? The impact on morale, team building and team continuity is bound to have an effect—admittedly one difficult to measure—on patient care.

What we want to know from the Minister, given the ending of the “Shaping a healthier future” programme, is how the NHS estate, particularly the acute estate in north-west London, will be planned and financed in future. It feels as if we are in a strategic vacuum. When will we know whether there will be sufficient acute beds? The original plan was that the “Shaping a healthier future” programme would free up a load of capital to be spent in other hospitals around west London, including St Mary’s in Paddington, West Mid and so on, but where are the acute beds that are so desperately needed as A&E attendances rise? How will they be funded? What does all this mean for the future of integrated care organisations?

I share the concern of colleagues across west London about the shambles of the “Shaping a healthier future” programme’s initiation, continuation and end. I also share their concern about what will happen next.

Photo of Gareth Thomas Gareth Thomas Party Chair, Co-operative Party 5:02 pm, 24th April 2019

Six months ago, at the beginning of November, the walk-in centre at Alexandra Avenue in my constituency closed its doors for the last time. If there was ever a much-loved and vital service that told the story of the NHS funding crisis in north-west London, it was Alexandra Avenue. Its opening 10 years ago was strongly opposed by the Harrow West Conservative party and its then parliamentary candidate. She and the Harrow West Conservatives were not immediately successful in getting it closed, but in 2013 it was closed during weekdays; it was kept open at weekends, although only as a result of local campaigning. In November, the Conservatives finally got their way: a service that, at its height, provided a valuable walk-in service from 8 am to 8 pm, 365 days a year, to 40,000 people in my constituency and the surrounding constituencies, finally shut its doors.

Bluntly, the centre’s closure was a result of the clinical commissioning group’s lack of funding. The CCG has been put into special measures because its forecast deficit is £40 million, according to a written answer that I received in February from the then Minister, Steve Brine. Not surprisingly, it is under pressure to make a huge range of cuts, so not only is there no prospect that the Alexandra Avenue walk-in centre will be reopened, but other walk-in centres that serve Harrow are vulnerable to the threat of closure at a moment’s notice.

Nor is it surprising that the situation has had an impact on Northwick Park Hospital, which serves my constituency. It has not met the A&E waiting target for some considerable time: over the past five years, 25% of patients in A&E have not been seen within four hours, which gives a further indication of the decline in quality across the national health service in north-west London.

I am grateful to my hon. Friend Andy Slaughter for securing this debate and allowing me to ask the Minister a number of questions. When will the north-west London NHS be properly funded? When will there be an end to the sorry tale of the clinical commissioning group always finding itself in deficit? It is not that it cannot manage its books. It has had excellent chairs and an excellent board; I pay tribute to the outgoing chair, Dr Amol Kelshiker, and the new chair, Dr Genevieve Small, for their willingness and commitment, but they deserve to know that their CCG will be properly funded.

When will Northwick Park Hospital no longer have to face inadequate funding, like the other hospitals in the trust? When will those hospitals get the support that they need to get the consultants and nurses in place to meet their A&E targets? My hon. Friend mentioned the closure of Central Middlesex Hospital’s A&E service, which has had a huge impact on services in north-west London, including the services at Northwick Park Hospital that my constituents depend on. Frankly, it should be reopened, because we need that acute capacity. It would be good to hear whether the Minister could ever foresee such a scenario.

It is now clear that cancer waiting times are also under pressure in our community. For the first time, the maximum two-week wait for a first consultant appointment after an urgent GP referral is not being met, according to the latest data on our area.

Harrow clinical commissioning group needs to be properly funded, funding for the NHS in north-west London needs to be significantly increased, and—in my view—England’s national health service needs a dedicated national fund for walk-in services in communities, such as my own, in which there is strong evidence of demand. I look forward to some positive reassurance from the Minister that the Conservative party has changed its attitude to walk-in services such as those at Alexandra Avenue in Rayners Lane.

