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Mr. Paul Burstow (Sutton and Cheam) (LD): I thank my hon. Friend for the opportunity to take part in this debate and for his initiative in securing it. It is timely to have the opportunity to discuss this matter, not least because the organisation of health services in the London borough of Sutton and beyond has been an issue of long standing. Over almost the past 10 years, there has been a series of attempts by the Epsom and St. Helier NHS trust to come forward with a set of plans that held together and would be viable. Yet we are still waiting, with out-of-date building stock. We are still waiting, in particular, for St. Helier hospital—which is almost ancient—to be replaced. One conclusion that I drew from yesterday's event in Addington is that it is almost universally accepted that, whatever happens, St. Helier needs to be rebuilt to be fit for the 21st century, whether it is a critical care or a local care hospital.

I want to emphasise several points made by my hon. Friend. One thing that emerged from yesterday's debate in Addington was concern about the lack of clarity so far in the process of deciding what local care hospitals are to be. If the new model of care proposed in the local clinical services strategy is to be realised, and people are to buy into it through the area covered by Epsom and St. Helier trust, it is important for us to know how many sites there will be, where they will be, and precisely what services will be provided by the local care hospitals.

The Minister will probably empathise with one point raised yesterday. So far, the opportunity to include social care in the services provided by local care hospitals has been missed. There is an immense need to co-locate and integrate social care, and I hope the Minister will ensure that the opportunity is not lost in Sutton and Cheam or in Carshalton and Wallington.

As a result of the lack of clarity over local care hospitals, the focus has tended to be on the critical care hospital and where it will be. It is not surprising that Members of Parliament and others have fierce loyalties to their existing hospitals, as do our communities. My hon. Friend has already outlined some of the concerns that he and I share with the London borough of Sutton. The local authority feels that the new critical care hospital must be at least as accessible as St. Helier. I
 
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would go further, and say that the St. Helier site seems to offer the best fit strategically for a new critical care hospital.

I want to raise two or three issues about consultation. As has been pointed out yesterday and today, we should ask whether a two-site solution is viable. People will want to know, and will want to see demonstrated in the formal consultation, that the two-site option has been properly evaluated. If it is not viable, it should be shown why. If that does not happen, it will inevitably fuel the view of those who think that this is an exercise to get rid of the hospital and have just one acute hospital in the area.

Another question that needs to be addressed in the formal consultation is my hon. Friend's point about UDI. I do not think that it is as much a question of UDI as a question of whether there is merit in exploring the case for an amicable divorce between Epsom and St. Helier hospitals and the recreation of the pre-existing trusts. That is certainly a live issue in Epsom.

One of the things that puzzled me most about the criteria so far for evaluating the various site options was the low weighting given to health equality and equity of access. I hope that the Minister can reassure us that the Government take health inequality seriously when it comes to the reconfiguration of services.

At this point in the life of the project, the capital costs have been estimated at anything between £215 million and £228 million. Other Members with an interest in the project have rightly asked whether that will be deemed affordable. It would be helpful to know whether people are wasting their time with this enterprise, or whether the Government feel that the public purse can afford it. I hope that the Minister will also be able to consider my hon. Friend's points about foundation trusts.

The consultation must not be just for the vocal and articulate few. It must strive to reach the hard-to-reach groups, the vulnerable and those who do not have a voice; otherwise, it will risk letting the community down and not providing health care closer to home that will meet the needs of my constituents and those of my hon. Friend. My hon. Friend mentioned that we plan to hold consultation events of our own during the formal consultation stage. Given our desire to ensure that the hard-to-reach groups are reached, we shall want to hold more than one meeting, and we hope that the NHS will co-operate with us to ensure that factual information is provided to our constituents during the process.

2.50 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): This is an important subject and I suspect that, as the consultation proceeds, we shall not have heard the last of it in the House. I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this debate, and I thank the hon. Member for Sutton and Cheam (Mr. Burstow) for his contribution. They both made important points about the way in which the consultation should proceed and the need to focus on evening out health inequalities. The hon. Member for
 
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Sutton and Cheam made the particularly important point that the consultation should involve not just the loud mouthed and the pushy—it also needs to reach those whose voices are not normally heard.

I would like to begin by paying a brief tribute to all the NHS and social care staff in the South West London strategic health authority area. They are hardworking, dedicated and committed to the improvement of the local NHS and local services. Let me start my response to the hon. Member for Carshalton and Wallington by acknowledging the pressures on the NHS, not only in his constituency but throughout the country. A consequence of that is that we must increase capacity, which is why the Government are investing so heavily in doctors, nurses, technicians and new equipment. We must also work to raise clinical standards generally. In other words, it will not be good enough for us to keep doing more of the same; we have to take a radical review of how services are provided.

