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Does the hon. Gentleman agree with his hon. Friend or not?

Mr. Lansley: We have made it clear throughout that we agree that services must be developed, but that must be done in response to the changing needs of patients and the development of technology. Where community hospitals are concerned, it is not only the Conservatives who argue that they are an integral part of the delivery of care closer to the patient: the Government said so in the White Paper published in January 2006. That White Paper presented the rhetoric of support for community hospitals and that is why the Government ostensibly provided for a new capital fund to allow community hospitals to be developed. But too much of that money has been siphoned off to primary care centres and too little is being delivered. At the same time as the fund was being established, too many community hospitals did not have the revenue to enable them to continue to work. So community hospitals are being shut down in Cornwall, Devon, Wiltshire, near Bristol, Norfolk and Kent, and the list goes on. There are probably a hundred more that are still under threat because the Government have not delivered on the promises made in the White Paper at the beginning of last year that services would continue to be commissioned—including diagnostic services close to patients, out-patient clinics and, most importantly in some respects, access to in-patient services that allow step-up and step-down services to be provided.

John Bercow (Buckingham) (Con): My hon. Friend rightly focuses on the services provided by PCTs. The
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Government are right to emphasise the importance of early intervention, but in Aylesbury Vale there are no fewer than 400 young children who are not statemented—some of whom are pre-school children, while others are on school action or school action-plus—and have not received the speech and language therapy that they desperately need. Can my hon. Friend offer a way forward in terms of collaborative exercises and joined-up government, so that the children who desperately need help get it before it is too late?

Mr. Lansley: I entirely share my hon. Friend’s concern, and he has been a redoubtable fighter for the interests of children who need speech and language therapy. There are two aspects to the problem. First, we must make sure that those who are in college training to be therapists find posts and are employed in the community. Secondly, I do not think that we are going to join up the services terribly effectively, given the present arrangements at the centre. It is not the job of those at the centre to join up services: instead, we should take budgets closer to the patient, allow GPs and PCTs to have access to those budgets, and make clear their responsibilities for commissioning services for young people with speech and language needs. That will mean that parents in particular will have someone to talk to, through whom they can access services. It should be as simple as that.

Tony Baldry (Banbury) (Con): Does my hon. Friend agree that the test of service reconfiguration is safety? Sir Ian Kennedy is the chairman of the Healthcare Commission, and he said the other day that people should keep an eye on safety considerations. Against that background, can my hon. Friend understand why my constituents in Banbury feel so desperate? They have had a consultant-led obstetrics and maternity unit for a long time, but it is to be taken away from them. The nearest consultant-led unit will be an hour away in Oxford, a distance of 26 miles. My constituents understandably feel that that will downgrade rather than enhance safety and access to NHS services.

Mr. Lansley: I am grateful to my hon. Friend for that very important point. We have argued in this House many times that both safety and access need to be considered when one is talking about maternity services. Safety is an essential element of quality of care, and choice and access are highly desirable elements, but the evidence base of safety is absent from service reconfigurations such as the one affecting his constituency. We are happy to see that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), still has his Front-Bench place. He is the Minister responsible for maternity services, and we have asked him many questions about how great should be the distance that people must travel between, say, a birth centre or a midwife-led unit and a unit providing consultant-led obstetric care. He does not know the answer and has provided no guidance, but at the same time the Department of Health is driving ahead with service reconfigurations across the country. Ostensibly, those reconfigurations are about safety, but no evidence is produced to support that. I do not see how one can have safety without evidence.

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Mary Creagh (Wakefield) (Lab): Most of the reconfigurations of obstetrics and gynaecology services are going ahead not because the NHS wants fewer women to give birth in fewer hospitals, but because the royal colleges have said that consultants need a certain amount of labour-ward cover and experience of births to continue their professional development. If the hon. Gentleman were a woman in labour who had had to wait 12 hours for an epidural anaesthetic, he would know that being in a local hospital is no comfort if that means that she has to compete with people brought in from the trauma department. It is much better for a woman to give birth in a hospital with a dedicated obstetric anaesthetist, but not all hospitals across the country have one.

Mr. Lansley: The hon. Lady should have attended our debate on maternity services, when we made it very clear that of course we must have proper risk assessment, and that mothers giving birth in places of relatively greater risk must have access to proper obstetric care. I am aware that, around the country, managers are representing the case for service reconfiguration by saying that, as a minimum, there should be 40 hours of consultant cover on labour wards. They make direct reference to what the Healthcare Commission said happened with the 10 tragic maternal deaths at Northwick Park and, in general, they say that there must be 2,500 live births at each hospital. One then asks how many live births there were at Northwick Park at the time, and the answer is 5,000. Another maternity unit had recently closed and a substantial amount of responsibility and additional births had been transferred to Northwick Park, and the transfer was not well organised. In fact, it was tragically badly organised. So there are issues to consider that are different and separate from the mechanistic approach of insisting on 40 hours of consultant cover on labour wards. We have to deal with the evidence, not just with simple management assertions that are driven as much by the European working time directive and financial pressures as by genuine evidence of clinical safety.

