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On accident and emergency services, I accept that there are cases in which a blue-light ambulance is called, and it does not go to the nearest hospital, and of course we have to accept the argument for that. However, as a consequence, across the country, primary care trusts and strategic health authorities are saying, “We’ve got to downgrade units.” I went to Chase Farm hospital accident and emergency unit, and
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people there were saying, “We want to become a minor injuries unit.” Frankly, the choice is not between having a full-service accident and emergency department and having a minor injuries unit. As George Alberti makes clear in his document, it is perfectly valid for us to retain accident and emergency departments.

If we add up all the myocardial infarctions, strokes, major head injuries, aneurisms and demands for vascular surgery, they still account for only about 300,000 out of 13 million attendances at type 1 accident and emergency departments. We cannot have a situation in which the NHS, because of financial deficits and the impact of the working time directive, shuts accident and emergency departments across the country, so that 97 per cent. of the people visiting those departments lose access to them, on the excuse that 3 per cent. of patients need to be blue-lighted to a more specialised centre.

Mr. David Burrowes (Enfield, Southgate) (Con): I am grateful to my hon. Friend for referring to Chase Farm, and I share his concern about its move towards having a minor injuries unit; that is simply one option among many concerning accident and emergency. Does he welcome the fact that Sir George Alberti is now to report on Chase Farm specifically, and the options open to it? Will he make the point that Chase Farm has a wide catchment area, and we should not move quickly to downgrade, simply in the interests of saving money?

Mr. Lansley: I entirely agree, and I hope that George Alberti, for whom I have a lot of respect, will come to the right conclusions in his report. I will not go on about maternity services in detail, because our debate on 10 January covered that subject, or most of it, but since 10 January, the Government have produced a document from the national clinical director for children, young people and maternity services. Fascinatingly, what is does not tell us is far more significant than what it does. It does not tell us anything about whether there are enough midwives to provide maternity services, and it does not tell us what might be regarded as safe transfer times between a midwife-led unit and a consultant-led unit. It does not tell us how swiftly, and under what circumstances, mothers should be able to have an emergency caesarean section.

In fact, at one point the report commends the fact that, in Huddersfield, a unit shut down because it could not maintain eight consultants and at least 2,500 births a year, but two pages later, it says:

There is no evidence in that report, published by the Department, that informs thinking on the delivery or configuration of maternity services across the country. It does not help at all. Indeed, I am afraid that across the country, campaigners are having to put together the arguments themselves, because the arguments are not presented in the work done by the Government.

Who is standing in the way of change? Let us have a look. The Labour party chairman, in Salford, does not agree with the Government’s policy. The Labour Chief Whip, who stood outside the Alexandra hospital in Redditch, does not agree with the Government’s policy.
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The Home Secretary does not agree with the Government’s policy, because of the closure of his local accident and emergency department up in Lanarkshire. I could go on; the list even extends to the Prime Minister. Back in September 2004, there were proposals for the reconfiguration of acute hospital services in north Teesside, and the Prime Minister, with the then Secretary of State for Health, now the Home Secretary, came to Hartlepool. As it happens, it was in the middle of a by-election, but of course I would not suggest for a minute that, in the heat of a by-election, the Prime Minister would say something that he did not believe, and that he was not prepared to deliver on subsequently. He arrived and said:

Subsequently, it was proposed that precisely that should happen.

The decision taken in that case may be right, or it may be wrong; it is not really for me to say, but the independent reconfiguration panel has become involved. Curiously, there have been 20 referrals from overview and scrutiny committees to the Secretary of State, and five of those, including three from local authorities in north Teesside, have been sent to the IRP. There is one single characteristic shared by those five referrals: they all related to places where Labour Members of Parliament were arguing with each other. They concerned north Teesside, Calderdale and Huddersfield, and, more recently, Greater Manchester. If Labour MPs are arguing with each other, and the Secretary of State does not want to have to decide between them, the case goes to the independent reconfiguration panel. In places where Liberal Democrat or Conservative Members of Parliament are involved, she will rubber-stamp the decision. Bang! There we go; the decision is made, and the debate is shut down immediately. She does not care.

At one point, the Secretary of State received proposals that the NHS hospital rebuild should be in Sutton, but she not only did not accept what the local NHS was telling her, but said that the rebuild had to be at St. Helier hospital, which—lo and behold—was in a Labour constituency, but she subsequently had to completely abandon her proposal. [Interruption.] Well, it serves a Labour constituency. We know perfectly well what that was all about. She subsequently had to abandon her intentions in the face of judicial review. Credit must go to my hon. Friend the Member for Reigate (Mr. Blunt) and other hon. Friends for seeing off the Secretary of State’s desire to gerrymander NHS services for political gain.

