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A consultation took place. We hear a lot in documents about wide consultation, but it did not reach the doors of many of my constituents or, indeed, those of my hon. Friends the Members for Chipping Barnet (Mrs. Villiers) and for Broxbourne (Mr. Walker). The consultation was woeful and incomplete, leading to
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widespread concern and a lack of confidence. It gave a clue as to what the world would look like if the Darzi model were followed through, and people should be concerned. It is apparent that the call for a local-led solution was nowhere near the mark when it came to Enfield. This was a top-down model, prescribed from on high and greatly restricted in the options presented. It asked the questions to produce the answers that were wanted in order to justify the Secretary of State's decision in September 2008 to downgrade consultant-led A and E and maternity services.

Interestingly, if one had gone across the country at the time of the consultation, one would have seen a replica model of health care being followed through. The model had nothing to do with any particular input or variation in local need. There were similar campaigns on the Sussex coast-across Chichester and Worthing, for example. All the models were based on the same one that came from on high in Enfield.

The same has been said elsewhere. Sir George Alberti came in as the troubleshooter to fix the problem. He also recognised the lack of public engagement and expressed concerns about the need for clinical engagement. Crucially, he said there was a need for pump-priming and bridge funding for the PCTs to ensure that their primary care services were in place before any of the secondary care changes were made.

Was there a bright new dawn in Enfield, which others could welcome and then follow down the same road? In the cold light of day in 2010, we see a primary care trust that is still strapped for cash and facing a historic debt of some £25 million. It is still struggling to get within a double-digit figure for its current debt, while the area still struggles to get any decent primary care. The poly-systems are hardly in place across the borough and we are left with the Secretary of State's decision to downgrade consultant-led A and E and maternity services. We have had some clarity about the situation, so we know that we are left with a 12-hour urgent care centre and at best a 24-hour doctor-led primary care service at Chase Farm hospital.

As in Islington and elsewhere, we had a march, with thousands of people participating, and I was joined by my hon. Friends the Member for Broxbourne and for Chipping Barnet and by the hon. Member for Edmonton (Mr. Love) and the right hon. Member for Enfield, North (Joan Ryan). We were all together, campaigning to ensure that we retained our consultant-led A and E and maternity services. Thousands of people signed petitions; the Conservative parliamentary candidate for Enfield, North, Nick de Bois, led the campaign, presented the petition and worked extremely hard.

What has happened to the campaign now? We have lost it. There has been a division. Conservative Members are full square behind the need to recognise that there should be consultant-led care, but the champagne has been popped, regrettably, by the right hon. Lady at the door of the A and E unit. What was the celebration? A downgrade of our services. It is not possible to sit on both sides of the barricades in this argument; it is necessary to stand full square behind the people of Enfield, who do not want a downgrade of our services.

What is the situation 18 months after the consultation? There is increasing demand, with more than 3,300 births at Chase Farm hospital and more than 100,000 attendances in A and E. My constituents-all our constituents-are
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asking why, given all the money that is going into the health service and given the rising demand, we are reducing access to accident and emergency services while increasing management of contracts and increasing waste. They want a new financial model and a new clinical model that would ensure that we look at the position again.

Mr. Charles Walker (Broxbourne) (Con): Why does my hon. Friend feel that the concerns of people in Broxbourne and Enfield have been ignored throughout the process?

Mr. Burrowes: I think that in many ways the deal was done before the point of engagement was even reached. As other Conservative Members have pointed out, the decision had already been made. Models have been adopted, irrespective of the different clinical needs.

Eighteen months on, we are seeing not just a campaign on Chase Farm, but a prospect that is even worse, whether that is at the Whittington or elsewhere. The £500 million funding gap is raised, and there is the question of whether between one and three major acute hospitals-the North Middlesex or Barnet, for example-will retain a 24-hour A and E service. A document published by NHS London questions whether it would be safe for those local hospitals to retain their maternity units, despite the increasing birth rate and increasing demand.

The proposals are unacceptable, and it is clear that we should halt them, not for the purpose of political convenience but because of the need for proper financial and clinical models. The choice is clear: people can support Labour if they want the status quo-a continued hospital downgrade-or they can support the Conservatives if they want the security of change that is based on local and clinical need.

