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Already 109 new health centres have been built and there are more to come—on average, one new community health centre is opened every week, bringing together GP services, district nurses, physiotherapists, minor surgery and diagnostic tests, all under one roof, convenient for people and in their own neighbourhood. That is reconfiguration.
Community nurses and other professionals are looking after elderly people in their own homes. In Dudley, for instance, one case manager alone prevented 88 admissions to hospital in just eight months last year. One case manager transformed the lives of elderly people—I have met some of them—who no longer needed to go into hospital as emergency admissions time after time. Dudley also has a superb new acute hospital, one of more than 150 already built, refurbished or under way. That new acute hospital, as my hon. Friend the Member for Dudley, North (Mr. Austin), whom I see in his seat, well knows, has almost 300 fewer beds than there were in the old hospital, meaning better care for the people of Dudley and better value as well. That is reconfiguration.
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): All that my right hon. Friend has outlined is indeed welcome, but will she please outline her vision and the Department’s vision for the future of district general hospitals? The Homerton hospital in my constituency is losing at the accident and emergency end because it is providing better services through GP acute services, but it is also losing out because the easier cases are being treated in the community. That is good for patients, but what role is envisaged for the district general hospital in the future NHS?
Ms Hewitt: The role of Homerton hospital and others like it—Homerton hospital is a superb hospital taking full advantage of its relatively new foundation trust status—is to do the things that can be done only in an acute hospital, working with GPs, health centres and other parts of the local NHS to ensure that wherever possible, care is delivered to people closer to their own homes because that is more convenient for patients, better for them, and better value for the local NHS. Then we can focus in the acute hospitals on the particularly complex cases, the specialist care and the in-patient surgery that can be done only in a hospital like Homerton. That is the future policy of such hospitals, and I know very well from my own visits to Homerton that staff there not only understand that, but welcome it and embrace it because it will improve care in one of the most disadvantaged parts of London, as my hon. Friend well knows.
Michael Gove (Surrey Heath) (Con): I am enjoying the Secretary of State’s Pollyanna-like vision of health care in this country, and it is striking that she takes the example of investment in Dudley, where there are two Labour marginal seats. In Surrey, how are patients better served when an accident and emergency unit is likely to close at Frimley Park hospital, the Royal Surrey or St. Peter’s? How will care be closer to patients if cuts are made there simply in order to meet the right hon. Lady’s budgetary criteria and in flagrant defiance of patients’ needs?
Ms Hewitt: I notice once again that an Opposition Member whose party voted against the increased investment that we have made in the NHS is demanding a blank cheque for the NHS in his own area, and refuses to face up to the fact that one of the things that any health service must do is ensure that services are organised in a way that gives patients the best possible care within the available budgets, which are bigger in Surrey and every other part of the country under this Government than they ever were or ever would be under the Conservatives.
Mr. Andrew Tyrie (Chichester) (Con): Is not that reply from the Secretary of State a clear admission that what is taking place in, for example, West Sussex, where at least one accident and emergency department is to close, is that such departments are closing not on the basis of clinical need, but purely because of the budgetary constraint that she has just mentioned?
Ms Hewitt: No proposals have yet been made either in West Sussex or in Surrey. Opposition Members should stop telling people that hospitals are to close when there is no intention that that should happen, and no proposal has even been made.
Ms Hewitt: No. Let me say to right hon. and hon. Members on the Opposition Benches that we have written a very big cheque for the NHS, bigger than they ever did or ever would, but it is not a blank cheque. Part of the changes that are taking place are designed to give patients care that is at least as good and, in many cases, far better than they are getting at present, but to do so in the most effective way within the available budgets, delivering better care and better value at the same time—a point to which I shall return.
Martin Linton: Does my right hon. Friend agree that many of the closures that one hears about are not closures at all? Wandsworth council is running a scare campaign against what it calls a closure, when in fact the proposal is to move out-patient services half a mile into larger premises in a brand new NHS building that has not yet been opened. At the same time, Conservative Wandsworth council really is closing two libraries, a museum and an art gallery.
Ms Hewitt: My hon. Friend is right. It is typical of the Conservative party to tell people that services are to close, when in fact they are being reorganised and improved. If I may say so, we heard exactly that from the hon. Member for South Cambridgeshire, who told people last year that Hinchingbrooke hospital was to close. He took part in a human chain, no less, around the hospital to protect it from the wicked plans to close it, and he now has the nerve to claim that he has saved a hospital that nobody was planning to close. That is a disgrace.
Mr. Nick Gibb (Bognor Regis and Littlehampton) (Con) rose—
Mr. Mark Francois (Rayleigh) (Con) rose—
Ms Hewitt: No, I shall not give way. I shall make a little more progress.
