My meetings with the South Thanet MP regarding the  closure of the NHS stroke unit at QEQM hospital in Margate.

Carly Jeffrey, 22 October 2018

“I will do everything necessary to make sure that your voice is heard, and that we get an outcome that is right for Thanet … have no doubt about that please!”

– Craig Mackinlay addressing the crowd at Save Our NHS in Kent protest rally, Oct 6th 2018.

What do you do if your local MP proclaims that he will fight ‘every step of the way’ for a cause that is tremendously important to your community, but you are struggling to see any evidence of meaningful action? How do you ensure that the politician who has been elected to represent you isn’t just paying lip service the issue?

I set out on Friday (Oct 19th) to see if I might be able to use my right as a constituent to get some answers, assurances and actions from Craig Mackinlay.

Some background: The QEQM hospital in Margate is set to lose its acute stroke unit after a public consultation held in February-May 2018, during which it became very apparent that local residents were not happy with the plan to relocate these life-saving services 40 miles away in Ashford. With the poor roads in this area, it means that Thanet patients will be facing a one hour journey in an ambulance compared with the current 5-20 minutes. Stroke is a highly time sensitive illness, and the NHS managers at Kent and Medway STP tried to ‘sell’ their proposal as an improvement, dismissing the familiar F.A.S.T guidelines, ‘time is brain’, and the golden hour all in favour of their new stipulations about what a safe journey time should be. It is part of a plan that covers all of Kent and Medway, reducing the current six stroke units to just three in the county. It is also part of a nationwide plan to reduce stroke care, maternity care, A&E and other services into fewer hospitals with longer journeys, creating different tiers of hospital; our current district general hospitals  will gradually mutate into the have and have not hospitals, with acute care, specialisms and consultant-led care being centralised, whilst the designated lesser hospitals are stripped of more and more services. This will mean being taken past your own hospital in an ambulance to a location much farther way in an emergency, and possibly your local hospital may end up with no ambulances going there at all. These plans come from the top, from NHS England, the Keogh report, Jeremy Hunt and the Five Year Forward View.

The local story

Returning to the storm that has been brewing in Thanet over NHS provision: The two MPs in Thanet, Craig Mackinlay and Sir Roger Gale both acquiesced with the proposals during the public consultation period, echoing the reassuring soundbites from the STP, whilst claiming to have constituents’ best interests at heart. It was back in May that I was shown a letter from Mackinlay to an elderly Ramsgate man in which the MP stressed that he was ‘fighting for QEQM’, whilst again reciting the arguments made by the STP in defence of closure. Sensing that Craig was attempting to have the best of both worlds, I decided to arrange a visit at his local surgery which occurs every two weeks on a Friday.

The first meeting

We met on 29 June, I recorded the meeting with his permission, and you can listen to it here.

My main request at the meeting was that he raise the the matter in parliament, but it also involved me breaking down the arguments of the STP one by one and crucially, telling my MP that there is no actual evidence that the plan will be safe or improve outcomes in this area, as the studies quoted by NHS managers have been grossly misused and misrepresented. I followed up with documents and links by email, and hoped for some sort of dialogue, and if I was lucky, an agreement to raise the matter in the House. I knew that there was a large obstacle to this happening, because my MP has not been known to rebel against his own party. He is a Conservative MP (ex-UKIP), and challenging the NHS reconfigurations locally would require him to point a critical finger back at the government itself, and the course they have been pursuing ever since 2012 when the NHS Health and Social Care Act came into being.

The lack of follow up

The dialogue never came. My messages were ignored and when weeks had passed, I requested another meeting. Again nothing. I tried social media, but that did not work either. Finally I got a letter in the post with on parliamentary notepaper telling me that he could not see me again ‘as my position had not changed’. It did not make sense to me that someone should have to change their view in order to get a follow-up meeting with an MP; it was clear from our first meeting that I wanted to change his mind, and that I had a lot of sound arguments which he had yet to refute. So I went to the local press with the story, and I continued to press home the fact that our MP was not serving his constituents well via the Save Our NHS in Kent campaign, of which I am a part. We even used an empty shop window on Ramsgate High street to get our message out (below).