Photo of Karen Buck Karen Buck Labour, Westminster North 5:07 pm, 24th April 2019

It is a pleasure to speak under your chairmanship for the second time today, Sir Christopher. I congratulate my hon. Friend Andy Slaughter on securing this short but important debate. He was quite right to use the word “bittersweet” in the context of the collapse of the “Shaping a healthier future” strategy. It was sweet, in that it lifted a shadow from Charing Cross Hospital. There has been a continuing surge in A&E admissions over many years, during which we have consistently been told that a strategic approach to health services should be about reducing such admissions and replacing them with services in the community. That is a principle that I think everyone would agree with, and the lifting of the shadow is a good thing, but as we have heard from other hon. Members, it is clear that the strategic shaping of healthcare in north-west London remains very much in doubt.

I will focus on St Mary’s Hospital in Paddington, which is just outside my constituency but is the main hospital for it. It is the major acute provider for north-west London, and one of the four major trauma centres in London, with a 24/7 A&E department. It is a hospital very dear to my heart—it saved my life once, and I gave birth there—and it is held in very high regard among my constituents. Quite rightly, it has a terrific reputation for clinical care; we should never miss an opportunity to record our admiration for the staff, who deliver healthcare so superbly to the public.

None of that should blind us to a very grim reality, which is that St. Mary’s Hospital is very old. In some instances, it is quite literally falling down. It is now 14 years since the Paddington health campus proposal finally collapsed, which was the first vision of the redevelopment of St. Mary’s Hospital. Here we are in 2019, with the collapse of “Shaping a healthier future”, and we are still frozen in terms of a major redevelopment for St Mary’s.

In January 2018, Imperial College Healthcare NHS Trust gained full planning permission for the first phase of the redevelopment of St. Mary’s, which is a new eight-story outpatient and ambulatory service building on the site. The trust submitted the outline business case for the investment required to NHS Improvement, NHS England and the local commissioning groups. Under those plans, the trust is looking to house most of the St Mary’s outpatient and ambulatory services in the new building, but this has been on hold since January 2018. It is not an academic issue; the failure to gain funding and approval from key stakeholders for the redevelopment programme is a key risk on the trust’s corporate risk register, because the conditions of St Mary’s Hospital have deteriorated so much. Planning permission has only two years left.

While we are waiting for the funding to be put together for the redevelopment of the hospital within that timescale, the structural issues in the hospital have become absolutely and imminently challenging. The structural problems in the Cambridge wing at St Mary’s resulted in two wards being out of use, with no possible value-for-money structural solution. There is a £1.3 billion backlog maintenance liability across the five hospitals, including St Mary’s. As we have heard, the backlog is the biggest in the country, and St Mary’s has the largest in the trust. In fact, 30% of all high-risk backlog maintenance in the NHS in England is at Imperial College Healthcare.

I just mentioned one of the wards that has been out of action, and St Mary’s maternity services had to be temporarily relocated due to a lift fault in September 2018. The Grafton ward closed due to significant structural concerns, with the loss of 32 beds in May 2018 and no possible structural solution. A ceiling collapsed in the Thistlethwaite ward. The Paterson Centre was flooded and closed for two weeks, with the loss of activity and 20 surgical beds in 2017. Floods, electrical issues and drainage problems are commonplace across the buildings and services at St Mary’s. The hospital simply cannot wait, yet everything is now frozen.

We urgently need advice from the Minister on how we will proceed. Should there be a further structural problem of the kind that we have already seen, it would not only be an imminent risk to patients, but would take out chunks of capacity from an already highly stretched hospital, which will have repercussions across the whole of north-west London. We simply cannot go on like this. I hope the Minister will give us an indication of how the St Mary’s maintenance backlog, structural programme and redevelopment will proceed.

Photo of Rupa Huq Rupa Huq Labour, Ealing Central and Acton 5:12 pm, 24th April 2019

Good news for a change from this Government, who have admitted that the crackpot “Shaping a healthier future” plan to cut the nine major hospitals in north-west London to five is not workable and has been killed off. It was always a David and Goliath battle.

