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Those who reveal plans to the public are accused of scaremongering. My hon. Friends the Members for Kingston and Surbiton and for Richmond Park (Susan
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Kramer) rightly decided to inform the public of what they have been told and about draft reports that they have seen regarding threats to their local hospital, but the Conservative shadow Minister, the hon. Member for Hemel Hempstead (Mike Penning), accused them, in an Adjournment debate, of scaring the public. The Conservative view seems to be that these issues are best kept secret and that they should not be revealed to the public until after the general election, which is outrageous. I applaud my hon. Friends for having had the guts to put that information into the public domain so that the public can know what threats exist.

The threat is real. I have a copy of a draft report entitled "Presentation to NHS Kingston Joint Board and PEC meeting", which confirms that one in three of its 18 options would involve the closure of Kingston hospital's maternity unit, accident and emergency unit and paediatric in-patient department. Sixteen of the 18 options would see Kingston lose a significant service from that hospital. My hon. Friends deserve an apology from members of the Conservative Front-Bench team and local Conservative campaigners. They have been accused of scaremongering, when the matter is in black and white.

Interestingly, the report ends with a note saying that it should be sent to NHS London but not published. My hon. Friends have got it into the public domain, and they made the right judgment in doing so. These are decisions of which the public should be fully aware.

Mr. O'Brien: I am a little confused by the point that the hon. Gentleman is making. He referred to the hon. Member for Kingston and Surbiton (Mr. Davey), who was busily telling us about these changes on his website on 5 October. Having talked about how good it was that public meetings were being held, he concluded by saying:

Norman Lamb rose-

Mr. Davey: Will my hon. Friend give way?

Norman Lamb: I am very happy to.

Mr. Davey: I am very grateful to my hon. Friend, as I want to explain to the Minister what I was talking about on the website. I was talking about proposals for polysystems, and about the fact that Kingston NHS was building a polyclinic at Surbiton hospital. My support for that polyclinic remains, and I also supported the changes to stroke and cardiac services that came from NHS London. What we oppose are these secret changes, with one option in three proposing that our local hospital should lose its A and E, maternity and in-patient paediatric services. The fact that the Minister does not understand that does him no favours.

Madam Deputy Speaker: Order. A great many people wish to contribute to the debate, so I would ask that interventions please be as they should be-brief.

Norman Lamb: Thank you very much, Madam Deputy Speaker, and I am grateful to my hon. Friend for that explanation.

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I was referring to the proposals for north-east London, which emerged only because my hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone) received a leaked letter from a clinician in the system. Again, the letter demonstrated what was going on but was kept from the public. It set out options, including the potential loss of A and E and maternity services at the Whittington hospital. The hospital is much loved and needed, and it serves one of the poorest communities in the country. The area has one of the lowest rates of car ownership in the country, yet it is proposed that those services should be lost. Again, my hon. Friend was right to get the matter into the public domain so that people can make their own judgments on the proposals.

The belief, certainly in north-east London, is that the proposals are not evidence-based, and that wrong assumptions have been made about the potential impact of the loss of an A and E department at the Whittington hospital. People believe that conclusions are being drawn that do not stand up to analysis.

I turn now to the private finance initiative, which has imposed an enormous burden on the NHS in London.

Mr. Duncan Smith: The hon. Gentleman is talking about north-east London, but a year and a half or two years ago Professor Alberti was called in to have a look at the process whereby the various PCTs in the area were going about the business of change. He was highly critical of the secrecy involved, and of the trusts' failure to tell the public exactly what was going on. The idea that the problems were driven by clinicians is absolutely not true.

Norman Lamb: I am very grateful to the right hon. Gentleman for that intervention. It appears that the PCTs have learned nothing from George Alberti's intervention a year ago, as the same secrecy continues to pervade the entire process.

As I was saying, I shall deal now with PFI. There have been 20 PFI schemes providing new facilities in London at a cost of £2.6 billion, but the repayments over the lifetime of those facilities will come to a staggering total of £16.7 billion. Those repayments have not been properly budgeted for, but they will bankrupt the NHS and in a sense drive the changes that we are debating today.

This year, PFI payments will amount to £250 million in London alone. By 2014, that will have risen to £400 million per year. That is forcing up overhead costs on trusts and squeezing the resources of other health services. It is also, as the hon. Member for Hornchurch (James Brokenshire) said, distorting decision making about service changes.

The proposals appear not to have taken sufficiently into account the pressure of rising case loads in London. Many London hospitals find that acute bed occupancy rates are approaching 100 per cent. In other words, throughout the year they are virtually entirely full. The BMA says that the 3.7 million attendances at accident and emergency departments reflect high levels of mobility and temporary residents often unregistered with GPs, who choose to go to their local A and E department because they have nowhere else to go. As the proposals are put forward, there is nothing else in place to reassure the public. It is dangerous to make assumptions about the ability to cut numbers going to hospital before new arrangements and facilities are put in place.

