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Healthcare in London

January 8, 2014

Mark made the following contribution to a Westminster Hall debate on healthcare in London tabled by Westminster North MP, Karen Buck:

Mark Field (Cities of London and Westminster, Conservative)

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate Ms Buck on securing this valuable debate. Although her conclusion was perhaps a little more hyperbolic than mine would have been in the circumstances, we work closely together, along with her hon. Friend, Mr Slaughter, to do our best for all our constituents. Over the past year or so, as we have tried to put our constituents first, we have had concerns about elements of the negotiations on this matter.

For all the lively debate about health care provision here in the capital, there is one thing on which we can all agree, as the hon. Lady made clear in her contribution: the pressures on the national health service here in London are huge and getting bigger. They are set to increase substantially, not only because the population is ageing but because of the hypermobility and hyperdiversity of that population. In the past, that was perhaps typical of inner London alone, but it now applies to the entirety of the capital.

At times, the national health service can seem a little like a national religion, whose traditions must not be questioned under any circumstance. In my view, if one good thing has come from the terrible events in Mid Staffordshire, it is that we can perhaps start to have a more honest and less ideological debate about where

the NHS is performing well, where it is letting people down and how it can better tackle the future challenges to which the hon. Member for Westminster North referred.

I have enormous respect for the Secretary of State for unashamedly refocusing the NHS around patients rather than protecting the sanctity of the system. Thankfully, the patient experience at some of our central London hospitals is, as the hon. Lady rightly pointed out, a world away from what happened in Mid Staffordshire. The diversity of population and the presence of top-flight medical schools and universities, particularly in central London, inevitably draw global talent to our local hospitals.

I am often staggered by the quality of facilities here, be it the state-of-the-art birthing unit in St Mary’s or theRoyal London, the beautiful Maggie’s cancer centre at Charing Cross or the brand new oncology unit at Barts in my constituency. Only yesterday, a constituent wrote to me about his young nephew’s recent stint in hospital. He said:

“Given it seems it is ‘in vogue’ to be ‘anti-NHS’ I wanted to let you know that my recent experiences with the high dependency unit at Chelsea and Westminster Hospital”—

that hospital is outside my constituency, but obviously caters for a lot of my constituents in the south of Westminster—

“were nothing short of exemplary. I am sure that my nephew’s speedy recovery was probably all down to the standard of care he received.”

More often in my constituency it is non-emergency services that fail to be so patient-focused. Londoners are spoilt for choice in so many aspects of their lives, and as a result they have the idea that they should expect to get a full choice in everything. Why should they not expect a similar consumer-driven, flexible and responsive system when it comes to primary care—one that allows them swift access to a GP or provides small surgical procedures outside hospital?

We have read a lot in recent days about the number of non-emergency cases being presented at A and E departments. I think that that is in part due to the hassle factor associated with the existing GP system. With the hypermobility of population in London, many people never bother to register with a GP, and those who do all too often find that they cannot get an appointment for days or at a time that is convenient for someone with a busy working life. It is therefore often a perfectly logical decision for those people to spend a few hours in A and E, where they are at least guaranteed to be seen.

Thankfully the story is rapidly improving for my constituents. The Central London clinical commissioning group has just extended its seven-day GP opening service from three practices to five. People are able to walk in and book a same-day appointment at those practices. They do not have to be a member of the practice to use the service, and registration with their own GP will not be affected. I also know that plans are afoot to locate more GPs within hospitals in London. That type of modern and practical response really needs to be rolled out more widely.

There are problems with the health service in central London, which my colleague the hon. Member for Westminster North has so carefully outlined. My own

constituency will hopefully be affected for the better by the huge changes to be brought in by the “Shaping a healthier future” programme. That programme began some five years ago to respond to the challenges of a rapidly increasing population and the variation we were seeing in the quality of acute care. It has caused most controversy in its proposals to close a number of A and E departments.

My constituents are grateful, as are the hon. Lady’s, that St Mary’s hospital in Paddington has been confirmed as one of five north-west London hospitals to provide advanced comprehensive acute care. I am assured that there is a strong business case for even greater investment on that site and exciting plans are afoot in that regard.

The Minister needs to be aware, however, that there have been issues of communication over the relocation of elective surgery, as was raised earlier. I accept much of the wisdom in the reconfiguration of services in north-west London to allow for specialist centres rather than having hospitals that are jacks of all trades.