Mr. Lansley: I am astonished at the comments of the Secretary of State. There was an option to close Hinchingbrooke and there is still an option to close it. I am against that. If we win, that is good. I am in favour of that.
Ms Hewitt: The hon. Gentleman is talking nonsense. He scare-mongered, he campaigned to save a hospital that nobody was planning to close, and he now claims a triumph. As was always going to happen, the local NHS—the strategic health authority—has been looking at hospitals across the region and has presented sensible proposals, on which there will be full local consultation.
Ms Hewitt: No. I shall make progress.
The hon. Gentleman referred to hospital beds. One of the changes that mean that we need fewer acute beds now than we did in the past is the increase in day-case surgery. A little less than 70 per cent. of all operations across the NHS are now done on a day-case basis. The figure was only 60 per cent. just 10 years ago, but in the best hospitals it is now 85 per cent. What does that mean? It means better care and faster recovery for patients, a service that is preferred by staff, but yes, fewer acute beds are needed as a result, as in the Dudley hospital, for example, so that money that is saved on those beds can be invested in better services, better quality treatment and new drugs. That is reconfiguration.
Mr. Evans: Why, then, not so long ago was the Secretary of State parading as a great benefit the fact that there were extra beds in the NHS? The right hon. Lady cannot have it both ways. She could not be right then and be right now.
Ms Hewitt: I certainly can. Given the state of the NHS that we inherited from the Conservatives 10 years ago, we desperately needed more capacity—both beds and staff—which we delivered, thanks to the record investment that we made and the Conservatives opposed. We are now seeing a reduction in the number of acute beds as a direct result of modern medicine and more day-case surgery in particular, and a continuing increase in the number of critical-care and intermediate-care beds where those are needed.
The Conservatives constantly accuse us of closing hospitals. That, too, is absolute rubbish. More than 150 acute hospitals have been refurbished or rebuilt, or are on the way. Hospitals are working differently, as was pointed out by my hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier). They are doing what only hospitals can do. Health services are provided as close to home as possible, but are provided in hospital where necessary.
Waiting lists are at their lowest ever in the NHS. Almost no patient waits for more than six months for operations such as hip replacements for which people used to wait over a year, sometimes up to two years, under the Conservatives. But now the NHS is doing
even more. Earlier this week my right hon. Friend the Prime Minister announced that 13 hospital trusts expected to be able to guarantee most of their patients a maximum wait of just 18 weeks from GP referral to hospital operation—far less, in the majority of cases—and to achieve that by the end of the year, a year earlier than the goal that we set. That is an enormous achievement, and I congratulate all the staff involved. However, as the medical director at King’s College hospital told my right hon. Friend and me on Monday, the NHS cannot get rid of waiting lists by doing things in the same old way; it can do that only by transforming the way in which hospitals, local GPs and other services work.
Bolton, for instance, has provided a clinical assessment and treatment centre where patients who would formerly have waited to see the orthopaedic consultant at a hospital are now referred to a community team. An orthopaedic consultant in the community, one of the first consultant physiotherapists in the country and other staff are all working together, treating patients who do not need surgery. Those patients—about 70 per cent. of the total—are given physiotherapy, or other treatments that they may need, much faster; meanwhile, hospital consultants can concentrate on the patients with the most serious problems, and spend more time on surgery. As a result, waiting times both for patients who need physiotherapy or other community treatment and for those who need in-patient care have been cut from months to weeks. That too is an enormous achievement. It means that the right care is being given to patients by the right professionals in the right place. That is the kind of reconfiguration that we need throughout the country.
Mr. Ben Wallace (Lancaster and Wyre) (Con): To work towards reducing waiting times, hospitals have to function. How would the Secretary of State respond to an e-mail sent by Morecambe Bay Hospitals NHS Trust on Monday, putting people on red alert that all routine elective surgery was to be cancelled and that any patients referred to the hospitals would have to be referred outside the trust area?
Ms Hewitt: I am not aware of the specific circumstances of the Morecambe Bay trust, but obviously we keep a close eye on what is happening in individual trusts, particularly during the winter months when pressures on beds are building up. The hon. Gentleman will recall that 10 years ago—in fact, only five years ago—pressure on beds in the middle of winter was typical in every hospital in every part of the country. Now it is very rare indeed.
Mr. Gibb: I am listening carefully to the Secretary of State’s arguments, which have been put to people in West Sussex over the past six months. If the consultation process in West Sussex reveals almost unanimous opposition to any of the options proposed by West Sussex primary care trust for downgrading the accident and emergency unit at St Richard’s hospital in Chichester or the A and E unit in Worthing, will those plans be scrapped or is the consultation process just a sham, with Government imperatives overriding local public opinion?