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There should be a recognition that the process is flawed. Consultation, despite the Conservatives' apparent faith in it, will not satisfy the public of London because all too often, as the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) suggested, consultation is seen-rightly, in many cases-to be a fait accompli, a rubber-stamping exercise. As the report from south-west London confirms in one of the charts that it contains, the final stage is consultation and implementation, as if consultation is a box that must be ticked before implementation of the changes that have already been determined.

We have surely tested to destruction the model that seeks to impose change decided by unaccountable bodies. We have the bizarre spectacle now of Labour Ministers leading protest marches against closures in their own local area. Instead, let us start by achieving savings in the NHS by slimming down the central bureaucracy, which has become overblown and entirely out of control under this Government, with 25,000 people working for NHS quangos at a cost of £1.2 billion a year. Let us reform the way that money is used in the NHS to manage those with chronic conditions much more effectively than we do at present, avoiding the crisis admissions to hospital which are so costly to the NHS and so disruptive to patients and their care.

Let us provide better incentives to prevent ill health in the first place. Critically, let us make primary care trusts democratically accountable to the people they serve. These are services that we all use, and those bodies that make decisions should be accountable to us. It is instructive that two former Secretaries of State from the present Government now support the case for democratic accountability in the decisions relating to the commissioning of health services. Decisions about local services should be reached in as open a way as possible by democratically accountable bodies.

Chris Ham, who will take over as head of the King's Fund, has cited the process in Sweden, where there are democratically accountable bodies responsible for health care. In Sweden they go about decisions in a collaborative way, involving the public not after the decisions have been taken, but at the start of the process, so that everybody understands the financial constraints that we all accept are there, involving the clinicians and reaching decisions together, rather than imposing them from on high.

Jeremy Corbyn: Will the hon. Gentleman give way?

Norman Lamb: No.

We want to be able to hold those organisations to account. Until that happens, we will oppose cuts in local services imposed on local communities by people who have no democratic accountability.

Several hon. Members rose -

Madam Deputy Speaker: Order. Mr. Speaker has imposed an eight-minute time limit on Back-Bench contributions, but in view of the amount of time that has already been taken, after the first two Back-Bench contributions the time limit will be reduced to six minutes.

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5.19 pm

Frank Dobson (Holborn and St. Pancras) (Lab): I find it very unconvincing when I hear a Tory Front Bencher speaking in favour of reducing health inequalities. When we came to power in 1997, each part of the country was supposed to be allocated health service funds that reflected the size, nature and health of their population, but the east end of London was getting 23 per cent. less than it was entitled to, and surprise, surprise, Tory Surrey was getting 23 per cent. more than it was entitled to. That is entirely typical of what the Tories have always done.

In my constituency, investment under the Labour Government has been quite dramatic. We have the new University College hospital, which I freely admit got under way when I was Health Secretary; and we have also had big improvements at the Royal Free hospital, which serves my area, and at Great Ormond Street hospital, which serves children from across the country. We have new health centres, with two in Kentish Town and one that has just reopened in Gospel Oak; most GP premises have been improved; and the survival rates and general performance in our area have massively improved because the buildings and equipment have at long last started to match the excellence of the staff.

As part of that, there has been a lot of investment in the Whittington hospital. I can remember, when I was in opposition, going to the Whittington and pledging all sorts of things. As I believe in keeping pledges, those pledges have been kept, and a lot of extra money has been invested in the Whittington. I could not get firm figures from the hospital today, but as I understand it £27 million was invested in the new accident and emergency department, so my hon. Friends and I find it slightly bizarre-to say the least-that nameless, faceless people have suddenly appeared on the scene and decided to recommend that the A and E department, in which all that money has been invested, no longer function, and that instead people be diverted to the Royal Free and University College hospitals.

I checked this morning at University College hospital. It was designed for 60,000 A and E attendees, and it now has knocking on for 90,000, so Lord only knows where the 90,000 people who use the Whittington will go. Apparently, the explanation is that many would go to clinics-new health centres-in Islington. The only trouble is that they have not been built, and it will cost money to build them. So if the closure is being undertaken to save money, it is utterly stupid because it will involve spending money to substitute for the money that has already been spent at the Whittington.

Glenda Jackson (Hampstead and Highgate) (Lab): The issue is not only the waste of money, because the Whittington A and E rumours, which are rife in our part of the world, are having a serious knock-on effect on the hospital in my half of the borough of Camden, namely the Royal Free, and that is producing anxiety among not only patients but staff. Surely we have not invested all that money in the national health service and its staff suddenly to make them feel that they are no longer wanted or useful. It must be having an effect on their contribution now.