Throughout the summer months there was no word from the MP, but then in September, when the STP announced their decision to go ahead with the stroke plan and confirmed which three hospitals would be continuing to offer stroke care (Ashford, Maidstone and Darent Valley – from the beginning QEQM was excluded), Craig seemed to reverse his position. He started to insist that one of the hospitals providing stroke care MUST be QEQM. We knew that the public pressure had got to him, and that our campaign, along with the action of the community, had achieved an end to the rhetoric that all will be well – from one of our MPs at least.

A breakthrough?

Having seen that an MP standing up in parliament and an effective campaign from Save Southend NHS had thwarted the plans to close the A&E in that area, we decided to keep pressing for our MP to raise it in the commons. Why? To shine a little light on what is happening, to highlight that the buck stops with the current government, and to remind those in power that they might just lose a parliamentary seat or two over this issue – something they can ill afford – if they don’t budge. The other reason for doing this is accountability, pure and simple. Democracy works only if there are accountable leaders; those leaders must act in the interests of those whom they represent. I wanted to nudge our MP to represent us. I wanted to make his actions match his words.

We asked Mackinlay to speak at our public protest on October 6th, knowing that many in the crowd would not welcome his late conversion too warmly, but hoping that the crowds and the confrontation with the public would do even more to encourage him to meet our demand, and also to back our call for 4 stroke units (HASUs) not 3 in the county. I introduced Craig, and I asked the crowd to be kind to him. You can watch his speech here.

MPs should be able to tolerate criticism and opposition, shouldn’t they?

Comments made later by Craig about our event, our campaign and his reception were very bitter. Despite being allowed to speak at our event uncensored, he complained about other speakers, complained that he was heckled, suggested that SONIK were misusing the donations that we have collected from the public, and resorted to calling us ‘Momentum-Socialist Worker Party’ despite the fact that SONIK is a non party affiliated group. He was heckled, but it was not abusive, people were asking him to ‘do something’. Strangely, he made the public comments about our group after posing with a one of Save Our NHS in Kent’s placards outside the hospital once after the crowd had moved off to march on Margate town centre. He wanted to have that photo opportunity with our ‘save our stroke services’ messaging, at the protest that we had organised, but he wanted to condemn us as well, and over so little. People often don’t trust politicians, and locally he has been seen to support this very unpopular NHS hospital closure – why would he turn on our campaign group because of the reception from the crowd – surely he must have been expecting it?

The second meeting – no recording allowed

I got a call from Mackinlay’s secretary on the morning of Friday October 19th asking if I could meet the MP in his Broadstairs office just after 4pm. I had been pressing for this, as I knew he would be in town that evening entertaining Jacob Rees-Mogg at a dinner. I changed the day’s plans, and agreed to go.

It turned out to be a different meeting from the previous one, during which Craig had maintained a fairly sympathetic tone. Straight away, Craig refused to allow the meeting to be recorded – “not after last time”, he said. He said that he would not “play these games anymore”, complaining that he was unhappy that one particular clip of our last meeting had been doing the rounds on social media. I explained that I felt it was reasonable to use the recording and to edit it; the entire 30 minutes was uploaded but not actually shared extensively until the point at which a further meeting and communication was denied. I made the recording available in full, and I hope many people have listened to it, as it is actually a concise breakdown of the arguments on both sides – anyone listening will get a good understanding of what is a large and complex topic in just 30 minutes. The snippet, in which Craig responds “Because I don’t think I’ll win” when asked “why don’t you raise it in parliament”, may seem unfair to Mackinlay, but it is the essence of the conversation we had. To make a short listenable excerpt of the discussion, it was the obvious choice, being the clip that covered my aim and the meeting’s outcome in a 10 second bite.

I agreed reluctantly not to record the conversation this time, but pointed out that a recording protects both him and me from being misrepresented and misquoted, and that I would have to use my memory and notes rather than a recording, which would  be a shame. He complained further of ‘trolling’ by SONIK, and said “no, we are going to have a open and honest discussion” and that that would be somehow better without a public record. I wondered what this meant exactly, and over the next hour it became clear that it meant my MP would feel freer to be critical of my methods and personal style of speaking and questioning, and to make an insinuation or two about my character – presumably he felt it best not to have public record of that.