6.22 pm

Mr. Tony McNulty (Harrow, East) (Lab): The hon. Member for Enfield, Southgate (Mr. Burrowes) was doing so well until the end of his speech. This debate has to be slightly bigger than the ponderous party politics outlined by him then, and outlined earlier by the hon. Member for South Cambridgeshire (Mr. Lansley). The notion that there is a land of milk and honey just waiting for the time when the hon. Member for South Cambridgeshire takes over is palpable nonsense, and the hon. Gentleman knows it.

A point made by the hon. Member for South Cambridgeshire went to the core of the matter. There is a dilemma between the local and the strategic in London, which has been woefully neglected since the inception of the national health service. I would say-of course I would, as a suburban Member of Parliament-that for too long everything has been sucked into the centre, courtesy of the fancy and precious London teaching hospitals, which admittedly are wonderful, and to the detriment of the suburbs. That dilemma has still not been resolved, and sadly it has not been and will not be resolved by Boris Johnson, as the hon. Member for South Cambridgeshire intimated.

On health as on a bunch of other things over the past two years, Johnson has done nothing of any consequence for public health or health in London. I stood here, or
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roughly here, in 1998, during the passage of the Bill that became the Greater London Authority Act 1999, and said that if in 10 years' time the Greater London assembly and the Mayor had not evolved enough to take a significant and direct role in the strategic health concerns of London, the Act would prove to be a failure. For all the glossy little documents that Boris Johnson has produced, he has, as I have said, done nothing of any consequence.

If we are honest in a cross-party context, we must agree that the dilemma is between the strategic and the local. I take the point made by the hon. Member for Enfield, Southgate, who lamented what had happened to Chase Farm. Chase Farm matters to me as well, because it is linked with Barnet, and if Barnet health authority decides to do things at either Chase Farm or Barnet there will be consequences for Edgware hospital, which is 10 yards away on the other side of the Edgware road.

Where does the local begin and where does it end? In January 1997 the Tories closed Edgware general hospital. They downgraded it, and left it with Barnet. It cannot be enough to make the local prevail over the strategic when people's health needs do not recognise borough boundaries in a nice convenient way.

Mrs. Villiers: A few months ago the Secretary of State signed off the controversial downgrade of Chase Farm that was mentioned by my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes), on the understanding, and on the basis of repeated promises, that Barnet would be upgraded to take the pressure and the extra patients. How can the right hon. Gentleman possibly justify the decision of NHS London to discuss downgrading Barnet after the promises made about Chase Farm?

Mr. McNulty: The hon. Lady should listen. I am not justifying it at all. I am simply saying that what happens in one part of London has serious ramifications in another part of London that is apparently not particularly close to it.

The key question is "If not this, then what?" Does there need to be a strategy review and overhaul of what is going on in London? I think that everyone would answer "Yes", but anyone who answers "No" is living in the past, because the real world moves on. However, when it comes to the question of whether the bureaucracy has the capacity and is properly equipped to deal with such an overhaul, I hesitate. Let me give an example. When the maternity service at Northwick Park hospital was reconfigured 10 or 12 years ago, it could not have been known that more than half the cases presenting to the service would be in the high-risk category, because that particular part of the population was not there then.

Where are the flexibility and responsiveness that would make it possible to deal with the dynamics of what is going on in London? Local needs cannot just mean PCTs. Unlike the hon. Member for Orpington (Mr. Horam), who has represented about three dozen parties and four constituencies-he is not in Chamber at present-I do not argue that there should be far fewer PCTs. There should be co-operation between PCTs. I believe-and here again I agree with the hon. Member for South Cambridgeshire-that there are local dimensions in which public and preventive health should be provided all the more.

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Over the past 20 or 30 years, a collective failure of public policy has meant that preventive medicine and primary care have not developed as they should have. Anyone who visits any other European country will find that most of the cases that present to A and E encounter nothing resembling the provision here, because people in such countries as Germany and Sweden are much more aware and much more educated.