Mr. Graham Stuart (Beverley and Holderness) (Con): Two years ago, during the general election campaign, my hon. Friend came to Hornsea and visited people there to join the campaign to save the hospital. He will remember that the local Labour party said that it was scaremongering to suggest that there was a threat to Hornsea cottage hospital. In fact, my hon. Friend was barracked by a Labour councillor at the event that we held. Since that time, the primary care trust has formally made the decision to shut every single bed at Hornsea cottage hospital and to betray local people. That Labour councillor feels that the Government have broken their word and let them down.

Mr. Lansley: I share my hon. Friend’s distress about the matter. It is clear that, on the criterion of access to services, his constituency will be extremely badly served by decisions that have emanated from the Government and are contrary to all that was said in the Government White Paper in January 2006.

Let me come to the points that I hope that the Secretary of State will have in mind. I understand that he has been in his post for only six days, but we need to get the immediate priorities up front. The following are
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among the things that he needs to do. He needs to start by working with primary care and especially family doctors. GP-bashing, which seems to have been the preoccupation of Ministers, has to stop—it is no good going down that path. Hamish Meldrum, the new chairman of the British Medical Association, has said:

That does not mean that one should just let GPs do as they like, but we know that GPs will respond if they have the right framework and incentives. The clearly required principal incentive, which has not been present in the new contract, is empowerment, professional autonomy and the ability to take decisions as senior public service and clinical professionals about real budgets, real commissioning and real opportunities to shape services.

Today, the NHS is not a primary care-led service but a centrally controlled service. The top-down initiatives are not working. Measures such as the 48-hour access target have been counter-productive, driving patients and practices into an absurd 8.30 am telephone scramble. Choose and book has been hopelessly mishandled and has compromised the freedom to refer that GPs always had.

Out-of-hours services under the new contract have de-emphasised the role of general practitioners. The hon. Member for Grantham and Stamford will recall that we had to fight that one too, because GPs simply did not form part of the out-of-hours service in south Lincolnshire, and we had to persuade Ministers to involve them. [Interruption.] I know that I have mentioned the hon. Gentleman, but I will not give way: we are just agreed about that issue, and we will settle at that.

Things can be changed. Let us take practice-based commissioning. Ministers, after a decade, have finally realised that the fundamentals of fundholding need to be brought back. GPs can take control of the commissioning of services, and that should include the commissioning of out-of-hours services. They can integrate those services more effectively with their own services.

The Department has also failed to publish an urgent care strategy, despite the fact that, at the beginning of last year, the White Paper stated that one of the jobs for 2006 was to produce such a strategy. I do not know whether the Department has admitted it to the Secretary of State, but it should have been done last year and it has not been done yet, and we are in July. We need an urgent care strategy which says to patients, “It is very straightforward how you access urgent care. If it is an emergency, you ring 999.” Some of our concerns about accident and emergency services would be met by such a strategy. We understand, however, that if someone is in an ambulance with a paramedic, they may not necessarily go to the local A and E, but instead go to a specialist centre for trauma, stroke and heart attack. Apart from that, however, we need a much more integrated urgent care structure. If it is not a 999 call and an emergency, the call should be made to 0845 4647, which would offer access not just to NHS Direct but to the necessary core handling and triage that determines whether an emergency response by an ambulance, a doctor response through the out-of-hours
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service, or a nurse or emergency care practitioner response is appropriate, or whether the person should be advised to attend a walk-in centre or an A and E department, visit their general practice the following day or receive advice on the telephone.

Anne Milton (Guildford) (Con): Does my hon. Friend agree that many people are completely muddled about what the Government are trying to achieve and the NHS that Labour Members describe? In my constituency, there have been cuts at Cranleigh hospital and Milford hospital. The whole of the Royal Surrey county hospital is under threat—accident and emergency, maternity and paediatric services are all under threat. That is not about increasing access for people and looking after them closer to their homes; it is about pushing all the care that my constituents in Guildford have been receiving further away from where they live.

Mr. Lansley: I am really grateful to my hon. Friend for making that point, because she sums up exactly the experience of so many constituents throughout the country, rather than the rhetoric we keep hearing. After the failed combination of arrogance and incompetence that has characterised the Labour party’s approach to health policy for the past decade, the starting point should be the experience of constituents—what they are feeling and what they see happening in their health service locally. That is what our approach will be.

Anne Snelgrove: Will the hon. Gentleman give way?

Mr. Lansley: No, because I have already given way to the hon. Lady.

