Health Care in London

Opposition Day — [5th Allotted Day] – in the House of Commons at 3:45 pm on 9th March 2010.

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Photo of John Bercow John Bercow Chair, Members Estimate Committee, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons 3:45 pm, 9th March 2010

I inform the House that I have selected the amendment in the name of the Prime Minister. The House will also be conscious that I have imposed a limit of eight minutes on Back-Bench contributions both in this debate and in the second Opposition day debate.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 3:49 pm, 9th March 2010

I beg to move,

That this House
recognises that London has some of the leading hospitals and healthcare services and expertise in the world;
notes with concern that some areas of London have the worst outcomes for stroke, heart disease and cancer in the country;
is alarmed that health inequalities in the capital rank among the worst in the country;
believes in improving services to meet the needs of London's 7.5 million inhabitants;
calls for the delivery of a public health strategy geared towards the reduction of health inequalities;
calls on NHS London to halt the implementation of current sector-wide reconfiguration proposals across London, including accident and emergency services, until a more effective public consultation is in place;
further calls for service configurations that are soundly evidence-based and which meet the choice of patients and the referral intentions of local GPs;
further believes that consultant-led obstetric departments and maternity units should not be closed, whilst they are safe, accessible and responsive to a continuing need;
and calls on NHS London and the Department of Health to publish the details of the commitments made at the time of the Olympics bid to fund healthcare services in the capital, and to disclose what the current estimate is of the cost of providing services for the Olympics and how it is proposed that this should be funded.

Members of the House, particularly the many with London constituencies, will be aware that for the past two years there has been a process called Healthcare for London, which has increasingly sought to prescribe to the health economies across London how they should design their services, which services should be provided and by whom, and, by implication therefore, where patients should go for their treatment. The purpose of the debate is to give the House, for what I think is the first time, the opportunity to express a view on how we want health care services in London to be provided in future. We want literally to fire a shot across the bows of those in the upper hierarchies of the NHS who want to determine these things without reference to the public whom they serve, to the general practitioners who refer patients, or to the patients themselves, who have a right to exercise choice. We also want to give the House an opportunity to set out how it wishes Healthcare for London to be improved in the years ahead.

My first point is at the heart of improving health outcomes. We need to focus on improving public health in London, which has some of the greatest health inequalities in the country. At ward level, between Tottenham and Kensington and Chelsea, for example, there is a disparity in life expectancy of 17 years. I know that such disparities exist in other parts of the country, but those are very pronounced. We feel the issue even more keenly when we see such relative wealth and poverty side by side in London, where nearly one in four children live in poverty.

There are many specific health problems that are greater in London than anywhere else in the country. The level of sexually transmitted infections is higher in London than anywhere else, and the level of alcohol abuse and dependency is higher than in any other region in the country, as is the level of drug use and abuse. We know-not least because London is where many refugees, asylum seekers and, indeed, rough sleepers are found-that London has 40 per cent. of the total number of tuberculosis cases in the country and more than 50 per cent. of HIV cases. The importance of having an effective public health strategy must be at the heart of this issue.

I commend the Mayor of London for the health inequalities strategy that he published last October. I shall not dwell on that at length, although there is plenty of reason to do so, because time will not permit it. The document that I published with my right hon. Friend Mr. Cameron in February was about focusing on public health, having a dedicated public health budget and having a health premium that is intended to support successful local strategies.

In the London context, I want to make it clear that if we were given the opportunity to do so by the electorate of London, we would equip the local NHS with individual London boroughs to pursue locally owned strategies to improve public health. We also intend that the NHS should co-operate, on a London basis, directly with the Mayor of London to pursue the health inequalities strategy. Given the particular characteristic of London as a city with city-wide government, we want that city-wide government to bear down on the particular public health challenges that I have mentioned and to exploit opportunities for promoting better health in London, and I know from my conversations with the Mayor that he is immensely keen to do that.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I share the hon. Gentleman's concern about health inequalities in London, and I am curious to know how much money he would transfer from Chelsea to Haringey, for example, to deal with those relative inequalities.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

As the Minister is in no position to tell us what the spending in individual primary care trusts will be beyond 2010-11, I shall not take any lectures from him on this. What we are clear about-this has never happened under a Labour Government-is having a direct focus on public health outcomes and a determination to use the resources of the NHS to reward successful strategies. It is understood as well in Kensington and Chelsea as it is in Haringey or Tottenham that the places with the worst current health outcomes should be where we focus our public health resources not only to improve everybody's health but to narrow those health inequalities.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

In a second, as I want to make the point set out in our motion. We have previously given Ministers a chance to be clear about what implications and opportunities will arise for the NHS and London through the Olympics. Clearly, the games represent a very great opportunity in public health terms, and we have to make sure that the legacy will be realised. However, some very particular costs will arise in 2012 itself, and I think, from what he said two or three weeks ago, that the Minister has estimated them to be in the order of some £30 million.

When he replies, I hope that the Minister will tell us precisely what the costs are. What commitments on costs have been given to the London Organising Committee of the Olympic Games, and how does he intend them to be met in the NHS in London during 2012?

Photo of Tom Brake Tom Brake Shadow Minister (Olympics and London), Shadow Minister (Home Affairs)

I thank the hon. Gentleman for giving way. On the subject of implications, will he make it clear to the House whether there are any implications for the Better Healthcare Closer to Home programme, which affects residents in Sutton and Merton? The programme would provide a new hospital on the St. Helier site, and local care hospitals in the area. Will he confirm that the argument that he is deploying today about what should happen with the NHS in London will have no implications for that programme?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I assure the hon. Gentleman that what I have said about public health will not impact directly on the availability of NHS services. I remind the House about the current level of spending on public health care in London through the Healthy Living programme. [ Interruption. ] The Minister might be interested in this, because 13 primary care trusts in London spend more on management than they do on public health under the Healthy Living programme.

Across London, the average spend on the Healthy Living programme is £38 a head, and average management costs are more than £30 a head. The total for management costs in London is £246 million a year, and that shows a rise of 22 per cent. in just the past three years. We want to cut those management costs by a third over the next four years. We will reinvest all the money, because we aim to protect the NHS budget and increase it in real terms every year. That means that we will be able to ensure that we have less bureaucracy and more promotion of public health.

Photo of David Burrowes David Burrowes Shadow Minister (Justice)

No areas of public health are more important than drug abuse and drug treatment. A great deal of public money has gone into them, targets have been set and a huge amount of management brought to bear, yet very little has been achieved in terms of outcomes or recovery from addictions. Is not that a prime example of Labour failure?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Yes; my hon. Friend has made a very important point. We have to be focused on results. I am afraid that for too long parts of the country have said, "We have relatively poor outcomes, so we must have more money," yet the money has never been used to deliver proper results.

I make no pretence about the fact that it is a tough call. In straitened financial circumstances, we intend that the dedicated public health budget will rise in real terms, but we have to ensure that that will deliver results. As we made clear in our public health green paper, we believe that we stand a much better chance of achieving those results if we engage properly with local authorities and the NHS as a local strategy, with voluntary-sector bodies as deliverers. That approach will help charities and voluntary-sector organisations, when the results come through from the services that they provide, to believe that their funding will be locked in on a more permanent basis. That will be better than the constant flow of short-term initiatives that have so undermined them in the past.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

No, as I want to make some points about the Healthcare for London programme.

In January, NHS London published an overall strategic plan, and we have begun to see some of the so-called "sector plans" for different areas of London. The plan for outer north-east London has been published and the one for north-west London has been leaked. In addition, people are speculating about what the implications might be for other places across London.

There are questions about the assumptions underlying the NHS London approach. It does not help that the text of the document published in January by NHS London is confusing and erroneous. The notes relating to the scenarios and the funding figures were transposed, they did not include the base case at all, and they were wrong. For example, there was a reference to 2.3 per cent. per annum funding growth in the next spending review period, which should have been minus 2.3 per cent. Essentially, NHS London is assuming that there will be unchanged real terms funding for the NHS all the way through to 2016-17. Alongside that, it assumes 3.5 per cent. cost inflation in the NHS. We need to challenge the assumption that costs can be accommodated in that way. NHS London also assumes 4 per cent. a year demand growth, which is not in line with the projections of demand growth produced by the King's Fund and the Institute for Fiscal Studies on a national basis.

We know what NHS London set out to do-make a set of assumptions, arrive at a big funding shortfall in 2017, and tell everyone that they must do the things that NHS London is calling for them to do-but let us leave that on one side.

Under any reasonable set of assumptions, we have to deliver efficiency savings and improving productivity in the NHS, including in London, in ways that have not been adopted in the past. Over the past 10 years, when funding for the NHS has more than doubled, how is it possible that in London there is still legacy debt of more than £500 million for the NHS trusts and a worrying number of financially challenged trusts, and very few of the changes that should have taken place in the NHS to redesign services and deliver care more appropriately and more effectively have happened? Perhaps the Minister will explain.

The moment when the financial pressures are assumed to begin is the moment when NHS London feels that it must start taking the management action necessary to respond to it. There has been a dereliction of duty. After a 20 per cent. increase in management costs and a £25 million management consultancy cost the year before last, many of the things that needed to be done have not been done.

Photo of Bob Neill Bob Neill Shadow Minister (Communities and Local Government), Deputy Chair, Conservative Party

My hon. Friend makes a powerful point. Is he aware that that concern is particularly reinforced in south-east London, where it seems that underlying assumptions based on a crisis-driven need to amalgamate three trusts into a huge super-trust are distorting the assumptions and the long-term planning, reinforced by the suggestion in documents seen by the South London Healthcare Trust, that the principal driver of this is to "right-size"-in other words, financially rectify-the enormous historic deficit that it inherited?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

My hon. Friend makes an important point. Experience suggests that merging three failing organisations does not make one big successful organisation. I hope I am proved wrong and that the South London Healthcare Trust succeeds in its objectives, but I am afraid that past evidence does not necessarily support that, and the trust has a massive debt.

The central issue is that NHS London is making extreme assumptions about the ability to transfer activity from within hospitals to a community context. Alongside that, it is assuming dramatic reductions in cost, which are not proven.

Photo of David Evennett David Evennett Shadow Minister (Business, Innovation and Skills)

My hon. Friend is making a powerful case. He has visited our area, south-east London, regularly to see at first hand the problems of health care that we had. The regrettable reorganisation that my hon. Friend Robert Neill referred to is causing great concern locally about the provision and quality of health care that constituents will receive. There is failure in our area. What reassurance can my hon. Friend Mr. Lansley give our area about the future?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I hope that I can give the reassurance that decisions will be made locally in relation to local needs, local patients' choice and GP referral decisions. My visit with my hon. Friend to his constituency, and the example of Queen Mary's hospital in Sidcup, begin to give the lie to the Government's amendment-in that none of the changes will happen unless and until new services have been developed. That is far from the case at the moment, and it is assumed that patients who are denied access to hospital services will simply be accommodated elsewhere in the community at a lower cost. The assumptions are literally heroic, stating that it will be possible for 55 per cent. of out-patient and 60 per cent. of accident and emergency attendances to take place in the community rather than in the hospital.

The Government cite the National Primary Care Research and Development Centre, which just over two years ago undertook a study on care closer to home, but that does not for a minute justify the 55 per cent. out-patients figure. All the examples are small-scale, and none systematically demonstrates a reduction in cost if one maintains quality, not least because good-quality community services often have to be delivered by the same hospital specialists-or certainly with them, and as a result of their training and co-operation. The Government cannot point to any evidence that supports their assumptions.

Photo of Theresa Villiers Theresa Villiers Shadow Secretary of State for Transport

My constituents are hugely concerned about the future of Barnet hospital and Chase Farm hospital. Does my hon. Friend share their anger that the whole NHS London process has been so secretive, compounding fears that it is all about suiting the agenda of NHS managers, not patients?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I entirely agree. My hon. Friend knows about this, because she, other hon. Friends and I have been to see the management of Barnet and Chase Farm Hospitals NHS Trust over five years to try to work out what they propose to do with Chase Farm hospital, and to argue the case for it. Time and again, in the private conversations that we have had, it was clear that options were not being presented. It was also perfectly clear that the management sought to prejudice the public consultation by tying up in advance the views of all the clinicians whom they employed. That is not satisfactory, either.

Photo of Richard Ottaway Richard Ottaway Conservative, Croydon South

Does my hon. Friend agree that there is no better example of things not being done that ought to be done than the redevelopment of Purley War Memorial hospital, which is part of the Mayday Healthcare NHS Trust? In 2001 a pledge was given at the Government Dispatch Box to redevelop that hospital. Nine years later, nothing has happened and there are still no concrete plans for redevelopment. Can my hon. Friend assure me that a future Conservative Government will get behind the local authorities and deliver something for the people of south Croydon?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am glad that my hon. Friend has made that point, because I can give him that assurance. Indeed, I have made it very clear to the chief executive of the Mayday Healthcare NHS Trust that I shall support its action in seeking to develop Purley War Memorial hospital, and I am very pleased that Croydon council is getting behind the project, too, because the planning authority and the NHS trust must be willing to make it happen. That redevelopment is very important, because if the trust is to become a foundation trust that service needs to be provided and that project needs to go ahead.

Photo of Edward Davey Edward Davey Shadow Secretary of State (Foreign Affairs)

I, too, deplore the secrecy of the process. Will the hon. Gentleman therefore join me, and his hon. Friends, in calling for the publication of many documents, including the McKinsey report that lies behind the process, and in my own area, the south-west London strategic plan, which contains many of the options that so concern people?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I entirely agree that it would be very helpful if those management consultancy reports were published. However, our every step has been taken not on the basis of speculating or scaremongering, but entirely on the basis of trying to identify clear evidence. I must confess that I was therefore rather disturbed to find that, according to the associate editor of the Daily Mirror, Liberal Democrat activists openly boasted that they had stirred up the campaign about the closure of Kingston hospital. No document had been published and there was no documentary evidence to support the closure claim, and the chairman and chief executive of the Kingston Hospital NHS Trust have completely refuted it. My hon. Friend Mike Penning has been to Kingston hospital to discuss this, and he can vouch for that fact.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I promised you, Mr. Speaker, that I would confine myself to taking interventions from those who are currently seeking to intervene, and no more than that.

Photo of Greg Hands Greg Hands Shadow Minister (Treasury)

My hon. Friend will know that the north-west London commissioning partnership is looking at closing five of the eight A and E departments in that sector. At the same time NHS London, in its letter of 22 January 2010, suggested that there should be only one site in the huge Imperial College Healthcare NHS Trust area. What does he think might be the implications of that for the residents of Hammersmith and Fulham, and the royal borough of Kensington and Chelsea?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend, who makes a very important point. One of the assumptions is a 60 per cent. transfer of accident and emergency cases out of A and E and into the community. A study on primary care and emergency departments commissioned, and published last Friday, by the Department of Health, said that, of arrivals at A and E,

"We found that the proportion that could be classified as primary care cases was between 10 per cent. and 30 per cent."

It went on to say:

"There is good evidence that the majority of patients choose the correct level of care. A few do not and it is always a risk to plan for the few rather than the many."

In north-west London-we have seen the documentation on that area-it is astonishing to make this proposal and talk about such a massive transfer out of A and E, given last year's figures. In Chelsea and Westminster the rate of A and E attendances has gone up by 4 per cent.; in Ealing the figure is up by 1 per cent.; for Imperial, taking Charing Cross and Hammersmith together, it is up by 9 per cent.; in North West London Hospitals it is up by 15 per cent.; in Hillingdon it is up by 6 per cent.; and in West Middlesex it is up by 5 per cent. All those hospital emergency departments have people pouring in. It is simply not true to say that there is any evidence to support the proposition that the services in the community that would justify what is being proposed in terms of the closure of emergency departments have been put in place.

Several hon. Members:

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Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I will give way to my right hon. Friend Mr. Duncan Smith, and then take interventions from those who are standing, but I will stop there.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

Will my hon. Friend bear in mind the fact that we have had exactly this problem in north-east London, where there is a shortfall in spending between the north-west and the north-east? The drive to close Whipps Cross is mainly down to the zealotry of officials, now released from secrecy, and people not telling the truth about it. They talk about pushing stuff out into the community, but in our area there has been a 10 per cent. fall in the number of health visitors, and the caseloads in relation to children under five are at least double that recommended by Lord Laming. It is an utter disaster, but we cannot get those people to face up to that.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

My right hon. Friend makes an extremely important point. Putting a walk-in centre or an urgent care centre on the front of a hospital is a perfectly reasonable and sensible idea, but when that happened at Whipps Cross the net effect was 2,000 fewer patients a month attending the emergency department at Whipps Cross, but 4,000 extra patients a month attending the urgent care centre. We should not assume that that leads to lower costs, as it might stimulate demand.

