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Health and Education

I want to focus on the proposed Bill to give the NHS a constitution. Unlike the hon. Member for Gainsborough (Mr. Leigh), I think that our public services need more public involvement rather than less, and on the basis of my constituency experience, I am sceptical about the suggestion that we should leave professionals to their own devices. I feel that that has led to a slightly unrepresentative NHS that sometimes makes decisions in its own favour as an institution rather than considering the needs of individuals. In 1996, during the last days of the last Conservative Government, the authorities at St. Helier hospital, which serves half my constituency, made a private, closed decision that the hospital should close and move further into Surrey, further away from those with the greatest health needs living in my constituency. A process was set in motion by NHS officers, who concluded that the hospital should be moved to Belmont, in the Surrey suburbs—one of the areas with the highest incomes and the lowest health needs and, indeed, an area that did not want a big hospital. How could such a decision be made? I wonder whether it was anything to do with the fact that not one of the 18 board members of Merton and Sutton primary care trust comes from, or lives in, my constituency. They all live in much more affluent areas, and know my area less well. What is more, in an area that is hugely ethnically diverse, all but one of the board members are white. I believe that such boards are set up as they are because people choose other people in their own image and likeness. Potential board members are judged on the basis of whether they are members of other quango boards and whether they have similar experience. The difficult people who tend to challenge the status quo are not included in the selection process. The NHS later set up a public consultation on where the hospital should go. To no one's surprise, St. Helier was the favourite choice and Belmont the least favourite, but the NHS wanted to stick to its decision. At that point, all the local boards rowed in behind the official NHS view that the hospital should move further into Surrey, despite the opposition of thousands of residents. Depending on whether or not one is charitable, one can believe either that the health service appointed consultants to re-examine the evidence or that it appointed them to manipulate the consultation results in order to suggest that people had voted for Belmont when they clearly had not. Because most people had answered the question ““Would you like a hospital near to where you live?”” in the affirmative, it was suggested that that constituted evidence that Belmont was near to where they lived, and that that justified the move. Even people living in the Belmont area did not want the hospital there. A staggering number of people wrote to me saying ““We do not want our nice residential area to be bulldozed to pieces, we do not want ambulances with blue flashing lights, and we do not want more bus services.”” No one wanted Belmont, except, of course, the NHS. Over the years, we had more and more arguments about the issue. Members who have been involved in arguments about hospital reconfigurations, or in any similar campaigns, will know how daunting it is to be faced with a wall of experts and professionals, given the limited resources possessed by many of our communities and, in many instances, by Members of Parliament. My local residents, however, had one thing in their favour. In 2004, the London borough of Merton had a Labour council, which, after being consulted by residents, used its powers to have the decision to close the hospital called in to the Secretary of State. The decision was reconsidered by my right hon. Friend the Member for Airdrie and Shotts (John Reid) and subsequently by my right hon. Friend the Member for Leicester, West (Ms Hewitt): they had listened to the people. Late in 2005 the then Secretary of State, my right hon. Friend the Member for Leicester, West, instructed the NHS to rebuild the hospital at St. Helier. She agreed with residents that it was better for it to be there, because that was most likely to reduce health inequalities. After all, the life expectancy of people in my constituency is 10 years shorter than that of those living in the Belmont area. One would have thought that that was the end of the matter, because the Secretary of State had made her decision. However, the local NHS did not give up that easily. There is nobody from our area on its boards, and there is no constitution to say this was unreasonable, so although Ministers told it to build a hospital at St. Helier and to stop working on Belmont, it continued to make progress with its initial plans. It held meetings with Transport for London where it made it clear that Belmont was still the favoured option. It then announced that—lo and behold—planning issues meant that the hospital simply could not be built at St. Helier. It asked the Secretary of State to reverse the Government's decision, and to build the hospital in leafy Belmont as it had originally hoped would happen. Again, local residents were up in arms. After all this time, why would the local NHS not listen to us? How could it be that there was nobody in the NHS establishment who would represent us? The Government had represented us; the local council had represented us; even the former Mayor of London, Ken Livingstone, had supported us. He told the local NHS, ““Look, I'm in charge of London's planning policy, and St. Helier is the right place to have this hospital.”” The local NHS just would not listen to us, however, so we campaigned, fought and lobbied, and eventually, after years and years, it looks like we have won. I have to say that I think we now have an excellent deal. Not only has St. Helier been saved, but it is going to be rebuilt and refurbished. There will be new wards with single rooms, to cut down on infections and improve patient privacy, a new local care centre, and a new 24/7 GP service. There will also be four care centres, including one at the Wilson, the hospital the Tories closed down in the early 1990s. These care centres will have diagnostics and treatments, and dentists and GPs open when people want them. Moreover, the Wilson is not just getting a care centre. It will reopen as a hospital, performing minor operations, and with more than 50 intermediate care beds for people recuperating from operations or needing care they cannot get at home. My constituents have seen a stark contrast between how their views are treated by local and national Government on the one hand and by the NHS on the other. That is because democratically elected organisations are far more likely to represent the views of those who are least able to express their own views. Sometimes it has seemed as if our achievements were in spite of, rather than because of, the NHS. As I reflect on our 11 years in power, I think it would have been much better if there had been a constitution for our NHS earlier, and in particular a constitution that forced the local NHS to listen to patients and staff, and which obliged it to be representative of the communities in which it is situated. Why, after all these years, have we not had even one local person on one of our NHS boards? Why, too, should the local NHS professional bodies be packed with people who have little connection with my constituency? I am particularly concerned about the composition of my primary care trust's professional executive committee. It is dominated by a practice far away from Mitcham and Morden. The medical committee comprises eight clinicians. The last GP from Mitcham to serve on this board was taken off it more than a year ago. Now all its members are white, even though the majority of the GPs in the PCT are not, and they represent an area that has the best health in the PCT area, rather than the worst. Six of the eight PEC members are from the same commissioning group, the Nelson, even though this group covers possibly the most affluent neighbourhood in the PCT. I should have thought that allowing a single commissioning group to dominate such an important committee was extremely dangerous. Indeed, I have received complaints that this very powerful practice-based commissioning group is at an advantage. It certainly appears to have a disproportionate influence. I am especially anxious because this extremely unrepresentative committee is taking decisions about health care in my area. Both locally and nationally, we have been told to demonstrate that there is equal access to health services. Even the Conservatives who run Merton council say that bridging the gap between my constituency in the east and the far more affluent west of the borough is the top priority. As I have said, the Government have instructed the local NHS to take more account of health inequalities, but I am not convinced that the PCT can eradicate inequality in the local NHS, because it is not representative of either the local NHS or local people. I hope that a new constitution will offer us an opportunity to achieve that. I want the NHS to listen to local people and to come from local people. I want it to reflect the people whom it serves and the people who work in it. I support the Government's plan to introduce a new constitution for the NHS, but I want it to ensure that local residents are represented. I want my local NHS to reflect the area that it serves. Over the last four years, foundation hospitals have shown that communities want to be involved in their NHS as a whole, not as a particular interest group or with a particular agenda. The 108 foundation hospitals have more than 1 million members, with turnouts in elections that often exceed local election numbers. If we can get far more people involved and having their say in an institution that unites this country, we will have a much better chance of having a service that reflects the needs and demands of local residents.