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Mr. Blunt : I am grateful to the hon. Lady for giving way. This might not be the last time that I seek to intervene on her, because the issue that she has raised affects half my constituents as well. Does she accept that the critical care hospital is going to have to serve 500,000 people, which is rather more than the populations of her constituency and mine put together, by some margin? Will she also explain to the House what particular health expertise she brings, given the advice that she has consistently been given by people involved in this exercise? That advice to the hon. Lady was summed up in this way:
 
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"I am sorry we continue to fail to convince you that the local care hospitals will be a far more significant influence on addressing the acknowledged problems of health needs in your area than ever the Critical Care Hospital would be."

The result of her intervention, and the Secretary of State's decision, is that her constituents will not have a community care hospital addressing health inequalities; instead, they will get a critical care hospital that addresses the needs of 500,000 people.

Siobhain McDonagh: My experience, as of Monday, is 46 years of living in the constituency, being a councillor for 18 years and being MP for the constituency for the past eight years. My experience is the same as anybody could have. I am willing to take any Member who is in the Chamber in my car to see my area and that represented by the hon. Member for Reigate (Mr. Blunt). Hon. Members will not need to be health professionals to see the differences.

Out of the 174 super-output areas covered by the East Elmbridge and Mid Surrey primary care trust, which covers the hon. Gentleman's constituency, only eight are below average in the index of multiple deprivation. I have counted at least 50 within just 3 miles of St. Helier hospital. I leave it to Members to judge whether the decision on locating a hospital should be based on 50 areas within 3 miles of a hospital or the eight within a PCT.

Mr. Kevan Jones : Does my hon. Friend agree that one important thing in tackling health inequality is enabling residents to sit on PCT boards and health boards? Unfortunately, the Government have made a big mistake by setting up the NHS Appointments Commission, which is leading to self-perpetuating medical bureaucracies, which in turn lead to nonsensical decisions that ignore clear need among local people.

Siobhain McDonagh: I fear that I agree with my hon. Friend that we have a real problem over who is on boards, who they represent and how representative they are. I cite my constituency as a prime example of that.

Rosie Cooper : If PCTs go on to be foundation trusts and have their boards of governors, or membership councils, that deficit will be sorted out.

Siobhain McDonagh: I agree with my hon. Friend, as I was a prime supporter of foundation hospitals precisely because of my constituency experience. This is the only way that people from Mitcham and Morden will get on any board of any hospital or health organisation in my area. Despite the fact—[Interruption.] I am always slightly overwhelmed by the condescension with which people's views are treated in this Chamber. I have first-hand experience of my constituency and how the health service works.

The decision was taken despite the fact that the area around St. Helier has the greatest health needs in the catchment area and the fact that people living there have up to 10 years less life expectancy than others. It was taken despite the fact that people living near St. Helier are the least likely to have a car and the most likely to need to go to hospital. It was taken despite the fact that those in the catchment area could reach St. Helier well within the critical golden hour that our health experts
 
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agree is crucial to survival, and despite the fact that more people could get to St. Helier within 20 minutes than to Belmont, and St. Helier has far better public transport.

Indeed, in looking at health inequalities, the programme board did not even consider access to a private car against access to public transport. In no example was the need for public transport ever taken into account. Losing those services from St. Helier would have affected not only the people in my constituency who need that hospital, but the other half of the area and the rest of south-west London because of the untenable pressure that would have been put on St. George's hospital, leading to even worse health services in another socially disadvantaged area of south London.

Due to the harm that would be done by health inequalities if Belmont was the location of the new critical care hospital rather than St. Helier, Merton council called in the decision. The issue of health inequalities did not seem important to the local health establishment. It did not even minute letters it received from 4,000 people back in 2003, saying that the most important thing when deciding where to locate health services is health needs. It allowed only 5 per cent. of its decision on where to put the critical care hospital to be based on health inequalities.

Then, to rub salt into the wounds, the health establishment scored St. Helier at 33 per cent. on health inequalities—just 3 per cent. higher than Belmont—yet the area around St. Helier has the lowest life expectancy, the most emergency admissions, the highest accident rate among children, the lowest level of general good health, the most people with long-term illness, the most babies born with low birth weights, the most people without access to primary care, the lowest incomes, the largest black and ethnic minority population, and the least likelihood of owning a car. Apparently, all of that was worth only 3 per cent. to the health establishment.

It would have been cheapest for patients if the hospital were at St. Helier, but that was not addressed by the health establishment either, even though Government rules say that the cost to patients must be included in its plans. Even the health establishment admitted that were the Belmont site chosen, people living in seven of the 10 most deprived postcodes in the region would have to travel further than they do at the moment. Despite public agreement and all the evidence supporting St. Helier, the health establishment discovered new evidence, which has since been discredited, and decided unilaterally to remove services from St. Helier.

In the face of that, the Government have demonstrated once and for all, to the whole NHS, that health inequalities matter. Merton council was brave to take on the powers that be and refer the decision to the Secretary of State, who was also brave, because she must have been under a lot of pressure from the health establishment, and the decision must have been close. She has come down firmly on the side of reducing health inequalities, however.

Mr. Blunt: I will address some of these issues if I have the opportunity to catch your eye later, Mr. Deputy Speaker. The hon. Lady has not addressed the central
 
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point of whether a critical care hospital that has to address the needs of half a million people is the appropriate vehicle for addressing health inequalities when the choice is between that and a community care hospital.

Siobhain McDonagh: If I had the opportunity, I would ask the hon. Gentleman how many super-output areas in his constituency are in the most deprived quarter in England in the index of multiple deprivation. I understand that there are none in the whole county of Surrey. In fact, there are more super-output areas in Surrey in England's most affluent 0.5 per cent. than in the whole of the bottom 50 per cent. I would have thought that he would agree that just because inequality in Surrey means inequality between the fabulously wealthy and the merely well-off, that does not mean that Surrey needs better health services than constituencies such as mine, where the inequalities are between the poor and those who just get by.

Mr. Blunt: The hon. Lady should not seek to characterise my constituency, which she plainly does not know. In my constituency, Merstham and Preston—which will become part of the Reigate constituency after the next general election—are the two most deprived wards in Surrey, and the people who live there face particular social and economic challenges. If she knew my constituency better, she would not make such remarks. We all come to this place to represent the interests of our constituents—

Mr. Deputy Speaker: Order. I am sure that the whole House is interested in this exchange, but the hon. Gentleman seeks to catch my eye, and might do so later, so I suggest that he contains himself until then.

Siobhain McDonagh: I do not wish to test your patience, Mr. Deputy Speaker, but I said that there are no super-output areas in the hon. Gentleman's constituency that fall into the bottom quarter of wards in the multiple deprivation index. While I understand completely that some less-well-off areas in his constituency face challenges, those challenges are nothing like those faced in my constituency.

The 250 people who came to our celebration wanted to thank my right hon. Friend the Secretary of State for Health for her decision. They wanted to thank her for caring about the tens of thousands of people from disadvantaged areas whose health will now be improved by having a brand new hospital on their doorstep in St. Helier. That is why I am grateful for this opportunity to pass on the thanks of my constituents to the Government for being serious about tackling health inequalities.

4.29 pm

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