Paul Burstow (Chief Whip; Sutton & Cheam, Liberal Democrat)

I am grateful for the opportunity to raise the future of the "Better Healthcare Closer to Home" project. The purpose of the debate is to enlist the Minister's support in bringing to an end more than a decade of limbo in the national health service in my constituency of Sutton and Cheam and the wider south-west London area. That decade of limbo has compromised improvements in services and undermined investment in the local NHS estate. In particular, it has delayed the long-overdue replacement of St. Helier hospital, which is in the constituency of my hon. Friend Tom Brake. That hospital was conceived in the 1920s and built in the 1930s, and it is not fit for the 21st century.

How have we come to this particular pass, and why have we been stuck in limbo for so long? There are many aspects to the situation, but I want to trace events back to the publication some years ago by the Epsom and St. Helier University Hospitals NHS Trust of what it called a clinical services strategy. The strategy envisaged shaking up the way in which services were provided to safeguard accreditation by the royal colleges. It involved closing maternity services in Epsom hospital and moving them into St. Helier hospital, which became a particular focus of the plans and, especially, of public opposition to them. Suffice it to say, these plans received a lukewarm reception within the trust and a hostile reception from my constituents, which led to the review sinking without trace.

After several years of reflection and the coming and going of three chief executives of the trust, new plans started to take shape. They were entitled "Better Healthcare Closer to Home", and, in 2004, a consultation process started, which involved a succession of stakeholder events and pre-statutory consultation on a grand scale—so grand, indeed, that many of the meetings took place at the Epsom grandstand itself. The proposals were groundbreaking. They envisaged a new model of care in which more health care would be delivered through primary care. The idea was to invest in primary care, establish a network of local care hospitals and build a new critical care hospital to replace the existing Epsom and St. Helier hospitals. However, a lack of detail about the purpose of the local care hospitals, the services that were to be provided in them and their locations left the spotlight on the location of the critical care hospital.

Throughout the process, other Members of Parliament and I questioned the affordability of the whole enterprise and whether it would be possible to make the sums stack up so that it would be possible deliver the vision of the "Better Healthcare Closer to Home" project. At the end of 2004, the majority of respondents to the consultation exercise backed St. Helier as the site for the critical care hospital. At that stage—after, rather than during, the consultation—the possibility of the Sutton site in my constituency becoming the preferred site started to emerge.

Over the Christmas period in 2004, a report was written by the project manager who had been leading the process. In January 2005, it went to the boards of Sutton and Merton primary care trust, East Elmbridge and Mid Surrey primary care trust and the Epsom and St. Helier University Hospitals NHS Trust. I cannot help but conclude that it went to those bodies so that they could rubber-stamp the decision, rather than listen clearly to the many voices and representations opposing the recommendations in the report.

The "Better Healthcare Closer to Home" project was approved. It envisaged five local care hospitals, with a critical care hospital on the Sutton site. That decision was reached despite the report itself, which showed that the economics of the plan did not stack up, with more patients and income being lost by locating it at the Sutton site than would have been lost if it had been located at the St. Helier site.

There then followed a year of work, drawing up the detailed business case, including the commissioning of the Prince's foundation for the built environment to embark on a community engagement and planning project, costing in the region of £60,000—probably more—to devise a plan for the Sutton site. It was an attempt to cajole the local community to buy into something that it did not wish to accept. At the same time as the local NHS was pressing ahead with the detailed business case, the Department of Health was considering what to do with the request from the London borough of Merton to call in the decision.

Finally, in December 2005, the Secretary of State gave her answer to the question. She issued a direction to the local NHS to draw up plans for a critical care hospital to be located at St. Helier. "Hallelujah" was the cry at the time, but it was a very short-lived cry of good cheer, because another year went by and although the local NHS was initially suffering from shock from the Secretary of State's decision, it soon regrouped. After five months, it told the Secretary of State that, for planning and legal reasons, the St. Helier option could not be pursued.