Photo of Joan Ryan Joan Ryan Labour, Enfield North

The hon. Gentleman referred to Barnet hospital and Chase Farm hospital, which we have discussed before. He knows that I do not support any downgrading of my local A and E, but we have won an important step forward in relation to a 24-hour doctor-led service for the future. These changes will not take place until 2013. He must also know that in an interview with The London Daily News the Conservatives have said that their position is

"not a guarantee that we will keep A&E".

In "Enfield News", which is hand-delivered by the Conservatives, they have said:

"It is impossible to make commitments".

Does not that say it all about the Tories on the NHS-no commitment?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Time and again I have told the right hon. Lady that we have been committed, over years, to defending the right of local people and local commissioners-general practitioners-in Enfield to determine what services should be provided for them at Chase Farm. It is a disgrace that local people have been ignored in what is being pushed through there. She should talk to Mr. Prentice to see how good he thinks it is to get rid of an emergency department and put in an urgent care centre, because the local people in Burnley did not accept it. Of course I shall not have a top-down Conservative approach replacing a top-down Labour approach. What we will have is a structure that listens to patients and responds to local GPs, allowing them to be sure that they can put services in place.

Photo of Stephen Hammond Stephen Hammond Shadow Minister (Transport)

My hon. Friend made a comment about Kingston hospital. I was so concerned about some of the campaigning that has gone on, including a challenge in newspapers to me as Conservative MP for Wimbledon, that I met Healthcare for South West London last Friday, and was told that nothing was going to happen. Mr. Davey has suggested that there should be transparency. Perhaps he and his colleagues would like to publish the evidence that they have on these matters.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I can tell my hon. Friend that after the election, one of two things will happen. There will be either a Labour-derived, top-down plan that threatens to turn many of London's major hospitals into what Labour terms "local hospitals", which in some cases seems to mean a move from an emergency department to a GP-led urgent care service-a potentially serious retrograde step when attendance at A and E is rising-or a Conservative approach of trying to allow GPs, local authorities and local people to design services that respond to patient need and choice and provide referral opportunities. If patients are arriving at an A and E department, they should be handled appropriately there.

Photo of Steve Pound Steve Pound Labour, Ealing North

May I say that the hon. Gentleman's remarks at the beginning about health inequality in London were very well made and struck the mood of the House? I profoundly hope that we can discuss this matter without descending into party political rancour. On his point about A and E admissions, Ealing hospital-I was there at the opening, not all that long ago-was built to treat 25,000 people a year but deals with 100,000 a year. Does he agree that although we may well move to a polyclinic model in future, we cannot do that now, and we cannot abandon people in A and E? This is not a matter of Labour and Conservative, but a matter of life and death.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I agree with the hon. Gentleman. That is precisely my point. He is right that Ealing hospital has 100,000 people coming through its doors to its emergency department each year. If it were not there, where would they all go? There is always a case for change, and nothing will be absolutely static, but let us work with the hospitals that we have, and let them start the business of designing new services.

I see the former Secretary of State, Frank Dobson, in his place. He was out with his colleagues and others protesting about the possible closure of the emergency department at the Whittington, which is on the same scale. We should work with hospitals in London and say that, yes, we may need to design better services, a care pathway that extends out into the community and services that are more integrated around patients instead of having a primary-secondary divide, but we should give the hospitals the opportunity to deliver those services. We have a lot of hospital sites in London, many of which are accessible to much of the population, and we can deliver services from them rather than shut them down and open polyclinics, as with the absurdity at Sidcup.

Photo of Clive Efford Clive Efford Labour, Eltham

In outer south-east London, when the proposals in the "A picture of health" programme were first put forward in October 2007, we were told that they had come from a conference of clinicians, doctors, nurses and midwives who had got together and come up with them. It was on that basis that they were supported. They were reviewed by Dr. George Alberti, who gave them his bill of health, for want of a better expression. The hon. Gentleman says that he is not in favour of top-down planning for our local NHS services, but if our local clinicians have drawn up the proposals, what is the basis of his objections?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I can tell the hon. Gentleman this in one sentence: he should go and talk to his local GPs. I have talked to representatives of the GP community across London, and they share our concerns about the nature of this process and about many of the assumptions that seem to underlie how it will be pursued.

Several hon. Members:

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Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I will give way to my hon. Friend James Brokenshire, but then I must finish my speech.

Photo of James Brokenshire James Brokenshire Shadow Minister (Home Affairs)

We have heard about the proposals being clinically led, but does my hon. Friend agree that some of the decisions have been made purely on the basis of private finance initiative contracts? The focus has been on hospitals with large PFI contracts. In north-east London, the focus is on centring everything around the Queen's hospital and putting more pressure on it, and in south-east London, non-PFI hospitals such as Queen Mary's hospital in Sidcup are effectively squeezed out. The focus is not on health care, but on finance and those PFI hospitals alone.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

My hon. Friend is absolutely right, and has a unique perspective in that he sees the problem from both sides of the River Thames. I defer to him because he is responsible for the care of my parents in Hornchurch.

It is astonishing that nowhere in the NHS London document does it say anything about the cost of establishing those polyclinics. In constrained financial circumstances, how absurd is it to spend million pounds shutting down hospital services only to spend millions more opening new polyclinics, sometimes on the same premises, as at the King George in Ilford? What kind of an absurdity is that?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I will not give way, if the hon. Gentlemen will forgive me. Mr. Speaker will not forgive me if I do not make progress.

I have one final point to make. Members from across London feel a similar way about the proposals, the assumptions that are being pursued, the lack of evidence, and the inability of NHS London to justify what it seems to expect will happen. In their amendment, Ministers are saying, "Look, don't worry; it'll be fine. Nothing will happen until the other services are already there." Ara Darzi said last year that there would sometimes need to be double-running to enable the plan to be established, but he has gone, and that plan seems to have disappeared.

I must tell Labour Members that the Government's amendment is not justified: there is no plan in any of the sectors to establish services in the community and get them up and running, or for a shift in activity away from hospitals, before the point at which hospitals are shut down.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

No.

Page 20 of the January 2010 document says:

"Implementing Healthcare for London means a considerable shift in activity from acute to polysystem settings. Unless any surplus capacity can be exited quickly"- which I think means shutting hospitals-

"there will be significant double running costs. Developing proposals for service change, consulting stakeholders on those proposals and implementing agreed service changes takes too long and is expensive. A speedier approach to reconfiguring services needs to be developed".

There we have it. The Government's amendment is not what NHS London is setting out to do: that is in black and white in NHS London's document. It says, "We don't want double-running costs; we want to be able to shut hospitals down quickly, and a speedier way of doing that"-but that is not what is in the amendment. I urge the House to support the motion and fire a shot across NHS London's bows.

Photo of John Bercow John Bercow Chair, Members Estimate Committee, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons

Order. Just before I call the Minister to move the Government amendment, I simply state-I think all hon. Members know this-that the longer the speeches from the Front Bench, the fewer opportunities there will be for those sitting on the Back Benches. To move the amendment in the name of the Government, I call the Minister.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health 4:23 pm, 9th March 2010

I beg to move an amendment, to leave out from "House" to the end of the Question and add:

"recognises that there are health inequalities, particularly around heart disease, stroke and cancer, to be addressed in London;
agrees that there is a need to build stronger organisations which are clinically and financially sustainable and provide the best service to their local populations;
recognises the importance of the work by Lord Darzi and over 200 clinicians who undertook the Healthcare for London review, which was widely supported and consulted on in London;
recognises that trusts have worked closely with their local communities to communicate the aims of the programme;
further recognises that lives will be saved because the NHS in London, supported by public consultation and following review and scrutiny by local and pan-London Health Overview and Scrutiny Committees, has agreed to implement new stroke and trauma networks surrounding world-leading major trauma centres and hyper-acute stroke units to ensure that patients receive high quality and innovative care in centres of excellence, expected to save approximately 500 lives a year;
acknowledges that there have already been improvements in cardiac outcomes;
notes that there must be no further changes to accident and emergency or obstetrics departments unless and until improved access to new services is available and that any changes must be subject to full and formal public consultation;
and further notes that the Government is preparing robust planning systems to ensure that NHS London is fully prepared to meet the challenges posed by the London 2012 Olympic Games.".

In opening, Mr. Lansley took 24 minutes. [Hon. Members: "Thirty-four minutes!"] I apologise. Perhaps I was more generous to him than I should have been. I normally take a lot of interventions, as the House will know, but I will try to make some progress today, because I am conscious that many hon. Members will want to raise their local concerns about NHS London.

I had a lot of sympathy with the hon. Gentleman's comments on inequalities, and with the motion, which is about a number of those. There is common ground on the need to address those inequalities. The difficulty is that the motion, and indeed his comments, identify a series of problems but offer no possible solution. I can see the opportunist, pre-election attempt to wrong-foot Labour, but the motion and the speech offer no vision, no new ideas, and frankly no agenda for government. They expose the Conservative party as offering no constructive way forward to address the very problems that the hon. Gentleman and his motion identify. We know that there are inequalities in stroke provision, and in heart provision. We know that London has worse outcomes and greater inequalities than other parts of the country. We know that lives are lost because of the current disposition of services. We know that infant mortality rates in Haringey are three times those in Richmond. We know that life expectancy deteriorates by a year for every stop on the Jubilee line from Westminster to Canning Town, from 77 down to 70. There is an over-reliance on A and E because GP practice in deprived areas in some parts of London is inadequate. But the best that the hon. Gentleman can offer is a vague view that we should leave it up to GPs to solve it through their budgets. He says that GPs should put more money into services if they want to keep them, on an ad hoc basis and without any process. That is an abdication of responsibility.

Photo of Emily Thornberry Emily Thornberry Labour, Islington South and Finsbury

Is my right hon. and learned Friend aware that NHS Islington is currently engaged in a so-called pre-consultation about the future of our greatly loved Whittington hospital? That so-called consultation is as chaotic and incoherent as it is alarming and wrong. Will he instruct NHS Islington to listen to local MPs and the public and dismiss any suggestion that Whittington A and E and maternity unit should close?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

As my hon. Friend knows, I have said in a debate on the Floor of the House in December that I have concerns about what is happening in relation to the Whittington. She has fought a strong fight on the issue and spoken to me about it on several occasions. We need to see strong clinical evidence for any change to the status of the Whittington. It is being discussed locally, but the national clinical advisory group will need to look at any case put forward. It is local now, but we have invested £32 million in the Whittington, much of it in A and E, and unless the case for change is established, there will be no change. At the moment I am not convinced of the need for the Whittington A and E to close. Those discussing these things need to know that. I have serious concerns about it and I would want to see a serious clinical case made for saying that the £32 million that the Government have decided to invest in the Whittington should be overridden. I do not see any justification for closure of the A and E at this time, and I would want to hear the case for closing it during the next Parliament. I have seen no such case.

Photo of David Burrowes David Burrowes Shadow Minister (Justice)

Is there any prospect of any change from this Government to the decision to downgrade Chase Farm hospital's consultant-led A and E and maternity services despite more than 100,000 attendances at A and E and more than 3,300 births at the hospital?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

We are looking with great care at all the various proposals and Chase Farm hospital is the subject of one of those proposals in London. The issues are supposed to be locally driven, locally led and locally determined reconfigurations. The hon. Gentleman and his party seem to think that this is all coming from Whitehall, but that is complete nonsense. These are local decisions, locally arrived at.

Photo of Jeremy Corbyn Jeremy Corbyn Labour, Islington North

I thank my right hon. and learned Friend for his reply to my hon. Friend Emily Thornberry. The overwhelming case for retention of the Whittington A and E has been made and continues to be made, but we discover that officials from the north central London NHS review are still working on a plan that we believe involves closure of the A and E, and they will not publish that plan for several months. Will he ensure that all the plans are published now so that the public can see what is being thought up by officials?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

If my hon. Friend will forgive me, I want to return to the various discussions that have taken place, the minutes and the proposals being circulated. Engaging with clinicians, and how we engage with them, is important.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I will give way to the hon. Lady, but then I want to make some progress.

Photo of Lynne Featherstone Lynne Featherstone Shadow Minister (Children, Schools and Families)

I welcome the Minister's remarks because, as he knows, the socio-demographic circumstances around Whittington hospital make the area one of the most deprived in London. My concern is that, of the seven current options, four suggest closing the accident and emergency department. That seems to be a huge waste of resource and energy when the money is needed in front-line services. Will he talk to north central London officials now and stop the process, because, as Jeremy Corbyn said, the case has been made for retention of the A and E department?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I hear what the hon. Lady says, but if she reads my comments just now and listens carefully, she will realise that, in a sense, I have addressed some of those points already.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

If the hon. Lady will forgive me, I need to make some progress; many people want to speak in the debate.

I do not mind the hon. Member for South Cambridgeshire taking the view that he does not like the Darzi process of clinically led, locally driven decisions made through a local process. He can object to that. We have set out a broad-based approach, and a decision-making process, as a result of a review by clinicians. I do not mind him objecting to that, and he is perfectly at liberty to do so-it is a matter of debate-but I find it bizarre that his alternative is no alternative. It is a "Stop the bus, I want to get off" approach. He is saying, "There are lots of inequalities in London, and lots of issues that need to be addressed, but I'm not going to address them because they are in the 'too difficult' category."

For decades, reconfiguring London to deliver better services has been in the "too difficult" category for too many Governments. Virginia Bottomley attempted to do it, but got hammered for it, because it was not clinically led. As a result, Londoners have put up with a worse service than many other parts of the country. Decisions about changing the NHS are difficult, and people are attached to local provision and fear changes. After the Thatcher period, they fear that the agenda is about cutting provision, not about making it better.

Going back decades, Governments-Labour and Tory-have failed. In 2006, NHS London asked Professor Ara Darzi-now Lord Darzi-to set out a vision for change in London: a process for bottom-up, clinically led improvements, the aim of which was to drive up the quality of services, not to make cuts. Because Ara Darzi was an eminent consultant-not a politician or a manager-clinicians bought into the process. They accepted his bona fides and his work to improve provision, and they engaged in the difficult process of change.

Discussions about possible reconfiguration have taken place across London- [Interruption.] Yes, they have, and clinicians are still engaged today, but they will not be if the Conservatives get in, because they will stop that process. Clinicians are engaged in a variety of meetings-this comes back to a point raised earlier-considering options and discussing them among themselves before making proposals through an iterative process of asking, "What are the best proposals for each area?" This is about clinicians discussing what is best for London.

Those proposals are already out for consultation in north-east London, and elsewhere they are still being discussed and weighed up. Local people will be engaged when there are clear proposals. They will be bottom-up, not Whitehall-led, proposals from the local NHS, not Ministers. That does not mean that it will not be difficult-the proposals raise concerns-but it means that clinicians concerned about quality services are leading the process. The key Darzi components can be summarised as localised services where possible, and centralised services where it is necessary for patient safety.

That is the process that the Conservative party is attacking and saying that it would do away with. Its motion identifies the problem in London, but rejects the bottom-up reconfiguration that clinicians say is needed to save lives. Instead, the Conservatives would dump the Darzi process, opportunistically attack every output from it and every attempt to allow clinicians the space to discuss what would work, play on the fears of local people, and, most damagingly and opportunistically of all, offer no real process to replace it.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I will give way to the hon. Gentleman in a moment.

The NHS changes are difficult, and they do raise local concerns. If there is a real alternative to what we are doing-if the hon. Member for South Cambridgeshire had come up with anything other than saying, "Let the GPs decide from their funding what they want to keep and what they do not"-then I missed it. He did not come forward with any such alternative: it is not in his motion and it was not in his speech.

Let us have a look at the motion. There is a vague call for something called a

"public health strategy geared towards the reduction of health inequalities".