Frank Dobson: As ever, I agree with my hon. Friend and good friend. The report that was produced on behalf of the primary care trust last week shows how it
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estimates that between only 10 and 30 per cent. of the people who currently attend A and E could be properly attended to at one of the devolved clinics, as we might describe them. However, up to now the basis of the Darzi report has been that between 50 and 60 per cent. of people could be safely dealt with at such clinics, and I do not agree. I am simply not convinced.

The whole basis of the concentration of stroke provision and major trauma provision, which I strongly support, is that practice makes perfect, but apparently practice does not make perfect in A and E any more, because the people who have a lot of practice at a large A and E will be substituted by people who have a lot less practice at clinics in the community. So the closure does not make sense in terms of the practicalities or, indeed, the money.

The idea that there was widespread, successful consultation of Londoners over the whole Darzi thing is really preposterous. About 1,800 Londoners-and there are rather a lot of us-expressed support for the Darzi proposition, and about 1,700 said that they did not want it, so the view was far from unanimous even among those who were consulted. I find that outcome about as convincing as Lord Ashcroft's protestations about his tax status, and we all know what that indicated.

Unfortunately, these aspects are bringing into disrepute a great deal of the achievements that the Government have brought about in the years that we have been in office. At the meeting I went to, when we had to listen to the burblings of some of the people who are proposing what is happening at the Whittington, nothing much was said about improving clinical performance; it was all about saying, "Oh, we think we're going to be £500 million down." When they were pressed to explain how that was going to happen, they could not come up with any satisfactory explanation. I can only assume that they are absolutely convinced that there will be a Tory Government and that there will therefore be a £500 million-a-year reduction in the money that is available, because they could not possibly conclude that from anything that the Labour Government have been committed to.

We need to look at the functions of NHS London. It is NHS London, not NHRS London: it is there to help clinicians in London to improve the services, not to be a national health reorganisation service for London. A lot more attention needs to be paid to what local people want.

In talking about A and E, I come back to the thing that I have been obsessed with for all the time that I have had an interest in this issue, and that goes back a very long way-if we want to make A and E departments more successful, let us put some GPs in there to deal with the folks who choose to turn up. People do not want to be told, even by clinicians, that they should not turn up at their local hospital. If they want to turn up for GP services, as well as strictly A and E provision, that should be fine by us, and it would be a proper response to the situation that we face.

I strongly welcome what the Minister said about being far from convinced of the merits of the closure of the A and E at Whittington hospital. One has to be careful what one says when one is a Minister, and what he said far from overstates the reaction of most people in the area and, according to all my sources, the reaction of most of the clinicians who are working at the Whittington
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and want to continue to do so. I welcome what he said, and I think he had better press on with it. We cannot leave this to bureaucrats. It is no good leaving things to bureaucrats, because when they get it wrong, they do not have to stand at the Dispatch Box to explain. Ministers have to do that, so Ministers should take responsibility right the way through. The people who take the decisions should carry the can, and the people who carry the can should take the decisions.

5.28 pm

Mr. John Horam (Orpington) (Con): I never thought that I would stand up in the House and agree with the right hon. Member for Holborn and St. Pancras (Frank Dobson), particularly on health matters, but he made a very important point in his criticism of the Darzi proposals. Having spent millions of pounds on new hospitals in London, the Government now want to make a radical change in favour of treating a huge proportion of the people who currently go to the accident and emergency departments of those hospitals in polyclinics, which have not yet been built and which they propose to build during a period of financial difficulty. It is mad to behave in that way. It is in the same category as the Government's deciding to pay GPs a lot more to do less, and then having to pay them even more to do the things that they were originally supposed to do. All these financial and medical decisions by the Government seem to come from Alice in Wonderland.

I doubt whether one could find a worse example of what is wrong with the NHS in London than in looking at my own corner of the city-south-east London. There, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has pointed out, we have the South London Healthcare NHS Trust, which was a shotgun marriage between three hospital trusts that had severe financial problems. It was set up with an accumulated deficit of £200 million, and was given an operating target for this year of a deficit of £29.7 million. Since we are near the end of the current financial year, that means that the accumulated deficit is now well over £200 million.

To be fair to the Government, a new management structure was put in place with the creation of the new trust a year ago. Some members of the Government have accused the Conservatives of scaremongering, but I have not done so about the management of the new trust. Although criticisms by consultants, patients and voluntary organisations, such as the local involvement network, have come my way, I said to myself that I would hold back from criticising the management publicly. One should be a responsible Member of Parliament and recognise that the management of any such huge organisation need time to bed down. However, the fact is that we have now had 12 months and the results are extremely disappointing, as the hon. Member for Eltham (Clive Efford) may well agree.

It is worrying, for example, that the operations director has already gone by mutual agreement. I now understand that the financial director is also going by mutual agreement, although I have not been able to check that. A new operations director is being put in directly from the Department of Health. As a former Health Minister, I know that means that the Department is worried about the new trust. There are clearly problems in its management.

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