Ms Hewitt: The consultation process is absolutely real. We strengthened it and put it on a statutory basis. We require any significant change in NHS services to go through a very full—some would say too full—process of local consultation with staff, patients and the public, including, of course, their elected representatives. That will apply to any proposals for reconfiguration of emergency services. I will not anticipate the results, but the hon. Gentleman will be aware that as a result of consultations in many other parts of the country, changes have been made to ensure that patients always receive the best possible services with the best possible value for money.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): What assessment has the Secretary of State made of the impact of local improvement finance trust projects in reducing the need for acute hospital beds?
Ms Hewitt: Although we have not made a formal assessment, it is clear that one of the great benefits of the LIFT centres—the new health centres that I have described—is a reduced risk that, for instance, an elderly person with chronic heart disease will end up in hospital as an emergency patient seven, eight or nine times a year, which is what has been happening. As the number of centres increases—and, as I said earlier, we are opening an average of one a week—along with the number of community nurses caring for people in the centres and, indeed, in their own homes, emergency admissions will fall rather than rise. As a result, acute hospitals will need fewer beds and more staff will be employed in the community.
Keith Vaz (Leicester, East) (Lab): Has my right hon. Friend received a report from the Minister of State on his visit to my constituency, where he launched a brand new £12.8 million LIFT centre? It has been widely welcomed by my constituents, because it will reduce the pressure that was building up on the general hospital.
Hon. Members: Wish him a happy birthday.
Ms Hewitt: My right hon. Friend is absolutely right—and I do wish him a happy birthday. I know about the new LIFT centre, and it is very good news for all his constituents, including those who are not celebrating their birthdays today.
Mike Penning (Hemel Hempstead) (Con): I thank the Secretary of State for being generous and giving way again. May I return her to the subject of public consultation on the closure proposals in the West Hertfordshire Hospitals NHS Trust area? Just under 90 per cent. of consultees opposed the closures, but that opposition was ignored and the board proceeded with them. Will the Secretary of State now step in and stop them, on the basis that the public are against them?
Ms Hewitt: In my view, such decisions are best made locally. Account must be taken of local consultations, and I can step in only if the local overview and scrutiny committee, consisting of elected councillors representing the area concerned, chooses to refer the matter to me.
Lynne Featherstone (Hornsey and Wood Green) (LD): When the Hornsey and Wood Green overview and scrutiny committee in Haringey approached you, it received a letter from the equivalent of a public relations department saying “Thank you for your letter”. There was no sense that, as you have suggested from the Dispatch Box, you had actually—
Madam Deputy Speaker: Order. May I remind the hon. Lady not to include me in the argument, but to refer to either the office or the constituency of the Secretary of State?
Ms Hewitt: I do not recall any referral to me from the overview and scrutiny committee. I think the hon. Lady is referring to a new hospital that is being built in the area. But as I have been accused of refusing to accept referrals from overview and scrutiny committees that do not happen to be in Labour constituencies, let me say something, first, about maternity services and the recent review in Greater Manchester. I have already accepted referrals from the overview and scrutiny committees of Bury, Rochdale and Salford, and have referred them to the independent reconfiguration panel. As for the “Healthy Futures” review in North-East Manchester, I have had one referral from the overview and scrutiny committee in Rochdale, and I announced today that that too was being referred to the panel.
Mr. Wilshire: Will the Secretary of State give way?
Ms Hewitt: No; I want to make progress.
Ms Hewitt: Forgive me; the hon. Gentleman was trying to get in earlier, so I shall give way to him.
Mr. Wilshire: I am grateful to the Secretary of State. I have been trying to intervene for some time, while the person to whom she gave way just now had just walked in.
The right hon. Lady said that decisions were best taken locally. If that is so, will she tell the House why the chairman of the Surrey PCT is telling people that we are wasting our time organising petitions because the Government have ordered him to make cuts?
Ms Hewitt: As I am sure the hon. Gentleman is aware, it is the statutory responsibility of the chair and board of every primary care trust in the country to ensure that their trust lives within its budget. Thanks to the investment that we have made, which he and his party voted against, that budget is bigger than ever before. He and the Opposition need to decide whether they believe that the NHS, like every other organisation, needs to live within its means; whether they are willing to support the sometimes difficult decisions needed to improve value for money for the public, whose money is being invested in the NHS; or whether they simply want to try to pretend to the staff and the public that there is a blank cheque for the NHS and that nobody need worry about value for money.
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