I am grateful for the opportunity to hold this debate today, Dr McCrea, and I am very pleased that other hon. Members are here in Westminster Hall to take part in it.
In the two and a half years that I have been the MP for Lewisham East, I have not known an issue to cause as much anger and concern as the proposals that are currently on the table to close the A and E department and the maternity department at Lewisham hospital. I know from my colleagues, my right hon. Friend Dame Joan Ruddock and my hon. Friend Jim Dowd, that in the 20 or so years that they have served the people of Lewisham, they too have not witnessed such outrage and disbelief over an issue.
Lewisham is not the only place in south London where emergency and maternity services are under threat. There has been a long-running dispute about the future of St Helier hospital, and of course changes at any hospital will always impact on neighbouring areas. Patients displaced by the closure of one unit have to go elsewhere. Children who are hurt and elderly people who have had a bad fall do not disappear into thin air; they still need treatment. Mums-to-be still need somewhere to give birth. It is not possible to close and A and E department that sees 115,000 people a year and axe a maternity department in which more than 4,000 babies are born each year and not to expect other hospitals to feel the impact.
This issue affects not only Lewisham but people across south London. The real problem is that there is no free capacity in the other hospitals close by to deal with the demand for hospital services that will be displaced.
I am grateful to the hon. Lady for giving way, and I congratulate her on securing this debate. She is making a very good point about the adverse effect that closing Lewisham hospital will have on neighbouring areas as well, especially, of course, with Queen Mary’s hospital also shutting both its A and E department and its maternity services.
Does the hon. Lady accept that the closure of Lewisham hospital will also have an impact on my constituency, including at Darent Valley hospital, with people seeking out A and E treatment or maternity services? In a hospital such as Darent Valley that already has its own capacity issues, there will be serious repercussions from closing Lewisham hospital—not only for the area that the hon. Lady represents but far beyond.
I very much agree with the hon. Gentleman, and I think that there will be a ripple effect across the whole of south-east London and beyond if the A and E department and maternity services at Lewisham hospital close.
I thank my hon. Friend for giving way and I join Gareth Johnson in congratulating her on securing this debate.
On the impact on neighbouring hospitals, my hon. Friend will be aware of the importance—not only to local people but to London as a whole—of King’s College hospital. Is she also aware that the effective closing of maternity and A and E services at Lewisham hospital will hit like a tidal wave at King’s College hospital, because of the numbers of people involved. The health service estimate is that the number of people at King’s College A and E will increase by 45%. The staff at King’s College A and E do a very good job, but they will not be able to cope with a 45% increase in patients. The additional emergency admissions from that increased number of people at A and E will create such a strain on in-patient beds that the proposal is that in-patients—non-emergency admissions—will have to be shipped off to Farnborough hospital, which is an hour away on a bus and a train from Camberwell.
As for maternity services, the situation is even more pronounced, with a 54% increase envisaged in the number of women giving birth at King’s College hospital. The staff there simply cannot cope with that increase. At the moment, many women are turned away and told to go—guess where?—to Lewisham hospital.
Ms Harman will know that interventions must be short. Certainly, however, the point she makes is well made.
My right hon. and learned friend encapsulates the issues in relation to King’s College hospital perfectly.
The fact of the matter is that millions of pounds will have to be spent at neighbouring hospitals to enable them to do the job that doctors and nurses at Lewisham hospital are already doing very well. Roughly £200 million has to be spent on making those changes happen, and that is not to mention the £12 million that has just been spent on Lewisham hospital’s A and E department.
In my view, this process is sheer madness. I do not think that there is any guarantee that money will be spent in the right places. If the predictions about where people will go after the closure of the A and E department and maternity department at Lewisham hospital are not right, we will end up spending money on the wrong hospitals. That could result in complete chaos. I cannot see the sense in the proposal, and neither can thousands upon thousands of people in south-east London.
The proposed closure of Lewisham’s A and E department and maternity department would also mean that two thirds of the building and land at Lewisham hospital would be sold off. These plans were hidden in an appendix to the initial proposals document, which was first published at the end of October last year.
I cannot overstate the opposition to these plans. More than 40,000 people have signed a petition against the closures; not one Lewisham GP is in favour of the changes; and the chair of the local commissioning group is also opposed to them. Put simply, these changes are unwanted.
I thank the hon. Lady for giving way, and I will make a short intervention, Dr McCrea, so that I do not get a finger-wagging from you. Frankly, GPs should be in support of these changes; support from GPs is one of the conditions that is a requirement for such changes. If they are not in support of these changes in Lewisham, that is a big problem.
The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.
I am most grateful to my hon. Friend for giving way, and I join others in congratulating her on securing this extremely timely debate. She said a few moments ago that she did not understand where this plan had come from. Has she considered that it is merely a rehash of the scheme that NHS London tried to get past the “Picture of Health” review four or five years ago but failed miserably, both in the review itself and in the subsequent re-examination by Professor Sir George Alberti, and that in its death throes—NHS London only has a few months before it is extinguished by this Government—it is trying to get through the scheme to reduce hospitals in south London from five to four, and for no other reason than that it thinks that that reduction should happen?
My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.
Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.
The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.
As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.
Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.
The statutory guidance to trust special administrators and the written statement that the former Health Secretary, Mr Lansley, made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.
I congratulate my hon. Friend on securing a debate on the hospital, which my constituents share with hers. When I brought the current Secretary of State for Health to the House to answer an urgent question, he seemed to imply that, in fact, reconfiguration is a major consideration. He said that giving details at that stage
“would prejudice my duty to consider the recommendations with care and reach a decision…I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister…with respect to any major reconfigurations”.—[Hansard, 8 January 2013; Vol. 556, c. 169.]
“I specifically promised…there should be no closures or reorganisations unless they had support from the GP commissioners, unless there was proper public and patient engagement and unless there was an evidence base.”—[Hansard, 9 January 2013; Vol. 556, c. 313-14.]