The NHS plan sets out a challenging 10-year programme for that reform. Far-reaching changes are often necessary to try to provide the best possible services for patients, and we must ensure that those services are accessible, flexible and designed around the needs of patients. However, we cannot do that from Whitehall. It is no good pretending that I know best what is right for the hon. Gentleman's constituency when I neither live there nor access health services there.

It is our policy to shift decision making to local areas. That is why we started the "Shifting the balance of power" initiative and why we now devolve funding decisions to the front line. It is now for the primary care trusts, in partnership with strategic health authorities and other local stakeholders, to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to do that because of their specialist knowledge of the local community.

As part of the modernisation programme, many NHS economies and organisations are using this freedom and responsibility to consider, with their local stakeholders, changes to the way in which they organise their services. They recognise that services cannot be static, and that they must change to reflect changing circumstances and to respond to local needs. In carrying out such reviews, they must take account of a number of different pressures on the local service, including changing medical practice, training-related issues, the working time directive, population distribution and travel times. The hon. Gentleman mentioned all those issues. They have an additional responsibility to live within their means. These issues and many others have to be taken into consideration. Of course, biggest is not always best. Local decision makers need to recognise that patients want more, not fewer, local services. However, that pressure has to be balanced with the need to ensure clinical safety and to develop excellence.

That brings me to the situation in south-west London. In terms of health care in the Sutton, Merton and mid-Surrey area, local stakeholders have looked at the local
 
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position and a general consensus has developed locally that the status quo cannot remain. The fabric of the estate at St. Helier hospital is poor, with problems of a lack of privacy and dignity on the wards, and of few toilets and bathrooms. The Epsom hospital is small and some of its building fabric is also poor.

There are challenges associated with recruiting clinical specialists to deliver services over split sites, and with supervising and training doctors. Sub-specialisation is difficult in the present circumstances and it is also proving difficult to create and sustain viable clinical rotas. There is also a duplication of services across the sites and the problems at each site are likely to worsen with time.

There is local recognition that things must change and that there needs to be a locally developed proposal with which to move forward. That proposal—I stress again that it is a local proposal, not one imposed from Whitehall—is to create several community hospitals, referred to in the proposals as local care hospitals, supported by one acute hospital, which is referred to in the proposals as the critical care hospital. This concept has received widespread local support from both consultants and GPs, and there is agreement on the model. There is also general consensus on the way forward that the model represents. It aims to separate the planned and emergency care processes and to redesign services around the patient.

The proposed strategy challenges the notion of what an emergency hospital should really be doing, while seeking to devolve the planned aspects of traditional hospital activity, so that they can be delivered closer to the patient's home. Those services will then be brought together with primary care services to challenge the traditional configurations within GP and health centres. The point that the hon. Member for Sutton and Cheam made about the need to involve social care in those activities is an important one, and he is right to press it.

The function of a local care hospital will be to offer more clinical services than can traditionally be offered in a GP surgery. They will include health surveillance and screening; elective work, such as day-surgery; the majority of high-volume, low-complexity out-patient appointments; some in-patient beds and intermediate care; minor injury and illness units; and diagnostic services such as X-ray.

The critical care hospital will deal with all emergency work, complex elective work and low-volume, high-complexity and multi-speciality out-patient work, supported by relevant diagnostics services. The advantages of placing these acute services in one critical care hospital include meeting national standards for clinical services; meeting national employment and training standards; providing capacity for planned growth in the number of patients needing services; providing flexibility for future needs; integrating clinical specialties in order to provide better care and to use scarce resources to best effect; and providing a better environment to help patients' recovery and staff recruitment and retention rates.
 
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This new model of care will realise the ambitions of "Keeping the NHS local". It will also mean that the constituents of the hon. Member for Carshalton and Wallington will benefit from better, more modern health care services, delivered in a better and more appropriate environment that is closer to their homes. The proposals will also give the local health service the opportunity to improve the standard of the environment in which hospital services are delivered—for example, by providing more single rooms. They will also create an opportunity to rationalise NHS land holdings locally and, potentially, to release land for key worker housing.

It is important that I point out, however, that while consensus has been developed over the model of service, no decisions have been taken on the site of the critical care hospital or of the local care hospitals. As the hon. Members for Carshalton and Wallington and for Sutton and Cheam have rightly pointed out, the decisions on the siting of the local care hospitals and of the critical care hospital are of equal importance.

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