I was talking about what we need to do to co-ordinate urgent care. It is necessary for NHS Direct to be franchised out properly. As I have told the House before, NHS Direct call handlers, ambulance trust call handlers and out-of-hours call handlers can all be in the same room—for example, as they are in Cornwall or Norwich—yet they cannot have an integrated system of triage and referral to deal with patients. When patients ring in, they have to speak to each service separately. After all these years, that system is absurd.

Walk-in centres are another issue that has been left in the Secretary of State’s in-tray. Two articles have been published, one of which said that walk-in centres have had no impact on access to emergency care locally and the other said that they have had no impact in reducing demand for GP services. Questions about the costs and benefits of walk-in centres need to be dealt with.

Somewhere there is a review of funding for walk-in centres. It has not been published, yet cover at the walk-in centre in Luton has dropped from about 107 hours a week, including weekends, to 20 hours during weekdays only.

Mr. John Redwood (Wokingham) (Con): Does my hon. Friend agree that people are not only upset about having to travel much longer distances to hospital, but worried that when they are in those large monopoly hospitals they will be more prone to hospital-acquired infections, which puts them at considerable risk when they are already vulnerable?

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Mr. Lansley: I share my right hon. Friend’s concerns. Furthermore, he represents a part of the country that secures the lowest per capita distribution of resources. The Select Committee on Health made it clear that, as we had argued, there should be a review of the resource allocation formula to make it fairer in distributing resources relative to the burden of disease. It is interesting that the Secretary of State’s predecessor handed him one admission of our arguments. Only the week before last, the right hon. Lady said that the Advisory Committee on Resource Allocation should be given Bank of England-style independence. She acknowledged that we were right and that it had been the subject of political interference. In a letter to me on her last day in office, she also accepted our argument that the principal cause of variation in health-related need in the burden of disease is age, so as an urgent measure I look forward to an independent review of resource allocation to deliver a fairer distribution across the country.

The purpose of the debate is partly to set out the things that need to be done. Local services, such as accident and emergency and maternity services, should not be shut down in the absence of evidence of what constitutes safe, accessible and good-quality care. I hope that tomorrow the Secretary of State will say that he will have such a moratorium.

The Prime Minister and the Secretary of State should not be wandering around the country saying that they are going to listen and then overriding things before they happen. We need care closer to home to mean exactly that, and not have services taken away that people have relied upon for a great deal of time. We need to know whether the Prime Minister has any substance to add to what he said in passing at the outset of his leadership campaign, or does he, as it turns out, have hidden shallows to him? Where in the Government amendment is the recognition that they must do better? If that is what the new Prime Minister said in his leadership campaign, why is it not reflected in the Government’s self-congratulatory amendment?

Morale in the NHS is at an all-time low. The Health Service Journal asked NHS staff about morale and published the results the week before last. It asked whether morale in the NHS was excellent and 0 per cent. said that it was. Some 4 per cent. said that morale was good and 30 per cent. said that it was moderate. However, 41 per cent. said that it was poor and 25 per cent. that it was very poor. That is nearly two thirds.

The Secretary of State is a former general secretary of a trade union and he must know that relations between the leadership of the NHS and the staff of the NHS are at all-time low. Even in his own Department, morale is low. Direction and leadership are badly needed, and we must have greater autonomy for health care professionals to re-empower and motivate them. We must have accountability to patients exercising choice and a public voice on these issues. We need evidence for the policies that are being pursued rather than simply a slash-and-burn pursuit of the Government’s fiscal targets, which are delivering inequitable access to care in too many parts of the country. Not least, we need strong commissioning decisions taken closer to the patients and stronger primary care-led commissioning in urgent care.

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We have a clear vision for an NHS that is patient- centred and professionally led. It is a vision of an NHS accountable for its outcomes and not hamstrung by targets, and in which we recognise that access to NHS care, as well the safety of care, is integral to quality services. It is a vision of what is, indeed, a national health service that respects the diversity and needs of patients at every level, and incorporates the essential principles that have stood the NHS in good stead for nearly 60 years, and puts them right at the centre of NHS care.

I hope that this is a starting point from which we and the Secretary of State and his ministerial team can work together positively and constructively to deliver a service that lives up not only to those principles, but to the ambitions of the people who work in the NHS and, not least, of those who depend upon it. I commend the motion to the House.

5.18 pm

The Secretary of State for Health (Alan Johnson): I beg to move, To leave out from “House” to end and add:

I thank the hon. Member for South Cambridgeshire (Mr. Lansley) for welcoming me to the Dispatch Box and for the copy of the Conservative party document. I have had my attention drawn to many documents that could profoundly influence the NHS, but this was not among them. I will have a look at it in good time.

I pay tribute to my predecessor. My right hon. Friend the Member for Leicester, West (Ms Hewitt) is a woman of great courage, great intelligence and great ability—more courage, intelligence and ability than the hon. Member for Beverley and Holderness (Mr. Stuart) possesses in his little finger, incidentally. I pay tribute to her for the tremendous work that she has done in my Department.

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