My hon. Friend will agree that none of those tests is met in the trust special administrator’s proposals.
The thing that really sticks in my throat about the proposals to shut Lewisham’s A and E and maternity departments is that they are fundamentally driven by money. If we start by saying that a process is being set up to sort out the financial woes of part of the NHS, how can people ever have any confidence that the clinical input and so-called clinical evidence that come later have not just been moulded to suit the accountants’ bottom line, which was there from the off?
I appreciate that there are financial pressures in the NHS, and I accept that it cannot be preserved in aspic for ever. For example, I support the recent changes to the way in which emergency care in London is provided for major trauma, heart attacks and stroke. However, where is the evidence that the changes on the table will result in more lives being saved and better health care overall?
That brings me to my second main point: the changes are not only unwanted and unfair but unsafe. It is proposed to replace the A and E at Lewisham with an urgent care centre. Initially, the special administrator told us that the centre would see 77% of the people who currently go to the A and E. In his final report, that was revised down to 50%. Based on an analysis of their case load, doctors at Lewisham suggest that the figure would be closer to 30%, so who is right? GPs in Lewisham, including the chair of the clinical commissioning group, suggest that the number of people who would go to an urgent care centre at Lewisham has been overestimated. They suggest that they would be inclined to send people to hospitals where they knew specialist opinion was available.
If I was a mum and my five-year-old woke up in the middle of the night in dreadful pain, where would I go? Would I go to a place that I was not sure had the appropriate staff and equipment to deal with my son or daughter, or would I go to an all-singing, all-dancing unit in central London or at King’s? I am not a mum, but I know where I would go. If people do not use the urgent care centre, the extra demands placed on neighbouring A and Es will exceed the numbers forecast in the plans before the Health Secretary. Ultimately, there may not be enough capacity elsewhere for people to be seen and to be seen quickly.
I should add to that the heroic assumptions in the proposals about reducing the need for acute care in the first place. I am all for tackling the reasons why so many people turn up at hospitals, but I know how hard it is to change people’s behaviour and to organise adequate community-based care to reduce the need for acute admissions.
One hallmark of the work at Lewisham hospital is that extremely important steps have been taken to integrate with community care. That is relevant for the elderly, who may have to be admitted for a short time before going back into the community, and for the young people with mental health problems, who need there to be integration between those who see them when they have an episode and those who receive them back into the community. All that will be lost if the proposals go ahead.
My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.
I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.
When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.
Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.
I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.
More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.
Does the hon. Lady agree that the Government do not want anything at all at this stage, and that the Secretary of State has not made, and will not make, a decision until
I acknowledge that a decision has yet to be taken, and I take this opportunity to press the Minister to confirm that the decision will be taken on
My hon. Friend has been making a powerful case. I want to pick up on the Minister’s interjection to the effect that no decision has yet been made and to reinforce my hon. Friend’s point that if changes as fundamental as those proposed in the trust special administrator’s report are introduced but are not safe and do not have clinicians’ true support, we run the risk of repeating the very mistakes of the last reconfiguration, which created South London Healthcare NHS Trust, and which proved not to be as financially sound as was expected when it was proposed. That is a real risk, and I hope that the Minister will pay attention to it.
My right hon. Friend has consistently made that point in the House, and I totally agree.
It is a fact that maternity services in south London are under enormous pressure. In the 20 months between April 2011 and November 2012 providers of maternity services across south-east London suspended services on 37 occasions. Women in labour were therefore turned away from hospitals and told that they would have to go elsewhere. Of those 37 suspensions, 26 were necessary because of lack of beds. King’s College hospital also tried to suspend services on a further six occasions, but was unable to do so as no other unit had capacity to accept the women it was trying to transfer.
As the father of six children, I can tell the House from experience that nothing is more upsetting for a lady who is about to give birth than being shipped around when she tries to get into hospital. That is deeply upsetting to someone at such a fraught time in their life.
The hon. Gentleman makes his point incredibly well.
Just a few weeks ago, both King’s and Woolwich were sending women to Lewisham to give birth. Women should be able to give birth at their local hospital and should not have to go to one hospital for the antenatal appointments only to have to go somewhere else to give birth. With high numbers of teenage pregnancies and a higher than average proportion of older mums in places such as Lewisham that is doubly important. The proposal for a midwife-led birthing unit at Lewisham is not a genuine option for any woman who wants to give birth safe in the knowledge that she would have back-up obstetric support if it were needed. I am told that that would not be an option for first-time mums. If I were to have a baby in two years’ time, I would not be able to go to Lewisham. The report tries to convince me that I would have greater choice, but that is just a joke.
One of my main concerns about the proposals for maternity services relates to where, and to what extent, capacity will be enhanced at other hospitals to deal with the mums who would otherwise have gone to Lewisham. The proposals before the Secretary of State assume a relatively even redistribution of women from Lewisham to King’s, the Queen Elizabeth hospital Woolwich and the Princess Royal university hospital in Farnborough. However, historically, when Lewisham women have not given birth at Lewisham, their main hospitals of choice have clearly been King’s and St Thomas’s. If more women go to those hospitals, projected births there could exceed 8,000 a year. Those would be really big maternity departments, potentially requiring a double rota of staff and consultants to deal with them. The cost of a double rota in maternity units at King’s and St Thomas’s is not accounted for in the plans before the Secretary of State.
On that very point, does my hon. Friend accept that the trust special administrator has deliberately manipulated the figures, in both the draft and final reports, to mask the fact that the proposal would push King’s at least and probably Queen Elizabeth hospital, Woolwich as well over the 8,000 births a year mark?
I do not know whether the trust special administrator has deliberately manipulated figures, but the way that the figures have been presented looks quite suspicious.