Yes, good-got that. Indeed, Darzi attempts to do just that, but if the hon. Gentleman does not accept the Darzi process, what will he put in its place? A policy of no-change conservatism is not a serious policy. It does not deal with the inequalities that the hon. Gentleman set out. People are now dying and getting poor health treatment because Governments in the past have found the problem too difficult. We are now making some of the changes that are needed. In the face of that, the Conservatives abdicate responsibility, advocate nothing to replace the Darzi process and play to public fears. That is what is happening. If they do that in government, the inequalities that the hon. Gentleman has identified will remain, because he has no approach to deal with them. All he wants to do is play Pontius Pilate, washing his hands of the problem and saying, "Well, we wanted something done-there were real inequalities-but it was up to the GPs locally."

Photo of Simon Hughes Simon Hughes Shadow Secretary of State for Energy and Climate Change

Does the Minister realise that the reason why a lot of people are fearful and suspicious is that they have recent memories of reorganisations? The Tories proposed, and Labour then agreed, to the closure of the A and E unit at Guy's hospital, for example. Money has been allocated to primary care trusts in deprived areas such as Southwark, but it has then been top-sliced and taken away, even though we were meant to need and deserve it. I can tell the Minister that we have wards in hospitals across the river from this place, including in Guy's, that are absolutely full and overstretched-and not full of "not ill" people, but full of seriously ill people who need to be in hospital, not treated by their GP.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

It is the case that Government funding for the NHS has, of course, increased massively over the past decade, as the hon. Gentleman well knows. [ Interruption. ] It has increased, and it is also the case that London has received substantial amounts of additional funding, and will continue to do so this year and the next. We need to ensure that that money is spent in the best way possible, so that we deliver the best quality of services and deal with the inequalities in London. At the moment that has to be done by engaging clinicians in a serious process of looking at what works and at how we can change the services, so that we address those inequalities effectively.

My concern is about the intellectual hole in the Opposition's policy. They would end the process that we have set up, and although I think that they genuinely want to will the end of having to deal with inequalities, I just do not think that they have any means to deliver that-they have not come up with anything, anyway. Frankly, from what I can see in the speech by the hon. Member for South Cambridgeshire, their priority is marginal seats, not saving lives. Their worry is about parliamentary candidates, not stroke victims. If they offered an alternative, there would be a debate, but how can we debate with someone who offers no alternative but to return the health of London to the "too difficult" column? That is what the hon. Gentleman is doing: no courage, no leadership, and, most worryingly for a possible alternative Government, no vision for how to solve the health problems of London.

Let me explain why we believe that London must change and how that can be done.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I will, and then I will make some more progress.

Photo of Andrew Slaughter Andrew Slaughter Labour, Ealing, Acton and Shepherd's Bush

My right hon. and learned Friend correctly identifies the fact that the Opposition speech was about politics, not health. There was a certain irony in Mr. Lansley denouncing scaremongering by the Liberal Democrats, but then entertaining every piece of scaremongering from those on his own Benches, including, in relation to north-west London, the complete fabrication that hospitals in the Imperial College Healthcare NHS Trust will close, which Mr. Hands used in order to get elected five years ago-he said that the hospital was going to close, but it is bigger and better resourced than ever. Will my right hon. and learned Friend confirm that there are no plans-

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. Interventions are to be brief.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

Our former hon. Friend, Keith Bradley, found that a campaign was run about a supposed hospital closure in Manchester, and he lost his seat. These are potent arguments, and I can see that opportunistic politicians might run scare stories. That is what is being done. We are trying to undertake the serious process of addressing some of the very inequalities mentioned in the motion on which Opposition Members are going to vote. We have clear proposals for dealing with them, but the hon. Member for South Cambridgeshire has no such proposals at all.

Eleven out of 32 London boroughs are classified as spearhead areas. They are the most deprived areas with the greatest need, and the case for change is clear. Money is not enough, but it certainly helps. Over the past decade, there has been unprecedented extra funding. As a result, the number of people waiting more than 26 weeks for in-patient care has fallen from 48,849 in 1997 to two in January 2010. That is still two too many, but it is a staggering achievement. In January, only three people waited more than 13 weeks for an out-patient appointment. That figure is down from 43,639 when we came to power.

The NHS in London has come a long way by having more money. Money alone is not enough, but it helps. This year, the PCTs in London will receive £13.2 billion. Next year, they will get £13.9 billion. The hon. Gentleman asked what we got for that money. There are 45,000 more staff in the London NHS than there were in 1997, and I should just mention that there are 3,000 more consultants, 18,000 more nurses, 1,500 more midwives, and 4,000 more doctors in training. I have a long list, but before I get completely carried away, I shall give way to my right hon. Friend Joan Ryan.

Photo of Joan Ryan Joan Ryan Labour, Enfield North

The Minister will know that Chase Farm hospital is a very good and much-loved, much-needed hospital. The changes to the hospital were decided on before, and outside, the Darzi review. We know that the Conservatives have said that they would make no commitments. They are hypocritical in criticising changes while making no commitment to do anything different. In the light of the achievement of a 24-hour doctor-led service for 2013, will the Minister agree to meet me to discuss further why it is so important to keep an ambulance service at the accident and emergency department at Chase Farm hospital?

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. I understand that the temperature is rising on both sides of the House, but may I advise Members to be aware of their language and, in particular, of the use of the word "hypocritical"?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I am very happy to meet my right hon. Friend to discuss the ambulance situation and to look at the way in which the services in her area are being dealt with. She has spoken to me on many occasions about the issue, and I am familiar with the local circumstances that she faces. She is also right to say that the hon. Member for South Cambridgeshire can give no real commitments on these issues. After all, if he is going to rely on the local PCTs-all 31 of them-in London to make decisions locally, and if the only extra funding is to come from GPs' budgets, he is not going to be in a position to make any commitments on anything, is he?

We, on the other hand, are making a commitment to an increase of £700 million at a time of financial restraint. Why? Because Labour prioritises the NHS. London now has the biggest hospital building programme in the history of the NHS, with 28 new schemes worth £1.8 billion already open to patients, and another three, worth £1.2 billion, under construction. The Royal London, with a £1 billion scheme, serves some of the poorest communities in London. University college hospital's scheme is worth £422 million. King's college hospital's is worth £76 million. The scheme at Lewisham hospital is for £72 million, and Guy's and St. Thomas's is for £50 million. These are massive enhancements from Labour for London.

In the community, the NHS local improvement finance trust scheme has led to 45 new developments in London, worth £371 million. Gracefield Gardens centre in Streatham, the Barkantine in Tower Hamlets, which I have visited, the Heart of Hounslow practice, and Alexandra Avenue health and social care centre in Harrow are all shining examples of the results of our investment in the health of our capital. All offer extended opening hours to patients; all offer a wide range of community services in addition to GPs; and all are delivering what patients tell us they want the NHS to do for them-local services in their local area.

Today, advances in medicine and technology mean that more and more patients can be treated and cared for in the area. We need to ensure that the type of care services people get are those that they need. That means change. It is not about freezing services in aspic, as the hon. Member for South Cambridgeshire suggests he can do-it takes vision, not the policy of NHS do-nothingism. The NHS in London can continue to do better for the people of London. That is why we have set out the Darzi agenda to make some of these changes.

Across the city, the NHS is looking at how best to implement this programme for improving the health and lives of Londoners. It is already concentrating specialist care in centres of excellence. Londoners who suffer heart attacks are now taken straight to the specialist care they need in one of eight heart attack centres, significantly improving their chances of recovery. Creating that was not easy; it took tough decisions. If we had left it to local PCTs, we would not have had a process. It is because we created the Darzi process that changes were made, addressing local fears rather than stoking them up for votes.

Last year, a joint committee of all PCTs in London agreed to new stroke and trauma networks based on that model, which will save hundreds of lives. That was fully endorsed by a joint overview and scrutiny committee of all 32 London boroughs, including the Conservative authorities. London's PCTs have invested £20 million in improving stroke care. In the coming months, eight new hyper-acute stroke units will open and standards will be up to the best in the world.

We are in the process of creating in London a world-class NHS, whereas the hon. Member for South Cambridgeshire has a "do-nothing" view of the NHS, which will change little or nothing. We also have three new trauma centres, which will be open by April, and that of St. Mary's is to open in October.

Ten new polyclinics are open, all of which are receiving excellent feedback from patients. An evaluation project is under way to ensure that the local NHS learns lessons so that the model of care can be improved and rolled out across the capital. By the end of the next financial year, another 20 will be in place. Following Lord Darzi's review, the challenge for local areas is to improve services in the most appropriate way for their communities.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

If the right hon. Gentleman will forgive me, I have said that others want to speak. I want to make progress as I need to get through my argument. After that, I may give way to him.

This Government are committed to empowering people to make those local decisions. We believe that decisions about how to provide local health care should be led by local clinicians in collaboration with patients and the public, not by diktat from Whitehall. That is not what we are doing, yet the hon. Member for South Cambridgeshire thinks that adopting any strategic view about how to deal with inequalities is diktat. I say that it is simply having a strategy. That is precisely what is absent from Conservative policy-any sense of strategy or of moving from many to fewer inequalities. There is nothing. That is an indictment of the Conservatives' approach.

Hundreds of the best clinicians across London are now working together to transform health care in this capital by talking through ideas, which this process provides the space for them to do. I know that there are concerns about the need for more openness in the process. The Liberal Democrats have called for the release of all documents, as we heard. Clinicians do complain a bit about too much sunlight, however. PCTs are working with clinicians to identify options for improving services. If some A and E services close, it will be because clinicians on the ground deem it in the best interests of patients-and never before the alternative services are up and running. Those alternatives have to be there and they have to be better before any change happens. Any changes will always be consulted on prior to implementation and the results of that consultation will be independently evaluated wherever there is a legitimate challenge.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

Before I end my speech-I think it is time that I did-let me give way to Mr. Duncan Smith, because I promised to do so.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

I am grateful to the Minister for giving way. This is not a party-political point: I believe that Members on both sides of the House agree with it. The fact is that, currently, decisions are being made and then driven through on the ground by officials who are determined to hide much of that process from Members of Parliament and the public. There is a good example of that in my area.

Whipps Cross University hospital bid for the stroke and trauma centre, having a good stroke centre itself. It was told that one of the two centres in our area had been awarded to the Royal London hospital because it was close to cardiac services, while the other had gone to Queen's hospital, not, suddenly, because of the availability of cardiac services-Queen's does not have any-but for reasons connected with neurological services. Then it was told that in any event it would not have been able to complete the process in the time available. When we checked, we found that Queen's could not have completed on time either, but had been allowed extra time. In other words, the decision was made long in advance that Whipps Cross would not be given the centre, but as those who had made the decision could not say that, they went through a rigmarole of consultation that was an utter nonsense.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

The right hon. Gentleman wants to be non-party-political, so let me be non-party-political as well. We need to ensure that the process is clinically led and locally decided-

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

Perhaps the right hon. Gentleman will stop shouting at me from a sedentary position and listen to what I am saying. As a former leader of his party, he does himself no service by reacting in that way. I am trying to respond to a genuine question in a genuine way. Let the vibrations settle a bit, eh?

It is important for the Darzi process to be led by local clinicians and not driven by managers following a purely financial agenda. [Interruption.] Will the right hon. Gentleman calm down and let me finish? If he does that, I will even let him intervene again.

We need to ensure that the process is driven by clinicians and not by finances. Finances are an important consideration, but the No. 1 priority in the health service must be patients' safety and the quality of care given to patients, particularly in a place like London in which there are massive inequalities. Then we need to ensure that the process is delivered within a budget. That should be the order of priorities. Managers need to be aware of that, and they also need to be aware that it is the views of clinicians that we will consider when we have to examine any proposals that are submitted. We will have them nationally examined by clinicians to ensure that the right clinical judgment is made. If local decision making and the budgets of GPs determine whether or not something happens, there will be no such overview of whether developments are clinically driven.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

The only reason I gave that example was that it was clear that a decision had already been made, and that those who had made the decision had simply gone through a process of changing the criteria throughout. The point that we are all making is that none of this is being done other than completely in secret. The process must be opened up to clarity in order for proper consultation to be possible.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I agree that the process needs to become much more open. Darzi said very clearly that people did not need to be treated in hospital unless that was absolutely necessary, and that they should be treated as close to home as possible. When it comes to working out how that should be done, clinicians should be at the heart of decision making. That is what is happening across the city. Change is coming. The NHS must invest more in preventive care, rather than waiting until people become unwell. The money needs to be identified. The NHS must give the best possible treatment to those who are very ill, concentrating specialist expertise in centres of excellence. That is what we want to be delivered.

Photo of Tom Brake Tom Brake Shadow Minister (Olympics and London), Shadow Minister (Home Affairs)

The Minister has talked of his vision. I know that part of his vision for London is the Better Healthcare Closer to Home programme. We are expecting an announcement from the Treasury confirming that the programme can go ahead. Is the Minister in a position to tell us that it has been given the green light?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I think we are still on an amber light. I am still very hopeful that a green light may well at some point be able to be flashed on. However, I cannot give the hon. Gentleman any firm commitment just yet, but he has made representations to me.

The hon. Member for South Cambridgeshire has moved a motion on which the House will vote. I give him credit for knowing the NHS well, but that is why I am so concerned with the motion's vacuity. He accepted stroke reconfiguration in Cambridgeshire because he knew that it was necessary and it was clinically led. The indictment of him is that he knows that the Darzi review is right but it is politically difficult. It requires courage to change London's NHS and save lives, and for there to be a credible alternative Government, there needs to be an Opposition party that comes up with a credible alternative if it criticises Darzi. Change is always difficult, but across the country the hon. Gentleman has not opted for the process of improving the NHS; he has taken the opportunist line.

Let us examine where we have made changes. The hon. Gentleman knows well that the NHS in Calderdale and Huddersfield has reconfigured its maternity services and is giving mothers and babies safer care, but his party would reverse that. In Manchester, the reorganisation of paediatric services is giving children safer, better care, but it appears that his party wants to overturn it. In Birmingham and Sandwell, the new hospital would not be there and patients would not be getting safer, better care without change, but his party opposes change in that area.

Change is difficult: it requires courage and judgement. In each of the cases I mentioned the Government have made the judgment and have made the change. We have had the courage to lead. We have created a bottom-up process that saves lives. The hon. Gentleman is committed to reversing that for the sake of political expediency, thus sacrificing patients for marginal seats. The clinicians wanted change to save lives and improve the quality of care. He wanted votes, and he seeks to obtain them by scaring people into a conservative view on opposing change.

I do not deny that it is easy to scare people and that seats can be won in that way-that has been done-but leaders do not do that. People who care about the NHS do not do that. We have not done that; we have made the change, we are improving the NHS and as a result of those changes we are going to be saving lives that will, if this process is stopped, be put at risk. We are prepared to make the change; the Conservatives are not the change.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health 4:57 pm, 9th March 2010

The Liberal Democrats welcome this debate on an incredibly important issue for the people of London. However, it is fair to say that the Conservative motion does not really achieve very much, because all it calls for, in effect, is a delay in the reconfiguration process until there has been more effective public consultation. [Interruption.] Well, that is exactly what the motion says. We have not even got to the point where the public consultation is built into the process, because we are told that that is due to take place this autumn. Our criticism of the process is much more fundamental than that.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

Not quite yet. I am only 30 seconds into my speech.

Our criticism is of the way in which the NHS makes decisions and the fact that they are taken by bodies that are completely unaccountable to the people they serve. The Minister made two assertions in his speech. The first was that these decisions are local decisions. Who are these local decisions taken by? They are taken by people who have no legitimacy; they have been appointed nationally, so there is no accountability to the communities-

Photo of Clive Efford Clive Efford Labour, Eltham

Will the hon. Gentleman give way?

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

I shall in a moment, but let me finish my point. There is no accountability to the communities that they serve.

The Minister's second assertion was that the whole process is clinically driven, but we know that that simply is not the case. I wish to refer to an anonymous e-mail that I received from someone who describes himself as

"a (traditionally Labour voting) commissioner working in the sector" in north-west London. He refers to the fact that the clinicians have been

"either left in the dark or openly hostile".

This is a process that is "clinically led", but very much the opposite is in fact the case. The process almost seems designed to alienate the public and the clinicians who are desperately trying to provide services. My hon. Friend Mr. Davey has referred to conversations that he has had with local clinicians who are deeply frustrated by what is going on. They may have been involved in the process, but they do not want it and they are not leading it in any sense of that word.

Photo of Andrew Pelling Andrew Pelling Independent, Croydon Central

I want to congratulate the hon. Gentleman and his colleagues on opening up the debate by having the courage to talk about this matter publicly. Is it not right that such a debate should take place during a general election, and not be postponed by the Conservative party or Labour party until afterwards, when patients' influence will be minimised?

