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Contrary to what is said in the NHS London document, the north-west London document does not promise local hospitals a continuing emergency department.

Barry Gardiner: I do not know whether the hon. Gentleman has had the benefit of speaking both to the chief executives of the hospitals and to Ruth Carnall from the strategic health authority. He would find that she has confirmed that there are no plans to take away the accident and emergency departments from those hospitals.

I turn now to my local primary care trust, NHS Brent. Four years ago, I was extremely critical of Brent PCT and was in part responsible for initiating the turnaround plan. Today, NHS Brent is one of the two fastest improving PCTs in the country based on the Care Quality Commission performance ratings for 2008-09. It is a borough that recalls 19-hour waits on trolleys in A and E under the Conservatives, and it is meeting its targets on four-hour waiting lists. In particular, it has exceeded the 93 per cent. target for cancer waits of no longer than 14 days. Critically, this is about not only improved targets, but lives saved: mortality-not only for cancer but for cardiovascular disease- has vastly improved.

All mortality has improved from 87 per 100,000 only two years ago to 79 per 100,000 now. Health inequality lies at the heart of this debate, and in the south of Brent, in Stonebridge ward, the average life expectancy is almost 10 years less than that in some of the more affluent wards that I represent in Brent, North.

Stephen Pound: On that point, my elder brother was born two years before the national health service and he died as a child. The next brother died. I was born in the same week as the national health service and I am still here. However, the key point is surely that there is confusion in the national health service. Doctors and clinicians feel that they are not being given the space to breathe and to do what they do best. Does my hon. Friend agree that there seems to be a disconnect between the public affection, respect and need for the national health service and this strategic exercise that is not being connected up at the moment?

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Mr. Deputy Speaker: Order. Before the hon. Member for Brent, North (Barry Gardiner) continues-and I ask him to keep an eye on the time-may I say to the hon. Lady and hon. Gentleman below the Gangway that they should not be reading newspapers in the Chamber?

Barry Gardiner: My hon. Friend the Member for Ealing, North (Stephen Pound) made his point in a characteristically robust fashion.

I want to focus on health inequality, and it is clear that one of the best ways of addressing health inequality is through increasing physical activity, particularly in the young. I urge the Department of Health to invest far more than it has in the past. It has already begun to work in this area and the Change4Life campaign that the Department has been running is extremely productive in this respect. I believe that much more must be done in co-operation with the fitness industry and with sports providers throughout the capital to ensure that we not only address the problems of obesity in the young but set up a platform for fitness throughout life that will help to address health inequalities as a whole.

Clive Efford: On a point of order, Mr. Deputy Speaker. In response to the rebuke that you just gave to me, I want to tell you that I was reading something that had just been pointed out to me. The Evening Standard seems to have a report on today's debate that is in the past tense in a newspaper that was printed before the debate took place.

Mr. Deputy Speaker: I merely say to the hon. Gentleman that it is a convention of the House that Members do not read books or newspapers while a debate is taking place. There are other places- [ Interruption. ] Order. There are other places in which that can be done.

6.43 pm

Justine Greening (Putney) (Con): I am sure that many people watching the debate will think that that time could have been better spent focused on what Members from all parties were saying. Indeed, as we have heard over the past few hours, concern has been expressed from both sides of the House about the process that is unfolding and about how our NHS services in London will be reconfigured over the coming months unless we halt this process. I hope that tonight's debate has given Ministers some cause for concern, because residents across London are absolutely furious that they are not being involved in this process in the way that they want to be.

We all know that London is a diverse and vibrant city. Residents are very mobile. Migration and demographic patterns mean that we have an every-changing population. That is a key part of London's identity, but we know that when it comes to providing health care in the capital, it means that we face some unique challenges. Even the Minister of State, Department of Health, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), when he was introducing the debate on behalf of the Government, admitted that Londoners put up with a worse health service than other parts of the country, in spite of the tireless work of NHS staff in our primary care trusts, GP surgeries and hospitals.

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I hope that at the end of this debate Ministers will address some of the concerns that have been raised. Although in London we have some of the best hospitals in the country-and, indeed, even in the world-we also have, as we have heard, some of the worst health outcomes, with stroke, heart disease and cancer being particular causes of concern.

Health inequalities in London are complex. The London poverty profile shows that three quarters of the London boroughs with the highest rates of premature death are in inner London. The risk of premature death in Newham and Lambeth is 250 per 100,000 people, which is twice that in Kensington and Chelsea. There are also unequal levels of long-term illness, with east London disproportionately affected. The last census revealed that 15 per cent. of adults in Islington, Hackney, Newham and Barking and Dagenham suffered a long-standing illness-twice the level of such illness in Richmond and Kingston. It is perhaps no wonder that some of the Members representing those constituencies have taken the opportunity to flag up their concerns about the changes in health care provision that could be coming down the track for their constituents.

What have we had in response to that complex series of health care needs? We have a city-wide strategy from NHS London and now, as we have heard today, some specific plans are being worked up, apparently behind closed doors, by individual so-called NHS sectors. NHS London has predicted that its funding shortfall by 2017 could be £5 billion. On the back of that assessment have come some serious unfolding plans to reorganise services, shifting care away from acute hospital provision to community services and centralisation of specialist services.