The plans are completely unjustified. There has been much talk in recent weeks of the need for things to do what it says on the tin. The metaphorical tin with respect to the recommendations of the trust special administrator presumably says it will resolve the financial problems of the South London Healthcare NHS Trust and put the health economy in south-east London on a stable footing. I do not think the proposals before us do that. It will be necessary to spend £195 million on a one-off basis to make changes at hospitals in south London, to deal with the displaced demand for A and E and maternity care that will result from the closure of services at Lewisham. It is not clear to me where that money is coming from: which Department of Health budget is it to come from? Has the Treasury approved that non-recurrent expenditure? If it has not approved the required capital outlay, the plans fall apart. Perhaps the Minister can deal with that point.
The changes to the Lewisham site would involve demolition of the recently refurbished A and E, so that the land could be sold. Long after the A and E was knocked down, the hospital would still be paying £400,000 a year in loan repayments for the £12 million it borrowed to make the improvements. That is a bit like someone taking out a loan to do up their kitchen and knocking down that part of the house while still paying money back to the bank.
Another big question relates to the continuing year in, year out costs of the changes. The possibility of a double maternity shift at King’s and St Thomas’s, which I have mentioned, is just one example, and would surely add hugely to the bill. How much would it cost to implement a community-based care strategy to reduce the need for hospital services? Where is the money coming from?
If the proposed changes to A and E and maternity care in south-east London cannot be justified financially, do not result in better health outcomes and are unfair and unwanted, why on earth are we here to debate them today? The Government have consistently said that changes will not be made unless four specific tests are met, as my right hon. Friend Bob Stewart have mentioned. In the present case, the tests are not met. The chair of the local commissioning group is opposed to the changes, as are virtually all Lewisham GPs. The process should result in strengthened patient and public involvement, but the current process has resulted in strengthened disillusionment among the public, and little else. Proposals should be based on a sound clinical evidence base—but the evidence base in the present case is virtually non-existent. It is also stated that the Government will not make changes to such major services unless doing so will strengthen and improve patient choice; the special administrator’s own report recognises that the proposals will result in a weakening of patient choice.
As I said earlier, the proposals are unwanted, unfair, unsafe and unjustified. Last week the NHS Commissioning Board announced a review of emergency care, to be led by the NHS medical director, Sir Bruce Keogh. I welcome that review, but what is the point of it if the Government are just going to push ahead with their proposals in south London? The chaotic handling of the process in Lewisham cannot be right. It rides roughshod over the wishes of the community and local clinicians. For the life of me, I cannot see how it is in the best interests of my constituents or the people of south London. I urge the Minister to reject these rushed and ill-conceived plans and to do as her party’s manifesto says:
“stop the forced closure of A and E and maternity wards, so that people have better access to local services”.
I am not asking for better access; I am just asking for the access that currently exists for people in Lewisham to be maintained.
This is an important debate, and I congratulate Heidi Alexander on her speech, on securing the debate and, with her colleagues in Lewisham, on co-ordinating an effective and well argued campaign.
Along with all other south London colleagues, I have long taken an interest in health service matters, including reconfiguration. I have the scars of the battle to keep Guy’s hospital open, which we managed to do, although we lost A and E. I have often joined my neighbours, Ms Harman and Dame Tessa Jowell, to ensure that King’s College hospital improved, which, thank goodness, it has. But I have a more direct interest: my constituents on the eastern edge of my constituency in the SE8 postal district and along the edge of the boundary with Lewisham often go to Lewisham hospital, rather than to King’s or to Guy’s and St Thomas’s. Of my remaining constituents who use hospital services, some go to the Royal London hospital across the river, but most go either to Guy’s and St Tommy’s or to King’s, and the report makes it clear that there would be a major impact, particularly on King’s, if the proposals go ahead.
Obviously, legislation initiated by the previous Government and passed by the previous Parliament anticipated problems in a part of the NHS. Although Labour understood that need, the legislation has not needed to be implemented until now. The legislation has been implemented—to be honest, those of us in other parts of south-east London knew this—because there was a history of bad financial management in the outer south-east London boroughs and in South London Healthcare NHS Trust. We know that to our cost because, twice to my certain knowledge, the health budgets further in—in our parts of south-east London—had to be top-sliced to fund other bits of London, even though they are more affluent and we are less affluent, because of poor management elsewhere. There was better management both in my borough and in Lewisham.
My right hon. Friend Andy Burnham, who was Secretary of State when the Health Act 2009 was passed, has made it clear that there was never any intention to use the legislation to address major reconfigurations. The legislation was meant to address a financial problem in a specific trust and not to encompass other trusts. Does Simon Hughes agree that we need to consider the NHS London-wide? That is where we must find solutions to the financial problems of one trust, quite differently from this particular case. The trust special administrator clearly could not find a solution by considering just the South London Healthcare NHS Trust, but we cannot have the inappropriate procedure that has now been adopted.
The right hon. Lady, who is my neighbour, raises an important issue. With the help of the Library, I have carefully examined the whole debate on the passage of the legislation, and that issue was not addressed. If she looks back at the debates and the notes on the National Health Service Act 2006, they are silent on whether a trust special administrator could or could not make recommendations that go beyond a trust. That may not have been in the mind of her colleague, Andy Burnham, who is a former Secretary of State, but he did not say that on the parliamentary record, although I stand to be corrected. It seems to be an open question.
The current Secretary of State told us that he has had legal advice and that he will take further legal advice, but whether or not the legal advice is that the trust special administrator can go beyond the boundaries of the area affected, there is a stronger argument for the Secretary of State not following the trust special administrator’s recommendation—and that argument starts from the legacy of the last general election in terms of the parties in government and the coalition agreement on how to deal with closures of A and E, and not doing so from the top downwards.