The initial questions, and Craig’s answers

Me: “Do you agree that something needs to be done about the stroke unit closure, and fast?”

Craig: Yes.

Me: Do you agree that the people of Thanet object strongly to the proposals?

Craig: Yes

Me: “There is something wrong with the democratic process, isn’t there, if if we know that a population is saying no; if we can prove that there’s no evidence for the change; and yet there’s nothing that can be done?”

Craig: “That would be a democratic deficit, yes.”

Me: “Do you agree that in the Stroke consultation, there should have been an option that included the hospital in Thanet, and that a consultation is not a real consultation if options are removed at the beginning?”

Craig: “Yes, there should have been an option for Thanet, and options shouldn’t be removed.”

Me: “Do you agree that the upcoming A&E consultation should have a third option in which QEQM gets to keep a full A&E and options aren’t taken off the table?”

Craig: “Yes, I think there should.”

The thorny issue of raising the stroke unit closure in parliament; an open letter to Matt Hancock, my ‘combative’ style, and the question of transparency

Me: “So will you raise this in parliament – and are you actually able to raise this in parliament now – given that this must be done before Christmas and your case could potentially last until then?”

Craig: I’m free in the afternoons, but the questions are largely held in the morning. You have to understand how parliament works, you can’t just turn up and ask questions, you have to plan it in advance and they can be rejected or not come up [having to paraphrase as I can’t remember the phrasing used]. It will be very difficult to do. I could raise it, but I can tell you right now what they’d say. I could write it down and put it in an envelope for you.”

“It will be very difficult to do. I could raise it, but I can tell you right now what they’d say. I could write it down and put it in an envelope for you.”

Me: “It’s not only the answer that’s important; it’s the fact that the question has been asked. We can publicise that, and it forces the government to take on board that there’s a very unhappy constituency that might not vote them back in. It shines a light on what is happening as well.”

Craig: “Well I have a lot of other matters that I have to attend to, and as you know I have to be in court as well. it’s going to be difficult and I don’t think it will make a difference”

Me: “But can you at least try? This is a huge issue, I think this is the biggest issues that is going to arise while you are in office”

Craig: “No, it’s your issue, it’s a big issue for you.”

Me: “But you agreed that the people of Thanet don’t want this. how many letters have you had about it?”

Craig: “About fifty. I get a lot more letters about Brexit.”

Me: “Yes, I can imagine. Brexit is a huge topic and dominates the news all the time. It’s a topic though where opinion is very divided, it’s 48/52%; you have to bear in mind that the public are very united on the NHS; a very high proportion support the NHS strongly and 84% want it to stay publicly run. We also know that many in Thanet are against losing the stroke unit, we don’t know exactly how many, but we can guess that it’s very high and it isn’t a divisive topic. You tend to hear the same opinion from most quarters.

Craig: “You know this isn’t some great panacea, raising it in parliament. It isn’t going to get you what you want.”

Me: “But will you try though?”

Craig: “There are lots of other things that I have to attend to, this isn’t the only issue. I spend my time helping the homeless who come to see me in dire need.”

“You know this isn’t some great panacea, raising it in parliament. It isn’t going to get you what you want.”

Me: “Isn’t that something your councillors should be dealing with?”

Craig: “Well yes, but unfortunately they don’t always.”

Craig’s secretary, Liz: “We do get issues like that escalated to Craig.”

Me: “OK, well  I don’t think it should stop you from doing this important thing. Will you do it or not?”

At this point I put my pen to paper and look to him for a response.

Craig: “You know this aggressive style of yours isn’t doing you any favours and isn’t winning you many friends.”

Me: “I don’t think this is aggressive, it’s challenging, and I’m holding you to account, as is my right as a constituent”

Craig: “Your methods leave a lot to be desired though, and the trolling from your group.”

Me: “I think you’re confusing trolling with your actions being criticised and people asking you to act and represent us. I  object to that characterisation of our group actually; we have taken this very seriously from the start, we have undertaken a lot of research…”

Craig: “Yes, I know that, you have done good research..”