If various different organisations such as trusts and PCTs are to deal with local health provision in this country, my one plea is that they should talk to each other. Apart from the Royal National Orthopaedic hospital, whose trust is separate from the PCT, there are no hospitals in my constituency. Edgware community hospital, 10 yards away on the other side of the Edgware road, is hugely important, but is run by Barnet. Just the other side of the Northwick Park roundabout is Northwick Park hospital, in the constituency of my hon. Friend the Member for Brent, North (Barry Gardiner), which is run by Brent. In the middle is Harrow PCT. At present the PCT is doing some very good work looking into the possibility of a polyclinic and the reconfiguration of GP services in the east of the borough, which is long overdue. Barnet, meanwhile, is considering what provision for Edgware community hospital should be over the next 10 years. Are they talking to each other? Not enough.

It is true that Northwick Park, to which my hon. Friend the Member for Brent, North will no doubt refer, has been given "stroke status"-if that is the right phrase-and is developing its acute facilities, while also dealing with serious financial consequences; but is it talking to Barnet about what will be provided at Edgware? Is it talking to Harrow PCT about the configuration of GPs in the east of Harrow? Can the three together come up with a solution that has a degree of synergy? That is almost sub-strategic, but it is certainly supra-local.

Simply talking about things being driven by local needs is bunkum. Simply talking-as I know Ministers are not-about things being driven top-down is equal bunkum. Where are the mechanisms that could get things right in the middle? I fear that they have not yet been developed. I think that the concern about sector-based and sometimes secretive solutions is partly due to the fact that no one in one part knows what those in the other part are doing. Of course there should be more openness, but there must also be a strategic review that takes local dimensions fully into account.

6.29 pm

Mr. Andrew Pelling (Croydon, Central) (Ind): I am very mindful that others wish to speak, so I shall be brief. The Minister constantly refers to the way in which these are local initiatives, but it has been clear in the debates from the four quarters of London that a single blueprint is being pursued on these proposals. I have a great deal of admiration for the hon. Members for Kingston and Surbiton (Mr. Davey) and for Richmond Park (Susan Kramer) because of how they have ensured that this debate has the highest profile. However, I fear that we will pass round the black spot as it were, on this proposal because if they are successful in defending services at Kingston hospital, somewhere else in the sector will lose out. I have been impressed, in a way, with how NHS officials have spoken to me in dramatic terms, saying that I will kill or disable people if I oppose these proposals. However, I beg to differ, particularly as regards the impact on Croydon.

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Croydon Members must remember that Croydon is a very ethnically diverse community and that more than 13 per cent. of our constituents are over 65, which is a higher proportion than the London average. We must remember that Croydon has a large black and minority ethnic community, which faces particular health issues to do with diabetes and stroke. Reference has been made to the concentration of stroke resources at St. George's hospital, which we campaigned against in Croydon. With this proposal we again face the prospect of the removal of a great deal of specialisms from hospitals such as Mayday university hospital. This sort of downgrading, which is also proposed for St. Helier and Kingston hospitals, means that that they will become "local" hospitals. In essence, this proposal will turn Mayday university hospital into what the Croydon general was: it will become, in effect, a place for respite and recovery. When I said that this is a bit like having a university where the research professors have been sent 10 miles down the road, I was told that I need not worry because the consultants would visit one day a week. That was not a terribly reassuring briefing to receive on how these things will work.

Obviously one must be cautious about what one discusses in terms of the secret documents that we were allowed to see. The document given to me and to the Liberal Democrat Members in south-west London shows clearly a proposal whereby

would be moved from hospitals in south-west London. That, along with the ambition to move more than 60 per cent. of current hospital out-patient appointments and the other drawing of patients away from GP surgeries into polyclinics, is disturbing.

I wish to conclude by giving an example of how difficult it will be to deliver on some of the savings that are in this secret document. We are talking about savings of about 33 per cent. I am concerned that an incoming Government, desperate to deliver financial savings in a Budget proposed within 50 days, might reach for this document and say, "Yes, we can deliver." That delivery will not happen, and I shall give hon. Members the Croydon example to show why.