Secondly, the Government have set up the four tests, to which the hon. Member for Lewisham East referred and which have not been met. The Secretary of State has been handed this matter on a plate; it is not of his doing and I am sure it is the last thing he would have wished for. The announcement that the trust was going into special administration was made by his predecessor, and the current Secretary of State has been given a report by someone he did not appoint but with whom he now has to work. He has no choice. He has to deal with it, but he made it clear in his answer to the urgent question from the right hon. Member for Lewisham, Deptford that the four tests, which both he and the Prime Minister have cited, must be met.
The first test—that the proposals must be supported by GP commissioners—fails before we even get to the other three. I have no reason to believe that a single GP commissioner in Lewisham is supportive—GPs elsewhere in London might be found but they implicitly do not comment—the whole idea of the proposal seems to be that if we are handing NHS decisions from the top to the doctors, we must do things that the doctors agree are the right decisions. So the proposal falls at that first hurdle.
Should I catch your eye later, Dr McCrea, I will address the four principles in more detail.
Simon Hughes says that the Secretary of State’s predecessor set up the four tests, but does he not accept that one of the previous Secretary of State’s first acts just after the 2010 general election was to suspend the implementation of the “A Picture of Health” process that the South London Healthcare NHS Trust was undertaking? I am not saying that the process would necessarily have led to success, but its suspension undeniably made the trust’s task unbelievably more difficult.
I do not dispute that. I am not as close to the process as the hon. Gentleman. I did not follow those issues as closely, because the process did not directly affect my borough, although it directly affected his. I have taken advice from someone who has been involved over the years at Lewisham hospital and in NHS management, and the history of financial poor management in the South London Healthcare NHS Trust stretches back over 10 years. The advice I have received is that poor management should have been gripped seven or eight years ago, but the problems escalated. We are in our present position because of a legacy of poor decisions made over effectively a decade. Things might have been rescued by the Government at the beginning of this Parliament, but they clearly were not and we are left in our present position.
I have a few comments, and I do not want to take time from other colleagues who have a direct interest. I responded to the consultation to make clear the interests of my constituents. The Secretary of State invited those of us with an interest to see him, and we are grateful for that invitation, which we used, I hope, to put our case effectively. The right hon. and learned Member for Camberwell and Peckham and I, and those MPs whose constituents use King’s, have written to the Secretary of State further to that meeting to make clear our concerns about the impact on King’s of any closure of Lewisham A and E, irrespective of the change in maternity services.
There is an alternative approach, which I commend to the Secretary of State. I hope he understands the benefit of going down the alternative route, rather than following the trust special administrator’s recommendations. The alternative, which we explored at our meeting and which I do not believe was adequately answered by the trust special administrator or his colleagues, is that five of the six recommendations—excluding recommendation 5 on the site configuration—leave open the option of amalgamating NHS management between Lewisham and Greenwich. NHS management could then be allowed to work out the best configuration of services across the two boroughs in consultation with, and with the confidence of, the local authorities in question, which now have direct responsibility through health and wellbeing boards under the Health and Social Care Act 2012, and in conjunction with GPs to seek GP commissioning endorsement and support. I hope there would be much more public support than for the present proposal, as is understandable.
I hope that the Secretary of State will find that to be an appropriate solution. It may have a small financial disadvantage over the present proposals but, as the hon. Member for Lewisham East said in her speech and as she and her colleagues from Lewisham have made clear in their letters to the Secretary of State, the TSA’s figures show a financial gap of only £1.7 million from a break-even position if recommendation 5 were not to be followed, compared with a financial gap of £75.6 million if the recommendations were followed. There are knock-on effects, but we seem to be talking about a sufficiently small amount of money, with little risk of any other financially adverse impact, and if people are motivated to reach a conclusion quickly, that must be a much more satisfactory way of proceeding and much more in line with the four tests set out.
I wanted to give the right hon. Gentleman those figures, so I am glad he has put them on the record, because they are significant. Furthermore, there is real willingness in Lewisham, from the hospital, the GPs, the consultants and all the staff, to work for some kind of merger or co-operation with Woolwich that would reduce costs. Everyone is willing and happy to explore that, but in the right circumstances, in the right time frame and with appropriate consultation, which is what has been missing from the process.
I have no reason to disbelieve what the right hon. Lady says, but even more important is returning the decision to the people in the health service who are now meant to be leading it—the GP commissioners and others. That is what all of us, in different ways, believe needs to be done. She made an argument for the issue being London-wide, and that of course is the context, but the practicalities of travel and transport, whether buses, cabs, cars and trains, are such that south-east London works as a segment for health service use in a way that does not really cross over into other parts of London, other than to King’s. The only knock-on bits are the small amount of crossover to the London hospitals for specialist reasons, and some to King’s because it is so near—technically, it is south-east London, but it is in Lambeth.
Secondly, the precedent would be a bad one to set for those parts of the NHS that have been financially well managed, compared with parts that have been badly managed. Lewisham has been relatively well managed, being very nearly in balance. We rely on trusts to do their job locally and on people to manage local trusts, so we have to support those who do that job well and responsibly.
My last point is probably the most important. I have been to Lewisham A and E and visited patients there privately. It and the maternity services have developed a reputation for good clinical care of all who attend it. That was not the case some years ago, but it has been worked on, and not only physically. It has become a university teaching hospital, as well as being a local general hospital, and it has good community links—the point made by the right hon. Member for Lewisham, Deptford in her intervention. It has also built up a good reputation for integrating acute care, hospital-centred care, with community provision.
The Secretary of State could take the clinically easy decision to follow the trust administrator’s recommendation, saying, “This is what has been recommended, therefore I am following what I have been told”, but I hope that he realises the greater benefits to the local community and to the wider health economy and service of south-east London, as well as to the Government if they are seen to be listening to the people and to the GPs more than to the trust special administrator. I understand why the trust special administrator takes a hard line, because he is a health economist and his interest is finance. The Health Secretary, however, has a different job, which is to be responsible for the NHS in England, and that means making responsible decisions to secure a good NHS in all parts of south London and elsewhere.