Me: “We have worked incredibly hard, and we are all volunteers and have to do this in our spare time. It takes a lot of work.”

Craig: “But you let yourselves down with the taping and putting out nasty little clips on the internet. Someone in your group decided to do that. Your group is being taken over and used for party political ends. Your protest was essentially a Momentum rally.”

Me: “It isn’t, and it wasn’t. And I edited that recording myself. Our group has members and supporters from all parties and from none. You have repeatedly said we are Labour or Momentum, but we aren’t. You are probably sending more Labour and Momentum people our way. Didn’t you see the Green Party banner that was at our event?”

Craig: “Well OK then, it was clearly a left leaning rally.”

Me: “We don’t ask anyone what their political leanings are, and we don’t censor anyone when they speak – that includes you; you spoke at our event. We keep our stance non party aligned, but we are certainly against what the current government is doing to the NHS. There’s so much anger about what is happening to our hospital, and a lot of that will be from Conservative voters as well as supporters of other parties – are you trying to turn them against our campaign by calling us Momentum whenever you feel cornered?”

Craig: “But you see you do have a very combative style. And you’re always looking for a conspiracy under everything, aren’t you? You want to find conspiracies.”

Me: “I feel it’s my job to ask these questions; someone has to. I want to hold you to account because you have said you’re fighting for QEQM every step of the way. If I appear combative to you, i’s because this is urgent and we have been trying to get traction for a long time, for months. Will you at least try to raise this in parliament? And can you submit any questions or make any preparations as soon as possible? Time is running out.”

Craig: “I am fighting for QEQM but I don’t have to do it the way you are telling me to. Your way isn’t the only way”

Me: “But there is only a handful of ways of stopping this. You don’t see very open to trying them”

Craig: “Your way isn’t the only way. I had a meeting with Rachel Jones, I think that’s her name. She’s the new head of Acute Strategy Partnerships at the STP”.

Me: “Isn’t that Patricia Davies? – oh I see, she’s the replacement now that Patricia has moved on.”

Craig: “Yes. And they gave me a very interesting and detailed presentation. Did you know how bad the services across Kent are currently for stroke?”

Me: “Did they show you a table where most of it is coloured in red?”

Craig: “Yes. The services really are shamefully poor in the existing hospitals, and the new centres will improve that. And they need to centralise to fewer units to do that.”

Me: “That table is very deceptive. They coloured most of it in red rather than showing different colours for each 10% change, which is a much more clear and accurate way of doing it. Also, the diagnosis times for QEQM and Ashford are shown in that table as red even though they are above the national average. And there are no guarantees that any of these metrics will improve in the new centres, we asked for safeguards and guarantees and there are none. And they are deliberately focusing on in-hospital door to diagnosis and door to treatment times whilst saying little about patient outcomes in terms of death and disability – that’s because their studies all show little or no improvement to those measures, and they are the measures that matter. They have done a number of studies now, and none of them have produced anything very positive. they are causing all this upheaval, cost and moving care further away for no good reason. I’m a bit confused as to why we are arguing about this again; I thought you were now in favour of a HASU at QEQM? Are you changing your position?

Craig: “No I’m not changing my position. But I was shown good reasons for having fewer units, and changes do need to be made.”

Me: “Are there minutes for this meeting?”

Craig: “Yes I believe someone was taking notes”

Me: “We need more than meetings behind closed doors. We would like to see you raise this in parliament, and how about writing an open letter to Matt Hancock? It would need to emphasise the lack of evidence that the Kent changes will be bring about an improvement to death and disability patient outcomes, and that it is essentially an experiment on the people of Kent, as there is no other area in the country with such a high percentage of people outside the 45 minute zone.’

Craig: “I will consider writing a letter to Matt Hancock; yes I can do that, but I will write it my own way and I will decide the content. I don’t have to do it in the way you decide.”

Me: “Well I hope you can consider adding those key points. They are in the email I sent to you last week, if you need it for reference. There’s something else I wanted to ask you about. Could you try to unite all the Kent MPs against this plan? Currently each area has been forced into a situation where it’s competing with its neighbours for essential NHS services. Three hospitals are going to lose out, four if you include Canterbury. Wouldn’t it be better to stand together and reject the plan? That sort of united front would make it very harder them to then force the plan though.”

