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This Government are committed to empowering people to make those local decisions. We believe that decisions about how to provide local health care should be led by local clinicians in collaboration with patients and the public, not by diktat from Whitehall. That is not what
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we are doing, yet the hon. Member for South Cambridgeshire thinks that adopting any strategic view about how to deal with inequalities is diktat. I say that it is simply having a strategy. That is precisely what is absent from Conservative policy-any sense of strategy or of moving from many to fewer inequalities. There is nothing. That is an indictment of the Conservatives' approach.

Hundreds of the best clinicians across London are now working together to transform health care in this capital by talking through ideas, which this process provides the space for them to do. I know that there are concerns about the need for more openness in the process. The Liberal Democrats have called for the release of all documents, as we heard. Clinicians do complain a bit about too much sunlight, however. PCTs are working with clinicians to identify options for improving services. If some A and E services close, it will be because clinicians on the ground deem it in the best interests of patients-and never before the alternative services are up and running. Those alternatives have to be there and they have to be better before any change happens. Any changes will always be consulted on prior to implementation and the results of that consultation will be independently evaluated wherever there is a legitimate challenge.

Mr. Duncan Smith rose-

Mr. O'Brien: Before I end my speech-I think it is time that I did-let me give way to the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), because I promised to do so.

Mr. Duncan Smith: I am grateful to the Minister for giving way. This is not a party political point: I believe that Members on both sides of the House agree with it. The fact is that, currently, decisions are being made and then driven through on the ground by officials who are determined to hide much of that process from Members of Parliament and the public. There is a good example of that in my area.

Whipps Cross University hospital bid for the stroke and trauma centre, having a good stroke centre itself. It was told that one of the two centres in our area had been awarded to the Royal London hospital because it was close to cardiac services, while the other had gone to Queen's hospital, not, suddenly, because of the availability of cardiac services-Queen's does not have any-but for reasons connected with neurological services. Then it was told that in any event it would not have been able to complete the process in the time available. When we checked, we found that Queen's could not have completed on time either, but had been allowed extra time. In other words, the decision was made long in advance that Whipps Cross would not be given the centre, but as those who had made the decision could not say that, they went through a rigmarole of consultation that was an utter nonsense.

Mr. O'Brien: The right hon. Gentleman wants to be non-party-political, so let me be non-party political as well. We need to ensure that the process is clinically led and locally decided-

Mr. Duncan Smith: It was not clinically led.

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Mr. O'Brien: Perhaps the right hon. Gentleman will stop shouting at me from a sedentary position and listen to what I am saying. As a former leader of his party, he does himself no service by reacting in that way. I am trying to respond to a genuine question in a genuine way. Let the vibrations settle a bit, eh?

It is important for the Darzi process to be led by local clinicians and not driven by managers following a purely financial agenda. [Interruption.] Will the right hon. Gentleman calm down and let me finish? If he does that, I will even let him intervene again.

We need to ensure that the process is driven by clinicians and not by finances. Finances are an important consideration, but the No. 1 priority in the health service must be patients' safety and the quality of care given to patients, particularly in a place like London in which there are massive inequalities. Then we need to ensure that the process is delivered within a budget. That should be the order of priorities. Managers need to be aware of that, and they also need to be aware that it is the views of clinicians that we will consider when we have to examine any proposals that are submitted. We will have them nationally examined by clinicians to ensure that the right clinical judgment is made. If local decision making and the budgets of GPs determine whether or not something happens, there will be no such overview of whether developments are clinically driven.

Mr. Duncan Smith: The only reason I gave that example was that it was clear that a decision had already been made, and that those who had made the decision had simply gone through a process of changing the criteria throughout. The point that we are all making is that none of this is being done other than completely in secret. The process must be opened up to clarity in order for proper consultation to be possible.

Mr. O'Brien: I agree that the process needs to become much more open. Darzi said very clearly that people did not need to be treated in hospital unless that was absolutely necessary, and that they should be treated as close to home as possible. When it comes to working out how that should be done, clinicians should be at the heart of decision making. That is what is happening across the city. Change is coming. The NHS must invest more in preventive care, rather than waiting until people become unwell. The money needs to be identified. The NHS must give the best possible treatment to those who are very ill, concentrating specialist expertise in centres of excellence. That is what we want to be delivered.

Tom Brake: Will the Minister give way?

Mr. O'Brien: I will, but then I must end my speech.