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

The hon. Gentleman makes absolutely the right point. It would be scandalous if any of the related papers were kept secret until after the general election. There almost seems to be a conspiracy of silence to prevent the public from knowing the real facts until after the general election.

The process seems designed to destroy confidence and to engender suspicion about motives. We know that the real pressure comes from the financial crisis faced by the NHS, which is in large part due to the way in which money has been spent by this Government within the NHS. I shall come on to one of the particular reasons for that-PFI, which was mentioned a while ago by an hon. Member on the Conservative Back-Benches.

An opinion piece in The Guardian on 3 March stated that

"proper discussion about the future of vital public services is being stifled because profound changes-in London and beyond-are accompanied by secrecy, obfuscation, double-speak and concealment by the NHS at almost every turn."

There is a culture of fear-people fear the consequences of speaking out. That Labour-voting commissioner from north-west London writes that he wants his e-mail kept anonymous. He does not give his name, because he fears that his job would be threatened

"were I to be linked to sending you this material".

What an indictment it is of the NHS under this Government that people fear for their jobs if they speak out and reveal to the public what is going on behind closed doors. He says in that e-mail that there has been produced in north-west London

"a long list of fantastical figures about the number of outpatient appointments, emergency admissions and diagnostics to be moved out of hospital and into 'polysystems' in the community. The idea is to move 55 per cent. of everything, even though the infrastructure and ability of the NHS outside the hospital to cope is not credible."

He goes on to talk about how the acute commissioning vehicle has emasculated the primary care trusts-the bodies that are supposed to be there under this Government to determine health care for their local communities. They have been emasculated by this new body that is imposing its decisions on the local area. Clinicians have been kept in the dark and feel completely excluded from the process in many cases.

Photo of Andrew Slaughter Andrew Slaughter Labour, Ealing, Acton and Shepherd's Bush

The picture that the hon. Gentleman is painting comes from tittle-tattle and innuendo. I represent a seat that is covered by the north-west London sector, and the picture that he paints bears no resemblance to the truth on the ground. All that people have seen for the past five years has been an improvement in the quality of their health services, whether at a polyclinic level, a tertiary level or in the three hospitals that make up the Imperial College Healthcare NHS Trust. He ought to pay some tribute to the work that is going on in the health service in those areas instead of simply spreading despondency on the basis of rumour.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

The hon. Gentleman refers to the views of a commissioner from north-west London as tittle-tattle and innuendo. I shall tell him a bit more of what that commissioner says:

"The result is ever increasing centralisation, and clandestine plans for the complete closure/downgrading of sites such as Ealing Hospital, West Middlesex Hospital and others."

The acute commissioning vehicle

"are telling us that there will be only 2 major hospital sites left in NW London, with threats to move all specialist services from others such as C&W Hospital, Central Middlesex, Charing Cross, Mount Vernon, Hammersmith, Hillingdon and possibly Royal Brompton and Royal Marsden."

That is the view on the ground from a commissioner working in the NHS in north-west London. The hon. Gentleman might not have received the leak, but that is the view the commissioner has expressed from the coal face.

Photo of Clive Efford Clive Efford Labour, Eltham

The hon. Gentleman surely cannot base his argument entirely on one anonymous e-mail that he claims to be a leak. We have all had concerns about the proposals in south-east London, but they were put forward in the autumn of 2007 as a result of a conference held by clinicians-doctors, nurses and midwives. They came up with them and it was on that basis that NHS London decided to move forward on the proposals, which were also reviewed by Professor Alberti on a clinical basis. On what does the hon. Gentleman base his argument that the proposals have nothing to do with local practitioners or local decision making?

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

I have expressed the view from north-west London, but we have heard other stories from north-east and south-west London, and I shall come to those in due course.

The origin of all this was a report that NHS London commissioned from McKinsey's, which has remained a secret to this day. Surely there can be absolutely no justification for that. The Minister has said that this process should be more open, so will he commit to publishing that report? I give him the opportunity to intervene. Will he publish it today? That is what people want.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I am grateful to the hon. Gentleman for that invitation, but I have not seen the McKinsey report to which he refers. It has not landed on my desk and I have not got-

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

Do you think it should be published?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

Well, no; it is not mine to publish. I cannot commit to publishing-

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

But do you think it should be published?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

Madam Deputy Speaker, I am being heckled from a sedentary position by the hon. Gentleman who has allowed me to intervene on him. Perhaps if I give the floor back to him, he can heckle me a little more.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

I do not know what to take from that. I do not know whether the Minister believes that the report should be published. It might not be his to publish, but he could at least indicate to NHS London that the Minister with responsibility for this sphere believes that it should publish the report. That would be very helpful. Is he willing to do that?

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I am grateful to the hon. Gentleman for again inviting me to respond. I do not know what is in the report in the sense that I have not read it. I do not have a copy, so this is a matter for NHS London to deal with, but I am sure that Ruth Carnall, the chief executive, will have heard his comments. I am not going to order her to publish it, no, but I shall ask her about it.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

I am pleased that the Minister will at least ask her about the report, because, as he said earlier, this process should be open, but it is certainly far from that. These are our local health services and our taxes that are being spent, so we deserve to know what is being planned behind closed doors. We demand disclosure.

We presume that the Conservatives know about the report because one of their parliamentary candidates works in McKinsey's health team, so they are presumably party to it. Meanwhile, the public and clinicians are kept in the dark. I ask the Government to commit to bringing into the public domain, before the general election, the processes that are taking place around the country, in every strategic health authority, so that people can cast their vote in the full knowledge of what is being planned behind the scenes.

Those who reveal plans to the public are accused of scaremongering. My hon. Friends the Members for Kingston and Surbiton and for Richmond Park (Susan Kramer) rightly decided to inform the public of what they have been told and about draft reports that they have seen regarding threats to their local hospital, but the Conservative shadow Minister, Mike Penning, accused them, in an Adjournment debate, of scaring the public. The Conservative view seems to be that these issues are best kept secret and that they should not be revealed to the public until after the general election, which is outrageous. I applaud my hon. Friends for having had the guts to put that information into the public domain so that the public can know what threats exist.

The threat is real. I have a copy of a draft report entitled "Presentation to NHS Kingston Joint Board and PEC meeting", which confirms that one in three of its 18 options would involve the closure of Kingston hospital's maternity unit, accident and emergency unit and paediatric in-patient department. Sixteen of the 18 options would see Kingston lose a significant service from that hospital. My hon. Friends deserve an apology from members of the Conservative Front-Bench team and local Conservative campaigners. They have been accused of scaremongering, when the matter is in black and white.

Interestingly, the report ends with a note saying that it should be sent to NHS London but not published. My hon. Friends have got it into the public domain, and they made the right judgment in doing so. These are decisions of which the public should be fully aware.

Photo of Mike O'Brien Mike O'Brien Minister of State (Health Services), Department of Health

I am a little confused by the point that the hon. Gentleman is making. He referred to Mr. Davey, who was busily telling us about these changes on his website on 5 October. Having talked about how good it was that public meetings were being held, he concluded by saying:

"For my part, I'm excited about what I've heard. I've been critical of the local NHS in the past, but this time the ideas look good."

Photo of Edward Davey Edward Davey Shadow Secretary of State (Foreign Affairs)

I am very grateful to my hon. Friend, as I want to explain to the Minister what I was talking about on the website. I was talking about proposals for polysystems, and about the fact that Kingston NHS was building a polyclinic at Surbiton hospital. My support for that polyclinic remains, and I also supported the changes to stroke and cardiac services that came from NHS London. What we oppose are these secret changes, with one option in three proposing that our local hospital should lose its A and E, maternity and in-patient paediatric services. The fact that the Minister does not understand that does him no favours.

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. A great many people wish to contribute to the debate, so I would ask that interventions please be as they should be-brief.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

Thank you very much, Madam Deputy Speaker, and I am grateful to my hon. Friend for that explanation.

I was referring to the proposals for north-east London, which emerged only because my hon. Friend Lynne Featherstone received a leaked letter from a clinician in the system. Again, the letter demonstrated what was going on but was kept from the public. It set out options, including the potential loss of A and E and maternity services at the Whittington hospital. The hospital is much loved and needed, and it serves one of the poorest communities in the country. The area has one of the lowest rates of car ownership in the country, yet it is proposed that those services should be lost. Again, my hon. Friend was right to get the matter into the public domain so that people can make their own judgments on the proposals.

The belief, certainly in north-east London, is that the proposals are not evidence- based, and that wrong assumptions have been made about the potential impact of the loss of an A and E department at the Whittington hospital. People believe that conclusions are being drawn that do not stand up to analysis.

I turn now to the private finance initiative, which has imposed an enormous burden on the NHS in London.

Photo of Iain Duncan Smith Iain Duncan Smith Conservative, Chingford and Woodford Green

The hon. Gentleman is talking about north-east London, but a year and a half or two years ago Professor Alberti was called in to have a look at the process whereby the various PCTs in the area were going about the business of change. He was highly critical of the secrecy involved, and of the trusts' failure to tell the public exactly what was going on. The idea that the problems were driven by clinicians is absolutely not true.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

I am very grateful to the right hon. Gentleman for that intervention. It appears that the PCTs have learned nothing from George Alberti's intervention a year ago, as the same secrecy continues to pervade the entire process.

As I was saying, I shall deal now with PFI. There have been 20 PFI schemes providing new facilities in London at a cost of £2.6 billion, but the repayments over the lifetime of those facilities will come to a staggering total of £16.7 billion. Those repayments have not been properly budgeted for, but they will bankrupt the NHS and in a sense drive the changes that we are debating today.

This year, PFI payments will amount to £250 million in London alone. By 2014, that will have risen to £400 million per year. That is forcing up overhead costs on trusts and squeezing the resources of other health services. It is also, as James Brokenshire said, distorting decision making about service changes.

The proposals appear not to have taken sufficiently into account the pressure of rising case loads in London. Many London hospitals find that acute bed occupancy rates are approaching 100 per cent. In other words, throughout the year they are virtually entirely full. The BMA says that the 3.7 million attendances at accident and emergency departments reflect high levels of mobility and temporary residents often unregistered with GPs, who choose to go to their local A and E department because they have nowhere else to go. As the proposals are put forward, there is nothing else in place to reassure the public. It is dangerous to make assumptions about the ability to cut numbers going to hospital before new arrangements and facilities are put in place.

There should be a recognition that the process is flawed. Consultation, despite the Conservatives' apparent faith in it, will not satisfy the public of London because all too often, as Mr. Duncan Smith suggested, consultation is seen-rightly, in many cases-to be a fait accompli, a rubber-stamping exercise. As the report from south-west London confirms in one of the charts that it contains, the final stage is consultation and implementation, as if consultation is a box that must be ticked before implementation of the changes that have already been determined.

We have surely tested to destruction the model that seeks to impose change decided by unaccountable bodies. We have the bizarre spectacle now of Labour Ministers leading protest marches against closures in their own local area. Instead, let us start by achieving savings in the NHS by slimming down the central bureaucracy, which has become overblown and entirely out of control under this Government, with 25,000 people working for NHS quangos at a cost of £1.2 billion a year. Let us reform the way that money is used in the NHS to manage those with chronic conditions much more effectively than we do at present, avoiding the crisis admissions to hospital which are so costly to the NHS and so disruptive to patients and their care.

Let us provide better incentives to prevent ill health in the first place. Critically, let us make primary care trusts democratically accountable to the people they serve. These are services that we all use, and those bodies that make decisions should be accountable to us. It is instructive that two former Secretaries of State from the present Government now support the case for democratic accountability in the decisions relating to the commissioning of health services. Decisions about local services should be reached in as open a way as possible by democratically accountable bodies.

Chris Ham, who will take over as head of the King's Fund, has cited the process in Sweden, where there are democratically accountable bodies responsible for health care. In Sweden they go about decisions in a collaborative way, involving the public not after the decisions have been taken, but at the start of the process, so that everybody understands the financial constraints that we all accept are there, involving the clinicians and reaching decisions together, rather than imposing them from on high.

Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health

No.

We want to be able to hold those organisations to account. Until that happens, we will oppose cuts in local services imposed on local communities by people who have no democratic accountability.

Several hon. Members:

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Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. Mr. Speaker has imposed an eight-minute time limit on Back-Bench contributions, but in view of the amount of time that has already been taken, after the first two Back-Bench contributions the time limit will be reduced to six minutes.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras 5:19 pm, 9th March 2010

I find it very unconvincing when I hear a Tory Front Bencher speaking in favour of reducing health inequalities. When we came to power in 1997, each part of the country was supposed to be allocated health service funds that reflected the size, nature and health of their population, but the east end of London was getting 23 per cent. less than it was entitled to, and surprise, surprise, Tory Surrey was getting 23 per cent. more than it was entitled to. That is entirely typical of what the Tories have always done.

In my constituency, investment under the Labour Government has been quite dramatic. We have the new University College hospital, which I freely admit got under way when I was Health Secretary; and we have also had big improvements at the Royal Free hospital, which serves my area, and at Great Ormond Street hospital, which serves children from across the country. We have new health centres, with two in Kentish Town and one that has just reopened in Gospel Oak; most GP premises have been improved; and the survival rates and general performance in our area have massively improved because the buildings and equipment have at long last started to match the excellence of the staff.

As part of that, there has been a lot of investment in the Whittington hospital. I can remember, when I was in opposition, going to the Whittington and pledging all sorts of things. As I believe in keeping pledges, those pledges have been kept, and a lot of extra money has been invested in the Whittington. I could not get firm figures from the hospital today, but as I understand it £27 million was invested in the new accident and emergency department, so my hon. Friends and I find it slightly bizarre-to say the least-that nameless, faceless people have suddenly appeared on the scene and decided to recommend that the A and E department, in which all that money has been invested, no longer function, and that instead people be diverted to the Royal Free and University College hospitals.

I checked this morning at University College hospital. It was designed for 60,000 A and E attendees, and it now has knocking on for 90,000, so Lord only knows where the 90,000 people who use the Whittington will go. Apparently, the explanation is that many would go to clinics-new health centres-in Islington. The only trouble is that they have not been built, and it will cost money to build them. So if the closure is being undertaken to save money, it is utterly stupid because it will involve spending money to substitute for the money that has already been spent at the Whittington.

Photo of Glenda Jackson Glenda Jackson Labour, Hampstead and Highgate

The issue is not only the waste of money, because the Whittington A and E rumours, which are rife in our part of the world, are having a serious knock-on effect on the hospital in my half of the borough of Camden, namely the Royal Free, and that is producing anxiety among not only patients but staff. Surely we have not invested all that money in the national health service and its staff suddenly to make them feel that they are no longer wanted or useful. It must be having an effect on their contribution now.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

As ever, I agree with my hon. Friend and good friend. The report that was produced on behalf of the primary care trust last week shows how it estimates that between only 10 and 30 per cent. of the people who currently attend A and E could be properly attended to at one of the devolved clinics, as we might describe them. However, up to now the basis of the Darzi report has been that between 50 and 60 per cent. of people could be safely dealt with at such clinics, and I do not agree. I am simply not convinced.

The whole basis of the concentration of stroke provision and major trauma provision, which I strongly support, is that practice makes perfect, but apparently practice does not make perfect in A and E any more, because the people who have a lot of practice at a large A and E will be substituted by people who have a lot less practice at clinics in the community. So the closure does not make sense in terms of the practicalities or, indeed, the money.

The idea that there was widespread, successful consultation of Londoners over the whole Darzi thing is really preposterous. About 1,800 Londoners-and there are rather a lot of us-expressed support for the Darzi proposition, and about 1,700 said that they did not want it, so the view was far from unanimous even among those who were consulted. I find that outcome about as convincing as Lord Ashcroft's protestations about his tax status, and we all know what that indicated.

Unfortunately, these aspects are bringing into disrepute a great deal of the achievements that the Government have brought about in the years that we have been in office. At the meeting I went to, when we had to listen to the burblings of some of the people who are proposing what is happening at the Whittington, nothing much was said about improving clinical performance; it was all about saying, "Oh, we think we're going to be £500 million down." When they were pressed to explain how that was going to happen, they could not come up with any satisfactory explanation. I can only assume that they are absolutely convinced that there will be a Tory Government and that there will therefore be a £500 million-a-year reduction in the money that is available, because they could not possibly conclude that from anything that the Labour Government have been committed to.