I will be commencing the winding-up speeches at 10.40 am at the latest. Three Members are seeking to catch my eye, so I ask them please to be conscious of that in their contributions, because I would like to get as many Members in as possible.
I will attempt to be brief, Dr McCrea, given your exhortation and out of consideration for my colleagues.
I do not think that the Secretary of State for Health will proceed with the proposed plan, because it is so far off the rails. It is such a ludicrous proposition, so ridiculous in its scope and even its intent and such a shoddy piece of work, frankly, that the Secretary of State will not be so foolish as to proceed with it, even if he can blame his predecessor for lumbering him with it. We have to recognise the threat, however, and to do what we can to make the case against it. That is why, after 10,000 people turned up on the
My hon. Friend was kind enough to mention that I have been in this place 20—now almost 21—years, but I was also involved with Lewisham council for 20 years before I came here, and, without doubt, the hospital proposal has raised more fury than anger—more so than any other local issue in all the 40-plus years that I have been involved in public life in Lewisham, even more than the madcap scheme of the Department for Transport under the now Lord Parkinson to further the south circular assessment study. That scheme had recommended widening the south circular to six lanes throughout, with eight lanes in some parts, right the way through the middle of Lewisham. People thought that was mad enough, but that pales into insignificance compared with the public response to the proposals that we are discussing.
What fuels the fury is not the incoherence of the plans, or even the gross financial assumptions—I have heard people call them heroic, but some of the claims are lunatic, and in pursuit of so little—but the sense of injustice, the unfairness of the scheme. Lewisham hospital, as in the recent past, has a strong commitment to safety, quality and patient experience. It has been rated in the top 40 hospitals nationally by CHKS—for clinical effectiveness, patient safety and so on—and has a strong record in achieving national and local performance targets. It is operationally lean, the reference costs index making it the most efficient trust in south-east London, delivering financial surpluses in each of the past six years—Guy’s and St Thomas’s trust, King’s College trust and, obviously, the South London Healthcare NHS Trust have not done that.
Our hospital has achieved the successful integration of acute and community services, fostering strong links with social care, and the people of Lewisham are already reaping the benefits. It has the reputation for strong and successful partnerships, so much so that many of the people at the Queen Elizabeth look forward to Lewisham management taking over to build links with commissioners, local GPs, the local authority, patients and staff.
Lewisham hospital, or University Hospital Lewisham, now part of the Lewisham Healthcare NHS Trust, with NHS London’s encouragement, was actively pursuing a foundation trust application when the process we are discussing interrupted and completely derailing that application. People are furious at the injustice precisely because Lewisham hospital has done everything in the services that it provides that could reasonably be expected of it by the Department and particularly by the people of Lewisham.
I want Lewisham hospital to survive as an institution, but I am not desperately keen on institutions for their own sake, important as they are. I am more interested in the services that they provide for the people they serve, and the hospital’s record is exemplary. To see that destroyed and devastated by the vandalism of the trust special administrator process is more than most reasonable people can stand or accept.
I have been inundated, as I am sure have my colleagues, with information from various quarters, and all has been hostile. One note from a constituent—I will not be too specific as I do not want to identify her, but she is a clinician at Queen Elizabeth hospital—who did not support the closure but does not want Lewisham hospital to be destroyed, said that the position at Queen Elizabeth hospital is dire, and needs strong leadership and a clear sense of direction and purpose, so that it too can provide the services that the people of Bexley, Greenwich and Bromley deserve. If the closure of A and E at Lewisham hospital goes ahead, 750,000 people in Bexley, Greenwich and Lewisham will have a single A and E department available. That would not be safe by any stretch of the imagination.
I can do no better than to quote an e-mail that I received just yesterday from the GP team in neighbourhood 4 of the Lewisham general practitioners clinical commissioning group that makes the case well. The group covers practices in Bellingham Green, Sydenham Green, Sydenham road, the Vale, Wells Park in Woolstone road, and the Jenner, which is in the constituency of my right hon. Friend Dame Joan Ruddock and just the other side of the south circular road on the boundary between our constituencies. It says that closing
“the A and E will hit the elderly, disabled…and children of single parents disproportionately” and that
“although an urgent care centre…will persist, its use its use will decline significantly as neither patients nor clinicians will have confidence to use an UCC unsupported by acute medical and surgical care”.
My right hon. Friend made that point elegantly. The e-mail continues:
“Loss of obstetric service will result in women in labour having to attend a different provider from their antenatal care, few women will choose this option, as both patients and clinicians are aware of the increased risk of disjointed maternity care and find it emotionally unsettling.”
It also says:
“The projected flows of patients are inaccurate and therefore so are the costings, our Primary Care survey across Lewisham showed 80%+ of patients would attend Kings, 10% St Thomas, 6%”
Princess Royal university hospital, Farnborough, and that only 4% of those currently attending Lewisham A and E would go to Queen Elizabeth hospital at Woolwich.
The point about going to Farnborough is that it is a heck of a long way from Lewisham, which makes it difficult. Public transport to Farnborough is not acceptable for people who are weak, disabled or poor.
I am grateful to the hon. Gentleman. He knows that many of his constituents attend Lewisham hospital, so the effect will be not just on people who are resident in Lewisham.
In view of the time, I will not go through the rest of my points, but suffice it to say that they are compelling, overwhelming and make sense. The problem with the trust special administrator is that he regards antagonism and opposition from local people, particularly clinicians, as a sign of his rectitude. One of our local football teams is Millwall, which is based in Lewisham, although Simon Hughes prefers to disguise that fact. It has an unofficial slogan, which is also a song to the tune of “Sailing” by the Sutherland brothers and was made famous by Rod Stewart. The words are:
“We are Millwall, super Millwall” and
“No one likes us, no one likes us
No one likes us, we don’t care!”