Craig: “Well yes this is the situation, Ashford of course will say, we’re fine thank you very much, we don’t have a problem with the plan. And then in Medway we have MPs who are talking about some course of action because they are not happy, even though they don’t have it as bad as us..”

Me: “Rehman Chishti and Kelly Tolhurst are talking about a Judicial Review, which is a strange course of action for two Conservative MPs who could just lobby the government in the way that we are asking you to”

Craig: “Yes, I think that is what they are going to try, a Judicial Review, going through the courts”

Me: “But what about bringing the Kent MPs together on this? Most of them, in fact all of them are colleagues in your party, apart from Canterbury. Can you not try to appeal to them on this?”

Craig: “I will speak to Helen Whately, and I’ll speak to Reh and Kelly”

Me: “I’d also really like to see it raised in parliament that staff shortages are being used to justify the closures of hospital units. The Stroke Association say in their own report that this should never be used as a reason. We haven’t seen any attempt to address the issue of serious staffing gaps in the NHS at a national level, and there really should be a national debate about this, and parliamentary scrutiny as well. This drastic solution of cutting back stroke and A&E services in many areas seems reckless and unscrutinised. Is there any way you could take this matter up and try to publicise it, bring it to national attention?”

Craig: “Raising thing in parliament isn’t always the way to go. Meetings go on privately and these are just as effective, if not more so”

Me: “But what about transparency?”

Craig: “I have said that I am doing all I can to fight for the best outcomes for Thanet. But I don’t have to do things just because you suggest them”

Me: “You should be able to discuss them with me, and if you don’t agree to take certain steps, you should be prepared to say why”

Craig: “I will meet with Helen Whately, I will speak to Roger”

Me: “Can I see the minutes of the meeting you had with Rachel Jones and the STP?”

Craig: “I don’t think proper minutes were taken”

Me: “But you said they were. This is the problem here, there’s not enough transparency. Don’t you agree with transparency?”

“I don’t think proper minutes were taken”

Craig: ” I do, but i’m not going to record every meeting I have”

At this point Craig said that he needed to leave to go and pick up his wife, and after summarising what he would do (Speak to fellow MPs Roger Gale, Rehman Chishti, and Kelly Tolhurst; write an open letter to Matt Hancock; ‘see what he can do’ to raise a question in parliament about the stroke unit) we ended the meeting and I left.

Craig’s private health insurance

I have tried my best to remember the conversation using just my memory, taking notes that evening when I got home and using the notes I took during the meeting. I did ask Craig at one point if he has health insurance for himself and his family, and he said yes. He ‘gets its through work’, that is the Accountancy firm Beak Kemennoe that he still works for, part time, now that he is an MP.

Craig is presented with Save Our NHS in Kent’s ‘Four Reasons’ briefing document

I handed Mackinlay a printed version of our recently produced ‘Four reasons why the stroke plan must be halted’ document before I left, and urged him to read it in full. It summarises the key counter-arguments to the Kent STP’s case for change, it delineates in brief why the studies used do not support the STP’s claims, and it should be useful briefing document for any MP or elected representative who wishes to challenge this forced cut to of stroke healthcare in Kent.

Did this meeting further the cause?

I honestly don’t know. Mackinlay insists that he is fighting for our hospital, and he avoided saying an actual ‘no’ to raising the matter in parliament, but he did not seem at all willing, and he may not even be able (due to his court case) to do what  is being asked of him. He was given the briefing document, and a number of suggestions of what might be done to turn around this juggernaut of NHS changes. I don’t think a meeting with 3 other Kent MPs on it’s own is going to swing this, and I don’t think he does either. It needs big, loud, decisive actions.

But we have given him the tools to fight back if he’s willing to. And a letter to Matt Hancock, the Health Secretary will be good to see. Let’s hope the letter is impactful and is very clear on the flaws of the stroke plan.

If we lose and if Craig doesn’t play his part in stopping this, he won’t be able to claim that he was unaware of the facts or wasn’t equipped to intervene.

I’m hoping that maybe there’s a chance our MP will come through and do something before it’s too late. Time will tell…