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Community midwives are being taken away from individual GP surgeries and grouped into clusters. This will cause great inconvenience to patients at large who will have to travel further for their care. The midwives will be unable to access patients medical records which are a necessary requirement.
I note that in other parts of the country smaller maternity units are being maintained, so why not in Bexley? My hon. Friend the Member for Bromley and Chislehurst has alluded to the finance, and I will not go over that in view of the shortage of time. Many people believe that the building is safe, but what about the services? The hospital is being downgraded and services cut for financial reasons.
I should like to ask the Minister a couple of questions. We know that a joint health overview and scrutiny committee referred the decision of the A Picture of Health board to the Secretary of State in the summer. I should like to know when the decision is going to be made. Does the Secretary of State intend to refer the decision to the independent reconfiguration panel to ensure that there is independent scrutiny? We would like to know that independent people have looked at the decision and made a judgment. All of us who are campaigning against the downgrades and closures feel that to date that has not been done. As my hon. Friend said, it looks as if there was a done deal and the consultation was a sham. I hope that the Minister will be able to answer these important issues and that he will tell me positively that the case will go to the IRP.
The hospital is not the only local health care issue. We have real concerns about the regrettable cuts made by the Bexley Care Trust, whose headquarters is in my constituency. Those cuts affect quality of life. Pensioners,
for example, are disadvantaged by cuts to the chiropody service. Many of them now have to pay for the service and travel to clinics rather than have a free service in their home.
Two years ago, I raised concerns with the Ministers predecessor about plans to redirect family planning services to GPs and about changes to speech and language therapy services. More recently, we have been concerned locally about the lack of NHS dentistry services. Those are quality of life issues.
When my hon. Friend the Member for Hemel Hempstead (Mike Penning) spoke at the end of the previous debate, he made some important points about polyclinics. Many local pensioners are concerned about how polyclinics will affect them. The closing of GP surgeries in favour of polyclinics could have a considerable effect on early diagnosis rates. We are also concerned that the relationship between pensioners and their doctor will be breached because they will not always see the same doctor.
Those are the concerns that are being raised locally. The fear is that Queen Marys hospital may eventually end up as simply a super-polyclinic. That is a real worry to pensioners who rely on their doctor. People get to know their doctor, which makes them feel confident. Elderly people in particular value that relationship.
I am pleased to have been able to raise these issues with the Minister. Will he give us some reassurance that there is no done deal on Queen Marys and that there will be independent consideration? South-east London is different from other parts of London; we have particular issues and problems, whether transport or the location of hospitals. We deserve better health care for all the people in Bexley.
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for Bexleyheath and Crayford (Mr. Evennett) on securing the debate and I pay tribute to NHS staff in Bexleyheath and Crayford, as well as across the NHS as a whole, for their hard work and dedication, which are delivering a better quality health service than ever, benefiting, not least, the hon. Gentlemans constituents.
As I am sure the hon. Gentleman will acknowledge, the NHS in south-east London has faced significant historical challenges, many of which are shared across London, as we can see from todays annual Healthcare Commission report. Incidentally, he is not quite correct to say that the commissions annual health check said that health care in London had declined. In fact, it has improved, but more slowly than in the rest of the country. However, he is right that there have for some time been particular challenges in south-east London.
I hope that the hon. Gentleman will acknowledge, too, that the health service can never stand still; it has to change. Lifestyles, society, medicine and technology are all constantly advancing, which means, for example, that many conditions that used to require admission to hospital can now be treated in the community, by GPs or even in someones home. For those who require admission to hospital, the average length of stay is just a fraction of what it was even only five years ago.
Although many services can now be delivered outside a hospital setting, closer to where people live, some more specialist and complex treatments require such a
level of expertise, with round-the-clock teams of doctors and nurses, that they are best delivered in a smaller number of major centres. That is the context against which the proposed reorganisation of health care in south-east London is taking place.
The other thing I need to make clear is that decisions on how local services are organised are no longer made by Ministers in Whitehall, but by autonomous NHS professionals on the ground. I take this opportunity to commend the collaborative approach that has been taken by the four primary care trusts involved in the south-east London reorganisationBexley, Lewisham, Greenwich and Bromleyand the four acute hospital trusts involved, Queen Marys Sidcup, Bromley Hospitals, Queen Elizabeth and University Hospital Lewisham. It is no mean feat that they have managed to come up with a set of proposals that they believe will ensure safe and high-quality services for the people of their boroughs and an NHS for south-east London that will at long last be put on a stable financial footing.
