Thank you very much for your e-mail.
Of course I will be there to vote in the debate, although my Human Rights Select Committee meets at the same time and I am may not actually be able to speak on this occasion. However, I can assure you that I have contributed to a number of other recent debates about the NHS, locally and nationally, and will continue to do so!
We face a massive set of overlapping problems in the NHS, the tackling of which has been hindered rather than helped by the expensive and unnecessary reorganisation contained in the 2012 Act. The NHS is now experiencing the worse financial squeeze in its history and if no action is taken faces a shortfall of £20bn by 2020-21. At the same time, local government has been forced to slash spending on social care- i.e. the home and community based services which can help patients be discharged safely from hospital or even prevent them from having to be admitted in the first place. And all the while needs are constantly rising- primarily, though not entirely, because of an ageing population.
Somewhere, now deeply buried underneath all this, lie the bones of some good ideas- the better integration and reshaping of the health and social services to increase specialisms in some areas. The concentration into fewer, better, stroke and trauma services has undoubtedly saved lives. And the building up of primary and community care outside hospital which was the underlying philosophy of the Darzi review under the last Labour government, and which envisaged a big expansion of diagnostic and treatment outside of hospitals were good ideas . And those ideas have, to some extent, fed in to the ‘Shaping a Healthier Future’ plans we now have before us. (‘Shaping a Healthier Future’ is the strategy for North West London’s NHS).
At one level, the NHS Sustainability and Transformation Plans (STPs) are intended to drive that agenda, not just in NW London but across the country, but (and it is a huge ‘But’) a lot has changed since the original concept was set out.
As money has drained out of both the NHS and social care, changes have to be funded by cuts elsewhere. ‘Shaping a Healthier Future’ for NW London envisages the closure of a number of Accident and Emergency units even while demand is rising, and in any event before alternative community based services are fully developed and tested. At my regular meeting with Imperial last week, for example, I learned that the 2016/7 deficit is projected to reach £52m, and, in addition, the Hospital Trust has to find £54m in ‘Cost Improvements’. Our local Clinical Commissioning Groups are deemed to be ‘over-funded’ and will see their budgets fall by 10% over the funding period. Meanwhile, the Better Care Fund, which is shifting some money from hospitals to the community, is simultaneously plugging holes made by cuts in Westminster Council support for social care. We saw all this before, when long-stay hospitals closed in the 1980s without adequate ‘care in the community’ being available- the essence of a good idea undermined in practice.
Westminster Council has been considering the STP proposals via reports to their Health and Well-Being Board, so in a sense, none of this is particularly secret or new. (Here it is, by the way)
However, there has certainly not been an honest presentation to the public of the scale of the financial pressures/cuts, nor the impact of changing patterns of demand. I am sure that the (Conservative) Council doesn’t want to publicise the plans, in order to avoid rocking the boat politically, though on the other hand Hammersmith Council has been outspoken and refused to sign them off.
The NHS does need to continue to change- developments in treatment and changes in the population make that essential. But it will struggle massively without considerable extra investment, not only in acute/hospital services but in primary, community, social and mental health care services as well. We also need to ramp up measures to prevent illness and promote well-being- from tackling air pollution and obesity to better mental health interventions, and give urgent priority to reducing health inequalities.
In the meantime, the worry is that the hospital changes, which affect us in Westminster rather less than they do in places like Hammersmith, (where they have been battling to save Charing Cross Hospital) have been driven more by the need to cut costs and generate receipts from land sales than by a proper plan to improve health care.
As I say, I will certainly vote for the motion later and continue to do all I can to expose the pressures on the NHS. Even under the strain it is unde , there is so much to value and be proud of in our system of healthcare, and we must fight to preserve, protect and improve it.
Karen Buck MP