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Mr. O'Brien: The priority for any reconfiguration must be patient safety. Any reconfiguration or examination of the quality of services, whether they be A and E or
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any other kind of service, must be on the basis that the clinically led judgment is that the quality of patient care will be improved by the change.

I know I am being slightly oblique, because I do not want to venture into the detail of local decisions that need to be arrived at, but it is clear that if the quality of care for local people will not be better as a result, a reconfiguration should not be proceeded with. If it will improve the quality of patient safety and care, of course it needs to be examined properly.

The north central London sector involves five PCTs-Barnet, Camden, Enfield, Haringey and Islington, serving a combined population of 1.3 million people. Despite the headlines, it is worth noting that the review of the sector is at a very early stage of development. That is why it is surprising that some people are already supposedly carrying out consultations. Managers ought to draw up clear proposals, then put them to the public, have a proper consultation and listen to what is said. It is important that that be a genuine consultation and that people be listened to and their views properly taken into account before any decisions are arrived at. I am told that the local NHS is working closely with clinicians and will engage in due course with the general public on any proposals that might come forward.

Lynne Featherstone: With the sort of letters that are going out, the fear is that when the options for consultation finally come forward to the public, which will be in September 2010, there will not be a 24-hour A and E in them and that option will not be on the table for the public to let the authorities know about it. That is why we need to hear public voices now, because there may not be any option that says, "Keep the Whittington A and E open." The options that will be consulted on will not be the ones that the general public want.

Mr. O'Brien: I am slightly confused as to quite what the hon. Lady is suggesting. Is she saying that she wants a consultation when there are no proposals, or that she wants to wait and see what the proposals are so that there is something to consult on? It is not entirely clear.

Lynne Featherstone: I was trying to say that if people across Islington and Haringey did not make it known now how passionately they feel about the A and E at the Whittington, they might find that the options that come forward for consultation next September contain nothing that they actually want.

Mr. O'Brien: The hon. Lady appears to suggest, then, that a consultation should happen now. That is a matter for her to engage with the PCT on, but it seems to me that it is always better to have something on the table so that people know what they are talking about, rather than to have some vague and general consultation. She appears to think that there should just be general discussion, and that is for her to take up with the PCT.

I understand that the Whittington Hospital NHS Trust and the Royal Free Hampstead NHS Trust have been in discussion about how they can work more closely together in a number of ways. They already have some successful joint working practices in place. For example, some clinicians work across more than one site, and the Whittington, Royal Free and University College hospitals collaborate on matters such as urology. As I understand it, they are holding further discussions with staff as work progresses.

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Any changes that the trusts might wish to make should be underpinned by a proper process, so that the public are aware of them and know what is being discussed. An options appraisal, followed by a strategic outline case, would need to be endorsed by the trust boards, the relevant PCTs, the sector chief executive and the strategic health authority. As I understand it, nothing has been put before either board yet.

Emily Thornberry: Does my right hon. Friend therefore agree with us that the case for the closure of the Whittington hospital A and E department has yet to be made?

Mr. O'Brien: I entirely agree that the case for the closure of the Whittington hospital A and E department, if such a proposal were ever made, has yet to be made.
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As I understand it, the situation is that some vague discussions are going on. Local people have expressed their views, as have my hon. Friend and others, and it is now a matter for the PCT to decide how properly to proceed. However, I would tell the PCT to proceed with caution. Local people will have a view and the NHS needs to consult them properly. They ought to know what the ideas and so on are on the table in order to express a clear view about them.

My right hon. and hon. Friends have expressed very clearly their views about these matters and the importance to local people of the Whittington hospital, including its A and E department, and I am sure that those on the PCT will have heard those words very forcibly indeed.

Question put and agreed to.

8.45 pm

House adjourned.

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