I suspect that Mr Kershaw has taken that local aphorism as his inspiration because he could not have gone further out of his way to antagonise all the people of south-east London. The problem is that most Millwall football fans sing it as a joke, but Mr Kershaw clearly believes it. He has succeeded in antagonising and alienating not just the medical community, but everyone in south-east London, because the whole scheme is a shambles. He said that no one came forward with a viable alternative to his plan, which is why the final report is as it is. I can tell him that if they had £5.2 million and rising and the services of McKinsey, Deloitte, Ipsos MORI and other consultants, year 6 at Dalmain road primary school could have come up with a better scheme than his. I suspect that the Secretary of State has enough sense to reject it. Action needs to be taken to secure health services across south-east London, but this is not the way.
It is a pleasure, Dr McCrea, to speak under your chairmanship. I congratulate my hon. Friend the Member for Lewisham East (Heidi
Alexander) on securing this important debate. I want to start by defending South London Healthcare NHS Trust. Its financial difficulties are enormous and there is no disguising that, so people have tended to roll up its performance into something that is failing on all fronts, but that is clearly not the case.
When the hospitals—Bromley hospital, Princess Royal University hospital, Queen Elizabeth hospital in Woolwich and Queen Mary’s hospital at Sidcup—were merged approximately four years ago into one healthcare trust, there were serious difficulties with clinical performance, but very quickly the trust improved its performance significantly, and so much so that it was one of the best performing on many indicators. That is why it was so sad that when the trust was put into administration, unattributable sources in the Department of Health put out rumours that that was about not just financial mismanagement, but the fact that standards of care were failing. That was completely and utterly untrue.
I go back several years, and I am on my fifth chief executive at my local hospital. All have gone through the same scenario as Mr Kershaw, and all have given me assurances about the areas—I will not go into them because I do not have enough time—where financial performance needed to improve and efficiencies needed to be made. Always, they made the point about the need to treat people close to where they live in the community and reduce pressure on acute services.
All have made that point, and all have needed to improve clinical performance. Just over a year ago, the South London Healthcare NHS Trust had only one case of blood-borne MRSA, which was the best performance in the country. The improvement in the quality of care under the new trust was significant indeed. Waiting times in A and E improved, and Dr Foster reported on a significant and consistent improvement in the standardised mortality ratios over a couple of years. On those performance indicators, it outperformed Lewisham hospital.
When the decision was made to put the trust into administration, its performance on quality of care for local patients was improving. Anyone who was concerned about care for local patients would have worked through the financial difficulties with the trust. It was a big ask in that short period to improve clinical performance as it did, to merge the hospitals as it did, and to improve financial performance as it was required to do. It was always a big ask, and I think it was impossible. That should have been recognised, and the Government should have worked with that hospital trust to work through those difficulties.
We all know that PFI has not caused this problem, but it has added to it. PFI accounts for roughly a third of the deficit, which is not to be ignored, but one issue that has come to light recently, in relation to PFI in general—not just in relation to South London Healthcare NHS Trust—is the effect that the manipulation of LIBOR has had on the rates that hospital trusts have had to pay, in terms of interest, as a consequence. I do not expect the Minister to have an answer to this question, but will she go away and consider what the cost implications of LIBOR manipulation have been for every PFI in the NHS? Are the Government considering taking legal action to retrieve any of that money, as is being considered in the USA?
I am conscious of time and I want to let Bob Stewart speak, so I shall move on. As has been said, the recommendations fail several tests, and they clearly fail the test of satisfying local GPs and receiving local GP support. The chair of the local GP commissioning body, Helen Tattersfield, wrote an article in The Guardianunder the headline: “GPs are already wise to the scam of new commissioning groups”. She absolutely lampooned what is being proposed by the Government.
Does the hon. Gentleman realise that the Government have shifted ground on that? In the response that the Prime Minister gave to my hon. Friend the Member for Lewisham East, he said that the first test was
“the support of local GPs.”—[Hansard, 31 October 2012; Vol. 552, c. 230.]
However, the Secretary of State’s written statement, following the publication of the final report said that the first test was “support from GP commissioners”. The word “local” has disappeared, and what the TSA is trying to do is claim the support of commissioners from outside Lewisham to meet that test.
The point made by my hon. Friend is self-evident, but if I may, I will not be drawn down the road, because I want to get the next point on record.
Lamenting the fact that local commissioners have not been listened to, Helen Tattersfield says in her article:
“No argument has any weight, however, against the needs of a failing trust, foundation trusts and potential private companies eager to expand their areas of influence, and NHS managers convinced of the merits of their model of fewer larger hospitals. Those of us who have spent hours acquiring the skills supposedly to lead commissioning have been shown that, in fact, decision-making and influence remains where it always was: with central managers, computer-derived models and reasoning that takes no account whatsoever of human behaviour in real life. We are little more than window-dressing for central planning geared to the needs of large foundation trusts, and open to the interests of the private sector.”
That comment alone just about sums up where we are.
I will finish soon to allow the hon. Member for Beckenham to speak, but I just want to ask the Minister whether she will consider a review of proposed A and E closures across London. We are seeing a piecemeal, salami-slicing of A and E services, which is putting the safety of Londoners at risk. As we know, we have seen a 50% increase in people waiting in ambulances for 30 minutes or more outside A and Es to gain access, and we have seen a 26% increase in those waiting for 45 minutes. We know that they are under pressure, so before we see any closures, that review must take place.
We can pray in aid what the Lord Chancellor and Secretary of State for Justice said. The headline on the relevant article read: “Hunt faces Cabinet split over A and E closure after Justice Secretary blasts plans as ‘sticking two fingers up’ to patients”. We also have Paul Burstow—the former Minister of State, Department of Health—who lamented, when he was still a Minister, the proposed closure of St Helier:
“This is a flawed conclusion from a flawed process. There is still a lot of water to flow under the bridge before final decisions are made. The panel have ignored the pressure on all the A and Es and maternity units in south west London.”