Siobhain McDonagh (PPS (Rt Hon John Reid, Secretary of State), Home Office; Mitcham & Morden, Labour)

I apologise to the hon. Gentleman for not having asked him earlier whether I could intervene. Is he also aware that through a freedom of information request, we discovered that the health service never accepted the Secretary of State's advice about St. Helier? Quite the contrary: right up until the decision was finally withdrawn by the Secretary of State, building surveyors and structural and engineers were being instructed to go ahead with the Sutton site—the Secretary of State's suggestions were flagrantly ignored.

Paul Burstow (Chief Whip; Sutton & Cheam, Liberal Democrat)

I am grateful to the hon. Lady, who I know has also campaigned on this issue for a number of years. She is right to highlight the ignoble nature of the conduct of some local elements in respect of decisions about this issue and the attempt to thwart the wishes of local people and the Secretary of State's direction by pursuing a completely contrary course of action. The freedom of information request provides clear evidence of that. Frankly, the planning and legal obstacles put in the way of the people's wishes and the Secretary of State's direction were red herrings. They were a distraction from what should have been happening.

By August 2005, NHS London entered the stage and the planning and financial issues came to the fore. Those were cited yet again as a reason for revisiting the whole matter. At that point, the Secretary of State agreed to withdraw her direction and hand the matter back to the local NHS for a review of the affordability of the whole plan. That review has now reported and it concluded that the "Better Healthcare Closer to Home" project was not affordable. Indeed, when set againstthe backdrop of payment by results, practice-based commissioning and the introduction of independent treatment centres, it is hard to see how the local health economy could ever have afforded those proposals.

The review now proposes a smaller number of local care hospitals, centred on existing NHS estate, and a local general hospital rather than a critical care hospital. Furthermore, the review is now to continue through to June to recommend the preferred location for the general hospital somewhere within the London borough of Sutton—either at the Sutton or St. Helier site.

The review raises a number of questions, though not necessarily questions for the Minister to answer tonight. I wish to lodge those questions with him, but I am also posing them for the people who have conducted the review. For example, will the new plans be viable, given that Surrey primary care trust is no longer seen to be part and parcel of driving the changes forward and is not expected to commission services arising from the project? Indeed, will the income and activity generated from within Sutton and Merton PCT be enough to ensure the sustainability and deliverability of the proposals under the guidelines issued by the Department in respect of the use of the private finance initiative and capital funding?

There are further questions. If the St. Helier site does emerge as the preferred site for a general hospital and a local care hospital is co-located there, what happens to the Sutton site and the range of services, including mental health services, currently provided there? Is there a spectre of that site being disposed, perhaps without regard to the longer-term needs of the community for community-based facilities, particularly health care facilities? Is the outlined coverage of local care hospitals right, given that the plans envisage moving from five to four such hospitals, leaving the south and west of the borough—and particularly my constituency—largely uncatered for?

Finally, and most important, there is the future of accident and emergency services. The review envisages an A and E department that does not deal with major trauma, but it is far from clear where it will sit on the emergency care spectrum. Indeed, at present it is not clear what the emergency care spectrum looks like, so it is hard to enter into a meaningful debate about where A and E will sit on that spectrum.

Many of my constituents are alarmed at the prospect of St George's taking on the role of a major trauma centre. They draw attention to the congested road network, fearing delays as their loved ones are carried in ambulances past St Helier to St George's. The evidence will have to be compelling and the case persuasively made if my constituents are to be convinced of the need of a change of status for the accident and emergency department.

After 10 years or more of uncertainty and limbo, we face a further period of uncertainty over sites and the configuration of health care services in my area, followed by yet another round of consultation ending in a further outline business case submission to the Department.

I said that my purpose in seeking the debate was to enlist the Minister's assistance. Given the Secretary of State's previous involvement, I hope that he will be prepared to do three things. First, I ask him to meet me, and other local Members of Parliament on both sides of the House, to explore further how we can ensure that the NHS is not left in limbo for another 10 years, or indeed for another year or more. Secondly, I ask him to act expeditiously, and not to let a year go by between local decisions and the Secretary of State's intervention in or confirmation of such decisions. Finally, I ask him to recognise that there are lessons to be learned from this sorry saga about effective consultation, board-level accountability and decision making.

