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Lords business is being covered by a Lords Whip.
I understand that Lord Darzi intends to spend little time in the other place, not to deal with any legislation and to answer few questions. Given that he is embarking on a fairly fundamental review of how the health service operates, dealing with the sort of issues raised by the hon. Member for Blaydon (Mr. Anderson), how on earth is Parliament supposed to hold him to account? Is this not precisely the sort of arrangement that the new Prime Minister indicated he opposed, whereby, effectively, Parliament is being sidelined?
With due respect to the hon. Gentleman, I do not think that that is the primary concern about health services. My belief is that Baroness Royall will cover many of the questions. She will be accountable on behalf of the Government. I know that the hon. Gentleman thinks a lot about these things. It is to everyones benefit to have someone of the reputation and skill of Lord Darzi, who will continue to practise two days a week, as well as meeting MPs individually and doing all the other things. He will continue to be a leading clinician in the health service and he will carry out the review, which will take up an awful lot of his time. It is innovative that not only do we have a clinician of his standing to lead the reviewalong with many other clinicianswe also
have him as a Minister to ensure that, unlike with the Turner report or the Leitch report, we have someone in Government to carry the report through. That is of more interest to the public than who is answering questions in the Lords.
Mike Penning (Hemel Hempstead) (Con): May I draw the Secretary of State back to the original question and ask him about his discussions with Unison in relation to the cuts around the country? Recently, the Secretary of State was quoted in the Health Service Journal as saying:
We have listened a bit too much to the British Medical Association and not enough to unions like Unison.
These 600 compulsory redundancies will resonate across the NHS and strike fear into the hearts of local communities.
Alan Johnson: First, may I welcome the hon. Gentleman, who is making his first outing at the Dispatch Box? I disagree profoundly with him and with other Opposition Members on this issue. As I understand it, they are asking for a moratorium on any change. [ Interruption. ] Yes, I read the seven steps. Step one was to have a moratorium on reconfigurations. Indeed [ Interruption. ]
Alan Johnson: Indeed, the right hon. Member for Witney (Mr. Cameron), who I believe represents David Camerons ConservativesI am not sure whether that is the same party as the one to which the hon. Member for South Cambridgeshire (Mr. Lansley) belongscalled at Prime Ministers questions, on the back of the London review, for absolutely no further changes. Of course Opposition Members like to put out scare storiesthat is part of their politics at the moment. However, the policy issue is that, with advances in medical science and new technology, and with changes in demography, we have to change our health service when it comes to issues such as stroke care, which we debated a couple of weeks ago, in order to save more lives. It would be perverse if we were to put a moratorium on saving lives.
There is a well-established and well-understood process for managing consultations on such proposals so that patients, staff, the public and other local stakeholders can have their say and help to inform decisions.
Robert Neill: I am grateful to the Minister for that reply. Will he therefore undertake to publish the clinical basis on which the Government justify their decision to increase the minimum catchment area for an accident and emergency department from 300,000, as recommended by the Royal College of Surgeons, to 450,000, as recommended apparently by no one apart from his own Department, and explain how, by coincidence, that fits in with the proposed population that would arise if the accident and emergency department at Queen Marys Sidcup were to be closed, as revealed in a memo that was written by NHS officials and not by any Member of the House?
Mr. Bradshaw: I suggest that the hon. Gentleman wait for the proposals that we are expecting from his local area. I am sure that once local health managers in his area publish those proposals, they will justify them on clinical grounds. A recent statement from the British Association of Emergency Medicine recommended that, in order to provide safe emergency services around the clock,
there needs to be immediate access to intensive care, anaesthetics, acute medicine, general surgery and orthopaedic trauma.
For the best use of resources, a figure of 450,000 was indeed mentioned, but this is not a one-size-fits-all issue. It will depend on the local circumstances. He should wait for the local consultation.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) (Lab): My hon. Friend may be aware that a not very sophisticated game is going on, with some members of some political parties in this House announcing that A and E departments are going to close when there is no question of them even being considered for closure. Immediately after an election, however, those same hon. Members suddenly announce that the departments have been saved. I hope that my hon. Friend will be a little less magisterial and a little more political and tell us firmly which A and E departments are going to close and which are unquestionably not going to. In that way, he will be doing us all a favour.
