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20 Mar 2007 : Column 790

Some of the matters raised by the hon. Gentleman have a long history, to put it mildly. He referred to “a decade of limbo”, but I hope that that description is not entirely accurate, for I see signs of progress and development. I trust that the hon. Gentleman can at least vouch for us in the Department when people claim that we push decisions through without adequate consultation. There has certainly been plenty of that.

As we can see, the issue of change in the health service gives rise to a huge amount of debate and a great deal of passion among communities across the country. At times, it can be difficult to accept change, and because of the difficulty of the arguments, the subject can provoke powerful reactions from key stakeholders and members of the public. In the face of uncertainty and anxiety in our communities, all of us Members of Parliament face a duty to grasp the difficult issues of health service change. We do our constituents a disservice if we do not tackle the issues head-on, particularly when doing so may lead to health progress and human progress in our constituencies. A different configuration of health services can lead to better health care and more lives being saved, so the issues are very difficult.

Of course, we must not jump to conclusions, and we must ensure that there is a thorough process, but I think that the hon. Gentleman would agree that there has been no jumping to conclusions in the case that he raised. Nevertheless, a process is under way. I will come on to the specifics that he raised in a moment, but first I want to put it on record that when we talk about the reorganisation of health services, people jump to the conclusion that it is all about money. That is the characterisation, but it is important to point out that many of the changes that we consider making to our health service stem from a desire to improve the quality of care. We want to provide the best possible care, according to modern standards, within the resources available. Money is often a secondary consideration; an attempt to drive up quality often lies behind changes that are proposed, and there is often clinical consensus.

It is a fact that lifestyles, society, medicine, technology and the NHS itself have all changed over the past 60 years. Patients now have greater choice in where they are treated and when. They have better information on health services, expectations have risen and there is an increasing focus on safety and quality. The public tell us that they want appropriate services that are available at times and in places that are more convenient for them. As far as is possible, they look for services in their communities that are closer to their homes. That, of course, is a key driver behind the project that affects the hon. Gentleman’s constituency.

Change is nothing new in the national health service. The NHS has always responded to change and the latest treatments by organising itself to deliver the care that is needed. It is up to us to respond to drivers for change; if we do not, services will not keep pace with changing times, we will not keep improving, and we will not make full use of the benefits of new medical technology and the possibilities that arise from delivering safer surgery closer to patients’ homes. Those benefits mean quicker recovery times and shorter stays in hospital. The Department’s White Paper, “Our health, our care, our say: Making it happen”, reflected those changes, and suggested
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moving towards a greater concentration of specialist services for people who need them, while providing more care closer to people’s homes for treatments that simply no longer require a hospital visit.

To come to the hon. Gentleman’s concerns, the “Better Healthcare Closer to Home” project in his borough and elsewhere in the locality is an example of how the national health service is responding to changes locally. Health services around Sutton have been grappling with not only the need to modernise and improve, but the need to ensure that services are clinically safe and financially viable in future. Epsom and St. Helier University Hospitals NHS Trust faces the challenges normally associated with a split site, including issues to do with the supervision and training of doctors, sustaining viable clinical rotas and duplication of services. I accept that the hon. Gentleman acknowledged some of those issues this evening and, more broadly, in the work that he has done on the subject, as has my hon. Friend the Member for Mitcham and Morden. He is right to say that the case has a history; let me rehearse some of the details for the record.

The “Better Healthcare Closer to Home” project dates back to 2003, and involved proposals for local care hospitals supported by one new critical care hospital, which was to be at either Sutton or St. Helier. There was a comprehensive consultation over a three-month period that ended in November 2004. In January 2005, the trust boards then involved—Epsom and St. Helier University Hospitals NHS Trust, East Elmbridge and Mid Surrey PCT and Sutton and Merton PCT—met separately and agreed to proceed with the proposed model of a network of local care hospitals supported by a single critical care hospital. They endorsed Sutton, as the hon. Gentleman said, as the preferred site for the development of the critical care hospital.

However, in March 2005, Merton overview and scrutiny committee referred the decision to the Secretary of State for Health who, at the end of 2005, responded to the referral, as the hon. Gentleman said, concluding that the arguments over the siting of a critical care hospital were finely balanced. She decided that it was right to give priority to the needs of communities suffering social and economic disadvantage and to ensure that major redevelopments should contribute to the broader regeneration of disadvantaged areas. She therefore asked the national health service locally to develop plans for the new critical care hospital on land opposite St. Helier hospital. However, it became clear that, for planning reasons, it was not possible to develop the site and there were no viable options for development of the existing St. Helier hospital site either. My hon. Friend the Member for Mitcham and Morden has put her observation on the record, and has raised a pertinent issue for the further consultation.

Mr. Burstow: In that further consultation, and given my request for proper examination of the original consultation, I hope that the freedom of information request submitted by the hon. Member for Mitcham and Morden (Siobhain McDonagh) will be considered by the Minister, as there is a powerful and compelling reason to look critically at the decision making that
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took place. The issue has been grappled with for far too long, and action has not been forthcoming.