As I go around my constituency consulting people about the proposals, I often ask those who might be expected to have some knowledge of the workings of their local health service questions such as, "Who is the chief executive of your local trust? Who is the chair of your local trust board? Who are the members of your local trust board?" No one knows. Who are these people who make decisions on our behalf, behind whom many hide and who are ultimately not accountable to us, the local people, for decisions that affect our lives?

The fact that the review of "Better Healthcare Closer to Home" has concluded that the proposals for a critical care hospital are not sustainable—and, I dare say, were never sustainable—calls the whole process into question. Hundreds of thousands, if not millions, of pounds have been spent on consultation, consultants, stakeholder events, staff salaries, public meetings and citizens' juries—and for what? There should be an inquiry into just how much has been spent and how much time has been wasted on this enterprise to date. I ask the Minister to consider that request seriously.

I hope that after waiting for so long, my constituents and hard-working NHS staff will see light at the end of the tunnel, and that rather than its being a train coming down the track towards them, it will be a new hospital and better health care closer to home, which is what they all want.

Andy Burnham (Minister of State (Delivery and Quality), Department of Health; Leigh, Labour)

I will begin with the last point made by Mr. Burstow. I think that he described what everyone seeks to achieve: the best possible outcome for his constituents, and for those of my hon. Friend Siobhain McDonagh. I pay tribute to both Members. I congratulate the hon. Gentleman on the measured way in which he spoke on matters which are hugely significant to his constituents, and also on his balanced approach to bringing a long-running issue to a satisfactory conclusion.

Some of the matters raised by the hon. Gentleman have a long history, to put it mildly. He referred to "a decade of limbo", but I hope that that description is not entirely accurate, for I see signs of progress and development. I trust that the hon. Gentleman can at least vouch for us in the Department when people claim that we push decisions through without adequate consultation. There has certainly been plenty of that.

As we can see, the issue of change in the health service gives rise to a huge amount of debate and a great deal of passion among communities across the country. At times, it can be difficult to accept change, and because of the difficulty of the arguments, the subject can provoke powerful reactions from key stakeholders and members of the public. In the face of uncertainty and anxiety in our communities, all of us Members of Parliament face a duty to grasp the difficult issues of health service change. We do our constituents a disservice if we do not tackle the issues head-on, particularly when doing so may lead to health progress and human progress in our constituencies. A different configuration of health services can lead to better health care and more lives being saved, so the issues are very difficult.

Of course, we must not jump to conclusions, and we must ensure that there is a thorough process, but I think that the hon. Gentleman would agree that there has been no jumping to conclusions in the case that he raised. Nevertheless, a process is under way. I will come on to the specifics that he raised in a moment, but first I want to put it on record that when we talk about the reorganisation of health services, people jump to the conclusion that it is all about money. That is the characterisation, but it is important to point out that many of the changes that we consider making to our health service stem from a desire to improve the quality of care. We want to provide the best possible care, according to modern standards, within the resources available. Money is often a secondary consideration; an attempt to drive up quality often lies behind changes that are proposed, and there is often clinical consensus.

It is a fact that lifestyles, society, medicine, technology and the NHS itself have all changed over the past 60 years. Patients now have greater choice in where they are treated and when. They have better information on health services, expectations have risen and there is an increasing focus on safety and quality. The public tell us that they want appropriate services that are available at times and in places that are more convenient for them. As far as is possible, they look for services in their communities that are closer to their homes. That, of course, is a key driver behind the project that affects the hon. Gentleman's constituency.