We can pray those people in aid to defend our A and Es, and the Government should go back and look again.
To make one last point, we have seen the closure of an A and E, despite the promises of local Conservatives. The Leader of the House of Commons, when he was shadow Secretary of State, was going to save the A and E at Queen Mary’s, Sidcup, but it never came about. Under “A Picture of Health”, there was a proposal to have overnight stay, elective surgery at that hospital. It was promised to my constituents, who welcomed it and wanted to see it. I ask the Minister to reconsider removing that planned service from that hospital, because it was beginning to work and people welcomed it. It will be a serious cut to the quality of health care.
No, I will not, because I want to allow the hon. Member for Beckenham to speak. It will be a serious cut to local services, and we should not allow that cut to go ahead.
I thank the previous speakers for allowing me to speak. I was not going to speak, but I felt induced to do so by the excellence of the debate. My constituency is bracketed: on one hand, we have Lewisham hospital, and on the other, the Princess Royal university hospital in Farnborough, so I feel very much like the piggy in the middle. However, we have the Beckenham Beacon, and if I have time, I will mention that at the end.
Lewisham hospital is excellent. Working within its budget, it has a good reputation and serves the local community, which includes people from my constituency. I really am against the idea of its role being changed. The idea that it becomes an urgent care centre is fine. When I asked the special administrator about that, he suggested to me that it was not much of a change, and the only real change was that people would not be admitted into the general hospital. That is not quite as I understood it. Now we do not have the specialist back-up, and there will be a big reduction in people being seen locally. Lewisham requires a hospital, and it should keep its hospital.
Travelling around south London is notoriously difficult, as we have heard. All the routes go in to the epicentre. The eye of the octopus is round about here, and so trying to cross London to go to various hospitals—particularly for those who do not have an easy transport option—is extremely difficult. I am thinking of the elderly, as it is very difficult for them to achieve what they want and get to a hospital—say, if they are sent somewhere other than Lewisham, when they live in Lewisham. I am very concerned about the idea that we can do away with maternity services in Lewisham. Some 4,000 babies is a heck of a lot of babies to cart off somewhere else, as I mentioned in an earlier intervention.
I finish by reminding Members that we have the Beckenham Beacon, which is only 70% used at the moment. It is an outstanding facility, and from what I have heard, I understand that the clinical commissioning group for Bromley intends to take up the services that are there now. However, I also commend the people looking at this problem to think about increasing the services of the Beckenham Beacon, to help not only my constituents but the people of Lewisham. I know that I have to stop now, Dr McCrea, so as I am a very good boy, I will sit down.
It is a pleasure to see you in the Chair, Dr McCrea. I congratulate my hon. Friend Heidi Alexander on securing this incredibly important debate. The future of accident and emergency and maternity services across south London is of genuine concern to a great many of her constituents and, indeed, for the wider area, as this is definitely an issue of real significance across the capital. I know from a meeting that I chaired with Labour colleagues before Christmas that it goes to the heart of their communities. I applaud the way in which my hon. Friend the Member for Lewisham East, our right hon. and hon. Friends and others from across the party divide have put together a campaign that highlights their constituents’ concerns in such a high-profile and persuasive manner.
It has long been accepted that difficult decisions might well be needed to secure the sustainability of health services in south-east London, as the challenges facing South London Healthcare NHS Trust are complex and of long standing. As we have heard, the proposals to close the A and E and downgrade the maternity unit at Lewisham hospital are intended to assist a neighbouring hospital trust to find its way out of significant debt problems. It is a highly controversial procedure, to say the least, because Lewisham hospital, as we have heard, is well respected and well managed and recently underwent a £12 million refurbishment.
The proposals also introduce wider considerations that could affect the whole of south London’s health care. At the same time as the trust special administrator has been reviewing services at South London Healthcare NHS Trust, plans for changes to management structures and the merger of services have been progressing, led by King’s Health Partners and three foundation trusts—King’s College hospital, Guy’s and St Thomas’s and the South London and Maudsley—in conjunction with King’s college London.
Any plans for the whole area need to take full account of all the potential knock-on effects on the quality of care that people receive, and they need to consider how the merger plans will affect the health economy right across south-east London and potentially limit other long-term options for changes in south-east London. The figures provided by my right hon. and learned Friend Ms Harman illustrate the real problems associated with some of the changes being presented today: a 45% increase in emergency admissions and a 54% increase in births at King’s if Lewisham closes. Those huge capacity issues would need to be resolved. The Minister needs to look carefully at those figures.
As we have heard today, there are real concerns among the local Members of Parliament about the future of services at Lewisham hospital, so much so that recently a delegation of local doctors and my right hon. Friend Dame Joan Ruddock and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East presented a petition against the closure of Lewisham’s A and E and maternity departments to 10 Downing street. In only five weeks, the petition against the changes has been signed by more than 32,000 people, and the numbers are still growing.
We have also heard that, as part of the campaign, there have been a number of protest marches against the closures. I believe that there will be one this weekend. I am sure that that will attract equally heavy support as the earlier ones, which I believe from my right hon. Friend the Member for Lewisham, Deptford took place in rather grotty weather. Notwithstanding the snow that there may be this weekend, I am sure that the good folk of Lewisham will still be out in force.
I am intervening quickly to support what my friend—I call him that despite his being on the Opposition Benches—Jim Dowd has said. This is a matter of fairness. It seems extraordinary that failing hospitals are being supported and allowed to continue essentially as they are, but Lewisham—a wonderful hospital that is within budget and is gaining an increasing reputation— is being kicked, slashed and destroyed. I just do not see that as right. It is a matter of fairness.
The hon. Gentleman is absolutely right. It is also telling that a very substantial number of GPs, including the chair of the new clinical commissioning group and the head of every single clinical area in the hospital, have written to the Prime Minister to express their concerns about the proposals. That clearly shows that the proposals do not have the support of local clinicians. I urge the Minister to read the very passionate article in Saturday’s Guardian online by Lucy Mangan as well. That helps to address some of those points.