Croydon has two polyclinics, one of which is to be found in the constituency of the hon. Member for Croydon, South (Richard Ottaway). He has been vehement in expressing his concern about the redevelopment of Purley hospital, which was promised in 2001. He raised the issue again and received reassurances from the Conservative Front-Bench team about it today. It has taken eight or nine years to get nowhere on that hospital, and that is an example of how polyclinic savings will not be delivered, because the place has just not been built yet. As for my constituency, people will have to go to a polyclinic in the centre of Croydon, sited on a slip road off a flyover. Let us try to imagine people having to go there in an emergency. They are not going to go on a bus. It will not be easy to deliver a baby on a slip road off a flyover. If there is a prospect of people being able to park, they will be competing in a town centre with residents who are already desperately competing for parking spaces. These are practical examples of how NHS officials-people who are making the decisions, and not democratically-have no understanding or sense of the real practicality of delivery.

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The final point I wish to make-I apologise to hon. Members for taking my allocated six minutes-is that this decision should be made during the general election campaign; it should not be postponed in the way that the Conservative motion surprisingly suggested or in the way in which the Labour Government and NHS officials wish. This decision should be made during a general election-when patients have real influence on the debate and on the decisions that will be made-rather than their being made by faceless NHS officials.

6.34 pm

Barry Gardiner (Brent, North) (Lab): In international women's week, I wish to pay tribute to all the women who work in our health service, from chief executives and chairs of trusts, to nurses, porters, physiotherapists, catering staff, cleaning staff, consultants, doctors, midwives and, above all, health visitors. The overwhelming majority of health visitors are women, because that is a profession that, above all, requires common sense. How many times throughout the world have women turned to their families after some apparent crisis and said, "At least we've got our health"?

Our physical and mental health is the bedrock of all that we do and all that we are. As an MP, I therefore take a fundamental interest in and fundamental responsibility for the quality of health care services that my constituents enjoy. My interest must be not just in outputs-how much money or resources the Government make available-but in outcomes such as mortality rates, quality of care and speed of treatment. I must also bear responsibility, not for individual cases but for the configuration of services, their proper resourcing and the proper benchmarking and monitoring of delivery.

Northwick Park hospital and St. Mark's hospital fall inside my constituency and, together with Central Middlesex hospital, which lies in the constituency of my neighbour, my hon. Friend the Member for Brent, South (Ms Butler), form the North West London Hospitals NHS Trust, which serves most people in Brent and Harrow. I am proud to say that it is the only trust assessed as "excellent" for the quality of its services in outer north-west London. Last summer, I was delighted that the trust was designated as one of only eight hyper acute stroke units for London. We have all seen the excellent public services adverts about FAST-Face, Arms, Speech, Time. I congratulate the trust on its success in winning this key unit, which is part of a scheme projected to save 500 lives a year across London. Although I was delighted by the announcement, may I advise the Secretary of State that I will be even more delighted when the Northwick Park hospital's trust is announced as one of the major acute hospitals for the sector, thus upgrading it still further? I trust that such an announcement may come later this year.

While discussing major acute trusts, I must comment on the intervention by the hon. Member for Hammersmith and Fulham (Mr. Hands), who is no longer in his place. He suggested that five accident and emergency departments would close at the eight north-west London hospitals. The "Healthcare for London" report actually talked of creating three major acute trusts. He has interpreted that to mean that three hospitals would stay the same and five would lose their accident and emergency
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departments, whereas in fact the strategic health authority has confirmed that all five will keep their existing accident and emergency departments, but three are due to be upgraded into what will, in effect, be super-providers. I trust that Opposition Members will now stop portraying as a cut what is in fact a proposed upgrade.

There are three key milestones for the Northwick Park hospital's trust. The first is dealing with the hospital's historic debt of £21.5 million. That will take place over the next two months when the primary care trusts across London meet to agree their support for wiping out that debt. The second is the public consultation on the future configuration of the sector this autumn. The third is the support from NHS London to embark on a hospital rebuild.

Mr. Lansley: Just so that the hon. Gentleman does not misrepresent what is in the north-west London sector document, I should say that page 54 makes it clear that the local hospitals-those that are not designated as major acute hospitals-will include a

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