Siobhain McDonagh On that point, may I ask the Minister—

Mr. Speaker: Order. The Minister must respond to the hon. Member for Sutton and Cheam (Mr. Burstow) first, then the hon. Lady may make an intervention.

Andy Burnham: Before I respond to the hon. Member for Sutton and Cheam, I will give way to my hon. Friend the Member for Mitcham and Morden, and I can deal with the two interventions together.

Siobhain McDonagh: I apologise, Mr. Speaker. Any review should consider whether it is appropriate for a hospital trust to be the lead organisation in a consultation, because producer interest is a problem. It is far better that those consultations are undertaken by primary care trusts or regional strategic health authorities than by the hospitals themselves. If that had been done, it might have prevented the fudge at Sutton hospital.

Andy Burnham: Given the point that we have reached, it is extremely important that all the relevant information is in the public domain so that people can make a decision based on it. There is no possible argument against full transparency in the conduct of the debate. I accept the point made by my hon. Friend, but it is important not only that there is transparency but that there is a full, inclusive debate about what is the right decision for patients in her constituency and in the constituency of the hon. Member for Sutton and Cheam. There should be no question of partial or vested interests dominating that debate, as the time has come for a full and open discussion before a decision is made locally.

It is important for the record to make clear the trajectory of events. The Secretary of State withdrew her original decision in August 2006, following the planning concerns that had arisen, and wrote to the then chief executive of NHS London, informing him and asking him to review the proposals for a new critical care hospital. NHS London was asked to ensure that particular attention continued to be paid to the needs of disadvantaged communities, given the determination to tackle health inequalities. I am pleased that the review has been used as an opportunity to engage positively with local stakeholders and address their specific issues. I hope that that is the experience also of the two hon. Members present.

I am aware there has been significant local involvement and engagement with a wide variety of organisations and individuals, including NHS trust boards, GPs, hospital clinicians, local authorities, overview and scrutiny committees, Members of Parliament, patient forums and representative groups, the Greater London authority, local media, and of course patients and the wider public.

The report from the latest review was published on 16 March, just last week, and concluded that the guiding principle of developing health services closer to where people live is the way forward. We are pleased to see that endorsement of a key policy of
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the Department. The report further recommended the development of local care centres at the Wilson, the Nelson, St. Helier and Wallington, and of other services in local and primary care settings without delay. I hope that the hon. Gentleman and others in his local area will welcome that step.

The review concluded that there should be a general hospital in the borough of Sutton with an accident and emergency service, but that that should be different from the critical care hospital that was originally proposed. The review also concluded that since the original proposals were put forward there had been a number of significant developments, including those in clinical practice, which have an impact, and that the population to be served is significantly less than was thought in the original programme because of changes in the assumed numbers of patients from Surrey who would travel into London. Also, the acute capacity created by the originally proposed critical care hospital would be more than required now, because of reduced patient flows and more services provided in community settings. More work will be done to decide where the hospital should be situated and on the full range of services to be provided there. The hon. Gentleman asked a range of further questions, which he said needed to be answered as part of that work. Without providing him with a full answer this evening, I shall simply say that he is right that there should be clear answers to those important questions. That is properly part of the local debate on those issues.

The review also concluded that the provision of health services in Surrey, and particularly the range of services to be provided at Epsom hospital, should be determined by the Surrey primary care trust following the Fit for the Future public consultation that is scheduled to start later in the spring. Further work detailed in the review report now lies ahead and is scheduled to be complete by June.

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The hon. Gentleman asked that the Department and the health service locally act expeditiously. That is the desire all round. It is not for us to dictate a timetable to the local NHS, but there should be a general recognition that it would be helpful to bring the considerations to an expeditious conclusion. The hon. Gentleman’s point is on the record and will be heard by those who need to hear it. He asked whether I would meet him and colleagues. I should point out that that is properly the responsibility of the London regional Minister in the Department, but I will take that request back. We want to ensure that the process moves ahead, but it must be a local process, not one run by the Department.

The hon. Gentleman asked me to comment on the lessons learned. As I said at the beginning, all health care reconfigurations raise difficult issues and we learn lessons from all of them. Sir Ian Carruthers has been conducting a review for the Department of the handling of reconfiguration processes in the health service. We can always raise our game and do better, and we will reflect on the lessons to be learned. The important thing is that the process leads to the right conclusions for the hon. Gentleman’s constituents and those of my hon. Friend the Member for Mitcham and Morden.

It would be inappropriate for me to say anything further at this stage, other than to add that if there are emerging proposals that require public consultation, I would urge both hon. Members to engage in that debate. I pay tribute to them for the way that they have continued to press us for what they believe is right for their constituents. We all hope that the process will deliver certainty soon to the residents of their constituencies—

The motion having been made at Ten o'clock, and the debate having continued for half an hour, Mr. Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.

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