I accept that that is easy for me to say, given that two local hospitals in my constituency, Chelsea and Westminster and St Mary’s Paddington, are not affected, and I know that the issue is a great concern for many Members, who are hearing such concerns from many constituents. But I suspect the perceived success or failure of any reorganisation of this sort will come down to smaller things: how well plans are communicated; how quickly alternative, out-of-hospital services are in place; and how transportation is organised for patients, many of whom are impoverished or will have to travel further and rely on public transport.

Diane Abbott (Hackney North and Stoke Newington, Labour)

On the acceptability of reconfiguration, we should never forget that many communities in London have a strong emotional attachment to a hospital that could have been in existence in some shape or form since the middle ages. That is why reconfiguration must go forward carefully and on a purely medical basis if it is to succeed in London.

Mark Field (Cities of London and Westminster, Conservative)

That is right to an extent. I know that the hon. Lady spoke in a debate that I led in the House almost a decade ago on Barts, which is located in my constituency and has a special place in the hearts of many millions of Londoners—and, indeed, of people throughout the United Kingdom. The truth is that at that juncture, the private finance initiative was the only funding game in town and we all went along with it, but that £1 billion PFI has now caused major financial issues that, I am afraid, affect not just Barts but hospitals right throughout the north-east of London, as the hon. Lady is well aware. We all feel a bit depressed about that knock-on effect.

We have to accept that in London, broadly speaking, we do pretty well as far as hospital care is concerned. Being absolutely candid with everyone, because I know what it is like, in central London we have a very good service, and it is partly outer London that suffers as a result. That is because of the strength of the links to which Ms Abbott rightly referred—the passion that we have for our historic hospitals—and the amount of resource that is pushed into central London because

the hospitals there are teaching hospitals with consultants, former consultants and alumni who are willing to make a strong case for the existence of those hospitals. Dare I say it, that makes it easier to make the case for Barts than for a hospital out in Romford or Whipps Cross, or one in the hon. Lady’s constituency.

We all have to face those issues. They have not arisen as a result of the reorganisation of the past three and a half years; this has been the situation in the capital for probably 40 or 50 years. I am aware that even in the latest reconfiguration there has been a sense that central London has got off slightly better than the middle portion of outer western London.

I turn to finance. There was a good outcome before Christmas for north-west London on commissioning allocations, as all of our CCGs received an uplift to offset inflation. However, I want to raise concerns about the funding formula used to determine allocation. The formula fails to take into account the needs of the large homeless population in Westminster, which places massive pressure on acute services. Rough sleepers are far more likely to attend accident and emergency; they attend six times more often than any normal member of the population. They are admitted to hospital four times more often and stay in hospital three times as long.

The formula also ignores the fact that CCGs are responsible for all attendances at urgent care centres or walk-in centres and for the costs of patients covered by reciprocal funding arrangements with other countries. Westminster welcomes more than 1 million commuters and visitors each and every day, many of whom will need health advice and care while they are here. It is important that a future funding formula recognises the impact of that on local health care services.

The proposed formula will exclude spending on community care. That cannot be correct considering the important move to provide more high-quality care at home and in the community rather than simply in hospitals. I welcome the Government’s assurances that the Advisory Council of Resource Allocationformula will not be accepted in its current state and that changes to the funding of CCG will be fully consulted on in future.

I turn to public health spending. A draft formula for local authorities was set out in the “Healthy Lives, Healthy People” consultation, which was published on 14 June 2012 and recognised that further work was needed on adjustments for age, fixed costs and non-resident populations. However, initial modelling by London councils suggests that Westminster would have a drop of 57% in public health funding. Central London and Westminster have unique population characteristics that make it more difficult to make public health improvements. They include the age structure, with a greater focus on working age and children, and levels of mental health problems and homelessness. Those are not properly reflected in the current formula.

The formula also fails to take account of substance misuse services, many of which fall outside the pooled treatment budget, which focuses on opiates and crack treatment. It also ignores the wider health and local authority investment needed to manage the individual family and community impact of drugs and alcohol on health and well-being.

Westminster experiences a high level of population churn—I accept that many other London boroughs are in that boat—and that leads to additional demands for services, including NHS checks and other screening programmes.

Glenda Jackson (Hampstead and Kilburn, Labour)

Will the hon. Gentleman give way?

Mark Field (Cities of London and Westminster, Conservative)

Other hon. Members want to speak so, if the hon. Lady will forgive me, I will finish with a request to the Minister. I would welcome an indication from the Government of when we can expect more clarity on how future public health allocations will be determined. I would also appreciate confirmation that the formula consulted on in June 2012 will not be used to determine public health funding allocation in future.