We need to look at the functions of NHS London. It is NHS London, not NHRS London: it is there to help clinicians in London to improve the services, not to be a national health reorganisation service for London. A lot more attention needs to be paid to what local people want.

In talking about A and E, I come back to the thing that I have been obsessed with for all the time that I have had an interest in this issue, and that goes back a very long way-if we want to make A and E departments more successful, let us put some GPs in there to deal with the folks who choose to turn up. People do not want to be told, even by clinicians, that they should not turn up at their local hospital. If they want to turn up for GP services, as well as strictly A and E provision, that should be fine by us, and it would be a proper response to the situation that we face.

I strongly welcome what the Minister said about being far from convinced of the merits of the closure of the A and E at Whittington hospital. One has to be careful what one says when one is a Minister, and what he said far from overstates the reaction of most people in the area and, according to all my sources, the reaction of most of the clinicians who are working at the Whittington and want to continue to do so. I welcome what he said, and I think he had better press on with it. We cannot leave this to bureaucrats. It is no good leaving things to bureaucrats, because when they get it wrong, they do not have to stand at the Dispatch Box to explain. Ministers have to do that, so Ministers should take responsibility right the way through. The people who take the decisions should carry the can, and the people who carry the can should take the decisions.

Photo of John Horam John Horam Conservative, Orpington 5:28 pm, 9th March 2010

I never thought that I would stand up in the House and agree with Frank Dobson, particularly on health matters, but he made a very important point in his criticism of the Darzi proposals. Having spent millions of pounds on new hospitals in London, the Government now want to make a radical change in favour of treating a huge proportion of the people who currently go to the accident and emergency departments of those hospitals in polyclinics, which have not yet been built and which they propose to build during a period of financial difficulty. It is mad to behave in that way. It is in the same category as the Government's deciding to pay GPs a lot more to do less, and then having to pay them even more to do the things that they were originally supposed to do. All these financial and medical decisions by the Government seem to come from Alice in Wonderland.

I doubt whether one could find a worse example of what is wrong with the NHS in London than in looking at my own corner of the city-south-east London. There, as my hon. Friend Robert Neill has pointed out, we have the South London Healthcare NHS Trust, which was a shotgun marriage between three hospital trusts that had severe financial problems. It was set up with an accumulated deficit of £200 million, and was given an operating target for this year of a deficit of £29.7 million. Since we are near the end of the current financial year, that means that the accumulated deficit is now well over £200 million.

To be fair to the Government, a new management structure was put in place with the creation of the new trust a year ago. Some members of the Government have accused the Conservatives of scaremongering, but I have not done so about the management of the new trust. Although criticisms by consultants, patients and voluntary organisations, such as the local involvement network, have come my way, I said to myself that I would hold back from criticising the management publicly. One should be a responsible Member of Parliament and recognise that the management of any such huge organisation need time to bed down. However, the fact is that we have now had 12 months and the results are extremely disappointing, as Clive Efford may well agree.

It is worrying, for example, that the operations director has already gone by mutual agreement. I now understand that the financial director is also going by mutual agreement, although I have not been able to check that. A new operations director is being put in directly from the Department of Health. As a former Health Minister, I know that means that the Department is worried about the new trust. There are clearly problems in its management.

As I have indicated, this year's target for the operating deficit will almost certainly not be met. That is a problem, because with generous help from the other parts of London, there is a window of opportunity for the South London Healthcare NHS Trust to pay off its deficit, if it meets its operating targets. It seems as though that may not happen, and the crisis that we face in south-east London will therefore be even greater a year from now.

As far as I am concerned, there has been no real improvement in the trust's performance for patients since its inception. As Members know, it currently has a norovirus problem that has meant the shutdown of many wards and waiting lists rising. That is a difficulty that many hospitals have had to face, but nevertheless I do not see any improvements in performance.

The origins of all that are quite clear. First, the Government have thrown money at the NHS in London, as elsewhere, with no idea of reform. Norman Lamb mentioned PFI, and he gave the overall statistics for London. In my area we have two hospitals, which now form part of the South London Healthcare NHS Trust. The construction cost of the Queen Elizabeth hospital in Woolwich was £96 million, but the taxpayer will have to repay £799 million. The new Princess Royal university hospital in Bromley will cost £118 million to construct, and the taxpayer will repay £780 million-seven times the construction cost. As Lord Warner, a former Minister in the Labour Government, has said, the NHS received more money than it knew what to do with.

Another problem has been top-down political management. Civitas, the consultancy, has said that market reforms have not worked as they should have done, because Whitehall is still exercising too much control. We have had endless and changing targets and endless changes in management. For a period of two or three years, the managing director of the Princess Royal university hospital was being changed every six months at considerable cost. Nobody ever gets sacked at the top level of the NHS. It is astonishing how people appear to perform badly and are removed, but then appear somewhere else in the NHS. No one ever suffers the consequences of poor performance.

Finally, weak structures are part of the problem. Commissioning has not been valued as much as it should have been, and in many ways, as has already been said, it has been emasculated. Lord Warner-I quote from an article in The Guardian-has said:

"We had 300 PCTs to begin with. That was insanity...The first thing I did was to cut them down to 150. But I wanted to go further and cut the number to 50 or 60."

He said, as The Guardian put it,

"that he was thwarted by the Labour backbenches, who feared they would lose vital services from their constituencies."

What is the answer? Briefly, the Government must cease micro-managing. Instead, we need to create opportunities for individuals and companies inside and outside the NHS to come up with more effective solutions, and for the Government to act simply as a regulator. We need fewer targets and quangos; we need commissioning to be more professional; we need to encourage a diversity of providers and for groups of professionals, private charities and so forth to be brought into play; and we need more competition. I suspect that efficiency and better patient care will go together.

The tragedy is that all those things were under way when the Conservatives were in charge of the health service, when we made the split between provider and purchaser. That was the opportunity for those sorts of reform. The Government, including Frank Dobson, with whom I might disagree on this, set back the whole process of reform. It is a tragedy that 13 years have been largely wasted.

Several hon. Members:

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Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. I remind hon. Members that the time limit is now reduced to six minutes.

Photo of Jeremy Corbyn Jeremy Corbyn Labour, Islington North 5:36 pm, 9th March 2010

I am delighted that we are having this debate and to have the opportunity to put my views on the NHS in London on the record.

I represent Islington, North, and most hon. Members who have contributed so far have mentioned the Whittington hospital in my constituency, as I will in a moment. However, the core of the debate is the question of the accountability of the NHS and how it operates. In London, the background is the Darzi report. Behind that, there are a series of associations-in my case, five north London boroughs have decided, as my right hon. Friend Frank Dobson has pointed out, that they must cut £500 million from their budget in the next five years. I keep asking where that figure comes from, but nobody can tell me. They say, "Well, it's a possibility," to which I ask, "A possibility of what, from where, by whom?" to which they reply, "We have to think to the future."

We all have to think to the future, but I do so in terms of improving health care throughout my constituency, north London and the rest of our capital city. I pay tribute to my right hon. Friend. When he was Health Secretary, he not only ensured large-scale investment in major hospital facilities, GP practices and all the rest of it, but put into operation the Black report, which was hidden by an earlier Conservative Government, and tackled health inequalities through health action zones and public health campaigns. There has been an improvement: life expectancy is greater; infant mortality and child obesity are lower; and a number of other things have improved.

We have a long way to go, as everyone should be well aware. The population is increasing, and desperate inequalities still exist, as does very bad housing, so we need investment in health care across the piece. We do not need senior officials who lead shadowy existences to decide that in the long run, there must be a cut in health expenditure through our part of north London. My plea is on behalf of an awful lot of people who rely desperately on local health services and facilities, who do not have the alternative of private medicine-for them, it is the NHS or nothing, so we need the NHS to be the very best.

Most speakers today, including my right hon. Friend, mentioned the future configuration of local A and E facilities across north London. As has been said, a proposal is lurking somewhere in the background of this debate. Eighty people-I do not know who they are-are being regularly consulted on the future configuration of health care across north London, and they appear to have decided that the most important hospitals are University College hospital and the North Middlesex, and that they will therefore downgrade or reduce everything else. I find that repugnant and wrong.

When news of those proposals leaked out to us, I called two public meetings in my constituency. Three hundred people attended the first, and 350 the second, which does not include those who could not get in because the room was so full. We held a march and demonstration through Islington, and 5,000 people attended. They were not subject to scaremongering: they were there to show their support for their national health service, their local hospital and its A and E department. My hon. Friend the Member for Islington, South and Finsbury, my right hon. Friends the Members for Holborn and St. Pancras (Frank Dobson) and for Tottenham (Mr. Lammy) and Lynne Featherstone and I were all there, as was every political party from the Revolutionary Communist party to the Conservative party. Opinion was unanimous in support for that casualty unit. I know that the Minister has heard us and understands what we are saying about this.

As a result of the march, I received a letter from the chief executive of NHS London, essentially telling me that I should not be so concerned. I read her letter with great care and was left even more concerned, because she talked about opening a hub at the Whittington hospital for north Islington, called a polysystem. I am not against GP-led health centres or improving primary care facilities. On the contrary, I am in favour of effective, efficient local GPs, but we should not close A and E departments. Casualty unit attendance figures in the north London area were 695,000 last year, of which 86,000 were at the Whittington. Do not close casualty units and do not cut our hospitals, and instead recognise that we conquer ill health and inequality by investment, not by cuts and closure. We conquer them by access, not by making services more complicated and less accessible.

Photo of John Randall John Randall Conservative, Uxbridge 5:41 pm, 9th March 2010

I welcome the opportunity to follow Jeremy Corbyn. I, too, received an e-mail from a commissioner, which contained the worrying words:

"Targets and centralisation have driven morale to an all-time low, with money wasted and no flexibility to be innovative or unique."

I go to regular meetings on this issue with my two colleagues from the other Hillingdon constituencies, and the terminology that we hear worries me. There is talk of turnover, margins and targets, which are of more use in the retail sector.

A secret operation has been going on. The Minister said that it was clinician-led, but I have a copy of a letter sent by the deputy director of service transformation at NHS London to the sector chief executive of north-west London. I have not got time to read much from it, but some of it should strike terror into our hearts, because it shows that the proposals are not about clinical decisions. It states:

"Overall, there is a considerable amount of work to be done to produce a high-quality strategic plan for transforming services in NWL, one that captures priority actions to be taken, by whom and by when. You should work with your PCT chief executive colleagues to ensure the PCTs' contributions to delivering the strategy for NWL are clear and coherent and that their plans are properly aligned, where necessary, with yours. You are accountable for ensuring that the NWL Sector exhibits the right leadership to ensure that NWL's strategic plan is robust, to ensure the delivery of Healthcare for London at the pace that the changed economic context now demands. We are confident you have the right governance structure in place to make this happen."

Those words mean, "Make sure you get it right, like we've told you to do. These are the plans we want."

The letter continues:

"Turning to your proposals for Local Hospitals and Elective Centres, there is no reference to the numbers you believe to be sustainable across the sector. I know that you have a programme in place for reviewing all hospital care settings and the plan should, at least, signal the likelihood that not all the current sites will make the transition to either MAH or Local Hospital."

I could go on, but I do not have the time.

The Government have undoubtedly put money into the NHS, but where has it gone? Like Norman Lamb, I think that it has gone into the new structures and bureaucracy and not necessarily where people expect it to be. The NHS has become like a huge sponge, with water being poured in, the money being poured out, and only drips coming down.

I regret that the situation has arisen so near the election, because I do not want this to be a competition-it is not about that. I want to save my local hospital and services more than anybody else. The hon. Member for Islington, North talked about demonstrations and marches in his constituency and about the all-party support for them. In Hillingdon, there is nothing but unity among all the local Members of Parliament and the other parties there. This is about trying to preserve what we want for our constituents and fellow residents; it is not about trying to score party political points.

In A and E departments, members of staff do not hang around waiting for work to come in; they are overstretched as it is. If, as is the suggestion in north-west London, three hospitals are left with an A and E department, Hillingdon will be saved. Of course, I would be delighted were that the case. However, if only two are to remain, I am afraid that Hillingdon will go, according to the plan. If Hillingdon is saved, however, Ealing is on the list to go-and where will all those people currently going to Ealing go? Are they all suddenly going to pour into Hillingdon hospital? There is not the capacity-never mind the difficulties of actually getting there and the geography of it!

The matter must be put into the open. People should know exactly what is being proposed at an early stage.

Photo of Steve Pound Steve Pound Labour, Ealing North

As the hon. Gentleman has mentioned the great and glorious borough of Ealing, may I say that the 100,000 people who currently attend Ealing A and E department would, I am sure, have no objection to going to Hillingdon-we have nothing against Hillingdon? However, we would quite like to keep what we have got-thank you very much.

Photo of John Randall John Randall Conservative, Uxbridge

The hon. Gentleman is absolutely right. We want Ealing to keep its hospital, because we do not want lots more cases coming to Hillingdon. The people of Ealing deserve to have their A and E department there.

I know Hillingdon hospital. I was first a customer there in 1967, and my family and I have been using it since then. It is doing an excellent job. It has never had a particular golden age. In 1967, I had to wait a very long time to have my wrist reset, because there had been a major accident. However, David McVittie, at Hillingdon hospital, has been putting a lot of time and investment into ensuring that services are improving. We had hoped that a new hospital would be built-it was talked about-on the RAF Uxbridge site. That dream has disappeared. We hoped then that Hillingdon hospital itself would be improved-that was talked about, too-but that idea seems to have gone now. There is also talk about having one polyclinic in each area, but where they might be has only been talked about. What about the people who do not have to go to A and E? There is nowhere for them to go.

We want the health centre in Yiewsley up and running. We have just opposed the move of a health centre from the green at West Drayton. I could go on about mental health services in London. While we are talking about our own hospitals, we should be talking about mental health services. Twenty one per cent. of NHS mental health beds in London have been lost over the past four years. My message to the NHS and the Minister is stop fiddling around with the systems and concentrate on delivering the service that my constituents and I, and all Members of the House and their constituents, expect and deserve.

Photo of Siobhain McDonagh Siobhain McDonagh Labour, Mitcham and Morden 5:48 pm, 9th March 2010

I want to tell a tale of two hospitals. Mitcham's Wilson hospital was endowed by a local benefactor, Sir Isaac Wilson, back in 1928. He specifically donated it for health purposes, but in the 1990s there was a Conservative Government. The public campaigned long and hard to keep this much loved cottage hospital open-but the Tories would not listen, and they closed it.

Now, however, there is a different Government, and later this month the Wilson hospital will reopen as a general practitioner-led health centre, open from 8 in the morning till 8 at night-the hours that patients want-365 days a year. However, that is just the first stage of the plan to improve the Wilson, and it will ultimately be a full care centre offering diagnostics, a variety of medical treatments, dentists and GPs, out-patient treatments, physiotherapy, speech and language therapy, X-rays, electrocardiography, ultrasound, a baby clinic and even minor day surgery.

What is more, the Wilson is not just getting a care centre; it is going to reopen as a proper cottage hospital, with minor operations and more than 50 intermediate care beds for people recuperating from operations or in need of care that they cannot get at home. The first stage-our local GP-led health centre-opens on 31 March. The remainder of the hospital will be open by 2013. That is still three years away and subject to planning approval, but I want to commend Ministers, officials and NHS staff for all that they have done so far, and take this opportunity to encourage them to keep up their good work. We are delighted with our new GP-led health centre, but we want the rest as soon as we can have it. The Wilson is in one of the most deprived wards in the whole of south-west London, and will make an enormous difference to many people's lives.

That was the tale of the Wilson; now I want to tell the House about St. Helier hospital. St. Helier opened in the 1930s to serve one of Europe's largest council estates, but by the 1990s it had become shabby, and in 1996 it became infamous when patients were left on trolleys in the corridor because there were no beds. If anybody wants a reminder of what a Tory Government means, it is patients dying in the corridor because there is no room in the hospital. St. Helier was at rock bottom, so NHS bosses under the previous Government developed plans to shut it and move its services across south London to Croydon. Things happen slowly in the NHS, but a process was set in motion, and eventually the local NHS proposed moving everything to Belmont, in the Surrey suburbs. However, when residents across the region were consulted, Belmont was the least favourite choice. St. Helier was the favourite choice.

