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I entirely agree that it would be very helpful if those management consultancy reports were published. However, our every step has been taken not on the basis of speculating or scaremongering, but entirely on the basis of trying to identify clear evidence. I must confess that I was therefore rather disturbed to find that, according to the associate editor of the Daily Mirror, Liberal Democrat activists openly boasted that they had stirred up the campaign about the closure of Kingston hospital. No document had been published and there was no documentary evidence to support the closure claim, and the chairman and chief executive of the Kingston Hospital NHS Trust have completely refuted
it. My hon. Friend the Member for Hemel Hempstead (Mike Penning) has been to Kingston hospital to discuss this, and he can vouch for that fact.
Mr. Hands: My hon. Friend will know that the north-west London commissioning partnership is looking at closing five of the eight A and E departments in that sector. At the same time NHS London, in its letter of 22 January 2010, suggested that there should be only one site in the huge Imperial College Healthcare NHS Trust area. What does he think might be the implications of that for the residents of Hammersmith and Fulham, and the royal borough of Kensington and Chelsea?
Mr. Lansley: I am grateful to my hon. Friend, who makes a very important point. One of the assumptions is a 60 per cent. transfer of accident and emergency cases out of A and E and into the community. A study on primary care and emergency departments commissioned, and published last Friday, by the Department of Health, said that, of arrivals at A and E,
"We found that the proportion that could be classified as primary care cases was between 10 per cent. and 30 per cent."
"There is good evidence that the majority of patients choose the correct level of care. A few do not and it is always a risk to plan for the few rather than the many."
In north-west London-we have seen the documentation on that area-it is astonishing to make this proposal and talk about such a massive transfer out of A and E, given last year's figures. In Chelsea and Westminster the rate of A and E attendances has gone up by 4 per cent.; in Ealing the figure is up by 1 per cent.; for Imperial, taking Charing Cross and Hammersmith together, it is up by 9 per cent.; in North West London Hospitals it is up by 15 per cent.; in Hillingdon it is up by 6 per cent.; and in West Middlesex it is up by 5 per cent. All those hospital emergency departments have people pouring in. It is simply not true to say that there is any evidence to support the proposition that the services in the community that would justify the proposed closure of emergency departments have been put in place.
Mr. Duncan Smith:
Will my hon. Friend bear in mind the fact that we have had exactly this problem in north-east London, where there is a shortfall in spending between the north-west and the north-east? The drive to close Whipps Cross is mainly down to the zealotry of officials,
now released from secrecy, and people not telling the truth about it. They talk about pushing stuff out into the community, but in our area there has been a 10 per cent. fall in the number of health visitors, and the caseloads in relation to children under five are at least double that recommended by Lord Laming. It is an utter disaster, but we cannot get those people to face up to that.
Mr. Lansley: My right hon. Friend makes an extremely important point. Putting a walk-in centre or an urgent care centre on the front of a hospital is a perfectly reasonable and sensible idea, but when that happened at Whipps Cross the net effect was 2,000 fewer patients a month attending the emergency department at Whipps Cross, but 4,000 extra patients a month attending the urgent care centre. We should not assume that that leads to lower costs, as it might stimulate demand.
Joan Ryan (Enfield, North) (Lab): The hon. Gentleman referred to Barnet hospital and Chase Farm hospital, which we have discussed before. He knows that I do not support any downgrading of my local A and E, but we have won an important step forward in relation to a 24-hour doctor-led service for the future. These changes will not take place until 2013. He must also know that in an interview with The London Daily News the Conservatives have said that their position is
"not a guarantee that we will keep A&E".
"It is impossible to make commitments".
Mr. Lansley: Time and again I have told the right hon. Lady that we have been committed, over years, to defending the right of local people and local commissioners-general practitioners-in Enfield to determine what services should be provided for them at Chase Farm. It is a disgrace that local people have been ignored in what is being pushed through there. She should talk to the hon. Member for Pendle (Mr. Prentice) to see how good he thinks it is to get rid of an emergency department and put in an urgent care centre, because the local people in Burnley did not accept it. Of course I shall not have a top-down Conservative approach replacing a top-down Labour approach. What we will have is a structure that listens to patients and responds to local GPs, allowing them to be sure that they can put services in place.
Stephen Hammond (Wimbledon) (Con): My hon. Friend made a comment about Kingston hospital. I was so concerned about some of the campaigning that has gone on, including a challenge in newspapers to me as Conservative MP for Wimbledon, that I met Healthcare for South West London last Friday, and was told that nothing was going to happen. The hon. Member for Kingston and Surbiton (Mr. Davey) has suggested that there should be transparency. Perhaps he and his colleagues would like to publish the evidence that they have on these matters.