Those far-reaching changes have raised the prospect that behind closed doors we could have plans for some of London's hospitals to be downgraded and even closed down. In all the proposals that seem to be being worked up, it is interesting to see that there does not seem to be much mention of the fact that management costs in the NHS have skyrocketed. There does not seem to be much mention of the fact that 15 per cent. of the estates owned by the NHS in London are either unoccupied or underutilised. I know that from personal experience, as the Putney hospital site in my constituency has been derelict for the past decade. The local primary care trust apparently has no ability to bring it into use for our local health care provision.

Mr. Davey: I am grateful to the hon. Lady for giving way and I agree with an awful lot that she is saying. Will she say a little more about the Conservative motion, however? She calls for the reconfiguration to be postponed

How would her public consultation differ from that proposed by the Government, which is due to start in some sectors of London around the autumn?

Justine Greening: I think it would have a number of important differences. First, it would be led at a local level by GPs. The Minister has said that clinicians are discussing it among themselves, but we think that that is not good enough. Of course clinicians need to be involved, but so do GPs and, critically-this has come across in every speech made tonight-so do the public. People feel like they are going to be presented with a fait accompli when they have had no opportunity for input at an early stage. That is why we have had the debate
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today-to start a proper debate that the public can be part of. If Ministers ignore that, they will be going down a very dangerous route.

Serious questions have been raised today about the reliability of the funding projections on which the reorganisation is based. The assumptions are questionable -they have even been questioned by the work of the King's Fund, for example, which seems to undermine whether the assumptions we have will actually work. Above all, it seems to be a financially driven process. We need a careful, considered assessment of London's health care needs and of how they will change over the coming years.

In particular, we have heard concerns about the fact that we will see patients transferred to community services when those services, or polysystems, as they are being called-more impenetrable language that the public can never understand-are not even necessarily in place. That is a real concern. We heard the concerns expressed by my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) about what has happened in his constituency, which flag up that we are right to be concerned.

I shall make progress, because I know that the Minister will want to answer some of the concerns that have been raised tonight. Of course, the other issue that has emerged is, as has just been mentioned by the hon. Member for Kingston and Surbiton (Mr. Davey), that the approach has been secretive. We have all urged our local NHS providers to be transparent with the public about the process. Whatever the Minister says, it is not being driven locally-it does not even seem to be driven clinically. The public seem to have no access to the debate that is going on in the inner recesses of the NHS, and they are deeply concerned about that. We need a different approach that is rooted in local communities and that involves GPs, clinicians and, critically, the public.

The conclusion to the debate must be that the current process has been discredited and should therefore be halted. The assumptions regarding the solutions that have been worked up about moving services into the community are flawed financially, the focus is apparently on cutting front-line services rather than on challenging the massive growth of bureaucracy in the NHS that has occurred under Labour, and the public have no involvement in the process at the very time when they should be central to it. That simply is not good enough. As we have heard, there is simply no transparency. I take this opportunity to urge NHS London to start being transparent and to start communicating with the public on the ground in the communities who are so worried about what is going on. Instead, the Minister has tried to justify the process when he should be challenging it. There has almost been unanimity across the Chamber regarding our concerns about this process. I conclude by saying that we all have a chance tonight to represent those concerns on behalf of our constituents. If we do not take that chance, I am sure that our constituents will represent their own concerns about this issue at the ballot box.

6.51 pm

The Parliamentary Under-Secretary of State for Health (Ann Keen): First, let me say what a pleasure it is to be part of the debate with the hon. Member for Putney
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(Justine Greening) this evening. The case for change in London is undeniable. When Lord Darzi started the process of reviewing the NHS in the capital, London was consistently rated as the worst of the 10 strategic health authorities. Its rates were among the worst for mortality, waiting times, quality measures and patient experience. It is impossible to argue that that was an acceptable state of affairs.

Much has been said about inequality in health tonight, particularly by the Conservative party. That is pleasing because I believe that until Labour came into government in 1997, the words "inequality in health" were not allowed to be uttered in the Department of Health. Londoners deserve, at the very least, the same chances and the same level of care and treatment that their family and friends in other parts of the country receive. That is what Healthcare for London is about.

The massive task of turning health care in London around is not led by politicians in Westminster, the Government or civil servants in Whitehall. It is all run by clinicians-doctors, nurses and other dedicated health care professionals on the ground-in close consultation with the communities they serve. The Healthcare for London framework for action was developed in response to that, and the case for change and the recommendations for responding to it were accepted by the public. Primary care trusts consulted on the case for change and received more than 5,000 responses. We had about 40,000 visitors in all to the website and to meetings and roadshows. The public were clearly in favour of our making a set of changes built on considerations of quality, safety, outcomes and patient experience. A joint London overview and scrutiny committee that represented all 33 boroughs was formed, and it agreed the proposals with recourse to the Secretary of State referral. That gives the proposals local legitimacy and means that we can be held to account for their delivery.