Luckily, in 2004 there was a Labour council in Merton, and it called in the Belmont decision. A year later my right hon. Friend Ms Hewitt agreed with residents, instructing the NHS to rebuild St. Helier rather than relocate, because this would help reduce health inequalities. Unfortunately, as I am sure the Minister of State, my right hon. and learned Friend Mr. O'Brien, would admit, things do not always run smoothly in an organisation as big as the NHS. There have been a few jolts along the way, but last year London's NHS finally approved the full plans for St. Helier hospital, and last month the Department of Health gave them the green light.

I would like to thank my right hon. and learned Friend personally for his enormous help. He has repeatedly met me, as well as the hon. Members for Sutton and Cheam (Mr. Burstow) and for Carshalton and Wallington (Tom Brake), who have been assiduously helpful themselves. He has been very hands-on, and has done his best to ensure that officials deliver the health service that people in Mitcham and Morden, Sutton and Carshalton all want. Now we just have to wait for the final rubber stamp from the Treasury. I thank Ministers for all their support.

I have invited my right hon. and learned Friend to meet my constituents to hear what they think about our local NHS. I am pleased to say that he has agreed to join us later this month. He is very welcome. In many ways he is the personification of the tale of two hospitals, but it is also a tale of two Governments. The first was a broken Government running a broken NHS, shutting a cottage hospital that had been built to help poor workers in south London and plotting to close a general hospital where people were dying on trolleys because they could not find beds-the worst instincts of a Conservative Government.

Those were the worst of times, but that was the 1990s. Now it is 2010. Our broken health service is slowly being put back together under a Labour Government, with the Wilson reopening and St. Helier not only safe from closure, but likely to be completely rebuilt. It might be stretching the point to say that we are now in the best of times, but things are certainly a lot better than they were. I am proud of the progress that we have already made and hopeful about future progress. On behalf of my constituents, I would thank like to thank everyone who has supported our local NHS in the past 13 years.

Photo of Lee Scott Lee Scott Conservative, Ilford North 5:53 pm, 9th March 2010

I shall restrict my comments. I shall not be party political, nor shall I give a history lesson, because our constituents want and deserve more than cheap political point scoring, although it is unfortunate that this debate is happening at a time when a general election is to be held in a matter of a few weeks.

Let me start by talking about secrecy. Normally, Mike Gapes and I would be called in to the primary care trust for a meeting to discuss any proposals, but surprisingly on this occasion the trust did not want us together; it wanted us separately. However, when we went in, we both faced the same panel-a panel of doctors and clinicians-telling us why it was better for our constituents not to have services at King George hospital, and how that would benefit them. We were told that things would be absolutely fine, but let me say this to those bureaucrats. After a public meeting with hundreds of people, which I, like Jeremy Corbyn, held, we too had a march involving all the parties. The hon. Member for Ilford, South and I, together with other hon. Members in the area, worked together for what is best for our constituents-not what is best for the political parties, but what is best for the people who put us here.

Photo of Jeremy Corbyn Jeremy Corbyn Labour, Islington North

Don't point your finger at me!

Photo of Lee Scott Lee Scott Conservative, Ilford North

I thank the hon. Gentleman for agreeing with me.

The proposals to cut A and E, maternity and other services at King George hospital will benefit nobody-not one constituent in Ilford, South, not one in Ilford, North, and not one in Leyton and Wanstead, or Chingford and Woodford Green-because believe me, if the services at King George are cut, Queen's hospital in Romford will not be able to take the pressure.

Photo of Angela Watkinson Angela Watkinson Opposition Whip (Commons)

My hon. Friend is absolutely right. Before A and E, and maternity services, could be transferred from King George hospital, which would be a negative move for his constituents, additional space would have to be created at Queen's hospital, which is already at full capacity. That could be achieved only by moving some existing services elsewhere, but there is no suggestion of what those services might be or where they would be moved to.

Photo of Lee Scott Lee Scott Conservative, Ilford North

My hon. Friend is perfectly right. The biggest problem in this whole exercise is that Queen's hospital cannot cope even now. There are many occasions on which it cannot take A and E patients, who are diverted back to King George hospital, so how cutting the services there could possibly benefit anybody I do not know.

We have also seen another major problem. We heard earlier about the NHS and rewards for failure. This House has heard me say before that the previous chief executive in the Barking, Havering and Redbridge trust got a substantial pay-off for working up one of the largest deficits in this country, totalling more than £100 million, which is why the current problems exist.

The most important thing that can be said is that we have to protect the services. I promise that I am not scaremongering, but lives will be lost, given the time that it would take for someone living in the west of my constituency-for instance, in Hainault, where I happen to live, or in Woodford or Woodford Bridge-to get to Queen's hospital in Romford. The proposals have to be stopped. That is why, whatever motion we have tabled, if it says, "We must halt this now," it is the right motion. We cannot have these ludicrous cuts. I have received more than 1,000 communications from my constituents. Surprisingly enough, not one has said, "We think it'd be a good idea to cut services at King George"-and that is true across the political spectrum; this has nothing to do with party politics or scaremongering. I have also received anonymous e-mails, but I am not even going to mention those because they were anonymous, and I do not know whether they were correct or not. However, I do know that many staff at the hospital are scared to speak their minds because they fear to lose their jobs. I understand and respect that.

I have one final point. At the public meeting that I held, I was told by the PCT and a doctor that if somebody had a heart attack outside King George hospital, they would be taken to another A and E unit. I have never heard anything so ludicrous. How could it possibly be better for anybody not to be assessed at the A and E unit closest to where they live? If we do not stop the proposals-not only the proposals for King George hospital, but those for hospitals across our area-we will be letting down the very people who elected us to this House last time, and who will or will not elect us here in a few weeks. We are here to represent them. Let us not forget that.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall 5:59 pm, 9th March 2010

I welcome this opportunity to debate health care in London, primarily because there has been a lack of transparency and debate about alleged NHS London plans for my local hospital, Ealing hospital, and for other hospital trusts across London. Leaked reports from NHS London have caused great concern among my constituents about the future of Ealing hospital and its A and E, maternity, children's and acute services. The local paper, the Ealing Gazette, has begun a campaign, along with the local community, to save our services at Ealing hospital, and I have pledged my support for that campaign.

Since the NHS London report came to light, I have had meetings with Ealing hospital's chief executive, with representatives of Ealing PCT, and with consultants from the hospital. I have also had discussions and correspondence with NHS London and with the Secretary of State for Health. I should like to quote from the NHS integrated service plan for 2009 to 2014, which was drawn up by the north-west London commissioning partnership at the behest of NHS London. The following paragraph relates to the plans for Ealing hospital:

"The Sector is actively promoting and supporting the concept of the Integrated Care Organisation, bringing the PCT provider services of NHS Ealing and NHS Harrow together with Ealing Hospital Trust. All three Boards support this proposal. The provider services of NHS Brent are likely to join this organisation. This will promote an innovative locally based model of community provision. All involved acknowledge that this will, over time, reduce the level of acute services on the Ealing site and they will be transferred or tendered to other acute provider management to ensure their clinical and financial viability. This acute activity change will enhance the viability of the surrounding acute hospitals."

I agree with Ealing's consultants that any reduction in the level of acute services at Ealing hospital will inevitably lead to the closure of the A and E department at Ealing, and the loss of acute services at Ealing can only mean that it will no longer be a meaningful local acute hospital.

I agree with the British Medical Association's London regional council when it says that London's doctors and patients are being kept in the dark about NHS London's proposals. I also agree with its statement that

"Lord Darzi pledged that all changes would benefit patients, be locally led and that existing services will not be withdrawn until new and better services are available to patients so they can see the difference."

Photo of Steve Pound Steve Pound Labour, Ealing North

My hon. Friend is making a characteristically powerful case, and I know how much he cares for, and has fought for, the A and E department at Ealing hospital. Does he agree that of all the boroughs he has mentioned, Ealing has the largest population-nearly 330,000-and that those people have an extraordinary range of health problems and inequalities that are almost unique within the sector? Does he also agree that, if this glorious amalgamation-this great mélange of trusts-should come together, all that is special and unique about Ealing would be lost, including, above all, the ability of Ealing hospital to attend to those special needs and demands?

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall

I thank my hon. Friend for that intervention. I agree with him, but I shall not repeat what has already been said by other hon. Members about this.

I recognise the need to develop more locally based primary care services at polyclinics, but they are as yet unbuilt and untried. Ealing hospital has approximately 100,000 A and E patients each year and, although many of those could be treated in a primary care setting, many could not, and those patients are dependent for their treatment-and, in some instances, their lives-on the acute services that are an integral part of the A and E department. With such large numbers visiting Ealing's A and E, which was originally designed to treat only 30,000 patients, we have to ask ourselves where they would all go if the A and E were to close.

I am still deeply concerned about the future of Ealing hospital. I live only five minutes away from it, and I am not planning on moving away from the area, so it will always be my local hospital. My children and grandchildren also see it as their local hospital. My grandchildren were born there, and my daughter-in-law received life-saving treatment there. Ealing hospital serves the majority of my constituents, many of whom are from ethnic minority groups and who do not have English as their first language. They are often disadvantaged, vulnerable and voiceless. They would have to travel much further if A and E and acute services were closed or downgraded at Ealing hospital. Their distinctive cultural and language needs are currently well met by the hospital, and I doubt that that would be the case elsewhere. Along with the consultants, I am also concerned for the safety of patients if there were no A and E and acute services at the heart of my community at Ealing hospital.

I am committed to speaking up for my constituents on this issue, and I have tabled an early-day motion that I ask other concerned Members to sign. I have also written to Mr. Speaker requesting an Adjournment debate on the same subject. I hope that these alleged plans never see the light of day, but if they are real, they must be brought out into the open so that local people can find out what is being proposed and make their views known. I for one want to make it very clear that I oppose any plans, real or otherwise, to downgrade acute services at Ealing hospital. I am grateful to you, Mr. Deputy Speaker, for allowing me to speak in this debate and to put this on the record.

Photo of Susan Kramer Susan Kramer Liberal Democrat, Richmond Park 6:06 pm, 9th March 2010

I particularly appreciate this opportunity to speak in the debate in defence of my local hospital, Kingston hospital. I am joined in my campaign by my hon. Friend Mr. Davey. We first learned of the risk to the hospital's accident and emergency and maternity departments towards the end of last year. We told NHS officials that we thought the plans were outrageous. Kingston's maternity department deals with nearly 6,000 births a year, and the A and E unit treats more than 100,000 patients a year. It is therefore busier than almost any other hospital that has been mentioned. We agreed that we would hold back from going public with our campaign until the documents had been published. However, we were told in January that the documents would be withheld until after the general election, so we went public with our campaign anyway.

I have heard about cross-party campaigns in every corner of London, but I am incredibly sad to say that south-west London is the exception, and accusations of scaremongering have been levelled against my hon. Friend and me today. Those who did so are well aware, however, that, on 8 February, we put into the public arena the document that was leaked to us confirming everything that we had said about the threats to Kingston hospital. That document-the "South-West London Strategic Plan: private and confidential: final draft"-is now on our website. It lists the 18 options under consideration, nearly all of which, unfortunately, involve the loss of services at Kingston hospital.

Those hon. Members will also be entirely aware that, on 24 February, Kingston's health overview panel held a five-hour scrutiny meeting, at which NHS representatives were questioned for almost the entire time. I will read the local newspaper's report of that meeting. It said:

"NHS bosses have bowed to public and media pressure and confirmed the closure of Kingston Hospital's accident and emergency and maternity units is being considered as part of a review of services in the area."

That is from our very reliable Richmond and Twickenham Times. We have also put into the public arena today, through our website, the presentation to NHS Kingston's joint board and professional executive committee meeting, dated 15 January. That document unfortunately shows the situation to be even worse, involving a greater loss of elective surgery than we had feared. I am expecting a sincere-and, I hope, written-apology from those on the other Benches.

More than anything, however, I am here to ask for the disclosure of information. My local residents want to be part of this conversation in detail. They want to understand all the facts and issues now, when they can be part of the fundamental discussion, and not when they have been told that they can find out about them. At that point, three final options will be presented to them, and there will be a 12-week formal consultation, which can have an impact only at the edges.

We have put freedom of information requests in place, but the response to all of them was, "You are asking for too much information." But there is no such thing as too much information for the public, who need to be able to participate and make decisions. Although I intend to pursue those FOIs, let me show how bad things are by reading from the front of the leaked document, now on the website:

"The document contains extensive material that is exempt from disclosure under the Freedom of Information Act 2000. It should not be released under the Act without prior consultation with the NHS in South West London."

Even FOIs will not obtain the full range of information.

I am incredibly sad to say that the Conservatives do not join us in the wish for full information. Mike Penning declared in the debate of 8 February that he would not have put into the arena the information that we have, which I find shocking. On 24 February, after five hours of questioning the NHS, Liberal Democrat councillors at Kingston council moved a resolution. It said that since the panel was now aware of the first of the documents, the south-west London strategic plan, it called

"upon NHS London to publish this document immediately."

Every Conservative councillor present voted against that resolution. I am afraid that we are in a battle for information by ourselves.

The House will be interested to know that my Conservative opponent joined in a letter with my Labour opponent and the Green, all saying that our campaign had been invented and amounted to scaremongering. I envy the many others who have cross-party co-operation because that is what people in our area deserve and should have. I turn to the Government and ask them to provide the information so that our local people can be fully engaged and involved in absolutely key and critical decisions at a time when decisions should be flexible and are formulated. I also turn to the Conservatives and ask why they are singling out south-west London as place for which they do not demand information and why they will not join in the defence of the hospital, because it is time that they did, for the sake of all our constituents.

Photo of Emily Thornberry Emily Thornberry Labour, Islington South and Finsbury 6:12 pm, 9th March 2010

Let me begin by putting the issues in the context of Islington. We have clearly benefited hugely, with the tripled budget, from the Labour Government's investment in the health service. We have the best cancer unit in Britain in the world's oldest hospital, at Barts. We have new doctor surgeries and more money is spent on health per head in Islington than anywhere else.

We also have the fantastic University College London hospital. My family, I am afraid, know the hospital all too well. The last time I went to its A and E department, my 10-year-old shouted rather loudly, "Mummy, this is normally where we sit." The A and E was built for 60,000 people to go to, but now 100,000 people go there. I understand that the A and E at the Whittington hospital has had £32 million invested in it. The reason we have all this money spent in Islington is because we die too early. Although the death rate has declined over the last few years, it is still very marked indeed, as about 46 per cent. of Islington residents die prematurely.

We have done well, but we now hear that the NHS in Islington has, after a dance of seven veils, a plan to close the Whittington A and E and the maternity unit, to which we say, "But why?" We are told that it is because we are going to be £560 million short, to which we say, "Well, why? Where did you get that from? What are you talking about?" Frankly, we get very little response that makes any sense. We then say, "Is this because you are anticipating a Tory Government? Because do you know what? There hasn't even been an election yet. Who knows whether or not we are going to have to suffer a Conservative Government? Why are you making plans in anticipation of those sorts of cuts?"

There has been, and still is, a great campaign. It was launched in Islington and is led by local MPs. As my right hon. Friend Mr. Lammy said at a large meeting after a demonstration, saving the Whittington is one of the few things that unites Tottenham and Arsenal supporters. We have a great campaign, which has involved more than 10,000 people, half of whom were on the demonstration that marched up Holloway road last week. We have had packed public meetings, led by my hon. Friend Jeremy Corbyn. The Islington Tribune has provided crucial support to the campaign, as has the Islington Gazette.

Let me assure the Islington PCT that we mean business; we do not expect the A and E or the maternity unit in the Whittington hospital to close. If decisions are to be made locally, the PCT should listen to local people. If it wants a consultation, all it has to do is ask, and we will tell it to leave the Whittington alone. If it thinks otherwise, it will have a fight on its hands.

Photo of David Burrowes David Burrowes Shadow Minister (Justice) 6:15 pm, 9th March 2010

I am pleased to follow Emily Thornberry. We are part of the north central London sector, facing similar challenges from the 80 or so wise men and women who are determining the health care of the people in our areas.

We often say that our constituencies are unique and require special attention, and no more so than my constituency and Enfield more widely. Perhaps, however, that should not the case in this instance, as we are all concerned about secrecy and plans that are being meted out without proper public consultation or clinical input. In Enfield, we can peer into and go beyond the world of Darzi and see what the real world could be like. We are, in a sense, the leaders of the pack when it comes to health care for London. Plans were put in place three years ago, which in many ways have been mirrored across London, so let us peer in and see what has happened in Enfield.