Tom Brake: The Minister has talked of his vision. I know that part of his vision for London is the Better Healthcare Closer to Home programme. We are expecting an announcement from the Treasury confirming that the programme can go ahead. Is the Minister in a position to tell us that it has been given the green light?

Mr. O'Brien: I think we are still on an amber light. I am still very hopeful that a green light may well at some point be able to be flashed on. However, I cannot give the hon. Gentleman any firm commitment just yet, but he has made representations to me.

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The hon. Member for South Cambridgeshire has moved a motion on which the House will vote. I give him credit for knowing the NHS well, but that is why I am so concerned with the motion's vacuity. He accepted stroke reconfiguration in Cambridgeshire because he knew that it was necessary and it was clinically led. The indictment of him is that he knows that the Darzi review is right but it is politically difficult. It requires courage to change London's NHS and save lives, and for there to be a credible alternative Government, there needs to be an Opposition party that comes up with a credible alternative if it criticises Darzi. Change is always difficult, but across the country the hon. Gentleman has not opted for the process of improving the NHS; he has taken the opportunist line.

Let us examine where we have made changes. The hon. Gentleman knows well that the NHS in Calderdale and Huddersfield has reconfigured its maternity services and is giving mothers and babies safer care, but his party would reverse that. In Manchester, the reorganisation of paediatric services is giving children safer, better care, but it appears that his party wants to overturn it. In Birmingham and Sandwell, the new hospital would not be there and patients would not be getting safer, better care without change, but his party opposes change in that area.

Change is difficult: it requires courage and judgment. In each of the cases I mentioned the Government have made the judgment and have made the change. We have had the courage to lead. We have created a bottom-up process that saves lives. The hon. Gentleman is committed to reversing that for the sake of political expediency, thus sacrificing patients for marginal seats. The clinicians wanted change to save lives and improve the quality of care. He wanted votes, and he seeks to obtain them by scaring people into a conservative view on opposing change.

I do not deny that it is easy to scare people and that seats can be won in that way-that has been done-but leaders do not do that. People who care about the NHS do not do that. We have not done that; we have made the change, we are improving the NHS and as a result of those changes we are going to be saving lives that will, if this process is stopped, be put at risk. We are prepared to make the change; the Conservatives are not the change.

4.57 pm

Norman Lamb (North Norfolk) (LD): The Liberal Democrats welcome this debate on an incredibly important issue for the people of London. However, it is fair to say that the Conservative motion does not really achieve very much, because all it calls for, in effect, is a delay in the reconfiguration process until there has been more effective public consultation. [Interruption.] Well, that is exactly what the motion says. We have not even got to the point where the public consultation is built into the process, because we are told that that is due to take place this autumn. Our criticism of the process is much more fundamental than that.

Mr. Andrew Pelling (Croydon, Central) (Ind): Will the hon. Gentleman give way?

Norman Lamb: Not quite yet. I am only 30 seconds into my speech.

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Our criticism is of the way in which the NHS makes decisions and the fact that they are taken by bodies that are completely unaccountable to the people they serve. The Minister made two assertions in his speech. The first was that these decisions are local decisions. Who are these local decisions taken by? They are taken by people who have no legitimacy; they have been appointed nationally, so there is no accountability to the communities-

Clive Efford: Will the hon. Gentleman give way?

Norman Lamb: I shall in a moment, but let me finish my point. There is no accountability to the communities that they serve.

The Minister's second assertion was that the whole process is clinically driven, but we know that that simply is not the case. I wish to refer to an anonymous e-mail that I received from someone who describes himself as

in north-west London. He refers to the fact that the clinicians have been

This is a process that is "clinically led", but very much the opposite is in fact the case. The process almost seems designed to alienate the public and the clinicians who are desperately trying to provide services. My hon. Friend the Member for Kingston and Surbiton (Mr. Davey) has referred to conversations that he has had with local clinicians who are deeply frustrated by what is going on. They may have been involved in the process, but they do not want it and they are not leading it in any sense of that word.

Mr. Pelling: I want to congratulate the hon. Gentleman and his colleagues on opening up the debate by having the courage to talk about this matter publicly. Is it not right that such a debate should take place during a general election, and not be postponed by the Conservative party or Labour party until afterwards, when patients' influence will be minimised?

Norman Lamb: The hon. Gentleman makes absolutely the right point. It would be scandalous if any of the related papers were kept secret until after the general election. There almost seems to be a conspiracy of silence to prevent the public from knowing the real facts until after the general election.