Mr. Bradshaw: I do not think that I have ever been described as magisterial before, and I am always happy to be as political as Mr. Speaker will allow. Many of these decisions are made at local level and not by me, as my right hon. Friend the Secretary of State has made clear, but my hon. Friend is absolutely right to draw attention to the fact that an awful lot of stir-mongering and scaremongering is going on out there. I could quote a number of examples, such as the A and E department at the Hinchingbrooke health care trust in Huntingdon. The hon. Member for South Cambridgeshire (Mr. Lansley) confidently predicted that that facility would close but, following recent consultation, a decision has been taken not to close it.
Mr. Nicholas Soames (Mid-Sussex) (Con):
Will the Minister acknowledge that there has been no scaremongering in respect of the Princess Royal hospital in Haywards Heath, which is part of the West Sussex PCT? It has been proposed that the hospitals A and E department be closed and its maternity services withdrawn. Clinicians and local GPs feel that that would be unsafe and unwise, although they accept that
other reconfigurations need to be made. Therefore, will he assure me that the PCT will be forbidden from going ahead with the proposals?
Mr. Bradshaw: My right hon. Friend the Secretary of State has said already that he will pass on to the independent review panel any proposed changes referred to by local scrutiny committees. He and I have both said that it is very important for patients and local Members of Parliament to engage in the consultation process, and that clinical concerns about proposals should be made plain. However, the driving force behind all the changes is the objective of improving care for patients. The technology is changing and, to save lives, local care should be given where that is possible and necessary.
Keith Vaz (Leicester, East) (Lab): My hon. Friend is no doubt aware of last Fridays shocking decision by the University Hospitals of Leicester NHS Trust to withdraw from the Pathway project, which will have a devastating effect on service provision in Leicestershire. What steps is he taking to reassure the public and local Members of Parliament that services will be protected? When was he told of the decision, and will he meet a delegation of hon. Members to discuss this very important matter?
Mr. Bradshaw: I should be happy to meet such a delegation, and I have already offered to meet my hon. Friend and the former Secretary of State for Health, my right hon. Friend the Member for Leicester, West (Ms Hewitt). The decision is shocking, yes, but perhaps not so surprising, given that the projects projected costs had spiralled considerably. I can well understand the concern that he expresses on behalf of the people of Leicester, but I am assured by the local health service management that the funds originally proposed to be spent on the project will still be available to improve services in Leicester, and I look forward to examining, with my hon. Friend and others, how that can best be done for the future.
Mr. Robert Goodwill (Scarborough and Whitby) (Con): I cannot even start to describe how angry doctors, nurses, unions and patients in Scarborough are after last weeks announcement of 600 job losses at Scarborough hospital. That is one third of the hospitals staff. Will the Minister come to Scarborough this summer to see for himself the effects that the cuts are going to have, and to let us convince him that we need to maintain full A and E cover at that hospital?
As far as I understand it, discussions on the proposals that the hon. Gentleman mentions have not even begun yet, but I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who is responsible for the heath service in the north-east, would be happy to meet the hon. Gentleman and the delegation to discuss the issue. As we said earlier, a difficult, tough decision was taken last year by our predecessor team. For years and years, we had a system in which a small number of health trusts were allowed simply to roll over deficits from one year to another, and well-performing trusts had to bail them out from year to year, but that is not acceptable or sustainable.
Tough and painful decisions have had to be made in some areas, but I am sure that my hon. Friend the Under-Secretary will be happy to discuss them with the hon. Gentleman.
David Taylor (North-West Leicestershire) (Lab/Co-op): Will my hon. Friend confirm that the emerging strategy used in some parts of the country, and particularly in the capital city, is for health authorities to require the diversion of trauma and complex emergency cases away from accident and emergency departments to private hospitals and elsewhere? That kicks the feet away from accident and emergency departments that are already threatened, and brings about the closures that the bureaucrats want.
Mr. Bradshaw: Noand the decisions are best left to the people whose job it is to deliver high-quality care, at value, to their local communities in a safe and appropriate way. If my hon. Friend wants to write to me with any examples of cases where there are such fears, and where that is having an impact on the quality of patient care, I will gladly respond to him.
The Parliamentary Under-Secretary of State for Health (Ann Keen): The NHS is changing because medicine and treatments are changing. If we do not keep up with the times, services will not keep on improving. Local services are changing for the benefit of patients, and that is what the NHS is there to ensure. That may mean changes to how surgery is delivered, who is admitted to hospital, and how effective community care is. There are so many issues involved in reconfiguration, which can make a huge improvement to patient care.
Mr. Carswell: Will the Minister give an assurance to my constituents, 9,000 of whom have signed a petition on the subject, that reconfiguration will not mean the closure of the Peter Bruff ward in Clacton and District hospital?