A consultation took place. We hear a lot in documents about wide consultation, but it did not reach the doors of many of my constituents or, indeed, those of my hon. Friends the Members for Chipping Barnet (Mrs. Villiers) and for Broxbourne (Mr. Walker). The consultation was woeful and incomplete, leading to widespread concern and a lack of confidence. It gave a clue as to what the world would look like if the Darzi model were followed through, and people should be concerned. It is apparent that the call for a local-led solution was nowhere near the mark when it came to Enfield. This was a top-down model, prescribed from on high and greatly restricted in the options presented. It asked the questions to produce the answers that were wanted in order to justify the Secretary of State's decision in September 2008 to downgrade consultant-led A and E and maternity services.

Interestingly, if one had gone across the country at the time of the consultation, one would have seen a replica model of health care being followed through. The model had nothing to do with any particular input or variation in local need. There were similar campaigns on the Sussex coast-across Chichester and Worthing, for example. All the models were based on the same one that came from on high in Enfield.

The same has been said elsewhere. Sir George Alberti came in as the troubleshooter to fix the problem. He also recognised the lack of public engagement and expressed concerns about the need for clinical engagement. Crucially, he said there was a need for pump-priming and bridge funding for the PCTs to ensure that their primary care services were in place before any of the secondary care changes were made.

Was there a bright new dawn in Enfield, which others could welcome and then follow down the same road? In the cold light of day in 2010, we see a primary care trust that is still strapped for cash and facing a historic debt of some £25 million. It is still struggling to get within a double-digit figure for its current debt, while the area still struggles to get any decent primary care. The poly-systems are hardly in place across the borough and we are left with the Secretary of State's decision to downgrade consultant-led A and E and maternity services. We have had some clarity about the situation, so we know that we are left with a 12-hour urgent care centre and at best a 24-hour doctor-led primary care service at Chase Farm hospital.

As in Islington and elsewhere, we had a march, with thousands of people participating, and I was joined by my hon. Friends the Member for Broxbourne and for Chipping Barnet and by Mr. Love and Joan Ryan. We were all together, campaigning to ensure that we retained our consultant-led A and E and maternity services. Thousands of people signed petitions; the Conservative parliamentary candidate for Enfield, North, Nick de Bois, led the campaign, presented the petition and worked extremely hard.

What has happened to the campaign now? We have lost it. There has been a division. Conservative Members are full square behind the need to recognise that there should be consultant-led care, but the champagne has been popped, regrettably, by the right hon. Lady at the door of the A and E unit. What was the celebration? A downgrade of our services. It is not possible to sit on both sides of the barricades in this argument; it is necessary to stand full square behind the people of Enfield, who do not want a downgrade of our services.

What is the situation 18 months after the consultation? There is increasing demand, with more than 3,300 births at Chase Farm hospital and more than 100,000 attendances in A and E. My constituents-all our constituents-are asking why, given all the money that is going into the health service and given the rising demand, we are reducing access to accident and emergency services while increasing management of contracts and increasing waste. They want a new financial model and a new clinical model that would ensure that we look at the position again.

Photo of Charles Walker Charles Walker Conservative, Broxbourne

Why does my hon. Friend feel that the concerns of people in Broxbourne and Enfield have been ignored throughout the process?

Photo of David Burrowes David Burrowes Shadow Minister (Justice)

I think that in many ways the deal was done before the point of engagement was even reached. As other Conservative Members have pointed out, the decision had already been made. Models have been adopted, irrespective of the different clinical needs.

Eighteen months on, we are seeing not just a campaign on Chase Farm, but a prospect that is even worse, whether that is at the Whittington or elsewhere. The £500 million funding gap is raised, and there is the question of whether between one and three major acute hospitals-the North Middlesex or Barnet, for example-will retain a 24-hour A and E service. A document published by NHS London questions whether it would be safe for those local hospitals to retain their maternity units, despite the increasing birth rate and increasing demand.

The proposals are unacceptable, and it is clear that we should halt them, not for the purpose of political convenience but because of the need for proper financial and clinical models. The choice is clear: people can support Labour if they want the status quo-a continued hospital downgrade-or they can support the Conservatives if they want the security of change that is based on local and clinical need.

Photo of Tony McNulty Tony McNulty Labour, Harrow East 6:22 pm, 9th March 2010

Mr. Burrowes was doing so well until the end of his speech. This debate has to be slightly bigger than the ponderous party politics outlined by him then, and outlined earlier by Mr. Lansley. The notion that there is a land of milk and honey just waiting for the time when the hon. Member for South Cambridgeshire takes over is palpable nonsense, and the hon. Gentleman knows it.

A point made by the hon. Member for South Cambridgeshire went to the core of the matter. There is a dilemma between the local and the strategic in London, which has been woefully neglected since the inception of the national health service. I would say-of course I would, as a suburban Member of Parliament-that for too long everything has been sucked into the centre, courtesy of the fancy and precious London teaching hospitals, which admittedly are wonderful, and to the detriment of the suburbs. That dilemma has still not been resolved, and sadly it has not been and will not be resolved by Boris Johnson, as the hon. Member for South Cambridgeshire intimated.

On health as on a bunch of other things over the past two years, Johnson has done nothing of any consequence for public health or health in London. I stood here, or roughly here, in 1998, during the passage of the Bill that became the Greater London Authority Act 1999, and said that if in 10 years' time the Greater London assembly and the Mayor had not evolved enough to take a significant and direct role in the strategic health concerns of London, the Act would prove to be a failure. For all the glossy little documents that Boris Johnson has produced, he has, as I have said, done nothing of any consequence.

If we are honest in a cross-party context, we must agree that the dilemma is between the strategic and the local. I take the point made by the hon. Member for Enfield, Southgate, who lamented what had happened to Chase Farm. Chase Farm matters to me as well, because it is linked with Barnet, and if Barnet health authority decides to do things at either Chase Farm or Barnet there will be consequences for Edgware hospital, which is 10 yards away on the other side of the Edgware road.

Where does the local begin and where does it end? In January 1997 the Tories closed Edgware general hospital. They downgraded it, and left it with Barnet. It cannot be enough to make the local prevail over the strategic when people's health needs do not recognise borough boundaries in a nice convenient way.

Photo of Theresa Villiers Theresa Villiers Shadow Secretary of State for Transport

A few months ago the Secretary of State signed off the controversial downgrade of Chase Farm that was mentioned by my hon. Friend Mr. Burrowes, on the understanding, and on the basis of repeated promises, that Barnet would be upgraded to take the pressure and the extra patients. How can the right hon. Gentleman possibly justify the decision of NHS London to discuss downgrading Barnet after the promises made about Chase Farm?

Photo of Tony McNulty Tony McNulty Labour, Harrow East

The hon. Lady should listen. I am not justifying it at all. I am simply saying that what happens in one part of London has serious ramifications in another part of London that is apparently not particularly close to it.

The key question is "If not this, then what?" Does there need to be a strategy review and overhaul of what is going on in London? I think that everyone would answer "Yes", but anyone who answers "No" is living in the past, because the real world moves on. However, when it comes to the question of whether the bureaucracy has the capacity and is properly equipped to deal with such an overhaul, I hesitate. Let me give an example. When the maternity service at Northwick Park hospital was reconfigured 10 or 12 years ago, it could not have been known that more than half the cases presenting to the service would be in the high-risk category, because that particular part of the population was not there then.

Where are the flexibility and responsiveness that would make it possible to deal with the dynamics of what is going on in London? Local needs cannot just mean PCTs. Unlike Mr. Horam, who has represented about three dozen parties and four constituencies-he is not in Chamber at present-I do not argue that there should be far fewer PCTs. There should be co-operation between PCTs. I believe-and here again I agree with the hon. Member for South Cambridgeshire-that there are local dimensions in which public and preventive health should be provided all the more.

Over the past 20 or 30 years, a collective failure of public policy has meant that preventive medicine and primary care have not developed as they should have. Anyone who visits any other European country will find that most of the cases that present to A and E encounter nothing resembling the provision here, because people in such countries as Germany and Sweden are much more aware and much more educated.

If various different organisations such as trusts and PCTs are to deal with local health provision in this country, my one plea is that they should talk to each other. Apart from the Royal National Orthopaedic hospital, whose trust is separate from the PCT, there are no hospitals in my constituency. Edgware community hospital, 10 yards away on the other side of the Edgware road, is hugely important, but is run by Barnet. Just the other side of the Northwick Park roundabout is Northwick Park hospital, in the constituency of my hon. Friend Barry Gardiner, which is run by Brent. In the middle is Harrow PCT. At present the PCT is doing some very good work looking into the possibility of a polyclinic and the reconfiguration of GP services in the east of the borough, which is long overdue. Barnet, meanwhile, is considering what provision for Edgware community hospital should be over the next 10 years. Are they talking to each other? Not enough.

It is true that Northwick Park, to which my hon. Friend the Member for Brent, North will no doubt refer, has been given "stroke status"-if that is the right phrase-and is developing its acute facilities, while also dealing with serious financial consequences; but is it talking to Barnet about what will be provided at Edgware? Is it talking to Harrow PCT about the configuration of GPs in the east of Harrow? Can the three together come up with a solution that has a degree of synergy? That is almost sub-strategic, but it is certainly supra-local.

Simply talking about things being driven by local needs is bunkum. Simply talking-as I know Ministers are not-about things being driven top-down is equal bunkum. Where are the mechanisms that could get things right in the middle? I fear that they have not yet been developed. I think that the concern about sector-based and sometimes secretive solutions is partly due to the fact that no one in one part knows what those in the other part are doing. Of course there should be more openness, but there must also be a strategic review that takes local dimensions fully into account.

Photo of Andrew Pelling Andrew Pelling Independent, Croydon Central 6:29 pm, 9th March 2010

I am very mindful that others wish to speak, so I shall be brief. The Minister constantly refers to the way in which these are local initiatives, but it has been clear in the debates from the four quarters of London that a single blueprint is being pursued on these proposals. I have a great deal of admiration for the hon. Members for Kingston and Surbiton (Mr. Davey) and for Richmond Park (Susan Kramer) because of how they have ensured that this debate has the highest profile. However, I fear that we will pass round the black spot as it were, on this proposal because if they are successful in defending services at Kingston hospital, somewhere else in the sector will lose out. I have been impressed, in a way, with how NHS officials have spoken to me in dramatic terms, saying that I will kill or disable people if I oppose these proposals. However, I beg to differ, particularly as regards the impact on Croydon.

Croydon Members must remember that Croydon is a very ethnically diverse community and that more than 13 per cent. of our constituents are over 65, which is a higher proportion than the London average. We must remember that Croydon has a large black and minority ethnic community, which faces particular health issues to do with diabetes and stroke. Reference has been made to the concentration of stroke resources at St. George's hospital, which we campaigned against in Croydon. With this proposal we again face the prospect of the removal of a great deal of specialisms from hospitals such as Mayday university hospital. This sort of downgrading, which is also proposed for St. Helier and Kingston hospitals, means that that they will become "local" hospitals. In essence, this proposal will turn Mayday university hospital into what the Croydon general was: it will become, in effect, a place for respite and recovery. When I said that this is a bit like having a university where the research professors have been sent 10 miles down the road, I was told that I need not worry because the consultants would visit one day a week. That was not a terribly reassuring briefing to receive on how these things will work.

Obviously one must be cautious about what one discusses in terms of the secret documents that we were allowed to see. The document given to me and to the Liberal Democrat Members in south-west London shows clearly a proposal whereby

"58 per cent. of A and E activity" would be moved from hospitals in south-west London. That, along with the ambition to move more than 60 per cent. of current hospital out-patient appointments and the other drawing of patients away from GP surgeries into polyclinics, is disturbing.

I wish to conclude by giving an example of how difficult it will be to deliver on some of the savings that are in this secret document. We are talking about savings of about 33 per cent. I am concerned that an incoming Government, desperate to deliver financial savings in a Budget proposed within 50 days, might reach for this document and say, "Yes, we can deliver." That delivery will not happen, and I shall give hon. Members the Croydon example to show why.

Croydon has two polyclinics, one of which is to be found in the constituency of Richard Ottaway. He has been vehement in expressing his concern about the redevelopment of Purley hospital, which was promised in 2001. He raised the issue again and received reassurances from the Conservative Front-Bench team about it today. It has taken eight or nine years to get nowhere on that hospital, and that is an example of how polyclinic savings will not be delivered, because the place has just not been built yet. As for my constituency, people will have to go to a polyclinic in the centre of Croydon, sited on a slip road off a flyover. Let us try to imagine people having to go there in an emergency. They are not going to go on a bus. It will not be easy to deliver a baby on a slip road off a flyover. If there is a prospect of people being able to park, they will be competing in a town centre with residents who are already desperately competing for parking spaces. These are practical examples of how NHS officials-people who are making the decisions, and not democratically-have no understanding or sense of the real practicality of delivery.

The final point I wish to make-I apologise to hon. Members for taking my allocated six minutes-is that this decision should be made during the general election campaign; it should not be postponed in the way that the Conservative motion surprisingly suggested or in the way in which the Labour Government and NHS officials wish. This decision should be made during a general election-when patients have real influence on the debate and on the decisions that will be made-rather than their being made by faceless NHS officials.

Photo of Barry Gardiner Barry Gardiner Labour, Brent North 6:34 pm, 9th March 2010

In international women's week, I wish to pay tribute to all the women who work in our health service, from chief executives and chairs of trusts, to nurses, porters, physiotherapists, catering staff, cleaning staff, consultants, doctors, midwives and, above all, health visitors. The overwhelming majority of health visitors are women, because that is a profession that, above all, requires common sense. How many times throughout the world have women turned to their families after some apparent crisis and said, "At least we've got our health"?

Our physical and mental health is the bedrock of all that we do and all that we are. As an MP, I therefore take a fundamental interest in and fundamental responsibility for the quality of health care services that my constituents enjoy. My interest must be not just in outputs-how much money or resources the Government make available-but in outcomes such as mortality rates, quality of care and speed of treatment. I must also bear responsibility, not for individual cases but for the configuration of services, their proper resourcing and the proper benchmarking and monitoring of delivery.

Northwick Park hospital and St. Mark's hospital fall inside my constituency and, together with Central Middlesex hospital, which lies in the constituency of my neighbour, my hon. Friend Ms Butler, form the North West London Hospitals NHS Trust, which serves most people in Brent and Harrow. I am proud to say that it is the only trust assessed as "excellent" for the quality of its services in outer north-west London. Last summer, I was delighted that the trust was designated as one of only eight hyper acute stroke units for London. We have all seen the excellent public services adverts about FAST-Face, Arms, Speech, Time. I congratulate the trust on its success in winning this key unit, which is part of a scheme projected to save 500 lives a year across London. Although I was delighted by the announcement, may I advise the Secretary of State that I will be even more delighted when the Northwick Park hospital's trust is announced as one of the major acute hospitals for the sector, thus upgrading it still further? I trust that such an announcement may come later this year.

While discussing major acute trusts, I must comment on the intervention by Mr. Hands, who is no longer in his place. He suggested that five accident and emergency departments would close at the eight north-west London hospitals. The "Healthcare for London" report actually talked of creating three major acute trusts. He has interpreted that to mean that three hospitals would stay the same and five would lose their accident and emergency departments, whereas in fact the strategic health authority has confirmed that all five will keep their existing accident and emergency departments, but three are due to be upgraded into what will, in effect, be super-providers. I trust that Opposition Members will now stop portraying as a cut what is in fact a proposed upgrade.

There are three key milestones for the Northwick Park hospital's trust. The first is dealing with the hospital's historic debt of £21.5 million. That will take place over the next two months when the primary care trusts across London meet to agree their support for wiping out that debt. The second is the public consultation on the future configuration of the sector this autumn. The third is the support from NHS London to embark on a hospital rebuild.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Just so that the hon. Gentleman does not misrepresent what is in the north-west London sector document, I should say that page 54 makes it clear that the local hospitals-those that are not designated as major acute hospitals-will include a

"GP led Urgent Care service."

Contrary to what is said in the NHS London document, the north-west London document does not promise local hospitals a continuing emergency department.

Photo of Barry Gardiner Barry Gardiner Labour, Brent North

I do not know whether the hon. Gentleman has had the benefit of speaking both to the chief executives of the hospitals and to Ruth Carnall from the strategic health authority. He would find that she has confirmed that there are no plans to take away the accident and emergency departments from those hospitals.