The process seems designed to destroy confidence and to engender suspicion about motives. We know that the real pressure comes from the financial crisis faced by the NHS, which is in large part due to the way in which money has been spent by this Government within the NHS. I shall come on to one of the particular reasons for that-PFI, which was mentioned a while ago by an hon. Member on the Conservative Back-Benches.

An opinion piece in The Guardian on 3 March stated that

There is a culture of fear-people fear the consequences of speaking out. That Labour-voting commissioner from north-west London writes that he wants his e-mail
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kept anonymous. He does not give his name, because he fears that his job would be threatened

What an indictment it is of the NHS under this Government that people fear for their jobs if they speak out and reveal to the public what is going on behind closed doors. He says in that e-mail that there has been produced in north-west London

He goes on to talk about how the acute commissioning vehicle has emasculated the primary care trusts-the bodies that are supposed to be there under this Government to determine health care for their local communities. They have been emasculated by this new body that is imposing its decisions on the local area. Clinicians have been kept in the dark and feel completely excluded from the process in many cases.

Mr. Slaughter: The picture that the hon. Gentleman is painting comes from tittle-tattle and innuendo. I represent a seat that is covered by the north-west London sector, and the picture that he paints bears no resemblance to the truth on the ground. All that people have seen for the past five years has been an improvement in the quality of their health services, whether at a polyclinic level, a tertiary level or in the three hospitals that make up the Imperial College Healthcare NHS Trust. He ought to pay some tribute to the work that is going on in the health service in those areas instead of simply spreading despondency on the basis of rumour.

Norman Lamb: The hon. Gentleman refers to the views of a commissioner from north-west London as tittle-tattle and innuendo. I shall tell him a bit more of what that commissioner says:

The acute commissioning vehicle

That is the view on the ground from a commissioner working in the NHS in north-west London. The hon. Gentleman might not have received the leak, but that is the view the commissioner has expressed from the coal face.

Clive Efford: The hon. Gentleman surely cannot base his argument entirely on one anonymous e-mail that he claims to be a leak. We have all had concerns about the proposals in south-east London, but they were put forward in the autumn of 2007 as a result of a conference held by clinicians-doctors, nurses and midwives. They came up with them and it was on that basis that NHS London decided to move forward on the proposals, which were also reviewed by Professor Alberti on a clinical basis. On what does the hon. Gentleman base his argument that the proposals have nothing to do with local practitioners or local decision making?

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Norman Lamb: I have expressed the view from north-west London, but we have heard other stories from north-east and south-west London, and I shall come to those in due course.

The origin of all this was a report that NHS London commissioned from McKinsey's, which has remained a secret to this day. Surely there can be absolutely no justification for that. The Minister has said that this process should be more open, so will he commit to publishing that report? I give him the opportunity to intervene. Will he publish it today? That is what people want.

Mr. Mike O'Brien: I am grateful to the hon. Gentleman for that invitation, but I have not seen the McKinsey report to which he refers. It has not landed on my desk and I have not got-

Norman Lamb: Do you think it should be published?

Mr. O'Brien: Well, no; it is not mine to publish. I cannot commit to publishing-

Norman Lamb: But do you think it should be published?

Mr. O'Brien: Madam Deputy Speaker, I am being heckled from a sedentary position by the hon. Gentleman who has allowed me to intervene on him. Perhaps if I give the floor back to him, he can heckle me a little more.

Norman Lamb: I do not know what to take from that. I do not know whether the Minister believes that the report should be published. It might not be his to publish, but he could at least indicate to NHS London that the Minister with responsibility for this sphere believes that it should publish the report. That would be very helpful. Is he willing to do that?

Mr. O'Brien: I am grateful to the hon. Gentleman for again inviting me to respond. I do not know what is in the report in the sense that I have not read it. I do not have a copy, so this is a matter for NHS London to deal with, but I am sure that Ruth Carnall, the chief executive, will have heard his comments. I am not going to order her to publish it, no, but I shall ask her about it.

Norman Lamb: I am pleased that the Minister will at least ask her about the report, because, as he said earlier, this process should be open, but it is certainly far from that. These are our local health services and our taxes that are being spent, so we deserve to know what is being planned behind closed doors. We demand disclosure.

We presume that the Conservatives know about the report because one of their parliamentary candidates works in McKinsey's health team, so they are presumably party to it. Meanwhile, the public and clinicians are kept in the dark. I ask the Government to commit to bringing into the public domain, before the general election, the processes that are taking place around the country, in every strategic health authority, so that people can cast their vote in the full knowledge of what is being planned behind the scenes.

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