Barbara Keeley (Worsley) (Lab): I want to read the hon. Gentleman a quote from the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears). He referred to her three times, saying that she disagreed with Government policy. Some time ago, following the picket that has been referred to, she said:

That is, the Manchester Evening News

The hon. Gentleman keeps making the point that there is a link to investment decisions or cuts, but that is not
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the case. Hope hospital is not in financial deficit, and more money is being invested. [Interruption.] I am just disagreeing. The hon. Gentleman has made a number of points that are simply not true.

Madam Deputy Speaker: Order. Will the hon. Lady please bring her intervention to a close?

Mr. Lansley: The hon. Lady should have read the debate on 10 January. I was not making the case that the changes in Greater Manchester were being made entirely for financial reasons. That is why we talk about financial and staffing pressures.

Barbara Keeley rose—

Mr. Lansley: No, I will not give way. If the hon. Lady reads “Making it Better, Making it Real”, the Manchester document, she will see that the matter is driven by the European working time directive. This Government signed up to the social chapter; they are implementing it, and they said, in 2004, that they would amend the working time directive, but they have failed to do so.

Mr. Nigel Evans (Ribble Valley) (Con): It is a long time since I studied politics at Swansea university. Indeed, one of my lecturers was the hon. Member for Huddersfield (Mr. Sheerman). In those days, however, I learned about the concept of collective responsibility. We have all seen the photographs of Government Ministers and read quotes in which they directly oppose the decisions that they made in cabinet. Will my hon. Friend tell the House where he believes collective responsibility now lies?

Mr. Lansley: Since my hon. Friend and I were politics students the world has moved on. We now have sofa government, so collective responsibility probably extends to the sofa and the armchair, but no further. We know precisely what members of the Government are doing. As my right hon. Friend the Leader of the Opposition said at lunchtime, they are all manoeuvring to try to save their skins when the time comes. We should have humility, because it happened to us in 1997: when a Government fail and the electorate decide that they ought to go, the tide goes out a very long way, and it will do so for Labour Members of Parliament.

Several hon. Members rose—

Mr. Lansley: I must conclude, because many Labour Members wish to make their own contribution.

The point of the motion is straightforward. I do not accept the proposition that we stand in the way of change. We believe in change to improve the national health service, whether it is primary angioplasty services, stroke services or reconfiguration to make sure that we deliver maternity services more effectively. We have made that clear, both today and in our previous debate. We will not allow the Labour Government to pretend that clinical considerations drive changes in the NHS that are not in patients’ interests. The proposed changes are not substantiated by clinical evidence, and there is no basis for them. The Government have not introduced a national stroke strategy or made an
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evaluation of primary angioplasty pilots. They have not conducted a review of walk-in centres. The Secretary of State said that it would be published in the new year, but we have not seen it. It has all gone out of the window. The Government argue for change, but they do not provide the evidence for it.

We know what it is going on, as the Government published the figures yesterday. Deficits of some £1.3 billion are littered across the national health service, and one third of trusts are potentially in deficit. The Government, however, are determined to drive down activity in the hospital sector to try to rescue the Secretary of State from the consequences of financial deficit. Astonishingly, the right hon. Lady now argues that fewer beds are a sign of success. It is “Yes Minister” politics, and in the next episode it will be suggested that if none of the patients turns up at hospital the NHS will work brilliantly. Fantastic! The Secretary of State has said that we are just over halfway through the NHS plan, but how many of her colleagues have re-read that document, which was published in 2000? I suggest that they look at it, because it is very interesting. It does not say anything about payment by results, practice-based commissioning or foundation trusts. It says, however, that the Government will implement a national beds inquiry and increase the number of beds by 7,000. Bed occupancy rates are so high that the number of cases of Clostridium difficile has risen from 17,000 six years ago to 45,000 in the past year, so we will not accept their lectures on the subject. Fewer beds will be acceptable when occupancy rates in hospital are such that patients can be treated properly and nurses have time to clean a bed before it is taken by the next patient.

Mr. Graham Stuart (Beverley and Holderness) (Con) rose—

Mr. Lansley: I will give way for the final time, as I have great respect for my hon. Friend’s campaign on community hospitals in his constituency.