Change is nothing new in the national health service. The NHS has always responded to change and the latest treatments by organising itself to deliver the care that is needed. It is up to us to respond to drivers for change; if we do not, services will not keep pace with changing times, we will not keep improving, and we will not make full use of the benefits of new medical technology and the possibilities that arise from delivering safer surgery closer to patients' homes. Those benefits mean quicker recovery times and shorter stays in hospital. The Department's White Paper, "Our health, our care, our say: Making it happen", reflected those changes, and suggested moving towards a greater concentration of specialist services for people who need them, while providing more care closer to people's homes for treatments that simply no longer require a hospital visit.

To come to the hon. Gentleman's concerns, the "Better Healthcare Closer to Home" project in his borough and elsewhere in the locality is an example of how the national health service is responding to changes locally. Health services around Sutton have been grappling with not only the need to modernise and improve, but the need to ensure that services are clinically safe and financially viable in future. Epsom and St. Helier University Hospitals NHS Trust faces the challenges normally associated with a split site, including issues to do with the supervision and training of doctors, sustaining viable clinical rotas and duplication of services. I accept that the hon. Gentleman acknowledged some of those issues this evening and, more broadly, in the work that he has done on the subject, as has my hon. Friend the Member for Mitcham and Morden. He is right to say that the case has a history; let me rehearse some of the details for the record.

The "Better Healthcare Closer to Home" project dates back to 2003, and involved proposals for local care hospitals supported by one new critical care hospital, which was to be at either Sutton or St. Helier. There was a comprehensive consultation over a three-month period that ended in November 2004. In January 2005, the trust boards then involved—Epsom and St. Helier University Hospitals NHS Trust, East Elmbridge and Mid Surrey PCT and Sutton and Merton PCT—met separately and agreed to proceed with the proposed model of a network of local care hospitals supported by a single critical care hospital. They endorsed Sutton, as the hon. Gentleman said, as the preferred site for the development of the critical care hospital.

However, in March 2005, Merton overview and scrutiny committee referred the decision to the Secretary of State for Health who, at the end of 2005, responded to the referral, as the hon. Gentleman said, concluding that the arguments over the siting of a critical care hospital were finely balanced. She decided that it was right to give priority to the needs of communities suffering social and economic disadvantage and to ensure that major redevelopments should contribute to the broader regeneration of disadvantaged areas. She therefore asked the national health service locally to develop plans for the new critical care hospital on land opposite St. Helier hospital. However, it became clear that, for planning reasons, it was not possible to develop the site and there were no viable options for development of the existing St. Helier hospital site either. My hon. Friend the Member for Mitcham and Morden has put her observation on the record, and has raised a pertinent issue for the further consultation.

Paul Burstow (Chief Whip; Sutton & Cheam, Liberal Democrat)

In that further consultation, and given my request for proper examination of the original consultation, I hope that the freedom of information request submitted by Siobhain McDonagh will be considered by the Minister, as there is a powerful and compelling reason to look critically at the decision making that took place. The issue has been grappled with for far too long, and action has not been forthcoming.

Siobhain McDonagh (PPS (Rt Hon John Reid, Secretary of State), Home Office; Mitcham & Morden, Labour)

On that point, may I ask the Minister—

Michael Martin (Speaker)

Order. The Minister must respond to Mr. Burstow first, then the hon. Lady may make an intervention.

Andy Burnham (Minister of State (Delivery and Quality), Department of Health; Leigh, Labour)

Before I respond to the hon. Member for Sutton and Cheam, I will give way to my hon. Friend the Member for Mitcham and Morden, and I can deal with the two interventions together.

Siobhain McDonagh (PPS (Rt Hon John Reid, Secretary of State), Home Office; Mitcham & Morden, Labour)

I apologise, Mr. Speaker. Any review should consider whether it is appropriate for a hospital trust to be the lead organisation in a consultation, because producer interest is a problem. It is far better that those consultations are undertaken by primary care trusts or regional strategic health authorities than by the hospitals themselves. If that had been done, it might have prevented the fudge at Sutton hospital.