I turn now to my local primary care trust, NHS Brent. Four years ago, I was extremely critical of Brent PCT and was in part responsible for initiating the turnaround plan. Today, NHS Brent is one of the two fastest improving PCTs in the country based on the Care Quality Commission performance ratings for 2008-09. It is a borough that recalls 19-hour waits on trolleys in A and E under the Conservatives, and it is meeting its targets on four-hour waiting lists. In particular, it has exceeded the 93 per cent. target for cancer waits of no longer than 14 days. Critically, this is about not only improved targets, but lives saved: mortality-not only for cancer but for cardiovascular disease- has vastly improved.

All mortality has improved from 87 per 100,000 only two years ago to 79 per 100,000 now. Health inequality lies at the heart of this debate, and in the south of Brent, in Stonebridge ward, the average life expectancy is almost 10 years less than that in some of the more affluent wards that I represent in Brent, North.

Photo of Steve Pound Steve Pound Labour, Ealing North

On that point, my elder brother was born two years before the national health service and he died as a child. The next brother died. I was born in the same week as the national health service and I am still here. However, the key point is surely that there is confusion in the national health service. Doctors and clinicians feel that they are not being given the space to breathe and to do what they do best. Does my hon. Friend agree that there seems to be a disconnect between the public affection, respect and need for the national health service and this strategic exercise that is not being connected up at the moment?

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. Before Barry Gardiner continues-and I ask him to keep an eye on the time-may I say to the hon. Lady and hon. Gentleman below the Gangway that they should not be reading newspapers in the Chamber?

Photo of Barry Gardiner Barry Gardiner Labour, Brent North

My hon. Friend Stephen Pound made his point in a characteristically robust fashion.

I want to focus on health inequality, and it is clear that one of the best ways of addressing health inequality is through increasing physical activity, particularly in the young. I urge the Department of Health to invest far more than it has in the past. It has already begun to work in this area and the Change4Life campaign that the Department has been running is extremely productive in this respect. I believe that much more must be done in co-operation with the fitness industry and with sports providers throughout the capital to ensure that we not only address the problems of obesity in the young but set up a platform for fitness throughout life that will help to address health inequalities as a whole.

Photo of Clive Efford Clive Efford Labour, Eltham

On a point of order, Mr. Deputy Speaker. In response to the rebuke that you just gave to me, I want to tell you that I was reading something that had just been pointed out to me. The Evening Standard seems to have a report on today's debate that is in the past tense in a newspaper that was printed before the debate took place.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

I merely say to the hon. Gentleman that it is a convention of the House that Members do not read books or newspapers while a debate is taking place. There are other places- [ Interruption. ] Order. There are other places in which that can be done.

Photo of Justine Greening Justine Greening Shadow Minister (Communities and Local Government), Vice-Chair (Youth), Conservative Party 6:43 pm, 9th March 2010

I am sure that many people watching the debate will think that that time could have been better spent focused on what Members from all parties were saying. Indeed, as we have heard over the past few hours, concern has been expressed from both sides of the House about the process that is unfolding and about how our NHS services in London will be reconfigured over the coming months unless we halt this process. I hope that tonight's debate has given Ministers some cause for concern, because residents across London are absolutely furious that they are not being involved in this process in the way that they want to be.

We all know that London is a diverse and vibrant city. Residents are very mobile. Migration and demographic patterns mean that we have an every-changing population. That is a key part of London's identity, but we know that when it comes to providing health care in the capital, it means that we face some unique challenges. Even the Minister of State, Department of Health, Mr. O'Brien, when he was introducing the debate on behalf of the Government, admitted that Londoners put up with a worse health service than other parts of the country, in spite of the tireless work of NHS staff in our primary care trusts, GP surgeries and hospitals.

I hope that at the end of this debate Ministers will address some of the concerns that have been raised. Although in London we have some of the best hospitals in the country-and, indeed, even in the world-we also have, as we have heard, some of the worst health outcomes, with stroke, heart disease and cancer being particular causes of concern.

Health inequalities in London are complex. The London poverty profile shows that three quarters of the London boroughs with the highest rates of premature death are in inner London. The risk of premature death in Newham and Lambeth is 250 per 100,000 people, which is twice that in Kensington and Chelsea. There are also unequal levels of long-term illness, with east London disproportionately affected. The last census revealed that 15 per cent. of adults in Islington, Hackney, Newham and Barking and Dagenham suffered a long-standing illness-twice the level of such illness in Richmond and Kingston. It is perhaps no wonder that some of the Members representing those constituencies have taken the opportunity to flag up their concerns about the changes in health care provision that could be coming down the track for their constituents.

What have we had in response to that complex series of health care needs? We have a city-wide strategy from NHS London and now, as we have heard today, some specific plans are being worked up, apparently behind closed doors, by individual so-called NHS sectors. NHS London has predicted that its funding shortfall by 2017 could be £5 billion. On the back of that assessment have come some serious unfolding plans to reorganise services, shifting care away from acute hospital provision to community services and centralisation of specialist services.

Those far-reaching changes have raised the prospect that behind closed doors we could have plans for some of London's hospitals to be downgraded and even closed down. In all the proposals that seem to be being worked up, it is interesting to see that there does not seem to be much mention of the fact that management costs in the NHS have skyrocketed. There does not seem to be much mention of the fact that 15 per cent. of the estates owned by the NHS in London are either unoccupied or underutilised. I know that from personal experience, as the Putney hospital site in my constituency has been derelict for the past decade. The local primary care trust apparently has no ability to bring it into use for our local health care provision.

Photo of Edward Davey Edward Davey Shadow Secretary of State (Foreign Affairs)

I am grateful to the hon. Lady for giving way and I agree with an awful lot that she is saying. Will she say a little more about the Conservative motion, however? She calls for the reconfiguration to be postponed

"until a more effective public consultation is in place".

How would her public consultation differ from that proposed by the Government, which is due to start in some sectors of London around the autumn?

Photo of Justine Greening Justine Greening Shadow Minister (Communities and Local Government), Vice-Chair (Youth), Conservative Party

I think it would have a number of important differences. First, it would be led at a local level by GPs. The Minister has said that clinicians are discussing it among themselves, but we think that that is not good enough. Of course clinicians need to be involved, but so do GPs and, critically-this has come across in every speech made tonight-so do the public. People feel like they are going to be presented with a fait accompli when they have had no opportunity for input at an early stage. That is why we have had the debate today-to start a proper debate that the public can be part of. If Ministers ignore that, they will be going down a very dangerous route.

Serious questions have been raised today about the reliability of the funding projections on which the reorganisation is based. The assumptions are questionable -they have even been questioned by the work of the King's Fund, for example, which seems to undermine whether the assumptions we have will actually work. Above all, it seems to be a financially driven process. We need a careful, considered assessment of London's health care needs and of how they will change over the coming years.

In particular, we have heard concerns about the fact that we will see patients transferred to community services when those services, or polysystems, as they are being called-more impenetrable language that the public can never understand-are not even necessarily in place. That is a real concern. We heard the concerns expressed by my hon. Friend Mr. Burrowes about what has happened in his constituency, which flag up that we are right to be concerned.

I shall make progress, because I know that the Minister will want to answer some of the concerns that have been raised tonight. Of course, the other issue that has emerged is, as has just been mentioned by Mr. Davey, that the approach has been secretive. We have all urged our local NHS providers to be transparent with the public about the process. Whatever the Minister says, it is not being driven locally-it does not even seem to be driven clinically. The public seem to have no access to the debate that is going on in the inner recesses of the NHS, and they are deeply concerned about that. We need a different approach that is rooted in local communities and that involves GPs, clinicians and, critically, the public.

The conclusion to the debate must be that the current process has been discredited and should therefore be halted. The assumptions regarding the solutions that have been worked up about moving services into the community are flawed financially, the focus is apparently on cutting front-line services rather than on challenging the massive growth of bureaucracy in the NHS that has occurred under Labour, and the public have no involvement in the process at the very time when they should be central to it. That simply is not good enough. As we have heard, there is simply no transparency. I take this opportunity to urge NHS London to start being transparent and to start communicating with the public on the ground in the communities who are so worried about what is going on. Instead, the Minister has tried to justify the process when he should be challenging it. There has almost been unanimity across the Chamber regarding our concerns about this process. I conclude by saying that we all have a chance tonight to represent those concerns on behalf of our constituents. If we do not take that chance, I am sure that our constituents will represent their own concerns about this issue at the ballot box.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health 6:51 pm, 9th March 2010

First, let me say what a pleasure it is to be part of the debate with Justine Greening this evening. The case for change in London is undeniable. When Lord Darzi started the process of reviewing the NHS in the capital, London was consistently rated as the worst of the 10 strategic health authorities. Its rates were among the worst for mortality, waiting times, quality measures and patient experience. It is impossible to argue that that was an acceptable state of affairs.

Much has been said about inequality in health tonight, particularly by the Conservative party. That is pleasing because I believe that until Labour came into government in 1997, the words "inequality in health" were not allowed to be uttered in the Department of Health. Londoners deserve, at the very least, the same chances and the same level of care and treatment that their family and friends in other parts of the country receive. That is what Healthcare for London is about.

The massive task of turning health care in London around is not led by politicians in Westminster, the Government or civil servants in Whitehall. It is all run by clinicians-doctors, nurses and other dedicated health care professionals on the ground-in close consultation with the communities they serve. The Healthcare for London framework for action was developed in response to that, and the case for change and the recommendations for responding to it were accepted by the public. Primary care trusts consulted on the case for change and received more than 5,000 responses. We had about 40,000 visitors in all to the website and to meetings and roadshows. The public were clearly in favour of our making a set of changes built on considerations of quality, safety, outcomes and patient experience. A joint London overview and scrutiny committee that represented all 33 boroughs was formed, and it agreed the proposals with recourse to the Secretary of State referral. That gives the proposals local legitimacy and means that we can be held to account for their delivery.

Photo of Clive Efford Clive Efford Labour, Eltham

I am grateful to my hon. Friend for setting out how the consultation took place. She, like me, will have worn out her shoes campaigning against many Tory cuts in the NHS. It is worth reminding the House that in the period between 1979 and 1997, 10 hospitals were closed in Greenwich. In comparison, a brand new community hospital is being opened in the heart of my constituency in 2011.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

That has also to do with the calibre of the MP and what they can bring to an area. Certainly, when I worked in the health service under the Conservative party, Barney Hayhoe, who is now a Lord, was a Health Minister, but one thing that he could not have been accused of was selfishly looking after his own constituency's health needs. I spent most of my time working in a crumbling old workhouse.

All the decisions that have been, are and will be made must be based on hard evidence and what works in the best interests of the patient. The objective of all the changes is simple-to save thousands of lives.

Photo of Andrew Slaughter Andrew Slaughter Labour, Ealing, Acton and Shepherd's Bush

After five years, my constituents are fed up with Tory smears that my local hospital will be closed or downgraded or that it will lose vital services. In fact, it is expanding and improving under Imperial College Healthcare NHS Trust. At the risk of trying my hon. Friend's patience, I ask her to confirm again that there are no plans to close the A and E at Charing Cross, Hammersmith or St. Mary's hospitals.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

I can give that assurance to my hon. Friend. There is no case for that at all.

Photo of Mike Gapes Mike Gapes Chair, Foreign Affairs Committee

My hon. Friend will know that I tabled an amendment, which was not selected, asking the Secretary of State to refer to independent review the proposal for reconfiguration in outer north-east London. Will she arrange an urgent meeting between me and her ministerial colleagues to discuss that proposal, which is supported by my local authority, the London borough of Redbridge and by Mr. Scott?

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

I assure my hon. Friend that that meeting can be arranged and that that consultation with us can, of course, take place.

Photo of Andrew Dismore Andrew Dismore Labour, Hendon

The Minister of State, Department of Health, made it pretty clear earlier that Whittington A and E department is safe. Will my hon. Friend make the same pledge regarding the Royal Free?

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

All the proposals are being considered clinically and in the appropriate way. [Hon. Members: "Ah!"] Opposition Members must not read anything into that. Their scaremongering is at its height in tonight's debate, but we will not take any more scaremongering this evening.

Many of the polyclinics that have been set up, including the Heart of Hounslow clinic in my constituency and another in Hammersmith and Fulham, are making a huge difference to what takes place in A and E departments. London's A and E departments are used and sometimes abused differently than those in the rest of the country. The way forward is to bring primary care into polyclinics- [ Interruption. ]

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. The debate is in danger of disintegrating. The Minister is replying to a debate in which a great many hon. Members have taken part. They are entitled to hear her reply, and I should like the debate to be finished in good order, as there is another debate to follow in which a great many hon. Members seek to take part.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

Thank you, Mr. Deputy Speaker. We must always consider the evidence, and the evidence shows that patients will receive better outcomes when they are treated in specific hospitals that have a high volume of particular clinical work. The changes are about patients being seen by the right people in the right place with the right equipment at the right time. Some difficult and sensitive issues have been touched on in the debate, and we are sensitive to the views of colleagues and their constituents on these matters-particularly to the wisdom that has been shown by my right hon. Friend Frank Dobson regarding the way in which all such consultations should be conducted-because the outcome is about safer patient care.

We must remain focused on the fundamental aims of the changes, which are to improve health care in London. The changes will save thousands of lives, will improve health outcomes in relation to major diseases such as cancer, heart disease and stroke, and will improve the overall quality of other health services to reduce disability and prevent pressure from being placed on our acute hospitals. Change is necessary to improve services, and we cannot and must not back away from the problems. Ministers have made it clear tonight that any changes in London must follow an agreed set of principles.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall

Given the needs of the unique and diverse communities in the area around Ealing hospital, can the Minister assure me that the hospital's A and E department will not be closed?

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

There are no proposals to close the A and E department at Ealing.

Change must always be to the benefit of patients. It must improve the quality of care that patients receive, in terms of clinical outcomes, experience and safety. Change must be clinically driven. We will ensure that it is to the benefit of patients by making sure that it is always led by clinicians, and based on the best available clinical evidence.

All change must be locally led. Meeting the challenge of being a universal service means that the NHS must meet the different needs of everyone. However, universal is not the same as uniform: different places have different and changing needs, and local needs are best met by local solutions.

I believe that MPs and Ministers are right to protest in their local areas if they feel the need to. As to marches, we on this side of the House are very good at marching, because we have had years of experience of marching to save our NHS. A local decision will involve the local MP, and he or she may be a Minister.

The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively. We are clear that any changes have to meet those requirements. If they do not, the powers exist to refer them to the independent reconfiguration panel.

Yes, we need to change to save lives. If we are honest, however, Governments for too long have backed away from the tough decisions needed to tackle these issues. I worked-

Photo of Andrew Robathan Andrew Robathan Opposition Deputy Chief Whip (Commons)

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put ac cordingly (Standing Order No. 31 (2)), That the original words stand part of the Question.

The House divided: Ayes 214, Noes 284.

Division number 104 Opposition Day — [5th Allotted Day] — Health Care in London

Aye: 214 MPs

No: 284 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Question accordingly negatived.

Question put forthwith (Standing Order No. 31(2)) , That the proposed words be there added.

Question agreed to.

The Deputy Speaker declared the man Question, as amended, to be agreed to (Standing Order No. 31(2)).

Resolved,

That this House recognises that there are health inequalities, particularly around heart disease, stroke and cancer, to be addressed in London; agrees that there is a need to build stronger organisations which are clinically and financially sustainable and provide the best service to their local populations; recognises the importance of the work by Lord Darzi and over 200 clinicians who undertook the Healthcare for London review, which was widely supported and consulted on in London; recognises that trusts have worked closely with their local communities to communicate the aims of the programme; further recognises that lives will be saved because the NHS in London, supported by public consultation and following review and scrutiny by local and pan-London Health Overview and Scrutiny Committees, has agreed to implement new stroke and trauma networks surrounding world-leading major trauma centres and hyper-acute stroke units to ensure that patients receive high quality and innovative care in centres of excellence, expected to save approximately 500 lives a year; acknowledges that there have already been improvements in cardiac outcomes; notes that there must be no further changes to accident and emergency or obstetrics departments unless and until improved access to new services is available and that any changes must be subject to full and formal public consultation; and further notes that the Government is preparing robust planning systems to ensure that NHS London is fully prepared to meet the challenges posed by the London 2012 Olympic Games.