Mr. Lansley: I can tell my hon. Friend that after the election, one of two things will happen. There will be either a Labour-derived, top-down plan that threatens to turn many of London's major hospitals into what Labour terms "local hospitals", which in some cases seems to mean a move from an emergency department to a GP-led urgent care service-a potentially serious retrograde step when attendance at A and E is rising-or a Conservative approach of trying to allow GPs, local authorities and local people to design services that respond to patient need and choice and provide referral opportunities. If patients are arriving at an A and E department, they should be handled appropriately there.
Stephen Pound (Ealing, North) (Lab): May I say that the hon. Gentleman's remarks at the beginning about health inequality in London were very well made and struck the mood of the House? I profoundly hope that we can discuss this matter without descending into party political rancour. On his point about A and E admissions, Ealing hospital-I was there at the opening, not all that long ago-was built to treat 25,000 people a year but deals with 100,000 a year. Does he agree that although we may well move to a polyclinic model in future, we cannot do that now, and we cannot abandon people in A and E? This is not a matter of Labour and Conservative, but a matter of life and death.
Mr. Lansley: I agree with the hon. Gentleman. That is precisely my point. He is right that Ealing hospital has 100,000 people coming through its doors to its emergency department each year. If it were not there, where would they all go? There is always a case for change, and nothing will be absolutely static, but let us work with the hospitals that we have, and let them start the business of designing new services.
I see the former Secretary of State, the right hon. Member for Holborn and St. Pancras (Frank Dobson), in his place. He was out with his colleagues and others protesting about the possible closure of the emergency department at the Whittington, which is on the same scale. We should work with hospitals in London and say that, yes, we may need to design better services, a care pathway that extends out into the community and services that are more integrated around patients instead of having a primary-secondary divide, but we should give the hospitals the opportunity to deliver those services. We have a lot of hospital sites in London, many of which are accessible to much of the population, and we can deliver services from them rather than shut them down and open polyclinics, as with the absurdity at Sidcup.
Clive Efford (Eltham) (Lab): In outer south-east London, when the proposals in the "A picture of health" programme were first put forward in October 2007, we were told that they had come from a conference of clinicians, doctors, nurses and midwives who had got together and come up with them. It was on that basis that they were supported. They were reviewed by Dr. George Alberti, who gave them his bill of health, for want of a better expression. The hon. Gentleman says that he is not in favour of top-down planning for our local NHS services, but if our local clinicians have drawn up the proposals, what is the basis of his objections?
Mr. Lansley: I can tell the hon. Gentleman this in one sentence: he should go and talk to his local GPs. I have talked to representatives of the GP community across London, and they share our concerns about the nature of this process and about many of the assumptions that seem to underlie how it will be pursued.
James Brokenshire (Hornchurch) (Con): We have heard about the proposals being clinically led, but does my hon. Friend agree that some of the decisions have been made purely on the basis of private finance initiative contracts? The focus has been on hospitals with large PFI contracts. In north-east London, the focus is on centring everything around the Queen's hospital and putting more pressure on it, and in south-east London, non-PFI hospitals such as Queen Mary's hospital in Sidcup are effectively squeezed out. The focus is not on health care, but on finance and those PFI hospitals alone.
Mr. Lansley: My hon. Friend is absolutely right, and has a unique perspective in that he sees the problem from both sides of the River Thames. I defer to him because he is responsible for the care of my parents in Hornchurch.
It is astonishing that nowhere in the NHS London document does it say anything about the cost of establishing those polyclinics. In constrained financial circumstances, how absurd is it to spend million pounds shutting down hospital services only to spend millions more opening new polyclinics, sometimes on the same premises, as at the King George in Ilford? What kind of an absurdity is that?
I have one final point to make. Members from across London feel a similar way about the proposals, the assumptions that are being pursued, the lack of evidence, and the inability of NHS London to justify what it seems to expect will happen. In their amendment, Ministers are saying, "Look, don't worry; it'll be fine. Nothing will happen until the other services are already there." Ara Darzi said last year that there would sometimes need to be double-running to enable the plan to be established, but he has gone, and that plan seems to have disappeared.
I must tell Labour Members that the Government's amendment is not justified: there is no plan in any of the sectors to establish services in the community and get them up and running, or for a shift in activity away from hospitals, before the point at which hospitals are shut down.
"Implementing Healthcare for London means a considerable shift in activity from acute to polysystem settings. Unless any surplus capacity can be exited quickly"-
"there will be significant double running costs. Developing proposals for service change, consulting stakeholders on those proposals and implementing agreed service changes takes too long and is expensive. A speedier approach to reconfiguring services needs to be developed".