Ann Keen: What is important to local people is the consultation. I am aware that the hon. Gentleman was involved in that and has met representatives from his primary care trust to discuss the issue. That is what I encourage him to do, because that is what he believes in. He believes in local accountability, and that is what he has in his constituency. As a founder member of the Cornerstone group, surely he agrees with removing decision making from Whitehall and making it into local accountability.
Dr. Howard Stoate (Dartford) (Lab):
In order to maximise the effectiveness of the health service, we have to ensure that we use to the full the considerable talents available to us in the NHS staff base. Has my hon. Friend yet had a chance to look at the all-party pharmacy group report on the future of pharmacy, and has she been able to make an assessment of how pharmacists could take the pressure off general
practitioners and accident and emergency departments to improve effectiveness and efficiency in the health service?
Ann Keen: I thank my hon. Friend for that question. Of course the skills mix in the health service is crucial to the changes that we can make to patient care. The advancements that pharmacists have brought about for us by operating out of health centres in larger supermarkets, and by being there to advise on many health issues, has generally improved the health of patients. As my hon. Friend said, the skills mix is crucial to future work force planning and the delivery of care for NHS patients.
Tim Loughton (East Worthing and Shoreham) (Con): Last week, the Worthing Herald reported that Worthings accident and emergency department had 1,258 admissions. That equates to 65,500 people visiting every year. Under reconfiguration proposalsnot scare storiesthe PCT proposes to close that accident and emergency department, and it expects people to join the car park that is the A27 and go to either Chichester or Brighton. How many of those people does the Minister believe are timewasters who do not actually need an accident and emergency department in the hospital of the largest town in Sussex?
Ann Keen: The hon. Gentleman raises an important issue on accident and emergency services, but how could I possibly know who was attending the accident and emergency department without looking at the figures? I would expect the local management and the local PCT to do that, and I would expect the local MP to conduct a responsible consultation to ensure that patient care is delivered appropriately in the accident and emergency department. That is why reconfiguration of the health service can be good for patients, as I am sure he would agree.
Dr. Vincent Cable (Twickenham) (LD): As NHS configuration depends not just on clinical judgments and local opinion but on the financial consequences of the tariff system, does the Department have any proposals to review the tariff regime, which almost certainly undervalues accident and emergency work relative to specialist surgery?
Mr. Jenkins: I am sorry to hear that because my right hon. Friend must be aware that there are claims that regulation has added greatly to the cost of providing that treatment. Will she comment on the fact that regulation adds greatly to the cost?
Dawn Primarolo: I agree with my hon. Friend that regulation, which is very important in this area for safety, does increase costs. In the NHS those would be met from the clinical budget. I confirm that I am taking steps to ensure that information on the provision of IVF by each primary care trust, including information on local criteria, expenditure, social access and work on IVF, is available to us. The Department will make available later today the details of that work, which is funded by the Department in partnership with the Infertility Network UK to address the very points that my hon. Friend raises.
Mrs. Maria Miller (Basingstoke) (Con): Women in Basingstoke still have to wait until they are 36 years of age to receive IVF treatment. For some who cannot readily conceive, that will mean more than a decades wait. What is the value of NICE guidelines to the residents of Basingstoke when the Hampshire primary care trust can so readily ignore them?
Dawn Primarolo: I am sure that the hon. Lady is putting her powerful argument to the PCT as it decides its spending on IVF [ Interruption. ] If she calms down for a moment, I will tell her that I sympathise with the concerns that she raises about inequitable access to IVF, which is why I am undertaking work to make sure that all the access criteria and other issues that are raised in regard to IVF are properly dealt with in the local area. She should return to her PCT and make her powerful case to it, as I will do as the Health Minister.
Dawn Primarolo: Certainly, that would have to be part of the consideration. Some PCTs offer one cycle, and there is dispute about whether it is a complete cycle, while others offer different types of treatment. Those are matters that we will need to consider.
John Bercow (Buckingham) (Con): I think that I heard the right hon. Lady refer to the need for the proper expression of criteria on the subject in the local area. As a matter of principle, does she believe that such treatment should be uniform across the country or the subject of local discretion?
Dawn Primarolo: I believe that it is the role of a Health Minister, along with those who advise NICE, to set the standards for equitable access across the country. That would always be mitigated by local decisions on expenditure after proper consultation, but the matter that needs to be addressed now is what is available, how much it costs and how it varies across PCTs, and then how to deal with an issue that is important to so many people in this country.
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