Part of the debate – in the House of Commons at 4:36 pm on 12th December 2013.
I thank the hon. Lady for her intervention, and I am glad that we have established some consensus on that point She is probably aware that I know her area quite well, having lived there for quite a few years before I moved to London.
All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents. We have put patients, carers and local communities at the heart of the NHS, by shifting decision making as close as possible to individual patients, devolving power to professionals and providers, who also have patient care, safety and sustainable service at the core of their public service commitment, and liberating them from top-down control.
The principles are enshrined in the four reconfiguration tests. I am sure the hon. Lady knows them well, but for the record they are support from GP commissioners; strengthened public and patient engagements; clarity on the clinical evidence base; and support for patient choice. Those are the tests against which any reconfiguration needs to be judged.
A and E is obviously very topical at the moment. The NHS is seeing increasing pressure on A and E services, but is generally coping well. I am sure that that is the case with the hon. Lady’s local hospital as well. We are meeting our four-hour A and E standard at the moment. It is the 32nd consecutive week the standard has been met. We are determined to do everything we can for the NHS to continue providing high-quality care. She will know of some of the extra moneys that we have allocated—I think it is £2.3 million for Calderdale and Huddersfield—for winter pressures. That does not allow us to escape the fact that there are longer-term challenges, and these have been acknowledged across the House. One million more patients have gone to A and E in the past three years, and there are the pressures of an ageing population. We, across the House, have to address those long-term challenges, and the Government are trying to focus on some of the underlying causes, whether by having named GPs for the over-75s or changes to GP contracts; or, in public health, helping people to manage long-term conditions and to live well for longer; or the £3.8 billion allocated to help to integrate health and social care, because we recognise how vital that process is. All those measures are about addressing the underlying drivers of pressure on A and E and pressure on our health service and looking at how we can make it sustainable in the longer term.
We have recently had an excellent review from Sir Bruce Keogh that looked at urgent and emergency care. It also looked at demands on services and how the NHS should respond. We asked for that review because of the determination not to sidestep the problem of growing pressure on A and E but to deal long term with a problem that has been building for decades. Too many sticking plasters have been applied in the past to get through a year or two. That is why we need to clarify to the public how we are planning to shape those services for the longer term and where they will be delivered.
Most of the current reconfiguration projects are in line with the Keogh report’s principles as an overall direction of travel. We have been clear about that for some time. All local health economies that are undergoing reconfiguration have to pay close heed to the direction of travel set out in the Keogh report, the essence of which was that this is about services, people and co-ordination. It is not just about the bricks and mortar; it is about getting the right care to people at the right time, and flexibility and the co-ordination of services are just as important as how they are geographically configured, and that was the message from the Keogh review.
Let me turn to the hon. Lady’s local area. She said that people want good quality health care rooted in the local area. That is exactly what is at the heart of the review that is being undertaken. As I have outlined, the configuration of local health services is a matter for the local NHS, for the very good reasons I have given. It cannot be dictated from Whitehall. Locally, I understand that the review is considering health and social care services with the point about ensuring that patients continue to receive high-quality and sustainable services at its heart. The work includes considering how best emergency care services and other acute services can be delivered, and in an intervention my hon. Friend the Member for Calder Valley touched on some of the ways that can be done differently and in a more imaginative and responsive way.
No decisions have been made at the moment, and of course any plans for major service change that emerge from the review would be subject to formal public consultation. Public consultation have to be real and robust. Commissioners know that, and at all stages of the process I would expect Members to be involved, as well as local government. At this stage, the commissioners have not brought forward plans for consultation, but they will need to be assured that any proposals they make for reconfiguration and change will meet the strengthened tests I mentioned earlier.
At the heart of all this is the need to serve local people better. I understand from some of the early engagement work, in which thousands of local people were involved, that the message was that people want quality and access. Those are the two key messages that came through and that are the forefront of people’s minds. They want quality services and they want access to them at the right time. The trust has, I believe, identified a need to co-locate acute services to maximise the potential of its work force, to ensure that services are safe and to deliver the best outcomes for patients for a long time.
The trust is taking on board a range of views as part of the review. I know that the hon. Lady has met local NHS leaders, as have my hon. Friend and other interested local parties. That will include external independent clinical opinion on how best to deliver emergency care, such as that given by the Keogh review. I stress again that the process is locally driven, and I encourage interested hon. Members to continue to engage with the process and to work with the local NHS as it develops those plans. The NHS is one of the world’s greatest institutions, so ensuring that it is sustainable and serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. Those decisions are taken for a reason: good-quality care and access to it are at the heart of this.
As the hon. Lady has acknowledged, sometimes things change over time. The pressures change, as do the way we respond to them and what we know about how we respond to them. For example, we know that more than 30% of people who go to A and E—in some places, it is more in the order of 50%—do not even need to be there. That is not sustainable in the long term and we need to address it, but those decisions are best made when the NHS is working in collaboration with local people, with local democratic representatives and with local authorities and considering what is best for the people of their area.
May I take this opportunity before I close to place on record my thanks to the hard-working NHS staff of Calderdale for the service they give to the people of that area and to the hon. Lady’s constituents? I hope very much that they have a good Christmas in the sense that they have as few people as possible in A and E who do not need to be in A and E over Christmas, because I know it is a difficult and challenging time for NHS staff, but we are all grateful for what they do for all of us.
Question put and agreed to.