The process of drawing up the proposalscalled, as we know, A Picture of Healthhas been led by doctors and other health care professionals and has involved, as the hon. Gentleman knows because he has taken part in it, extensive public consultation. The clear view of the clinicians involved has been that while many services can be devolved further out into local communities, there are others that, because of their speciality, urgency or complexity, need to be concentrated on three rather than four sites to make the most of the available expertise.
John Austin: In his speech, the hon. Member for Bexleyheath and Crayford (Mr. Evennett) often used the word downgrading. Does my hon. Friend share my view that there is a powerful and arguable case for the separation of elective care from trauma services? Is he aware that the proposals for Queen Marys Sidcup mean that it will become a centre of excellence for elective care, including cancer services, not just for the borough of Bexley but for Greenwich, Lewisham and Bromley as well? Does he consider it correct to describe that as downgrading?
Mr. Bradshaw: No, I do not. I have been trying to improve understanding of how health care is organised. There are many services, and many in the case of this reorganisation, that are being delivered and devolved out into the communities; I will come on to the extra services that these proposals are intended to provide at St. Marys Sidcup in a moment.
It is obvious that no change is not an option. This has been stressed particularly by hospital clinicians. We support the view of concentrating acute services on fewer sites as soon as possible.
As I am sure that the hon. Gentleman knows, in July a joint committee of the primary care trusts involved agreed to recommend a variation of a number of the options that had been considered during the public consultation. Its recommendation is for two fully admitting hospitals, Queen Elizabeth in Woolwich and Princess Royal in Orpington, and a medically admitting hospital at University Hospital Lewisham and a borough hospital at Queen Marys Sidcup. The local NHS has said that it believes that that solution would deliver the most clinical and non-clinical benefits to local people.
Under the proposals, as my hon. Friend the Member for Erith and Thamesmead (John Austin) has just mentioned, Queen Marys Sidcup would lose its full A and E department and maternity services, but its urgent care centre would be expanded to provide 24-hour cover, routine surgery would also be expanded to cover not only Bexley but all of Bromley and Greenwich, and there would be an expansion of several community diagnostic and specialist ambulatory services.
The advantages of those proposals, according to the NHS in south-east London, is that they will bring together small teams that currently provide specialist care, such as emergency and trauma care, into larger teams with the capacity and round-the-clock expertise to provide top-quality and safe care, while other services would be provided closer to peoples homes. That will make services easy to access and help to reduce health inequalities and differences in access to care in the area.
As the hon. Member for Bexleyheath and Crayford is aware, the overview and scrutiny committee of Bexley council, which has the role of monitoring NHS decisions in his area, has formally referred the proposals to the Secretary of State for review. The joint overview and scrutiny committee, comprising six interested boroughs and Kent county council, has indicated its intention to refer at least some of the proposals to the Secretary of State, and I understand that it is meeting shortly to agree the precise terms of any referral. I can assure the hon. Gentleman that in any event the referral by Bexley means, under the independent system set up by the Government, that the national independent review panel will look again at the proposals. As for the process, I suspect that the panel will not wish to consider the referral formally until it hears from the joint overview and scrutiny committee, because it will need to be clear about the exact reasons for the referral, and what its terms are.
As the hon. Gentleman acknowledged, the panel is genuinely independentfor example, it recently rejected proposed NHS reorganisations affecting East Sussex and Oxfordshire. Anyone, including the hon. Gentleman, and the hon. Members for Hornchurch (James Brokenshire) and for Bromley and Chislehurst (Robert Neill), who are sitting behind him, and my hon. Friend the Member for Erith and Thamesmead, may make representations to the panel. I hope that that has gone some way to reassure the hon. Member for Bexleyheath and Crayford that the decisions that are being taken on health in his local area are being led by the local NHS and clinicians, and are aimed at trying to provide his constituents and the rest of the public in south-east London with the modern, safe and high-quality health services which I hope we all agree they deserve.