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"The scope of work of the Integrated Impact Assessment (IIA) includes further work on the impact of any changes to distances and travel times. This work will take place during consultation and will be made available via the Health for North East London website".
So they are starting a consultation at the end of November and then halfway through the process they start producing more information for the consultation. Surely the consultation cannot be started until all the information necessary to make it accurate has been provided. This is a bit like changing the party affiliation or the candidates halfway through an election campaign, once the nomination papers are in. This is absurd, but it is typical of the determination of certain people in the London region NHS to go ahead regardless. They want to push this through and to present a fait accompli before the general election but not make the decision until after it.
Harry Cohen: This will be a very brief intervention. I congratulate my hon. Friend on being a doughty fighter for the NHS and his local hospital in his constituency, and I express my solidarity with him. Should not the urgent care centre that the PCT says will be at the King George hospital 24/7 be of high hospital standard? Should there not be hospital-standard cancer care, chemotherapy, renal dialysis and other such services there?
I am sure that my hon. Friend would not be happy if I suggested that they closed the accident and emergency at Whipps Cross and turned Whipps Cross into a 24/7 urgent care centre. We need urgent care centres, state-of-the- art polyclinics and all kinds of
other facilities, but we also need people in Ilford to have access to accident and emergency and maternity services in Ilford, rather than their having to go to other parts of north-east London.
There are clear grounds for throwing out the consultation process before it is launched and I hope that the Minister is listening carefully to what I am saying. The clinical reference group behind the proposals said that there was a "preferred" location of having obstetric maternity on the same site as accident and emergency. When I met the officials behind the plan last Friday, I asked medical director Mike Gill whether it was absolutely necessary to have an A and E on the same site as an obstetric maternity facility. He said that it was not, and that the closure of the maternity services was not due to the closure of the A and E. The midwifery director, Carol Drummond, took a slightly different view. She was arguing that it should all be on one site together. The documents that they produced admit that
"obstetrics can be provided with no A&E."
If there is a need to have the maternity facilities consolidated in one place, perhaps the King George hospital could be a good site for them-or for most of them, given that about 4,000 children are born at the site each year. The maternity issue raises a serious concern for me, because my constituency has the youngest population in Redbridge, as well as the highest number of births, people from ethnic minorities, people for whom English is not a first language and complicated births because of deprivation, poor housing or genetic factors.
I am concerned about my constituents, who also have less access to cars than those in other parts of outer north-east London. Barking and Dagenham is in a slightly worse position than some of the wards in my constituency, but I have constituency wards where 38 or 40 per cent. of households do not have access to a car. In the wards near Queen's hospital, 10, 15 or 20 per cent. do not have access to a car. The proposal will move the facilities away from the area with the poorest people in the poorest areas, with less access to transport. People will be made to rely on two buses and a train to get to the Queen's hospital in Romford. That is unacceptable. A poor migrant woman from Ilford, South, without access to a car, does not wish to go several miles to a strange environment elsewhere. Those responsible for the plans say that they will encourage home births and that they will encourage the establishment of a birthing centre, but we need a maternity hospital in Ilford.
I also want to say something about the quality of the maternity care. I have a constituent, Mr. Ali Hai. He and his wife had their second child just a few weeks ago. His wife was going to give birth in Queen's hospital but, as he stated in an e-mail:
"I asked the Director responsible for Maternity Care...to be switched to KGH"-
"because of the state of chaos and the ridiculously long waiting times at Queens".
"totally unacceptable given that it is responsible for dealing with High Risk Maternity cases."
"Had KGH not been there I hate to think of the consequences. Needless to say the attention, care and organisation at KGH was outstanding."
I have one final point to make. All the data treat Barking, Havering and Redbridge NHS trust as though it were one place, but the trust has two hospitals and it is very difficult to get disaggregated information. The documents that are about to be published should not be published until the information in them has been disaggregated in all respects.
When proposals are made for changes that would affect one of the hospitals in a joint trust, every part of the relevant documents should have a clear breakdown of the data so that people can see what all the costs are. The information should show where the deficits and complaints come from, and where the quality variations are. It may be claimed that the data are not available, but lots of money has been spent on Mott MacDonald's scoping exercise on the assessments, and on consultants. If some money could be spent on getting together the information that I have described, it is possible that a proper consultation could be held.
My local authority in Redbridge is a hung council with a Conservative administration, but Conservative, Labour and Liberal Democrat councillors are all together in being strongly opposed to the proposals. If the local health overview and scrutiny committee were to request a reference to the NHS reconfiguration panel, could that reference be implemented speedily, so that we can stop the consultation exercise? I hope that my right hon. and learned Friend the Minister will be able to answer that. Apart from anything else, stopping the exercise would mean that I would not have to spend the whole of my Christmas collecting another 28,000 signatures to defend my local hospital.