Andy Burnham (Minister of State (Delivery and Quality), Department of Health; Leigh, Labour)

Given the point that we have reached, it is extremely important that all the relevant information is in the public domain so that people can make a decision based on it. There is no possible argument against full transparency in the conduct of the debate. I accept the point made by my hon. Friend, but it is important not only that there is transparency but that there is a full, inclusive debate about what is the right decision for patients in her constituency and in the constituency of the hon. Member for Sutton and Cheam. There should be no question of partial or vested interests dominating that debate, as the time has come for a full and open discussion before a decision is made locally.

It is important for the record to make clear the trajectory of events. The Secretary of State withdrew her original decision in August 2006, following the planning concerns that had arisen, and wrote to the then chief executive of NHS London, informing him and asking him to review the proposals for a new critical care hospital. NHS London was asked to ensure that particular attention continued to be paid to the needs of disadvantaged communities, given the determination to tackle health inequalities. I am pleased that the review has been used as an opportunity to engage positively with local stakeholders and address their specific issues. I hope that that is the experience also of the two hon. Members present.

I am aware there has been significant local involvement and engagement with a wide variety of organisations and individuals, including NHS trust boards, GPs, hospital clinicians, local authorities, overview and scrutiny committees, Members of Parliament, patient forums and representative groups, the Greater London authority, local media, and of course patients and the wider public.

The report from the latest review was published on 16 March, just last week, and concluded that the guiding principle of developing health services closer to where people live is the way forward. We are pleased to see that endorsement of a key policy of the Department. The report further recommended the development of local care centres at the Wilson, the Nelson, St. Helier and Wallington, and of other services in local and primary care settings without delay. I hope that the hon. Gentleman and others in his local area will welcome that step.

The review concluded that there should be a general hospital in the borough of Sutton with an accident and emergency service, but that that should be different from the critical care hospital that was originally proposed. The review also concluded that since the original proposals were put forward there had been a number of significant developments, including those in clinical practice, which have an impact, and that the population to be served is significantly less than was thought in the original programme because of changes in the assumed numbers of patients from Surrey who would travel into London. Also, the acute capacity created by the originally proposed critical care hospital would be more than required now, because of reduced patient flows and more services provided in community settings. More work will be done to decide where the hospital should be situated and on the full range of services to be provided there. The hon. Gentleman asked a range of further questions, which he said needed to be answered as part of that work. Without providing him with a full answer this evening, I shall simply say that he is right that there should be clear answers to those important questions. That is properly part of the local debate on those issues.

The review also concluded that the provision of health services in Surrey, and particularly the range of services to be provided at Epsom hospital, should be determined by the Surrey primary care trust following the Fit for the Future public consultation that is scheduled to start later in the spring. Further work detailed in the review report now lies ahead and is scheduled to be complete by June.

The hon. Gentleman asked that the Department and the health service locally act expeditiously. That is the desire all round. It is not for us to dictate a timetable to the local NHS, but there should be a general recognition that it would be helpful to bring the considerations to an expeditious conclusion. The hon. Gentleman's point is on the record and will be heard by those who need to hear it. He asked whether I would meet him and colleagues. I should point out that that is properly the responsibility of the London regional Minister in the Department, but I will take that request back. We want to ensure that the process moves ahead, but it must be a local process, not one run by the Department.

The hon. Gentleman asked me to comment on the lessons learned. As I said at the beginning, all health care reconfigurations raise difficult issues and we learn lessons from all of them. Sir Ian Carruthers has been conducting a review for the Department of the handling of reconfiguration processes in the health service. We can always raise our game and do better, and we will reflect on the lessons to be learned. The important thing is that the process leads to the right conclusions for the hon. Gentleman's constituents and those of my hon. Friend the Member for Mitcham and Morden.

It would be inappropriate for me to say anything further at this stage, other than to add that if there are emerging proposals that require public consultation, I would urge both hon. Members to engage in that debate. I pay tribute to them for the way that they have continued to press us for what they believe is right for their constituents. We all hope that the process will deliver certainty soon to the residents of their constituencies—

The motion having been made at Ten o'clock, and the debate having continued for half an hour, Mr. Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.