Clive Efford: I am grateful to my hon. Friend for setting out how the consultation took place. She, like me, will have worn out her shoes campaigning against many Tory cuts in the NHS. It is worth reminding the House that in the period between 1979 and 1997, 10 hospitals were closed in Greenwich. In comparison, a brand new community hospital is being opened in the heart of my constituency in 2011.

Ann Keen: That has also to do with the calibre of the MP and what they can bring to an area. Certainly, when I worked in the health service under the Conservative party, Barney Hayhoe, who is now a Lord, was a Health Minister, but one thing that he could not have been accused of was selfishly looking after his own constituency's health needs. I spent most of my time working in a crumbling old workhouse.

All the decisions that have been, are and will be made must be based on hard evidence and what works in the best interests of the patient. The objective of all the changes is simple-to save thousands of lives.

Mr. Slaughter: After five years, my constituents are fed up with Tory smears that my local hospital will be closed or downgraded or that it will lose vital services. In fact, it is expanding and improving under Imperial College Healthcare NHS Trust. At the risk of trying my hon. Friend's patience, I ask her to confirm again that there are no plans to close the A and E at Charing Cross, Hammersmith or St. Mary's hospitals.

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Ann Keen: I can give that assurance to my hon. Friend. There is no case for that at all.

Mike Gapes (Ilford, South) (Lab/Co-op): My hon. Friend will know that I tabled an amendment, which was not selected, asking the Secretary of State to refer to independent review the proposal for reconfiguration in outer north-east London. Will she arrange an urgent meeting between me and her ministerial colleagues to discuss that proposal, which is supported by my local authority, the London borough of Redbridge and by the hon. Member for Ilford, North (Mr. Scott)?

Ann Keen: I assure my hon. Friend that that meeting can be arranged and that that consultation with us can, of course, take place.

Mr. Andrew Dismore (Hendon) (Lab): The Minister of State, Department of Health, made it pretty clear earlier that Whittington A and E department is safe. Will my hon. Friend make the same pledge regarding the Royal Free?

Ann Keen: All the proposals are being considered clinically and in the appropriate way. [Hon. Members: "Ah!"] Opposition Members must not read anything into that. Their scaremongering is at its height in tonight's debate, but we will not take any more scaremongering this evening.

Many of the polyclinics that have been set up, including the Heart of Hounslow clinic in my constituency and another in Hammersmith and Fulham, are making a huge difference to what takes place in A and E departments. London's A and E departments are used and sometimes abused differently than those in the rest of the country. The way forward is to bring primary care into polyclinics- [ Interruption. ]

Mr. Deputy Speaker: Order. The debate is in danger of disintegrating. The Minister is replying to a debate in which a great many hon. Members have taken part. They are entitled to hear her reply, and I should like the debate to be finished in good order, as there is another debate to follow in which a great many hon. Members seek to take part.

Ann Keen: Thank you, Mr. Deputy Speaker. We must always consider the evidence, and the evidence shows that patients will receive better outcomes when they are treated in specific hospitals that have a high volume of particular clinical work. The changes are about patients being seen by the right people in the right place with the right equipment at the right time. Some difficult and sensitive issues have been touched on in the debate, and we are sensitive to the views of colleagues and their constituents on these matters-particularly to the wisdom that has been shown by my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) regarding the way in which all such consultations should be conducted-because the outcome is about safer patient care.

We must remain focused on the fundamental aims of the changes, which are to improve health care in London. The changes will save thousands of lives, will improve health outcomes in relation to major diseases such as cancer, heart disease and stroke, and will improve the
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overall quality of other health services to reduce disability and prevent pressure from being placed on our acute hospitals. Change is necessary to improve services, and we cannot and must not back away from the problems. Ministers have made it clear tonight that any changes in London must follow an agreed set of principles.

Mr. Sharma: Given the needs of the unique and diverse communities in the area around Ealing hospital, can the Minister assure me that the hospital's A and E department will not be closed?

Ann Keen: There are no proposals to close the A and E department at Ealing.

Change must always be to the benefit of patients. It must improve the quality of care that patients receive, in terms of clinical outcomes, experience and safety. Change must be clinically driven. We will ensure that it is to the benefit of patients by making sure that it is always led by clinicians, and based on the best available clinical evidence.

All change must be locally led. Meeting the challenge of being a universal service means that the NHS must meet the different needs of everyone. However, universal is not the same as uniform: different places have different and changing needs, and local needs are best met by local solutions.

I believe that MPs and Ministers are right to protest in their local areas if they feel the need to. As to marches, we on this side of the House are very good at marching, because we have had years of experience of marching to save our NHS. A local decision will involve the local MP, and he or she may be a Minister.

The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively. We are clear that any changes have to meet those requirements. If they do not, the powers exist to refer them to the independent reconfiguration panel.

Yes, we need to change to save lives. If we are honest, however, Governments for too long have backed away from the tough decisions needed to tackle these issues. I worked-

Mr. Andrew Robathan (Blaby) (Con) claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put ac cordingly (Standing Order No. 31 (2)), That the original words stand part of the Question.

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