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2.41 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Horam): As my hon. Friend the Member for Harrow, East (Mr. Dykes) said, we have had a number of Adjournment debates on this matter. As he will recall, I have already replied to one of those, which he initiated. Until today, however, I had not had the pleasure of replying to an Adjournment debate initiated by my hon. Friend the Member for Hendon, North(Sir J. Gorst), but I know of his continuing concern about the issue.

My hon. Friend the Member for Hendon, North dealt, centrally, with the issue of emergency medical care. I should like to consider for a moment the original consultation carried out by Barnet and Brent and Harrow health authorities in 1994. My hon. Friend started the debate by mentioning the history of the project. We have been considering that consultation exercise, on which the changes in service at Edgware were based.

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The consultation document made some important points. It said that there is a growing acknowledgement that fewer centres, with a larger population base and a higher number of emergency cases attending them, provide an improved service. That is not just what Barnet and Brent and Harrow health authorities thought; it is what the evidence shows.

That evidence is substantial. A report by the Royal College of Surgeons in 1988, called "The Management of Patients with Major Injuries", said:

"there are far too many small units treating serious injuries and we consider that smaller departments should be closed or have their ability to treat major injuries restricted."

In March 1995, the Department of Health published a review of the literature on accident and emergency departments and clinical outcomes. I am sure that both my hon. Friends are equally concerned about clinical outcomes. The review stated that

"existing research . . . has been enough to mould a consensus, shared by many professional staff and by health authority managers, that larger accident and emergency departments offer better care to seriously ill or injured patients."

That was the context for proposing that there should be a new accident and emergency department at Barnet general hospital, and that the accident and emergency department at Edgware general hospital should close when the new unit opened. The then Secretary of State for Health approved that proposal in April 1995. Since then, matters have moved forward.

Sir John Gorst: All that my hon. Friend says is fair, but one important thing that he leaves out is the social factor. The facilities were to be removed from an area that was deprived in many ways--in terms of income, old age and an immigrant population--but the most important factor was the transport that would take people in an emergency to a nearby A and E department. That problem is not solved by anything that my hon. Friend has said.

Mr. Horam: I shall deal with transport in a moment. My hon. Friend the Member for Harrow, East also raised the matter in the debate that he initiated.

I have described the situation with regard to Barnet general hospital. Edgware will have a new type of local hospital--one that provides a wide range of services for local people. Its services will include a casualty service. The unit at Edgware will be open 24 hours a day. It will have doctors in attendance.

Those are not the features of the original proposals put forward by Barnet health authority, which were for a nurse-led service open only 13 hours a day. Thus, the original proposals have been revised and improved, which represents a real commitment to listening and responding to local wishes. The proposals are in line with my right hon. Friend's assurances to both my hon. Friends. The words were explicitly mentioned in the letter of June this year, which my hon. Friend the Member for Hendon, North mentioned.

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I should say to my hon. Friend the Member for Harrow, East that, although I cannot speak for my right hon. Friend in this debate on this particular matter, I do not believe that he would have any objection to publishing the June letter.

Mr. Dykes: The letter refers--I can give the paragraph reference, if my hon. Friend wishes--to the provision of a casualty service and specifically not to a minor accident treatment service.

Mr. Horam: Indeed, the letter uses the word "casualty". My hon. Friend refers to the distinction that I have just made--the uprating of the existing proposals along the lines that I described.

Sir John Gorst: My hon. Friend the Minister has made an important change in the position because of what he has just said to my hon. Friend. As recently as the night before last, the Secretary of State declined absolutely to permit the letter to be published. Is my hon. Friend now saying that my right hon. Friend has had second thoughts? That is an important factor in demonstrating to a wider public exactly what we were promised.

Mr. Horam: As I said, I cannot speak for my right hon. Friend in this debate, and I have not been privy to any conversations that might have taken place between my two hon. Friends and my right hon. Friend. I do not know what was said on those occasions, but I am saying off the cuff that I do not believe that my right hon. Friend would object to the publication of the letter on his own account. I am merely stating that opinion.

Obviously, transport is a matter of concern--in a sense, access to services is as important as the services themselves. Under the new arrangements, no Barnet resident will need to travel more than six miles to an A and E department. The Wellhouse trust provides a bus service for patients, visitors and staff between the Barnet and Edgware sites. The service, which supplements existing public transport links, will be maintained and improved.

In addition, the Department of Health has commissioned a survey to provide reliable information about journey times and optimum travel routes for people travelling by car from the Edgware hospital catchment area to each of the hospitals that they may need to travel to--that is, Barnet, Northwick Park and the Royal Free. The survey will also provide comparative information about public transport travel times. The survey data will be used to assist the health authorities in providing information to the public about travel times and optimum modes and routes of travel for Edgware residents to the other hospitals.

There has also been work by a project group comprising the health authorities, trusts and local authorities along with London Regional Transport, community health councils and disability groups. The group has identified areas for action in both public transport and special needs transport. A particular aim is to ensure that there are reasonable public transport routes for people who may have difficulty changing buses. As a result of the group's work, discussions are taking place with London Regional Transport with a view to implementing improved bus services between

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Edgware and Barnet. Work in that area is progressing. I stress that the public transport services will be in addition to the existing Wellhouse trust free bus service from Edgware to Barnet.

The group will undertake a further review and evaluation of the adequacy of transport services in the six months after implementation of the planned changes--including a survey of the transport needs of hospital users and visitors and their level of satisfaction--which will provide an opportunity to initiate more action if that is required. I also draw to my hon. Friends' attention the fact that health authorities are spending no less than £320,000 on improving the London Ambulance Service in their area. I understand that they will provide two extra ambulances and crews to help meet demand in the immediate area.

I have already mentioned that Edgware will have a new type of hospital, and I shall now enlarge on that statement.

Mr. Dykes: My hon. Friend has accepted that there should be a full casualty service, and we are grateful to him for making that promise on the record. In order to avoid any future doubts and procrastination, will he list specifically the conditions that will be treated by the new casualty emergency service at Edgware general when the old unit is closed?

Mr. Horam: I am about to do precisely that.

The hospital will include general out-patient services and a diagnostic and therapy service--for example, radiology. It will also provide day surgery; a breast-screening service; elderly and rehabilitation services; and a range of mental health services, including in-patient units, outreach and assessment services, a base for community mental health teams and a brain injury rehabilitation unit. There will also be children's services, including specialist out-patient clinics and an education and information centre.

That is not all. As my hon Friends know, Barnet health authority is submitting an application for central funding for a demonstrator project at Edgware general hospital, with a number of key elements. First, the casualty service will be open 24 hours a day--I have mentioned that already--and, secondly, a low-risk maternity unit will be provided to allow mothers to give birth close to home. Thirdly, there will be a GP-type admissions unit to provide in-patient beds, to meet the immediate needs of elderly people living locally.

Mr. Dykes: What injuries will be treated by the casualty unit? What services will it provide?

Mr. Horam: It will provide a normal casualty service. My hon. Friend should understand that it is not an A and E department: it will treat the injuries normally dealt with by a casualty service.

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