I am grateful for the opportunity to speak on the subject of the NHS in London, and delighted that so many colleagues from the four corners of London want to say something about the health service in their areas. I want to sketch out, with some specific reference to local issues, the momentous changes that are happening within London’s health care and the extent to which the Government have made necessary changes far more difficult to achieve than should have been the case. I fear the results.
When I applied for this debate before Christmas, I did not know that I would spend a large part of the next two weeks experiencing the health care system with a close relative, who was admitted to hospital on Christmas day. We went through the whole process of ringing 111, of paramedics, of the ambulance, of A and E and of spending two weeks in St Mary’s hospital. I can confidently say two things on the basis of that experience. First, I have seen, and my relative has experienced, nothing but kind and efficient health care at St Mary’s and within the health care system in general. It is true that, over the years, there have been instances of the health care system falling far short of the standards that we expect, but it is also true that most health care professionals and auxiliaries are doing a stunningly good job for the people of London and the rest of England.
There is kindness and the effective delivery of health care everywhere we look in our health service. We must be careful not to succumb to the tendency—I see this too often from Government Members—to talk down the health service’s achievements. It is completely right that Sir Mike Richards of the Care Quality Commission said in his comments on the first wave of inspections that
“there are some very good hospitals in this country, and it is possible, within the NHS, to receive good, excellent, even outstanding care.”
Secondly, from my observations this past fortnight, I can say that the health service is under extraordinary pressure. One would expect not to have the level of staffing for the two-week period of Christmas and new year that one might have outside the holiday period, but it has been alarming to note instances of health care auxiliaries being two thirds below planned staffing levels and nursing being down by one third. Incidentally, I was also shocked to discover when talking to health care assistants that they sometimes work an 11-hour day for a £90 day rate, which is not the London living wage—it is the minimum wage. How can we expect people to provide the intensity and quality of care that we want when we do not pay them even the living wage? That causes me great concern.
Pulling back to the wider picture, as our experiences have demonstrated, the health service is under extraordinary pressure, particularly in the emergency service. Some of that is unsurprising in London, because the capital has the fastest-growing population and has had the fastest rise in the over-65 population of any region in the country. It also has the highest demands on mental
health care services and an overwhelming concentration of rarer and more difficult conditions, including tuberculosis, which places particular pressures on London.
Unsurprisingly, those facts are showing themselves in A and E attendance and waiting times. Just before Christmas, the London assembly found that more than half of London’s A and E departments failed to meet their waiting time targets for more than half of last year. Across the capital, Londoners had to wait for more than four hours on 202,000 separate occasions. A and E attendance has soared in London since 2010 and is up by 47% at St George’s hospital in Tooting, 46% at St Bartholomew’s Hospital, 33% at West Middlesex university hospital and 35% at Hillingdon hospital. For my own Imperial College Healthcare NHS Trust, even a relatively modest increase of 19% equates to an extra 44,812 people seen last year compared with 2010. Cancelled operations were running at a 12-year high even before the winter, owing to pressure on hospital beds. One London hospital, Barts, topped the national list with 649 elective operations cancelled in the first half of last year.
Vacancy rates are a particular concern in London. Regionally, 11% of nursing posts are vacant, compared with a national average of 6%. At some London trusts, the rate is more than 20%. The regional total represents more than 6,000 vacant nursing posts in London. The Royal College of Nursing, which kindly briefed me for this debate, says:
“Our worry is that the hard work of some trusts in protecting posts is being undermined by a lack of available, suitably qualified nurses to take vacant positions, raising obvious questions about whether training is being commissioned at the level needed.”
Given that pressure, it is beyond dispute that there is a need to carry on changing how health care is delivered, which we all accept and have accepted for many years. The broad principles mapped out by Lord Darzi in 2007, which were not new, proposed a greater concentration of high-level surgical services to save lives, and better community and primary services to reduce unnecessary admissions and enable speedy hospital discharge. Both the demand side of the equation, which is driven by an ageing population and the challenge of chronic conditions, and the delivery side, which utilises the opportunities of new drugs and surgical techniques, push us to the same conclusion. There is clear agreement in principle that we need to carry on with the changes.
The central thrust of my argument, which will be echoed by colleagues, is that managing change of that scale requires that essential preconditions are met. Those preconditions are, however, not being met at the moment, and in some cases the means of delivering them are going into reverse. First—all are important, but this is the first—there must be public confidence in the process, and that confidence is so catastrophically lacking.
Labour colleagues who are facing the closure or downgrading of their A and Es will know what their own communities are telling them, which is that closing A and E units in the midst of an A and E crisis is utterly perverse and should not happen until and unless trusted alternatives are in place. In that context, clause 118 of the Care Bill confirms everyone’s worst fears, because, having failed to win public confidence in London and other parts of the country, Ministers want to give powers to special administrators to override local opposition.