I pay tribute to, on the one side, Ealing Save our NHS, which works shoulder to shoulder with Save our Hospitals Charing Cross and our two Labour councils, as my hon. Friend Andy Slaughter mentioned. They are people like Ollie, Eve, Arthur and Judy Breens, Aysha, Raj and Gill, who held protests and popped up at every carnival. They organised parties, lobbies and petitions, and distributed a quarter of a million leaflets, all of which were paid for out of rattling buckets and their own pockets.

On the other side, we had “Shaping a healthier future”, with its swanky offices in upmarket Marylebone. Tens of millions of pounds of NHS cash from the public purse was spent on private management consultants, who all mysteriously alleged that if they junked departments, A&Es and hundreds of beds, health outcomes would somehow improve. In the end, the figures did not work. Quelle surprise! They never worked.

As early as 2012, John Lister pointed out in his report that the whole thing was a pile of nonsense, as did reports from the two councils, which involved the forensic skills of Sir Michael Mansfield QC. Even then, seven years into a five-year-long failing plan, local health bosses were still carrying on as if the emperor were fully clothed. There was a heavy-handed threat of legal action against me, because my 2017 general election leaflets pointed out that it did not work. That arrived days after my mother passed away at Ealing Hospital—I know every bit of the hospital, right down to the morgue.

Where next? These disastrous Frankenstein plans have seen the two A&Es nearest to Acton Central—Middlesex and Hammersmith—completely shut their doors. I congratulate the Minister on her appointment, and my question to her is: can we have them back, as well as the stroke unit, paediatrics, maternity services and A&E admissions for children at Ealing? All these things mean that the figures for type 1 A&E urgent visits are going through the roof. No more babies are to be born at Ealing. As a mum, I recently had to schlep out of the borough for a paediatric appointment at the West Middlesex Hospital, which is in the constituency of my hon. Friend Ruth Cadbury.

As my hon. Friend the Member for Hammersmith said, we need a serious exercise in lessons learned from this whole sorry episode, rather than clinging on to defend the indefensible and denying that there are serious problems. Ealing Hospital remains perilously underfunded and in crisis. Staff morale has been sapped, as was pointed out by all the uncertainty. We could go on and on about the Brexit effects—the EU nurses exiting in droves and the social care sector being hollowed out by this Government, who are obsessed with their £30,000 skills target.

The slaying of the beast that was “Shaping a healthier future,” which was always known locally as “Shafting a healthier future,” is not before time and has raised eyebrows, such is the cynicism of politics in our time. As we did at the Drayton Court Hotel in my constituency last week, let us eat, drink and be merry, because tomorrow there might be another election.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health) 5:16 pm, 24th April 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend Andy Slaughter for securing this debate. I know that he is a passionate advocate for the NHS in his area. Although I am pleased to respond on behalf of Labour, it is with sadness that hon. Members have to come here over and over to explain the impact on their constituents of the crisis in the NHS.

We have heard a mixed message of plans made and abandoned. It is a story of a shambles, and declining and reducing services, including the loss of services for children, maternity and stroke care. It is no secret that the NHS is under extreme pressure. After nearly a decade of stagnant investment, coupled with a recruitment crisis and a retention time-bomb, the cracks are really starting to show, as we have just heard. The King’s Fund notes that during the Labour Government, budget growth in the NHS was an average of 3.7% a year. It has dropped to an average of 1% a year during the Conservatives’ time in office. The recent announcements of additional funding are of course welcome. However, the British Medical Association and the King’s Fund acknowledge that the promised £20.5 billion, which equates to an increase of 3.4%, is simply not enough after nine years of severe underfunding. It is not even enough to wipe out hospital deficits.

Where is the funding to guarantee sustainable health services in the face of ever-increasing demand from a complex and changing demographic? Where is the funding to renew NHS infrastructure or outdated hospital equipment? Just repairing the dilapidated hospital buildings will cost in excess of £3 billion. We have heard from my hon. Friend Ms Buck about the state of the buildings at St Mary’s Hospital and the urgent work that is needed. My hon. Friend Mr Sharma outlined the refurbishment work that is urgently needed.