Mr. Stuart: Thanks to the advance of modern medicine and improvements in public health, the number of beds has generally declined over the years, but that will not continue for ever. Our bed use is similar to that of the United States, where it is among the most efficient in the world. In the East Riding of Yorkshire alone, every year there is a net increase of 500 in the number of people who are over 85. When elderly people are ill, they need a hospital bed. They need time to recuperate, and they need community hospitals as well as decent acute hospitals. The Government believe that that downward curve can go on for ever, but it cannot.

Mr. Lansley: Absolutely. I agree with my hon. Friend. We have made that point, and I know that his constituents subscribe to the campaign that he is fighting on community hospitals. Indeed, I recently read a letter from Professors Flint and English from Beverley in east Yorkshire making exactly the same point about the necessity of maintaining access to services closer to home. That is what the Secretary
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of State told us that she wanted. It is what my hon. Friend wants, and it is what we are arguing for but, as a consequence of Government policy, we could lose it.

In the motion, we are seeking to reassert the right and need for the NHS locally to make decisions in the light of views expressed by professionals, patients and the public. Decisions should be based on clinical evidence, rather than being driven by deficits and financial pressures. We want an NHS in which we do not stand in the way of change. That change, however, must be managed well. [ Interruption. ] The Secretary of State scoffs, and says that change must be managed by the Department of Health, but before she goes down that track, she must accept that 96 per cent. of senior civil servants in the Department did not believe that departmental change was managed well. Some 81 per cent. disagreed or strongly disagreed with the proposition that change was managed well. There is no belief in the Department itself that it manages change well and there is no confidence in the Department’s leadership. I do not blame the civil servants, as it is Ministers who decide and lead. This Minister has failed to lead her Department or the national health service. Doctors do not have any confidence in her, and we know from Monday’s edition of The Times that they have far more confidence in my right hon. Friend the Member for Witney (Mr. Cameron) than in the present Government or prospective Government under the leadership of the Chancellor of the Exchequer. They believe in what we are saying about the national health service, and they know that we are fighting for it, so I commend the motion to the House.

2.36 pm

The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

I welcome every debate on the health service, but I am afraid that they are developing a familiar pattern. Every time, I look forward to hearing from the Opposition an acknowledgement of the dramatic
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improvements that NHS staff are making and an apology for the condition in which they left the NHS 10 years ago. Every time, I hope that we will hear constructive criticism and practical proposals to build on the success that has already been achieved to meet the enormous challenges that we still face. Every time, we are disappointed. Today, we have had to listen again to the usual mishmash of evasions and contradictions, the whingeing and nit-picking that passes for a speech from the hon. Member for South Cambridgeshire (Mr. Lansley). He complained about reconfigurations and changes—

Mr. Wilshire: Will the Secretary of State give way?

Ms Hewitt: No, I should like to make some progress first.

The hon. Member for South Cambridgeshire complained about reconfigurations and changes to the health service across the country, before complaining that they have not taken place fast enough. Of course health services are changing fast—and they will continue to do so—because medicine and, people’s needs are changing. The NHS has to keep up with those changes, as it has always done. The hon. Gentleman referred to the White Paper entitled “Our health, our care, our say” that we published last year after the biggest ever public engagement on health policy that any Government have undertaken. The White Paper was warmly welcomed by professionals, staff and trade unions, as well as by voluntary organisations across the country.

Mr. Graham Stuart: What the White Paper said on the subject of care closer to home came as great news to Members on both sides of the House. It suggested that facilities should not close because of short-term budgetary pressures, yet more than 160 community hospitals across the country face cuts and closure, or have already closed. How does the Secretary of State justify that, as patient need is not being met?

Ms Hewitt: The hon. Gentleman is talking absolute nonsense. It is a pity that he did not refer to the additional funding that there has been and the additional staff, and the benefits that those have delivered to his constituents.

In the White Paper, as the hon. Gentleman will recall, we examined the biggest challenge that is facing the health service in every developed country—that is, the need to support the growing numbers of elderly people, in particular, with long-term conditions—and we set out a strategy for taking advantage of modern medicine and bringing health care that was previously available only in an acute hospital closer to people’s homes, improving their care and transforming their quality of life as a result. Those changes are already taking place, and it is high time the Opposition celebrated, rather than criticised.

Mr. Evans: Will the right hon. Lady give way?

Ms Hewitt: No. I will make a little more progress before I give way again.

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