As we have heard, more than 120,000 people visit the A and E at Lewisham hospital each year and more than 4,000 babies are born in the maternity department. With the prospect of the A and E being closed and the maternity unit being downgraded, a number of worries have quite rightly been expressed, not least because, as we have heard from my hon. Friend the Member for Lewisham East in the debate, Lewisham’s population is estimated to rise significantly in the next few years as a result of the huge increase in the birth rate.
As I have said previously, there is no doubt whatever about the unanimity among the professionals and the population about the importance of maintaining services at Lewisham hospital—something that Ministers have always stressed they would fully take on board. As we have heard in the debate today, the right hon. and hon. Members who represent the areas affected believe that the plans are based on inaccurate data and flawed assumptions and that the whole issue has been misunderstood and largely mishandled.
We have the final report from the trust special administrator, urging this closure at Lewisham, and the Secretary of State is to make the final decision by
It is quite concerning when the rules on making changes to hospitals seem to have been changed to allow back-door reconfigurations in the way that I have described, without the proper scrutiny and consultation that would ordinarily take place. Indeed, the trust special administrator used powers passed by the Labour Government in a way that was never intended. I take the point made by Simon Hughes. Nevertheless, what has happened sets a worrying precedent whereby the normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services could be pushed through. This is a worrying situation, as it takes the NHS over a very dangerous line and is potentially the first back-door reconfiguration in that manner. If it is allowed to go ahead in that way, it could mean that any hospital services could be changed for purely financial reasons, which has never been the case in the past. We need to ask where the clinical case for change is in these proposals.
The 2009 Act clearly says that administrators must make recommendations relating to the trust that is failing. That has not happened in this case. Reconfigurations need to be based on solid clinical evidence that they will save lives. Where there is a clear clinical case, I think that that is right, and we should look carefully at changes before deciding whether we should oppose them. However, the TSA’s actions are leaving a very confusing and worrying situation surrounding hospital reconfigurations.
My hon. Friend the Member for Lewisham West and Penge got it right. We are starting to see a situation in which primary care trusts are moving quickly to try to secure service changes before the clinical commissioning groups take over, and it is becoming all too clear that it is financial pressures that are starting to lead to closures and health service changes. That is clearly wrong.
On the four tests for reconfigurations, does the Minister really think that they have been fully met and does she believe that this change has the support of local commissioners?
As ever, it is a great pleasure to serve under your chairmanship, Dr McCrea. I congratulate Heidi Alexander on securing this debate. I have about 10 minutes to respond to all the points. In the normal terms of any debate, there is an airing of conflicting views, different ideas and different points of views, but today there has been no such disagreement; we have had an outbreak of complete agreement among all the speakers and all those who have intervened. Everyone who has spoken this morning has done so with great passion and sometimes with ferocity in defence of the maternity unit and the A and E department at Lewisham hospital.
Let me make it absolutely clear that we are not in this position because of a Government decision or proposal, or as a result of some set of Government cuts. I made that same point a couple of weeks ago in an Adjournment debate that was called by Jim Dowd. I hope that those in the public domain who report these matters make that point very clearly, too. Anyone who seeks to make political capital out of this exercise does so at their peril, because, in many ways, this transcends party political divide and should not be used for party political advantage.
The trust’s special administrator published his report on
Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by
I have not finished my sentence; do forgive me. What is most important is that the right decision is made after careful consideration. I am pleased that the Secretary of State was true to his word and had a meeting with Members who are rightly concerned about the future of Lewisham hospital on
The Minister mentioned that a decision is to be made on
Minister accept that this is an issue of national import? Will she prevail on the Secretary of State to ensure that, whenever the statement is made, it is not on
That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.
Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.
The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.
No one disputes the existence of financial problems, but the closure of A and E and maternity departments affects people’s lives and health. Will the Minister confirm that, were the Secretary of State minded to agree to the proposals put before him, the four tests set by her own Government will be applied?
I am happy to remind us all of those four tests and principles; they remain as firm as ever. First, any reconfiguration should have the support of GP commissioners. Secondly, there should be full public and patient engagement and proper consultation. Thirdly, there should be a clear clinical evidence base. Fourthly, any reconfiguration should be in support of patient choice.
The hon. Lady comes to the House to represent her constituents and to put forward their views, which she undoubtedly shares, and their anger and concern about their hospital. In her speech, she understandably uses the words outrage and disbelief to say that those four tests, in all or in part, have not been made. She speaks with passion and with detail about the lack of support from GP commissioners and consultants at Lewisham and beyond. She says that this is a hospital that has had many successes and a long-standing investment. She makes the point that, given all the arguments that have been advanced by her and other hon. Members, the decision clearly has no merit.
Let me mention here the interventions by Ms Harman, my hon. Friend Gareth Johnson, Dame Joan Ruddock, who speaks in accord with others in support of the hospital, and Mr Raynsford. There were speeches by the hon. Members for Lewisham West and Penge and for Eltham (Clive Efford) and by my hon. Friend Bob Stewart.
This is a very serious subject and I do not want to be flippant. The views of all are certainly taken on board. In due course, the Secretary of State will announce his decision. Therefore, as I said at the outset, I cannot be of great assistance in addressing the various comments that have been made, because I am not allowed to give my opinion. I should, however, mention the contribution of my right hon. Friend Simon Hughes—I think that I missed him off my list. He gave a thoughtful and frank speech in which he talked about his concerns about the legislation that brought about the appointment of the administrator. He has looked at an alternative and he advanced that.
Finally, the hon. Member for Eltham calls for a review of A and E, but he should do so with great caution. There might be merit in that, but when one embarks on such a review, we have to make it clear that, in those circumstances, some tough decisions might be made, and everyone involved in that would have to sign up to it on that basis.