The Minister of State, Department of Health (Mr. Mike O'Brien): First, may I congratulate my hon. Friend the Member for Ilford, South (Mike Gapes) on securing the debate? He has been a champion of good local health services in Ilford and I have the greatest respect for the dedication with which he serves the needs of his constituents.
I have listened carefully to my hon. Friend's points, and he has spoken to me on a number of occasions to express his very real concerns about how the consultation might develop. He has also spoken to my right hon. Friend the Secretary of State, and I shall certainly look at the points that he has raised.
My hon. Friend asked in particular about a reference to the local health overview and scrutiny committee, and I shall consider what he has said and get back to him. As I understand it, it is normal for a reference via the overview and scrutiny committee to take place at the end of a consultation, but I am not sure that there is any obligation in that regard. I shall check on that and write to him shortly.
I am sure that my hon. Friend will want to recognise the contribution of NHS staff, not just at the King George hospital but across the whole of Ilford and
north-east London. They are constantly striving to deliver better quality health care, benefiting his and other hon. Members' constituencies.
The Government remain absolutely committed to supporting health service staff in the provision of better health services, across London and in the deprived areas of north-east London in particular. We have been consistent in emphasising the value of strong clinical and local leadership so that doctors, nurses and other clinicians, who understand best what their patients need, are at the forefront of shaping the health service locally in the best interests of patients.
However, I of course recognise that any programme of change will generate controversy. Our hospitals are much-loved institutions, to which local people are understandably very attached. The challenge is for the local NHS to explain to patients, the public and their representatives-including Members of Parliament such as my hon. Friend-when change is needed and how proposals will deliver safer and better quality health care. Of course, if it can explain that, and can work through the consultation and get support, that is one thing, but consultation needs to be genuine, and local people need to be listened to.
In recent years, my predecessors have put in place a robust process for the Department of Health, strategic health authorities and primary care trusts to follow to ensure that any proposed service reconfiguration is driven by clinical need, not anticipated financial savings. Such savings sometimes occur, but the primary aim must be to ensure that clinical needs are better met. We are moving into very difficult financial and economic circumstances, and we have to look at all the issues facing the NHS in the context of the situation that now confronts it. It has to ensure that it deals with the problems that we face, rather than the problems that it faced some years ago.
The review in 2007 by Professor Lord Ara Darzi, together with more than 100 leading clinicians, resulted in a series of recommendations for changing London's health services. The Healthcare for London programme sets out a clear direction for the capital's NHS, and was the subject of a wide and extensive consultation with Londoners. Lord Darzi was clear: change must be led by doctors, nurses and other clinicians. There is evidence that, where necessary, specialist services should be provided by clinicians with specialist skills, supported by the latest high-tech facilities. That might be done in a local hospital, a polyclinic hub, a general practitioner's surgery, or even in people's homes, where that is possible. Across London, the NHS is looking at how those arrangements can be put into practice. That involves looking at what the NHS has to offer in a new light, and thinking about how its staff, buildings and resources can best serve patients.
Such issues are rightly always matters for debate; those who seek change need to demonstrate that their case is the right one. The NHS in London is concentrating specialist services in centres of excellence across the city. A Londoner suffering a heart attack will now be taken straight to the hospital providing the specialist care that that person urgently needs, rather than simply to the closest hospital. People will go straight to the experts with the equipment, experience and expertise that can save their lives. Those changes were often difficult. However, they have produced results; it has been shown that people now have a better chance of surviving. Those charged with driving forward the programmes of change all over London are learning the lessons of cardiac care.
As my hon. Friend has said, north-east London is a place of marked contrasts, with a rich cultural and ethnic diversity and a growing population. It has particular transport needs, and particular needs relating to ensuring the highest quality health care. There are many opportunities for improvement in north-east London, and we need to ensure that proposals are properly, and sometimes critically, examined. We should make decisions to ensure that patients get the best possible outcome. Why should out-patients have to travel to a hospital, when they can be treated just as easily and more conveniently in the community or at home? How do people best access primary care? How do people best ensure that when they need to use a hospital, they can get the best quality treatment? All those issues need to be addressed in the broader context.
We need to ensure that any consultation is done properly. My hon. Friend indicated that the committee that met today proposed launching a consultation on 30 November, with a view to it running until 8 March 2010. The purpose of consultation is to gain a better understanding of the views of the local community, and to deal with the arguments put forward on both sides-both for and against any change.
We need to ensure that the debates are conducted in a way that means that the best interests of patients overall are considered. Patients and the public are at the heart of the NHS, and the Government are absolutely committed to that principle. It is important that communities are listened to, which is why I expect the local NHS to demonstrate that any proposals will improve care. As well as improving clinical care for the people of Ilford, the local NHS will need to ensure that it can deliver a financially sustainable platform for the NHS in north-east London. I am sure that my hon. Friend will continue to champion and support health services on behalf of his constituents.