t: 020 7730 8181 e: mfield@twocitiesconservatives.org.uk

Hospital Services (West London)

July 11, 2012

City & Hackney PCT (Tuberculosis)

Mark Field (Cities of London and Westminster, Conservative) I congratulate Mr Slaughter on getting this important debate, which affects all of us who are central and west London MPs. I am sure that he regrets the necessity of the debate. Our constituencies have a number of hospitals in common and, over some time, he and I have discussed health matters that affect them.

New commissioning boards, run by local GPs, will come into play from next April. The Westminster board will share its management with Hammersmith and Fulham, Kensington and Chelsea, and Hounslow, and it is currently considering how the hospital configuration in west London should work. It is the soon-to-be-defunct primary care trusts, however, that will formally make the final decision. As recently as 25 June, the North West London Joint Committee of Primary Care Trusts considered the business case for closing four A and E departments in the north-west London region. The plans are out for consultation until 6 October, and the results will, I think, be presented to the PCTs in advance of final consideration next January.

As the hon. Member for Hammersmith pointed out, it is recommended that four departments in west London be closed, including those at the Hammersmith and Charing Cross hospitals in his constituency. The plan is that people can easily be steered away from A and E and towards their local health centres and GP services. There are of course a couple of fall-back options, both of which involve closing Hammersmith, though. One also involves closing Charing Cross, and the other affects the Chelsea and Westminster hospital, which, although outside my constituency—in that of my hon. Friend Greg Hands—serves a considerable number of my constituents. The joint committee seems to favour the closure of both Hammersmith and Charing Cross A and Es. I agree with the hon. Member for Hammersmith that there is little doubt that if Charing Cross’s A and E is closed, we will see the end of a hospital there, because it would, I suspect, be only a matter of time before the majority of the Fulham Palace road site was disposed of commercially.

I have two major hospitals in my constituency, one of which, Barts, serving the eastern part of my patch from over in the City of London, is not affected by any of the considerations. The other is St Mary’s, Paddington which, ironically, is probably more important to the constituents of my neighbour, Ms Buck, than to mine, although a significant number of my constituents in the Hyde park area and Marylebone use it as their local hospital. The Department of Health has been mindful of the fact that hospitals in the centre of London, which serve large working populations as well as residential ones, give the NHS more bang for the buck. I have often observed that my constituency has been well served over the past decade and a half by new walk-in centres and the like.

The joint committee might have been tempted to realise one of its most valuable assets on the St Mary’s site, which is, like Charing Cross, a prime piece of central London real estate. From the recommendations, it seems that that temptation has been resisted, and I am glad about that, but, like the hon. Member for Hammersmith, I am not going to take anything for granted until the whole process is over. There is, inevitably, a sense that there is an element of a zero-sum game here but, like the hon. Gentleman, I do not recognise that we should necessarily be in this place, for reasons I will set out.

My constituency next-door-neighbour, the hon. Member for Westminster North, and I would have vigorously fought any plans to close St Mary’s, because the hospital has a proud historical importance and is incredibly well served by public transport, which makes it a key local service for countless central London residents. Let us not forget, in this week of all weeks, the seventh anniversary of the terrible 7/7 bombings in London. One of the bombings was on the Edgware road, and St Mary’s, Paddington had pride of place as one of the sites that played an important part in ensuring that lives were saved.

I have a great deal of sympathy, therefore, with the hon. Member for Hammersmith, as he faces two closures on his doorstep. If the closures went through, they would not, perhaps, cause me the same amount of political grief, but they would affect my constituents, many of whom receive hospital treatment from some of the institutions earmarked for closure. There would also be the ongoing effect of the substantial burden of increased pressure on the area’s existing hospitals.

I accept the clinical wisdom of trying to steer traffic away from A and Es as far as possible, but before we press ahead with closures, particularly in this part of west London, we must ensure that the alternative services are truly in place and that we are not operating on some naive hope that the pressure on A and Es will miraculously dissipate once four west London departments are removed. Until there has been a proper assessment of out-of-hours care, I question the wisdom of closing as many as four busy A and Es in this area of the capital. The plan is misguided because the population is transient, with huge numbers of non-residents spending time in central London as workers, visitors and tourists. The pressures on central London are very different from those in other parts of the UK. I can understand that the Minister does not want to hear all sorts of special pleading from different parts of the country, but I think that he will recognise that in my unusual constituency I have 70,000 UK nationals, but 920,000 people working there every day of the working week. That is an extreme example, but it is fair to say that around Ealing Broadway and Heathrow airport there are also huge clusters of people who work but do not live in the area, and that should play some part in the thought process about the closures.

I want to say a little about two slightly more parochial issues, because this is not the only health proposal that has caused my constituents alarm. One is the Royal Brompton hospital, which the hon. Member for Hammersmith mentioned. The hospital is just outside my constituency, in that of my hon. Friend the Member for Chelsea and Fulham, but it serves a lot of my constituents. I have received many e-mails and other correspondence imploring me to fight the decision to close the specialist children’s heart surgery unit at the hospital, as I am sure have other central London MPs.

I buy into much of the thinking on the issue of specialist care, not just by this Government but also from before 2010. In my view, it is better to concentrate specialist services in fewer and larger centres, rather than to hold on to a widespread but perhaps more mediocre service. I know that it is easy to make that case in a constituency such as mine, where services are in parts of London that are only 10 miles apart, and I appreciate that in more rural parts of the UK we are talking about distances of many dozens of miles, but I have great sympathy with the concerns that some of my constituents have highlighted.

They are particularly worried that the review of the Royal Brompton has failed to consider what a difference having child and adult cardiac services in the same centre makes to the quality of care. My constituents will point out that the Royal Brompton is one of only two hospitals in the country where four surgeons already handle well over 500 congenital cardiac cases a year, meeting, therefore, the standards expected by professionals and the review panel’s criteria. It is the only centre in the country to have undertaken more than 1,000 interventions in a year for such diseases, and the service has consistently been rated as excellent by the Care Quality Commission, the review team and, of course, Ministers.

The campaigners fear that the decision to close children’s heart services will threaten the viability of the entire trust in the Royal Brompton area. The hospital hosts the country’s largest service for children with cystic fibrosis, which requires intensive paediatric care, and also anaesthesia teams to support the respiratory team with some of the most complex cases. I hope that the Minister will continue to listen to some of the concerns.

Finally, the other parochial issue, which the hon. Member for Hammersmith also raised, relates to Imperial College Healthcare, which has an important part to play on the St Mary’s, Paddington site. If the changes go ahead, the hospital looks set, rightly, to become ever more important in that part of London. I wish to touch on the recent negative press coverage, and give Imperial the right to reply, as it were. Following the deaths of some 25 patients, my local authority, Westminster city council, has expressed concern about Imperial’s poor record keeping, and the loss of a large amount of referrals data.

I received this week a missive from Mark Davies, Imperial’s chief executive, explaining that in January the trust took the rare step of taking a temporary break from reporting its performance in meeting the 18-week waiting time target for referral to treatment, and waiting times for both cancer and diagnostics. He contends that the break was necessary to establish new and robust systems for recording and reporting patient data. Reviews of that period have found that there is no evidence of the trust missing any cancer diagnoses, and the measure was a short-term one, allowing for new configuration. The trust’s view is that the negative press coverage rather overstates the case.

The matter we are debating affects us all as Members of Parliament. We understand that it will inevitably be a partisan, party political issue to an extent, but we all hold close to our hearts the area of London that we represent, and I hope that as far as possible we will work together to get the best deal for west and north-west London as a whole