Of course, it is not all about money. I was brought up to believe that you get what you pay for. It is clear that if we do not invest much, we will not get much. Is it any wonder that we have a staffing crisis in the NHS? The Conservative Government’s failure to provide adequate resource and support has created problems in both staff recruitment and retention. The Government continue to exploit the good will of dedicated NHS staff, many of whom are pushed to breaking point. As my hon. Friend Ruth Cadbury pointed out, staff morale is at an all-time low.

It is inconceivable that more and more hospitals should constantly face the threat of closure. I commend my hon. Friend the Member for Hammersmith and the committed grassroots campaigners for their extensive work over many years to save these vital hospitals. These victories are really welcome, but the Hammersmith and Fulham CCG faces cuts of £30 million. Is it not disgraceful to hear, in the light of that, that £72 million was wasted on private consultants? It is astonishingly incompetent, above all else.

Of course, the cuts to the CCG forced it to reduce urgent care, local GP hours and access to primary care, which is short-sighted as it causes suffering for constituents and often leads to more expensive or hospital treatments. It seems that the Health Secretary’s only answer is to focus on technology. I agree that technology has a role to play in the future delivery of NHS services, but we must proceed with caution. Patients’ needs are paramount, and we must ensure that their safety is never compromised.

I share my hon. Friend’s concern about the use of online GPs. It is clear that the app providing access to such services, GP at Hand, will be very convenient for some people, and is likely to appeal to younger patients. Indeed, Ipsos MORI found that 87% of all GP at Hand patients are aged between 20 and 39. It is also likely that online GPs will prove attractive to patients with less complex medical needs, leaving the providers open to the accusation of cherry-picking. They are undoubtedly delivering a service for which there is demand, but the fact remains that many patients need to attend a traditional GP consultation.

Of course, many patients do not know when they register with an online GP that they are deregistered from their GP surgery. That has serious consequences for the financial viability of the traditional surgery. Hammersmith and Fulham CCG has paid £10 million to GP at Hand. That money is no longer paid to local surgeries, which are as busy as ever catering for patients with multiple complex needs, and their overheads are still as great as they ever were. It is imperative that the funding model for the delivery of GP services is adjusted to reflect the fact—

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

Order. I have interrupted the hon. Lady, because we must hear from the Minister and time is very limited.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health)

I will sum up, Sir Christopher.

Patients are suffering. We want assurances from the Minister about future hospital closures, sustainable funding and the role of technology in the modern NHS. We want to know the direction of travel of the NHS in north-west London and the country as a whole.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care 5:22 pm, 24th April 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank Andy Slaughter for securing this important debate, and all hon. Members for speaking so passionately. I welcome the campaigners, who have been following our deliberations this afternoon. Everybody has spoken passionately about NHS services in north-west London, and the hon. Gentleman spoke about his area of Hammersmith and Fulham. I am under considerable time pressure, and if I do not answer all the questions that hon. Members raised, which ranged over primary and acute care, I am be happy to write to them later.

I would like to start by thanking everybody who works in the NHS—in primary, secondary and community care—for everything they do, particularly in north-west London, which is a busy area with a lot of demand on services. It is exposed to unique pressures, but there are also unique opportunities. It has some of the country’s busiest services and is used by an increasing, complex and dynamic population. Our capital city challenges our NHS, but it is also home to transformation and innovation that has delivered important benefits for patients.

“Shaping a healthier future” looked at the pressures on the NHS in and around the hon. Gentleman’s constituency. It achieved significant benefits for patients in north-west London. It delivered 24/7 urgent care centres in every local borough and improvements in maternity and emergency paediatric care, and introduced a range of initiatives to help people obtain the specialist care they need closer to home. The NHS in north-west London is now in agreement to move on from the “Shaping a healthier future” programme. The hon. Gentleman asked specifically what the future will hold. In January, the Government announced that there will be an extra £20 billion a year for the NHS by 2024. As part of that, every area in the country will need to develop its own local plan for the next five year for how to spend the extra money. The north-west London sustainability and transformation partnership, working with clinicians and the public, will develop a new long-term, five-year plan for how best to spend that money, working together as a single health system.

