My hon. Friend makes a good point. In 2006, reconfiguration was mentioned for the first time in the White Paper, "Our health, our care, our say". That title bizarrely suggests citizens' involvement in decisions about future provision. It referred to complementing primary care and community facilities with specialist hospitals. That was the origin of the current round of reconfigurations. It was intended that complex surgery would be undertaken in those specialist hospitals and that there would be full-scale emergency departments. However, the White Paper did not refer to hospital closure.
Let me say a word about the case for reconfiguration, as Roger Berry asked about Liberal Democrat policy. There is a case for reconfiguration that is undertaken for the right reasons, and openly and transparently. The motion acknowledges
"the need to develop and improve acute hospital services".
It implies, although it does not state, that reconfiguration is sometimes necessary or appropriate for improving patient care.
The motion also mentions the need for reconfigurations to be
"based on safety, quality of care, accessibility and choice".
If we are honest, we should accept that those objectives, which are all worthy, sometimes conflict. Sometimes safety and quality of care are not compatible with the most accessible service. Sometimes choice is constrained. If royal colleges advise that robust mechanisms are in place to determine the numbers that need to be treated in any one year to maintain skill levels and provide sufficient quality of service, we should listen to that advice. The Secretary of State made a similar point.
The Royal College of Surgeons has argued for acute hospitals to have catchment areas ideally of 500,000, but at least of 300,000. That is because of the need to ensure that consultants in the main surgical specialties are available to provide emergency cover. It is also argued that such a catchment area provides the necessary concentration of case load for training doctors and maintaining surgical expertise. However, we must also recognise that, in remote rural areas, distance can be a safety issue, especially in respect of accident and emergency provision. We need to take that concern seriously.