There we have it. The Government's amendment is not what NHS London is setting out to do: that is in black and white in NHS London's document. It says, "We don't want double-running costs; we want to be able to shut hospitals down quickly, and a speedier way of doing that"-but that is not what is in the amendment. I urge the House to support the motion and fire a shot across NHS London's bows.
Mr. Speaker: Order. Just before I call the Minister to move the Government amendment, I simply state-I think all hon. Members know this-that the longer the speeches from the Front Bench, the fewer opportunities there will be for those sitting on the Back Benches. To move the amendment in the name of the Government, I call the Minister.
"recognises that there are health inequalities, particularly around heart disease, stroke and cancer, to be addressed in London; agrees that there is a need to build stronger organisations which are clinically and financially sustainable and provide the best service to their local populations; recognises the importance of the work by Lord Darzi and over 200 clinicians who undertook the Healthcare for London review, which was widely supported and consulted on in London; recognises that trusts have worked closely with their local communities to communicate the aims of the programme; further recognises that lives will be saved because the NHS in London, supported by public consultation and following review and scrutiny by local and pan-London Health Overview and Scrutiny Committees, has agreed to implement new stroke and trauma networks surrounding world-leading major trauma centres and hyper-acute stroke units to ensure that patients receive high quality and innovative care in centres of excellence, expected to save approximately 500 lives a year; acknowledges that there have already been improvements in cardiac outcomes; notes that there must be no further changes to accident and emergency or obstetrics departments unless and until improved access to new services is available and that any changes must be subject to full and formal public consultation; and further notes that the Government is preparing robust planning systems to ensure that NHS London is fully prepared to meet the challenges posed by the London 2012 Olympic Games.".
In opening, the hon. Member for South Cambridgeshire (Mr. Lansley) took 24 minutes. [Hon. Members: "Thirty-four minutes!"] I apologise. Perhaps I was more generous to him than I should have been. I normally take a lot of interventions, as the House will know, but I will try to
make some progress today, because I am conscious that many hon. Members will want to raise their local concerns about NHS London.
I had a lot of sympathy with the hon. Gentleman's comments on inequalities, and with the motion, which is about a number of those. There is common ground on the need to address those inequalities. The difficulty is that the motion, and indeed his comments, identify a series of problems but offer no possible solution. I can see the opportunist, pre-election attempt to wrong-foot Labour, but the motion and the speech offer no vision, no new ideas, and frankly no agenda for government. They expose the Conservative party as offering no constructive way forward to address the very problems that the hon. Gentleman and his motion identify. We know that there are inequalities in stroke provision, and in heart provision. We know that London has worse outcomes and greater inequalities than other parts of the country. We know that lives are lost because of the current disposition of services. We know that infant mortality rates in Haringey are three times those in Richmond. We know that life expectancy deteriorates by a year for every stop on the Jubilee line from Westminster to Canning Town, from 77 down to 70. There is an over-reliance on A and E because GP practice in deprived areas in some parts of London is inadequate. But the best that the hon. Gentleman can offer is a vague view that we should leave it up to GPs to solve it through their budgets. He says that GPs should put more money into services if they want to keep them, on an ad hoc basis and without any process. That is an abdication of responsibility.
Emily Thornberry (Islington, South and Finsbury) (Lab): Is my right hon. and learned Friend aware that NHS Islington is currently engaged in a so-called pre-consultation about the future of our greatly loved Whittington hospital? That so-called consultation is as chaotic and incoherent as it is alarming and wrong. Will he instruct NHS Islington to listen to local MPs and the public and dismiss any suggestion that Whittington A and E and maternity unit should close?
Mr. O'Brien: As my hon. Friend knows, I have said in a debate on the Floor of the House in December that I have concerns about what is happening in relation to the Whittington. She has fought a strong fight on the issue and spoken to me about it on several occasions. We need to see strong clinical evidence for any change to the status of the Whittington. It is being discussed locally, but the national clinical advisory group will need to look at any case put forward. It is local now, but we have invested £32 million in the Whittington, much of it in A and E, and unless the case for change is established, there will be no change. At the moment I am not convinced of the need for the Whittington A and E to close. Those discussing these things need to know that. I have serious concerns about it and I would want to see a serious clinical case made for saying that the £32 million that the Government have decided to invest in the Whittington should be overridden. I do not see any justification for closure of the A and E at this time, and I would want to hear the case for closing it during the next Parliament. I have seen no such case.
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