I want quickly to address the points that the hon. Gentleman made about the lack of honesty in the north-west London process. Reconfiguration processes are, by their very nature, contentious, and raise many passions locally and nationally. His passion was evident from his contribution. The consultation process in north-west London involved extensive public consultation and clinical engagement throughout. It is important to recognise the high level of clinical engagement. It was never a political exercise or a fait accompli. Its underpinning principle was what was best for patients with the available resources. We need to support NHS staff and managers as they face the challenges before us. We must help them to manage service change responsibly. General practice primary care is the front door to and the cornerstone of the NHS, which is why the long-term plan addressed it when it was published in January.

I want to speak about Babylon GP at Hand. The hon. Gentleman raised a number of issues, and I will do my best to answer them. He spoke about the cost to the CCG. I wrote to one of his council colleagues this morning about the issues he raised. I understand that the CCG has reported that it overspent by £10 million in 2018-19, specifically in relation to GP at Hand. NHS England will of course have to look at the year’s final accounts and any overspend in more detail to understand better the precise financial impact of changes in the borough. For 2019-20, the CCG’s target allocation has increased, all else being equal, in line with the growth in its overall registered population up to the 12-month average for November 2017 to October 2018. NHS England does not believe that the CCG has had to scale back services because of any extra financial burden from GP at Hand, but we will continue to work with the CCG and other partners to explore options for maintaining the robustness of the commissioning system, both now, while GP at Hand is focused in London, and in the future.

I just want to address the hon. Gentleman’s point about safety.

Photo of Andrew Slaughter Andrew Slaughter Labour, Hammersmith

I suspect the Minister was referring to my colleague, Councillor Ben Coleman, the cabinet member for health and adult social care, who wrote to the Secretary of State on 15 April specifically asking for the money spent—£10 million—to be refunded, and for a commitment to reimburse the CCG fully for the cost of GP at Hand. I did not hear the Minister say that, so will she give that assurance?

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I cannot give that reassurance, and I would only reiterate what I have just said to the hon. Gentleman.

On the safety of the app, all NHS providers are held to account through a robust network of systems, including, and not limited to, the inspections of the Care Quality Commission. Any apps providing video consultations must be evaluated and regulated to ensure that the patients who access those services can be confident that they receive safe, effective and high-quality care. Hammersmith and Fulham CCG, along with NHS England, has commissioned an independent evaluation of GP at Hand, which will report shortly.

I question what the shadow Minister said. Digital technology is part of the solution, but the Department is looking at other ways of transforming primary care. We are looking at how we look at partnership models and at how we pivot to primary in future. All patients will have a right to digital-first primary care, including web and video consultations, from April ’21. All patients will be able to have digital access to their full records from 2020. They can, from this month, order repeat prescriptions electronically as the default.

By the end of the next decade, digital innovations are likely to have transformed the NHS. They will allow clinicians to work more efficiently and flexibly so they have more time to spend caring for patients. Every pound spent will go further. That will allow for greater responsiveness and personalisation for patients. We need to design services for patients and things that are available for people when they want them and at times that are convenient for them. I am pleased that the Government have committed to saying that all patients will have access to digital-first primary care from April 2021.

I acknowledge the hon. Gentleman’s concerns about the effect of GP at Hand on primary care as a whole in his constituency. The challenge for the Government and NHS England is to ensure that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers, ensuring that the new technology is safely integrated into existing pathways without unduly destabilising the services it works alongside. Two important principles within the NHS are that a patient can choose which practice they register with, and that funding follows the patient. The emergence of digital-first providers, which register patients who may live some distance from the practice, raises the question of whether these funding arrangements are fair. This year, NHS England is analysing and reviewing the out-of-area registration.

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).