North-east London STP — House of Commons, 2016-12-16
Topic: Health
Michael John Gapes (Labour, Centre-left): I am grateful to my hon. Friend, who spends a great deal of time, as I do, campaigning with her local council to improve the NHS locally. Throughout our sub-region of north-east London, we are all concerned about what we are facing The King’s Fund reported in November that the speed of development of these plans means that "patients and the public have been largely absent" from the process and that NHS England has instructed that freedom of information requests should be "actively rejected". Locally in north-east London a freedom of information request for the financial and working detail of the STP was rejected in November on the basis that: "Disclosure would be likely to inhibit the ability of public authority staff…to express themselves openly...and explore extreme options…Deliberation needs to be made in a ‘safe space’ to develop ideas and to reach decisions away from external interference which may occur if there is premature public or media involvement." My local council, Redbridge Council, has been concerned that it has not been adequately involved in the process. It has made it clear that it will act in the interests of our local community and that Redbridge will not be signing off or endorsing the STP unless we are satisfied that it is in the interests of Redbridge residents I understand that the STP programme boards are not required to hold meetings in public, and no agenda or minutes are published. The secrecy surrounding this process has not been helpful in building public trust and has caused suspicion within communities all over the country—I speak particularly from local experience—as to the intentions of the proposals. In many respects what could be a reasonable response in the circumstances to the crisis we face in terms of future funding, the ageing population and other challenges to the NHS, is being undermined because of process issues. The NHS needs to learn from these experiences about how better to engage with the public and key stakeholders, including elected local representatives. We are fortunate in Redbridge and north-east London because there are good working relationships within the NHS and local government, and there is already a model of collaborative working. However, the problem with the STP is that it brings a top-down process into this situation and potentially undermines the joint-working that has been voluntarily established over recent years Redbridge along with neighbouring authorities will be strongly arguing that the developing STP governance structures should not stifle or negatively impact the local work that is happening. Redbridge and its partners in Barking and Dagenham and in Havering have over a number of years been developing cross-borough, collaborative approaches on the integration of health and social care. Redbridge is arguing that STP governance needs to ensure that this subsidiarity to the local level is taken as a model for the future, and is not undermined by the STP approach. We need to ensure democratic accountability if we are to get public buy-in, and we do not have that at present. Public engagement needs to be enhanced and improved The north-east London October STP draft is subtitled "transformation underpinned by system thinking and local action". It says, however, that "the system partners may not be able to work together collaboratively to deliver the plans." Today we have seen news about the reality we face in our NHS: large numbers of hospitals with dangerously high bed-occupancy levels and little or no flexibility. The CQC’s chief executive recently talked about hospitals being dangerously full. On 26 November, a leaked memo from NHS England revealed that hospitals were being banned from declaring so-called "black alerts" and told to prepare for the winter crisis by passing on scheduled surgery to private hospitals and discharging thousands of patients to get bed occupancy down from a national average of 89% to 85%. However, north-east London’s population is massively increasing. The report states that the population of north-east London boroughs will increase by 18% over the next 15 years—equivalent to a new city—and yet there is no plan for an additional hospital to cope with that change. In fact, page 20 of the draft policy states that building an additional hospital is "not practical or realistic." Indeed, the situation is worse than that. Not only is there no extra hospital, there is the planned closure of the A&E at King George hospital in my constituency. The plan is to stop overnight ambulances sometime next year, with a total closure in 2019. The STP is calling for that not only because it would meet some savings and restructuring requirements, but also because there are unsustainable costs. The previous Health Secretary announced in 2011 that the A&E at King George would close in "around two years". That has not happened because it was deemed unsafe and because there is insufficient capacity at Queen’s hospital in Romford or at Whipps Cross university hospital in Waltham Forest to cope with the increased demand Despite our excellent and hard-working staff, all the hospitals in north-east London are in crisis. With pressure for early discharges, but inadequate social care and community support, we have large-scale bed blocking and delayed discharges. Sick patients then get readmitted because they cannot get GP appointments due to the pressures that exist in that sector. The STP sees out-of-hospital and integrated community care as the way forward. However, Dame Julie Moore, who in 2014 chaired a commission on hospital care for frail elderly people, said: "As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population… the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing… but this can never be a substitution for hospital care." We still need hospitals and acute care. Plans to transform care in the community are good, but that requires a transformation of primary care, which needs resourcing. The STP projects a 30% shortfall in nurses by 2021, and we know that many GPs plan to retire over the next few years. Both are difficult issues Problems also exist in the potential financial situation, and one such issue is the estates strategy. The STP delivery plan highlights sites such as Goodmayes hospital, which is a large mental health hospital, and King George hospital as places where land could be sold. Contractual issues and other matters mean that that is probably an optimistic approach.